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As a member of a society so deeply affected by the university and the higher education system, it is fascinating to delve into the origins of such an institution. The European and western culture that America so closely associates with makes it even more interesting to consider the history of European universities, and what better place to start than with the earliest – the medical school of Salerno. The school at Salerno is legendary for many reasons, from the mere fact that it was the earliest European institution of its kind, to its admittance of female students and professors (Medical 946). Perhaps the most prominent woman of Salerno was Trotula de Ruggiero, a female physician who contributed to a widely distributed textbook on women’s diseases, Passionibus Mulierum Curandoru also known as Trotula Major, and another book – the first of its kind to be written by a woman and intended for women – on women’s cosmetics, most commonly known as Trotula Minor (Cavallo, P. et al. 80-82). The legendary school of Salerno has remained prominent throughout the twentieth and twenty-first centuries with its fame surrounding its treatment of women along with other characteristics of the school. The Salerno medical school has received historical mentions at a multitude of medical association meetings and medical school ceremonies in the last few centuries. For instance, in the early 1900s, Professor Stirling of the University of Manchester mentioned Salerno in an address following the University’s admittance of women to medicine degrees, finding it suiting “to say something of the earliest school in which medicine was professed, taught, and practiced, and which opened both its teaching and its degrees to members of the fair sex” (Medical 946). Dr. Dawson Williams, in contrast to Stirling, credits the specialized schools of medieval times, such as Salerno whose students concentrated on medicine, as the foundation upon which the modern concept of the university formed (Fifeshire 1186). Others have admired the medical school of Salerno for the methods used by students and professors, the written works that came from the school, and the traditions established there. “Among the contributions associated with the school of Salerno were textbooks of anatomy, insistence on certification and training for physicians, [and] application of investigative thinking and deduction that led to important advances such as the use of healing by secondary intention” (Cavallo, P. et al. 80). While these many contributions and facets of the medieval medical school at Salerno have factored into its historical influence, nothing was more significant to its initial success and lasting importance than the legendary character and combination of Greek, Arabic, Jewish, and Latin cultures which were embraced in the formation of the school.

Many would argue that the concept of university originated in ancient Greece with Plato’s Academy, developed at the school in Alexandria, and survived in the monasteries of the Dark Ages. While the schools of these periods were important to the development of colleges, the medical school of Salerno is most commonly recognized as the true origination of the European university and thus represents the significant role that medieval higher education played in the advancement towards the modern university. James Ewing claims that it was at Salerno where the university “proved to be the first step toward the revival of learning and the Renaissance” (Ewing 173).

Ewing thus indicates that the school in Salerno not only maintained the work of the Dark Ages and prior allowing it to survive and be passed on to future generations, but also that Salerno truly represented a re-birth of education statement made by the scholar S. S. Laurie seems to display a consensus between him and Ewing. In his book, The Rise and Early Constitutions of Universities, Laurie says that Salerno served as a demonstration of “how universities gradually came into existence as the expression of the reviving intellect of Europe, and for the satisfaction of new intellectual and social needs” (Laurie 172). The revival of education which was brought about by Salerno in the medieval times was crucial to the survival of ancient works as it followed a very dark period when virtually no new knowledge was gained and education made little advancement aside from the books copied and works maintained by monasteries (Pedersen 66).

The widespread acceptance of the Salerno school of medicine as the root of modern medical schools and universities certainly explains one major aspect of its lasting importance to the history of higher education, but the true basis of Salerno, and therefore the foundation of the European university, cannot fully be understood and appreciated until the formation of the medical school at Salerno is examined. Many attempts have been made to explain why it was at Salerno in Southern Italy that the first European university evolved. Hastings Rashdall offers the town’s “renown as a health-resort” as one such explanation (80). Southern Italy served as a major battle ground during the sixth century, and therefore it was common for the injured to be sent to receive medical attention in Salerno. The high concentration of physicians in the city that resulted from its use as a medical center eventually brought about the development of a medical school as not only injured individuals would travel here, but also students who sought to study under the practicing physicians (C. S. 402). A number of varying explanations have been offered as to why Salerno provided the optimal location for catering to the development of the first European university, but amongst all of the differing accounts and stories, a certain set of ideas seems to continually resurface. This most commonly told story regarding the formation of the medical school in Salerno revolves around the collaboration of four men, “the Jewish Helinus, the Greek Pontus, the Arab Adela and the Latin Salernus” which culminated in the legendary school (Cavallo, P. et al. 80).

