900-1300: The Soporific Sponge

Physicians at the School of Salerno in the 15th century are believed to be the first to provide anesthetics during surgery.  The method used was to turn a simple sponge into an inhaler, what surgeons referred to as the "soporific sponge," according to historian Garrison Fielding Hudson. (1, page 142)

Hudson said that "surgical sleeping draughts" are referred to as the "soporiphic sponge" as early as the 11th century in "the beautiful Jenson imprint of the Antidotarium of Nicholas of Salerna that was published in Venice in 1471.  (1, page 142)

This was a sponge that was "steeped in a mixture of opium, hyoscyamus, mulberry juice, lettuce, hemlock, mandragora and ivy, dried, and, when moistened, inhaled by the patient, who was subsequently awakened by applying fennel-juice to the nostrils." (1, page 142)

This "prescription" was believed to be derived from earlier treatments of "anodyne applications" used to treat insomnia at the temples of the Aesclepius by the Ancient Greeks and Romans.  Later on Mandragora became "preferable to opium and hemlock."  (1, page 142)

Could you imagine the stress that a physician wanted to give you such a medicine in an age when it was still greatly feared to be operated on?  This type of fear was noted in a poem in Marlowe's Jew of Malta: (3, page 143)

"I drank of poppy and cold mandrake juice. And being asleep, belike they thought me dead." (3, page 143)

So the anesthetic may have been taken internally by some, yet it was due to this fear that the anesthetic was not taken "internally by Salernitan physicians."  I think this was a wise decision, and this made the "Soporific Sponge" a wise alternative.

The"Soporific Sponge" is an early, yet primitive, example of one of the first uses of an inhaling device. It is for this reason I mention it here.

It is also surmised that the Salerno medical community greatly influenced Arabic medicine. (1, page 187)

Yet, ultimately, Arabic medicine would grow so that it superseded the old Greek traditions taught at Salerno, and this is believed to be what caused the fall of Salerno from its "high estate."  (1, page 187)

The School of Salerno met its demise sometime in the middle of the 13th century.(1, page 187)

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company

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1316: Mundinus publishes book of anatomy

Figure 1 -- Title page of Mundinus:
 "Anathomia," Leipzig, 1493
(1, page 151)

So we know that the School of Salerno was a great medical institution from the 10th to 13th centuries, and physicians from all over the world flocked there to get the best medical instruction.  Yet most historians will acknowledge that while it was a great learning place, there were few medical advancements made there. 

One of the great exceptions occurred in 1316 when Mundino de'Luzzi, or Mundinus of Bologna (1270-1326), who wrote a book called "Anathomia," which translates to "Dissection."  Still, while he wrote it while teaching at Salerno, it was first published until 1487 at Padua, and 1493 at Leipzig by Martin Pollich-von Mellerstadt. (see figure 1) (1, page 150-151)

Mundino was professor of medicine and anatomy at the University of Bologna, and he was one of the few physicians "to turn his eyes from the pages of Galen to the book of nature, and to learn for himself, by actual dissection of the human body, how this body was constituted." (5, page 199)

It was, therefore, from his own observations that he compiled his book.  (4, page 199)

The book was basically an account of how to perform an autopsy beginning with the abdominal cavity, which contains the perishable viscera, and then moving to the chest, where he provides a description of the heart, and to the skull where he describes opening it.  (4, page 376) (1, page 150-151)

However, because of the dogmatic nature of the Church, he was not able to sway far from the teachings of Galen, said D. Kerfoot Shute in 1910.  "The all-powerful Church still taught the sacredness and the inviolability of the human corpse and was alert and ready to punish as a sacrilege the use of the anatomist's scalpel; and what Mundinus did was done in the face of this powerful opposition." (5, page 199)

Perhaps this is why Garrison said:

In intention, this work was really a little horn-book of dissecting, rather than a formal treaties on gross anatomy.  (1, page 150)

He said the book was full of...

