La historia de monastic hospitals

priests and monks developed what has been termed monastic med¬icine and monastic hospitals in which they provided cace to the sick. That care, based on theological concepts which emphasized treatment by prayer and attributed results to God's will, had no place for operative intervention. Beginning in 1125 at Rheims a series of ecclesiastic edicts were issued to preserve traditional monastic lifestyle and limit involvement of the clergy in medical activities. The edict of the Council of Clermont in 1130 decreed that priests and monks should no longer practice medicine.5 Con-sequently, the monastic hospitals either ceased to function or were subsequently taken over by lay physicians. In the absence of the clergy, hospital care deteriorated with litde attention given to hygiene and cleanliness because of total ignorante of the cause of infection. For the next severa( centuries hospitals in civilian life were generally held in low regard and were commonly populated by the economically indigent.

The subsequent Ecclesia Abhorrent a Sanguine edicts of the Council of Tours in 1169 and of Pope Innocent III in 1215 which were issued to prohibit the clergy from any surgical activity, in essence defined surgeons as inferior to practitioners of general med¬icine and thereby separated medicine from surgery.16'11Collectively the edicts removed the stagnating effects of religious dogma on medica' progress and opened medicine to the beneficia( influence of scientific thinking and experimental observation on the part of secular practitioners.

Failure of the monasteries and cathedral schools of the Holy Roman Empire to provide an effective program of medical educa-non resulted in a shift of medical education to the universities as hey developed. The school of Salerno, at which the physicians had :emained free of church control and female practitioners were accepted, was the site of the first re-emergence of western European medical education. Constantinus Africanus, a Carthaginian who Secame a prominent member of the early Salerno faculty, trans-=red Greek and Arabic texts ínto Latin and made those teachings available to the Salerno students. King Roger II of Sicily issued a .iecree mandating passage of an examination proving the ability to Jure patients and requiring a license to practice. Frederick II, the zrandson of Roger and subsequent Emperor of the Holy Roman Empire, dictated in 1240 that all candidates for a medica' license ze publicly examined by masters of the Salerno school and estab-examination standards which classified medicine and surgery a. equal disciplines. Two classes of surgeons were defined by Fred-erick, i.e., the first class questioned in Latín by three professors and second class questioned by two teachers in Italian. A preceptor -rear was required before the candidate could take the examination zlet obtain a medical license.'

The "Bamberg Surgery", named after the principality in which

was found, describes the treatment of a variety of wounds and actures including those of the skull and is considered ro be the rst (mid-12th century) surgical manuscript written by a faculty ember of the Salernitan School. Two decades later, Ruggierio rugardi, known as Roger of Salerno, authored the Practica lhirurgiae, the first independent systematic surgical text in the es tern world. That volume describes the treatment of fractures,

h simple and compound, treatment of lacerated nerves, and in .r..szussing the treatment of wounds recommends immediate Irraction of foreign master. The repaír of an incomplete laceration

the intestine by suture of the intestinal wound over a wooden 'rent placed within

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