Although a literal interpretation of this account – the actual coming together of four such men to form a school in Southern Italy – is a rather unlikely story, it appears that “it does faintly reflect an actual situation” (C. S. 402). In fact, much has been said about the combining of cultures which occurred throughout the establishment and continuation of the Salerno school. Through this legend it has been shown that not only was the medical school revolutionary for its attitudes towards women, but also in its demonstration that the acceptance of and reliance on a mixture of cultures, each contributing its own background and strengths, was essential to its early and rapid growth and success.

One reason the legend which suggests that the University of Salerno evolved from a mixture of four cultures is so plausible is solely because of the school’s location in Southern Italy. In his article “Salerno: Its Medical School and Its Medical Legends,” C. S. illustrates how this setting made Salerno much more apt to form a university than almost any other area at the time:

During the “Dark Ages” – that is, from about A.D. 400 to about 1200 – the great tradition of Hippocrates and Galen faded. All theoretical medical knowledge lapsed. Even the bare elements of anatomy were forgotten. Prognosis became a childish rule of thumb; therapeutics a ridiculous and disgusting drug list; medicine a collection of formulae punctuated by more or less sacred incantation. Yet there was one area where a slightly higher standard prevailed. In South Italy dialects of Greek were spoken, and there a faint travesty of the ancient medical learning still lingered. This was notably the case at Salerno (C. S. 402).

The preservation of the Greek language in this Southern Italian region is majorly responsible for Salerno’s ability to connect “the Dark Ages with the remote classical past” (Monte 260). This point it furthered with J. G. Schurman’s claim that “classical tradition still lingered there with the classical literatures” (Schurman 189). Thus, not only was the Greek language spoken by the southern Italian peoples of medieval times, but they also had access to the medical texts by such Greeks as Hippocrates and Galen. In fact, it is argued that “the connection with the East, and the retention of Greek culture in Southern Italy after the fall of the Roman empire, perhaps greatly helped the introduction of Greek medicine into Southern Italy, and may in part explain its renown as the Civitas Hippocratica,” (Town of Hippocrates) (Medical 946).

The fact that ancient Greek culture acted as a major stepping stone for the citizens of medieval Salerno can clearly be realized by the existence of the literature and language of the Classical era. However, what is even more fascinating is witnessing the ancient Greek persuasion in primary documents and accounts of practices that came from the medical school of Salerno. John F. Fulton writes of ancient Greek and Roman medical practices, saying “the apprenticeship system spread to Rome and persisted there long after formal schools of medicine with regular course work had been established. According to Galen, anatomical dissections were sometimes carried out by students in early childhood under the direction of a father-physician” (457). Once this practice eventually faded out, it became necessary to develop a system of standardization for medical practices and instruction, which ultimately led to medical schools, such as the one in Salerno (457). The Greek customs mentioned by Fulton significantly outlived Galen and were apparently as much a part of the tradition at Salerno. Schurman, for one, says that with Salerno’s status as “a health resort, it was very natural that if any sort of school were to spring up in the region, it should be a medical school,” and thereby implies that as Salerno drew in experienced physicians, it also attracted students who essentially apprenticed under the physicians in the beginning phases of the school, and this eventually led to the organization of professors and students as the medical school of Salerno (Schurman 189). The anatomical dissections addressed by Fulton seem to have been equally as valued in medieval times as in Classical times as well. On the study of anatomy at Salerno, Fulton says that “students dissected various animals, including pigs and monkeys, and they likewise attended formal demonstrations” (Fulton 458). It has also been claimed that at one point during Salerno’s operation as a medical school, “instructions were given that a human body should be dissected once in five years” (Medical 946).