...Galanic errors in regard to the structure of the human frame, preserving the old fictive anatomy of the Arabists, with the Arabic terms, this book was yet the sole textbook on anatomy for over a hundred years in all the Medieval schools." (1)

The book would be the "universal textbook" of anatomical dissection for the next 200 years at all medieval schools, passing through "39 separate editions and translations." (4, page 376) (1, page 151)

His work was continued by his pupil Niccolo' Bertuccio (died 1347), said Garrison.  He said:  "After this time, dissecting gained a firmer foothold as a mode of instruction." (1, page 151)

However, Shute said that, perhaps due to the opposition of the Church, "Mundinus had no disciples carry on his work.  All that remained of him was his very inadequate book which was used in schools merely as an introduction or help to Galen.  At best he became little more than a later and smaller Galen." (5, page 199)

While there were little or no advancements in medicine as a result of his book, it helped to preserve medicine during the dark ages of medicine.  It would be over 200 years after Mundinus (at the beginning of the 16th century) that the Church would finally start to lose its grip and influence over medcine.   (5, page 199)

Jacobus Berengarius da Capri, who lived from 1460-1530, was an Italian physician who continued the work of Mundinus.  Shute said:

But he had his struggles with the church. He was driven to desert Bologno, where he had long been a teacher, and to live in exile in Ferrara.

Yet this was a time when the Church learned to appreciate anatomy, although trough paintings more so than medicine.  Shute said

In the sixteenth century the ruling powers of the church not only sanctioned but even favored the pursuit of that branch of anatomy which is indispensable to sculpture and painters. In 1525 Albert Durer published a work illustrating the symmetry of the body—but as an artist and not anatomist. Under the protection of the Popes, Julius II and Leo X, Leonardo da Vinci, Michael Angelo, and Raphael copied from nature the superficial muscles. (5, page 199)

This was the state medicine was in when two of the most significant figures in our medical history were born: Jacobus Sylvius and Andreas Vessalius.

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
2. The John Hopkins Hospital bulleton," (volume XV 1904), "from the epoch of the Alexandria School (300 B.C.)"
3. "The Ancient Medical School of Salerno," associazioneermes.it, http://www.associazioneermes.it/MedicalSchoolSalerno.htm, accessed 12/4/12
4. Frampton, Michael, "Embodiments of Will: Anatomical and Physiological Theories of Voluntary Animal Motion from Greek Antiquity to the Latin Middle Ages, 400 B.C. - A.D. 1300," 2009, Berlin, VDG Verlag
5. Shute, D. Kerfoot, "The life and works of ndreas Vesalius," Old dominion journal of medicine and surgery, Tomkin, Beverly R. Tucker, Douglas Vanderhoof, Murat Willis, R.H. Wright, editors, 1910, Richmond Virginia, The Old Dominion Publishing Corporation, pages 195-211

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802--1300 A.D..: The School of Salerno

Figure 1 - An early depiction of the School of Salerno

The Dark Ages of Medicine that engulfed western civilization from the 9th to 14th centuries were not completely dark, as there were a few places where wisdom continued to shine brighltly.

There were various towns and cities in and around Europe where the old Greek and Roman traditions continued to be studied and worshiped. One of the most significant of these towns as far as our medical history is concerned is that of Salerno in Naples. It was here that medical schools were formed amid a flourishing medical community.

Salerno was a town in Southern Italy "that was beautifully situated in a district which as early as the times of the Roman Emperors was famous as a health resort and attracted a number of visitors to it's precincts."   (3, page 187)

Some authorities say the school was founded in 802 by Charlemagne, said historian Thomas Bradford, although no one knows for sure.  Others say it "dates from the destruction of the library of Alexandria by the Arabs." (6, page 103)

Ordericus Vitalis, a historian from the 12th century, said it was started in ancient times. Another historian speculated it was formed by fugitives from Alexandria.  (3, page 187)

In all actuality, there there were probably towns like Salerno all over Europe where Greek and Roman tradition continued to flourish. Chances are that physicians in these towns, in Salerno, had no connection with the clergy that influenced the decline of the Roman Empire.  (3, page 187)

What is known for sure is that a school, hospital, and university were established in in the town of Salerno, thus creating a "bridge over which ancient culture took its way during the Middle Ages from East to West. They were the means of crystallizing the great thoughts of the early fathers so that we of the present times are enabled to understand them."  (6, page 106)

Salerno was on the route taken by pilgrims trying to escape the Christians who ruled much of Europe and Asia, and therefore they took refuge in Salerno. There teachers at the School of Salerno (or Salernum) were a combination of Greek, Arabians and Jews, said Bradford. (6, page 103)

The School was referred to as The Schola Medica Solernitano.  It thrived between the 10th and 13th centuries. While exact dates of when it started and when it closed are unknown, what is known is that the sick who wanted the best medical treatment went there, and medical students who wanted the best education went there.  It became known as the city of Hippocrates (Hippocratica Civitas or Hippocratica Urbs) (4)

By the mid 11th century, Salerno was a full, flourishing medical community that was significant to the evolution of the history of medicine. There were many physicians who worshiped under the traditions of Alexandrian medicine. They studied the works of Hippocrates, Galen, and the other ancient philosophers and physicians.

