Roger Frugard's Chirurgia

Roger Frugard (pre-1140 - c.1195) was also known as Rogerius, and sometimes called Roger of Salerno because he taught and worked at the hospital there (but not to be confused with the Roger of Salerno who was a regent of Antioch during the Crusading period). We don't know much about his life, but c.1180 he produced Practica Chirurgia ("The Practice of Surgery") with a no-nonsense approach to the subject.

Rather than write long pre-ambles, quoting Hippocrates or Galen or other surgeons and doctors on which much of 12th-century surgical knowledge was based, he gives clear and brief explanations for how to treat different illnesses and injuries. His writing provided the first Western European practical manual for teaching surgery. It was duplicated and used in universities at Bologna and Montpelier. Besides describing surgical techniques, he also described how medicines were prepared and applied, and how to diagnose illnesses. He was the first to use the word "lupus" to describe a rash that appeared on the cheeks.

In the 13th century, an Anglo-Norman translation was made and illustrated (above you see the dispensary and a doctor instructing his students). Though written in French, it was likely written in England because English terms are used throughout the text. This manuscript is now in the Trinity College Library collection. One of the delights of the illustrations is the facial expressions given to the patients, indicating the level of (dis)comfort they are going through. Also, surgical instruments are drawn with admirable accuracy.

(There are errors, however, due to sloppy reading of the text. One illustration is supposed to depict a condition that causes a blackened tongue, but the illustrator painted the tongue red. In another section on nasal polyps, the copyist did an "eye skip" where, while looking from original to copy, his eye skipped to a later occurrence of a word he just wrote, omitting the section in between. These errors can be determined by comparison to other manuscripts, and show that the copyist was not paying close attention to textual comprehension.)

Medieval surgeons were always looking for new ways to treat injury:

For example, it is believed that Roger of Salerno may have originated a technique for detecting a tear in the dura or cerebral membrane in skull fractures. Now known as the Valsalva maneuver, the doctor would have his patient hold their breath, introducing pressure into the skull, and the doctor would watch for air bubbles or cerebrospinal fluid leaking from the skull. Additionally, Roger was a pioneer in the treatment of nerve damage, advocating reanastomosis – the realignment of damaged tissue by surgical means – to repair severed nerves. [source]

The illustration of the dispensary above is in the section about treating fistula. This brings us to one of the most painful and "icky" treatments, but also to one of my favorite figures in medieval medicine, John Arderne, whom I'll tell you about tomorrow. 

Jerusalem Hospital

The Hospitallers were nicknamed thus because they were founded by members of the First Crusade who joined together to protect a hospital built at the Benedictine monastery of Saint John the Baptist. That hospital and monastery were in Jerusalem, in a section of the Christian Quarter called Muristan. In fact, "Muristan" comes from the Islamic Bimārestān, meaning "hospital." The hospital in question, however, built in 1023, was not the hospital for which Muristan is named.

The name Muristan appears much earlier, due to a hospital built by Abbot Probus about 600CE at the orders of Pope Gregory I. This was built to treat ill pilgrims who made the trek to the Holy Land. We should note that this is long before any Crusades to "liberate"—actually, "conquer" would be more accurate—the Holy Land. Muslims, Jews, and Christians all managed to coexist through many periods of time—though not always, as you'll see. About 614CE, a Persian army invaded, killing Christians and destroying their structures, including the hospital.

Jump ahead 200 years, and Charlemagne in 800 (after being crowned Holy Roman Emperor) revived Probus' hospital and expanded it, adding a library (Charlemagne was a great supporter of learning, as you can read about in a 2013 post.) Unfortunately, in 1009, Caliph al-Hakim bi-Amr Allah (sometimes called "the mad caliph" or the "Nero of Islam") destroyed the hospital as well as thousands of other buildings.

Which brings us up to 1023, when merchants from Amalfi and Salerno requested of Caliph Ali az-Zahir the opportunity to rebuild the hospital. It was granted, which brings us back to the Hospitallers several decades later, and the incarnations of the hospital are complete.

But there is a postscript. During excavations for a restaurant, he original structure was discovered and explored between 2000 and 2013 by the Israel Antiquities Authority. At its heyday, between 1099 and 1291, it was 150,000 square feet and could accommodate up to 2000 patients. Evidence exists that it served kosher food to Jewish patients, and that it also housed orphans, many of whom joined the Hospitallers. Bones from horses and camels found suggest it was also used as a stable. Part of a vaulted roof will be incorporated into the restaurant, and so the first home of the Hospitallers lives on in some small fashion.

But what about the "mad caliph" who destroyed a hospital and the kind caliph who let one be built? Would you believe they were father and son? Sometimes the apple does fall far from the tree, which we'll go into tomorrow.

Ginger

The European Middle Ages did not like bland food, and used spices extensively—often in combinations we would find odd or downright unappealing (although cinnamon-flavored pork tartlets are surprisingly very tasty). Among the many spices cultivated and grown in Europe was ginger.