The influence of the great Greek medical scholars – Hippocrates and Galen – took many forms at the medical school of Salerno. However, the best documented proof of Greek contribution to the work at Salerno is found in “the most famous Salernitan treatise…Regimen Sanitatis Salernitanum, written at the end of the eleventh century, and dedicated to Robert Duke of Normandy. It deals in pithy Latin verse with the six non-naturals of Galen – air, food, exercise, sleep, excretion, and the passions” (Medical 946).

Although the connection that Salerno and Southern Italy held to the ancient Greek cultures may be seen as vastly important to the development of medical education and the university, during the sixth century as a result of war, the Greek language spoken by so many of the southern Italians was eventually replaced by Latin, Arabic, or Hebrew (C. S. 402). Charles and Dorothea Singer explain in their essay how the introductions of these outside cultures and languages came about:

The imperfect grasp of the Byzantines… gave an opportunity for the entrance of other tongues. Latin of a peculiar southern type was spoken in many places; in others Greek was replaced by some form of Arabic speech. Nor were Latin, Greek and Saracen cultures the only competitors. Material and literary remains combine to tell us of a considerable development of Jewish culture in this region (Singer 122).

The Jewish, Latin, and Arabic influences that were brought about proved increasingly important to the establishment and success of Salerno. For one, it appears that “it was in Latin translations that the works of Hippocrates were habitually studied in what was henceforth styled the Civitas Hippocratica” (Rashdall 79). It is indicated by this quote that without the supplement of the Latin translations of ancient Greek works, the Greek influence which had such a vast impact on the traditions and practices of Salerno would not have been so fully realized.

As for the influence of the ‘Jewish Helinus’ on the school of Salerno, it seems to have been an impact that evolved over several hundred years. During the wars of the sixth century between the Goths and Byzantines, “the Jews naturally took the Italian side rather than that of the autocratic Justinian who had attempted to close their synagogues. They were especially responsible for the defense of Naples which fell to the arms and skill of Belisarius in 536” (Singer 123). The Jews not only supported the Italians in these battles, but there is also evidence that “Jewish physicians could be traced into Sicily and Southern Italy” (Jewish 1266). After the Gothic wars and up to the eighth century, the population of Southern Italy “was of mixed race and the country was broken up into a number of small states” (Singer 123). Despite their presence in the region and support they offered the Italians, it is apparent that under Byzantine rule, the Jewish communities of Salerno suffered greatly during the seventh and eighth centuries (123). Despite their suffering, the Hebrews continued to write as they did in more ancient times; many of their writings that came out of Southern Italy remain today (123).

The Jewish communities of Southern Italy seem to have been treated as minorities during the medieval times, and in effect, Charles and Dorothea Singer claim that the Jewish influence on the medical school of Salerno was “purely cultural,” despite the practice of Jewish physicians in the area (124). In fact, the position held by the Singers that the Jews of Salerno made negligible contributions to the medical school, is disputed by others who claim that “the founder of the famous medical college at Salerno was a Jew” (Jewish 1266). Although it would be nearly impossible to determine the winner in this debate, especially due to the numerous legends surrounding the true origin and foundation of the Salerno school of medicine, it is agreed by all that the Jewish culture did have a place and an effect on the university. It can hardly be argued that the Jews played a critical role in the transmission of ancient Greek medical traditions and instructions to the Arab communities, who further developed the study of medicine and were also important to the basis of Salerno (1266).

