Salerno impressed itself much more deeply on surgery than on medicine, for the magnificent development of medieval surgery, the knowledge of which has proved so surprising in our day, began down at Salerno. Some of the details of this phase of Salernitan accomplishment are given in the chapter on Medieval Surgeons of Italy. Roger and Roland and the Four Masters were great original founders in a phase of medical science that proved extremely important for the next three or four centuries. Undoubtedly the presence of a hospital at Salerno, where there were gathered a number of the chronic cases from all over Europe, most of them of the better-to-do classes looking for ease from their ills, gave the incentive to this development. When the natural means of cure, tried for a considerable time, failed, recourse was had to surgery for relief, and often with excellent results. This chapter on Salerno's history shows how thoroughgoing was the effort of the members of the faculty of the medical school to develop every possible means of aid for their patients, even when that required pioneer work.
Pagel's appreciation of Salerno's place in the history of medicine, in his chapter on Medicine in the Middle Ages in Puschmann's " Handbuch Der Geschichte der Medicin," Berlin, 1902, gives in very brief space a summary of what was accomplished at Salerno that emphasizes what has been said here, and his authority will confirm those who might possibly continue to doubt of any institution of the Middle Ages having achieved so much. He said :
" If we take up now the accomplishments of the School of Salerno in the different departments, there is one thing that is very remarkable. It is the rich, independent productivity with which Salerno advanced the banners of medical science for hundreds of years, almost as the only autochthonous centre of medical influence in the whole West. One might almost say that it was like a versprengten Keim — a displaced embryonic element—which, as it unfolded, rescued from destruction the ruined remains of Greek and Roman medicine. This productivity of Salerno, which may well be compared in quality and quantity with that of the best periods of our science, and in which no department of medicine was left without some advance, is one of the striking phenomena of the history of medicine. While positive progress was not made, there are many noteworthy original observations to be chronicled. It must be acknowledged that pupils and scholars set themselves faithfully to their tasks to further, as far as their strength allowed, the science and art of healing. In the medical writers of the older period of Salerno, who had not yet been disturbed by Arabian culture or scholasticism, we cannot but admire the clear, charmingly smooth, easy-flowing diction, the delicate and honest setting forth of cases, the simplicity of their method of treatment, which was to a great extent dietetic and expectant; and while we admire the carefulness and yet the copiousness of their therapy, we cannot but envy them a certain austerity in their pharmaceutic formulas, and an avoidance of medicamental poly-pragmasia. The work in internal medicine was especially developed. The contributions to it from a theoretic and literary standpoint, as well as from practical applications, came from ardent devotees".
One very interesting contribution to medical literature that comes to us from Salerno bears the title "The Coining of a Physician to His Patient, or an Instruction for the Physician Himself." It illustrates very well the practical nature of the teaching of Salerno, and gives a rather vivid picture of the medical customs of the time. The instruction as to the conduct of the physician when he first comes into the house and is brought to the patient runs as follows :
" When the doctor enters the dwelling of his patient, he should not appear haughty, nor covetous, but should greet with kindly, modest demeanour those who are present, and then seating himself near the sick man accept the drink which is offered him [sic], and praise in a few words the beauty of the neighbourhood, the situation of the house, and the well-known generosity of the family —if it should seem to him suitable to do so. The patient should be put at his ease before the examination begins, and the pulse should be felt deliberately and carefully. The fingers should be kept on the pulse at least until the hundredth beat in order to judge of its kind and character; the friends standing round will be all the more impressed because of the delay, and the physician's words will be received with just that much more attention".
The rest of the advice smacks rather more of sophistication than we care to think of in a professional man, but its display of a profound knowledge of human nature makes it interesting.
" On the way to see the sick person he (the physician) should question the messenger who has summoned him upon the circumstances and the conditions of the illness of the patient; then, if not able to make any positive diagnosis after examining the pulse and the urine, he will at least excite the patient's astonishment by his accurate knowledge of the symptoms of the disease, and thus win his confidence".
Salerno taught as well as it could the science of medicine, and initiated great advances in surgery; but it also emphasized the art of medicine, and recognized very clearly that the personality of the physician counted for a great deal, and that his influence upon his patients must be fostered quite as sedulously as his knowledge of the resources of medicine for their ills.