Ginger has a long history of use for medicinal and culinary purposes. References to it indicate that it was used thousands of years ago in Southeast Asia, spreading elsewhere as trade routes were established. Ancient Rome procured it from trade with India and valued it greatly. By the Middle Ages, Arab cultures were spreading westward and carrying ginger rhizomes with them to plant and sell.

The name "ginger" [Zingiber officinale] is from the Old English gingifer, the adaptation of the Medieval Latin gingiber, from Classical Latin zinger, the Romans name for the spicy root they used in cooking and healing. (No, this is not the source of the modern term "a zinger," although relating a "zinger" to spiciness is tempting.) One author's history of ginger called it "the Alka-Seltzer of the Roman world." Ginger ale is still considered good for an upset stomach. The University of Salerno, famed for teaching medicine, claimed that a recipe for a happy old age was to "eat ginger, and you will love and be loved as in your youth."

From the 11th century, ginger became more popular as a flavoring agent, used in all sorts of medieval dishes. It became so popular that its import (it would not grow in the cold wet climates of the north, although it can be grown in well-warmed greenhouses, such as the Royal Botanic Gardens at Kew) made the value (in 14th century England) of a pound of ginger equivalent to an entire sheep (1 shilling and 7 pence, if you must know).

There is a legend that Queen Elizabeth I created gingerbread men cookies as gifts for the men of her court. That is unverified, but gingerbread definitely was known to the Anglo-Saxons. A recipe for medieval gingerbread can be found here.

Scholar of the Supernatural

[I am on a brief vacation, so here is a post from the past. This post first appeared 23 August 2012.]

In Dante's Inferno, the eighth circle is reserved for sorcerers, astrologers, and false prophets. There the narrator sees Michael Scot. You might think, if someone were so well-known after his death, that we would know more about him. Well, we know a little, but we have some cool stories.

Michael Scot, depicted here tearing up the Scriptures.*

Michael Scot was no doubt born in Scotland, although other locations (like Salerno and Toldeo) have tried to claim him. Dates of 1175-c.1232 seem to work for what little we know of his life. We know that Pope Honorius wrote to Stephen Langton on 16 January 1223, urging him to grant Scot a religious position, and that Honorius himself nominated Scot for Archbishop of Cashel. If Scot was educated sufficiently to be offered these positions, he would not have lived until 1290, which is the date Sir Walter Scott offers for his death. (Scott was confusing Scot with a Sir Michael Scot who lived later.)

Scot turned down the position in Cashel; it looks like he did hold benefices in Italy, however, spending time in Bologna and Palermo before going to Toledo in Spain. It was probably in Spain that he learned Arabic, which helped get him invited to the court of Holy Roman Emperor Frederick II. Besides translating texts for Frederick, he was a court astrologer, saying of the work:

Every astrologer is worthy of praise and honor, since by such a doctrine as astrology he probably knows many secrets of God, and things which few know.

This was not likely to endear him to the Roman Catholic Church.

Although he was known in his lifetime as a brilliant Aristotelian scholar, and Fibonacci's Liber Abaci was dedicated to him, his books on alchemy and astrology and the occult sciences earned him a reputation for magic. A Bronze Age circle of stones in northwest England called "Long Meg and Her Daughters" was supposedly a coven of witches turned to stone by Scot. Other stories have him hosting feasts served by invisible spirits. Boccaccio refers to him in the Decameron as a magician. It is also told (long after the fact) that he predicted he would die from a small stone falling on his head from a great height. He always wore an iron cap to prevent it, but he removed the cap when entering a church one day (more not to stand out than for reverence of God, we are told), and a small stone of the size he predicted fell on his head. He picked up the stone, recognized that his prophecy was coming true, put his affairs in order, and died of the head wound shortly after! His reputation (helped by the dearth of facts) has made him a prime subject for fiction right up to the present day.

*From a fresco painted between 1366 and 1388 by Andrea Bonaiuti in the Cappellone degli Spagnoli of Santa Maria Novella in Florence. St. Dominic preaches to the crowd.

Jacob Anatoli

Daily Medieval has frequently mentioned the importance of Arabic texts in the transmission of knowledge to Western Europe. Arabic, however, was not a commonly known language, and Arabs did not have a strong presence in Western Europe. Arabic culture often brushed up against Latin culture in the southern Mediterranean, as mentioned Salerno, or when a scholar such as Michael Scot made it a point to learn Arabic. Scot probably had help in the form of Jacob Anatoli.

Jacob ben Abba Mari ben Simson Anatoli (c.1194-1256) grew up in southern France, and gained such a reputation for scholarship that he was invited to Naples by Frederick II, who gathered several other academics to his court, such as Scot and Fibonacci. Anatoli became known for his translations of Arabic texts into Hebrew, and he very likely aided Michael Scot in his Arabic translations. Roger Bacon explains that Scot was aided by a Jew named Andreas, and some scholars believe "Andreas" to be a misunderstanding of "Anatoli."