The Jewish and Latin influences played relatively minor, yet nevertheless crucial roles in the formation of the Salerno medical school. It might seem obvious that the works which came out of the ancient Greek influences were the most essential materials for the medical students and professors at Salerno. However, the Arabic contributions might prove to have been much greater than many of today’s college educated Americans would think. In a publication of The British Medical Journal on the medical school of Salerno, it is noted that “after the advent of Constantinus Africanus (1075), Arabic doctrines began to be introduced, until in the long run the Arabic Influence became potent, not only in Salerno, but also in medical schools of newer growth” (Medical 946). Many agree that Constantinus Africanus, also referred to as Constantine of Carthage, was a crucial player in the development of the medical school of Salerno. Of the more general Arabic peoples, it was said by Samuel Williams that “for medicine they showed special aptitude, and in this during the Middle Ages they were everywhere acknowledged as authorities. They had translations of Galen and Hippocrates, to which some of their writers added much of value, and the medical school of Salernum doubtless owes its origin to one of their pupils, Constantine of Carthage” (Williams 27). The assumption of the vast contribution made by Constantine to the university is in part due to his “varied learning” which he had gained in his time spent in the East (115). Constantine, who spent the majority of his life travelling, seems to have been the first man with real reputation in Europe to visit the school of Salerno, and for this reason, the date of the establishment of the university is often associated with his arrival around 1065, though others argue that there was no true establishment of the school as it gradually developed out of the health center that previously existed in Salerno (Laurie 114).

Though the exact origin of the medical school of Salerno is largely unknown, seemingly all modern scholars of the institution form a consensus that the school was representative of the mixture of four distinct cultures present in Southern Italy during the Middle Ages. For several hundred years, the medical school of Salerno successfully “kept the Greek-Latin cultural tradition going, merging it harmoniously with the Arab and Jewish culture. The meeting of different cultures led to a medical learning arising from the synthesis and the comparison of different experiences” (Cavallo, P. et al. 80). The coexistence of multiple cultures and religions at Salerno proved quite revolutionary following the Dark Ages when almost all learning was centered in monasteries around Biblical texts and finding a place for Classical Greece within Christianity. “Its essentially secular character was shown by the fact that Jew and Gentile alike were admitted as teachers and students, that its Prior of Praepositus was married, and that women taught and wrote in its Schola” (Medical 946). Hastings Rashdall insists that at the medical school of Salerno, “the smoldering sparks of scientific culture which had survived from the old-world illumination were fanned into flame by the first breath of that mysterious new spirit which at this time began to move upon the face of European civilization” (Rashdall 78). This beautiful statement demonstrates both the importance of past civilizations’ scientific works on the medieval medical school, and the importance of Salerno as the first university to portray the significance of this culmination of information to Europe. It also illustrates that Salerno was not merely a successor of any other type of school, rather a truly original unification of the education and science of various cultures. S. S. Laurie claims that the new university of the Middle Ages owed nothing to the schools of the western Roman Empire, Byzantium, or the Mohammedan nations. Rather, he insists that “the simplest of the new university origins is the most correct. It would appear that certain active-minded men of marked eminence began to give instruction in medical subjects at Salerno” (Laurie 107).

This school at Salerno, which seems to have begun as a simple union of men from different backgrounds who together to learn and teach medicine, will long be remembered as one of the most influential European universities. The acceptance of multiple cultures allowed for a more widespread understanding of medical practices of the past, without which Salerno may not have attracted the interested medical students that it did. The medical school of Salerno can thus be summarized as “the earliest and greatest international school of medicine; it was not dominated by the Church, it formed one of the channels by which Greek medicine and culture were introduced into Europe, and through it Arabic medicine and drugs were transmitted from the East to the West” (Medical 946). The Salerno school begged to be remembered for its cultural diversity and non-secular character, which brought unbiased and all-encompassing learning to the forefront of European higher education.



The Medical School of Salerno’s Multi-Cultural Markings


Page Author: Cloe McDonald

Sunday, 4 March, 2012



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