Here is a portrayal of a hospital at Salerno.  
"Patients eat and rest while workers share a meal and
 others engage in domestic tasks."  From the book:
De donservanda bona valetudine, opusculum
Scholae Salernitanae published 1545. It was written
 by Arnaldus de Villanova  who lived from 1240 to 1311. (5)

The school was a place where traditional Greek and Roman medicine commingled harmoniously with Jewish and Arabic medicine. Many historians say that both men and women were involved in education there, with the main courses of education being, along with medicine, philosophy, theology and law. (4)

Students were taught by physicians from their own country, and in their own language the various subjects essential to medicine, which included "symptomatology, dietetics, treatment and materia medica," said Bradford, "but little time was given to anatomy and physiology." (6, page 104)

Of anatomy, however, Bradford said that:

In the twelfth century Frederick II (1194-1250) ordered a special provision with respect to the study of anatomy at this school, made in his medical code. It is said that by the emperor's direction a dissection was made every five years at Salernum. No one was allowed to practice medicine in the kingdom of Naples who had not been examined and created a master by the college of Salernum. In order to do this the student was obliged to study logic three years, and follow a course of medicine and surgery for five years. In order to become admitted to an examination at the end of the term, the student must present a certificate of his legitimate birth, and that he had attained his 25th year (according to Baas in his 21st year); after this he was examined publicly in the therapeutics of Galen, the first book of Avicenna, and the aphorisms of Hippocrates. He then took an oath to be faithful to good conduct, to submit to the rules of the profession, to give gratuitous attention to the poor and not to share in the profits of the apothecaries, to teach correctly according to the received doctrines, and to administer no poisons. All these things having been fulfilled, the candidate received a ring, a wreath of laurel, a kiss, and finally the benediction. The graduation was in public. Renouard says that after this the candidate must have his diploma confirmed by the proper officer of state, and was then obliged to continue with some experienced physician before entering into independent practice. Baas says that after the graduation he could teach and practice wherever he wished; the office of medical teacher was open also to him. The degree conferred was that of magister, or doctor. (6, page 104-105)

During it's most prosperous times the "town of Salerno was famous for the skill of physicians." After the decree of Frederick II, it was perhaps the first school since the School of Alexandria in 300 B.C where dissections were performed and anatomy was studied.  (2, page 28)

It was also a town where successful surgeries were performed and where people traveled hundreds and thousands of miles in search of a treatment or cure for ailments.  (3, page 187)(6, page 105)

Two other schools of medicine that were significant to the transfer of medicine from the ancient world to the revival of medicine among western civilization were Monte Casino and Montpellier.  (6, page 102)

Bradford said the school of "Monte Casino was founded by the Benedictines on the site of an ancient temple of Apollo in Campania."

He said school of Monpellier "was first mentioned in 1137 when Bishop Adelbert II went there to listen to its medical teachers."  He said both the Jews and Christians lived among the city.  (6, page 102-106)

The schools, hospitals and universities of Salerno gradually declined, "until in the fourteenth century the poet Petrarch (1304-1374) mentioned the school as a memory." (6, page 103-104)

References:

1. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
2. The John Hopkins Hospital bulleton," (volume XV 1904), "from the epoch of the Alexandria School (300 B.C.)"
3. Suppan, Leo, "The Medical School of Salerno and the Salernitan Writers," The National Druggist, May, 1918, 
4. "The Ancient Medical School of Salerno," associazioneermes.it, http://www.associazioneermes.it/MedicalSchoolSalerno.htm, accessed 12/5/12
5. "Arnoldus de Villanova (1240-1311) and the School of Salerno,"Vaulted Treasures, virginia.edu, http://exhibits.hsl.virginia.edu/treasures/arnaldus-de-villanova-ca-1240-1311-and-the-school-of-salerno/, accessed 12/5/12
6. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey

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