Of his non-translations, the greatest work is the Malmad ha-Talmidim (the title is a pun, being interpreted either "Teacher of the Students" or "Goad to the Students"). The Malmad shows a wide range of knowledge, incorporating the Old Testament and Jewish commentators, but also the New Testament, Aristotle, Plato, and Averroes. His egalitarian approach to Christian and Muslim matters was refreshing, but Judaism still had special status; he wrote "the Greeks had chosen wisdom as their pursuit; the Romans, power; and the Jews, religiousness." He tells us that a non-Jew who seeks religious Truth should be respected by Judaism and not mocked.

Anatoli extended this intellectual courtesy to Frederick II, incorporating remarks by the emperor in his works. He also mentions a Christian whom Anatoli considers a second master (after Anatoli's own mentor, Samuel ibn Tibbon); this "master" has been equated to Michael Scot.

As for his Arabic translations, Anatoli's crucial contribution was exposing the West to the work of Averroes, one of two Arab scholars (the other was the medical expert Avicenna) whose work is considered fundamental to the Middle Ages.We'll look at Averroes tomorrow.

The First Female Professor of Medicine

The medical school in Salerno had on its staff the first well-known female physician and professor of medicine. Sadly, we know nothing of her personal life, not even her dates: her existence at Salerno in the 11th or 12th centuries is inferred from the handful of texts she wrote or contributed to. Fortunately, her texts were considered important enough that they were preserved and copied, translated and distributed throughout Europe.

Trotula

Her name was Trotula (listen here for pronunciation), and we find it on several texts. The best-known is the three works collectively known as La Trotula.

• Conditions of Women—based on the Latin translation of an Arabic work, with additions of several Latin-based passages that had been around for awhile.
• Treatments for Women—"a disorganized collection of empirical cures with only a thin theoretical overlay."*
• Women's Cosmetics—a head-to-toe listing of ways to beautify all aspects of a woman's appearance, with no medicinal applications.

Although there are conditions that make no sense to modern medicine (such as a "wandering womb"), there are also techniques that we would consider very sound, such as using opium on the patient during childbirth (defying church tradition that women should suffer; see Genesis 3:16), and using silk thread to repair tears that occur in childbirth.

Some scholars have attributed these works to a man, perhaps through simple chauvinism, but also because it is believed that the frank addressing of gynecological topics would be too indelicate for a female author of the era. The author of La Trotula, however, self-identifies in the texts as a woman, and the analysis of history is always turning up surprises that challenge modern notions of medieval sensibilities. Also, in Chaucer's Canterbury Tales, the book of wicked wives read by the Wife's husband Jankyn includes the name "Trotula." However little we may know of her now, it seems she developed a reputation that preserved her name for at least a couple centuries after her prime.

*Quotation from The Trotula: An English Translation of the Medieval Compendium of Women's Medicine, by Monica Green.

The Edict of Salerno

Salerno, located on the lower "shin" of Italy's southwest coast, has been occupied continuously since pre-historic times, frequently changing hands due to the many wars in the peninsula. Despite the changing political landscape, however, at least one feature of Salerno rose to a prominence that it held for several centuries, through several political shifts.

We don't know precisely when the Schola Medica Salernitana (Medical School of Salerno) was founded, but at some point, the dispensary of a 9th century monastery became a focal point for medical study and earned the title of the first medical school in history. Because of the fame of the school, Salerno became known as the "Town of Hippocrates."

The School today.

One of its unique qualities for the time was that it not only was well-versed in the Greco-Roman traditions of Hippocrates, Galen, Dioscorides and others. Its proximity to North Africa and Sicily gave it access to Arabic learning (Sicily was under Arab control from 956 until 1072). In fact, it was the arrival in 1077 of the Tunisian Muslim merchant-turned-monk Constantinus Africanus that started a Golden Age at the school. He compiled the Liber Pantegni (Book of All Arts).  It was (as is typical for the time) largely a collection of the work of others, but it drew together Greek and Arabic medical knowledge in what is called the earliest surviving Western medical treatise [source].

Salerno produced other medical texts as well. A 12th century pair named Johannes and Matthaeus Plantearius wrote the Liber de Simplici Medicina (Book of Simple Medicine). Several books on gynecology and cosmetics were created by the most famous woman doctor of the time.

Salerno thrived, even after Holy Roman Emperor Frederick II declared the Edict of Salerno. The Modern Age would approve of the Edict: it created a legal separation between physicians and apothecaries. Physicians could no longer prescribe medicines that they themselves prepared and sold. The Edict also fixed prices to prevent overcharging the sick. Over time, this Edict was copied throughout Europe, and we have reason to be glad that similar regulations exist today.