Early Contributors to Nephrology Am J Nephrol 1994;14:317-319 Sergio Musitel/ib Paolo Marandolaa Hussein Jallousa Alberto Speronia Tomaso de Bastiania The Medical School at Ravenna Scuola di Spccializzazione in Urologia, Universita degli Studi di Pavia. Pavia. Storico della Scienza. Milan. Italy; Abstract The existence of the Ravenna School of Medicine can be deduced from a codex in the Ambrosian Library of Milan, which contains Latin translations of 3 Hippocratic works and commentaries on 4 works by Galen. Although it was written in the 9th century, the codex appears to be a copy of an earlier work, probably 7th century. The Ambrosian commentaries follow other commenta tors on Aristotle, rather than the original Aristotelian works, and contain a number of misinterpretations. Nevertheless, the commentaries make it clear that the earliest literature in Salerno had its roots in the studies of classical medicine at the Ravenna School of Medicine, where the teaching was essen tially Galenic in structure. Clues to the Existence of a Medical School at Ravenna In 1870 Daremberg wrote in his monumental Histoire des Sciences Médicales ( 1, page 257): ‘Un manuscrit de Milan contient la preuve qu’il y avait à Ravenne, vers la fin du V ille siècle, des leçons publiques sur Hippo crates et sur Gallicn.’ Evidently Daremberg must have consulted the codex G. 108 inf. conserved in the Ambrosian Library of Milan, which contains the Latin translation of 3 Hippocratic works and, most importantly, the commentaries on 4 works by Galen (DeSectis, Ars Parva, De Pulsibus, Therapeutica ad Glauconem). Henry Sigerist also consulted the codex G. 108 inf. in 1934 and published an article  in which he wrote (page 39): ‘The manuscript was written at the end of the 9th or at the begin ning of the 10th century, and contains in its first part Latin transla tions o f Hippocratic writings. Whoever was interested in the Hippo cratic texts studied this manuscript, and I found in it traces of Dar emberg, Kuehlcwein. Roschcr and others. I was most anxious to see the m anuscript... this manuscript proved to be the most important of all the manuscripts I saw ... All the scholars who examined this manu script were interested in Hippocrates. But the second part of the manuscript proved to be far more important than the beginning. I t ... proves that in the early Middle Ages, Galenic treatises were already translated into Latin, and were interpreted; but more than this, we even know where and by whom these texts were discussed, for, in the manuscript, at the end of three of these treatises, we find mentioned: ‘ex voce Agnello iatrosofista ego Simplicius deo iuvante legi et scripsi in Ravenna feliciter’. Iatrosofista at that time meant ‘professor’ of medicine, and so we know that in Ravenna there were teachers of medicine who had, and probably did, translations of Galenic works, and interpreted them. Our manuscript was written at the end of the 9 th century, but in all probability it is not an original, but a copy of an older manuscript. The text of the Milan manuscript was never printed before and will therefore be published in the second volume of my work.’ Paolo Marandola. MD Scuola di Spccializzazione in Urologia Universita degli Studi di Pavia 1-27100 Pavia (Italy) €> 1994 S. Karger AG. Basel 02 50-8095/94/0146-0317 $8.00/0 Downloaded by: Vanderbilt University Library 188.8.131.52 - 10/26/2017 8:58:32 AM Key Words Ravenna School of Medicine Galenic medicine Ambrosian codex Early medieval medicine The Ambrosian Codex The Ravenna School of Medicine is referred to in the colophon of the first 3 commentaries: ’Explicit scolia peri hereseon Galeni actio trigesima tertia félici ter. Ex voce Agnello iatrosophista ego Simplicius deo iuvante legi ct scripsi in Ravenna féliciter.’ 318 ‘Ex vocem Agnello archiatro deo iuvante ego Simplicius medicus legi contuli et scripsi in Ravenna feliciter.’ ‘Ex voce Agnello iatrosophista ego Simplicius audiui legi contuli Deo iuuante et scripsi feliciter.’ Ex voce means that Simplicio wrote under direct dicta tion of Maestro Agnello or took notes from his lessons. The structure of the first 3 commentaries is derived from the scheme initiated by Ammonius, which was fol lowed by the School of Alexandria and perfected by Olympiodorus in the 6th century. The commentary is divided into ‘lessons’ (actiones), each of which begins with a general introduction (theoria)', it then quotes only lemmata from the works of Galen with some explanation. At the end of each theoria and each actio are fixed expres sions:.//«/? theoria or finit actio. The 4th commentary does not have a detailed colo phon as do the previous 3, nor does it have a similar struc ture. It is divided into chapters without a specific scheme. Agnello and Simplicio based their commentaries on the line of thought followed by the commentators on Aris totle (Ammonius, Olympiodorus, David, Elias, etc.) rath er than on the original Aristotelian works, and above all they were subjected to the influence of Boezio. Even so, a number of elements confirm that Agnello and Simplicio are not the true authors of the commentaries. For exam ple, they confuse kion (column) with khion (snow) or porus written with omega (to) (corn) with poms written with omicron (o) (hole). It is thus easy to understand how misinterpretation of Galen’s work was possible for these authors. Moreover, many other points confirm that Agnello and Simplicio combined several sources of infor mation, ranging from Greek texts, lexicons that were the sources for Esichio and Zonara. and their own experience, to organize the commentaries. After reading these commentaries it can be deduced that the earliest literature in Salerno had its roots in stud ies of classical medicine mainly carried out by the Raven na School of Medicine. It should be noted that De Renzi in his Collectio Salernitana (cfr. vol I, page ff.; particularly page 143) affirms that Gariopontus of the Salerno School of Medicine was the first to Latinize certain Greek words, e.g. gargarizare. cicatrizare. cauterizare, when in actual fact these words were already present in the works by Agnello and Simpli cio of the Ravenna School of Medicine. Moreover, the Latin translation and the commentary on Hippocrates’ Aphorisms that are found in a great number of Beneventan manuscripts are the same as those produced in Raven- Musitelli/Marandola/Jallous/Spcroni/ de Bastiani The Medical School at Ravenna Downloaded by: Vanderbilt University Library 184.108.40.206 - 10/26/2017 8:58:32 AM Sigerist never fulfilled this intention. Parts of the manuscript had, in fact, already been published by Kuehlewein in 1890 and 1905, by Ilberg in 1894, by Gundermann in 1911 and by Roscher in 1913, but all these authors concentrated on Hippocrates and paid no atten tion to Galen. Finally, in 1956 Augusto Beccaria examined the codex G. 108 inf. completely in his work I Codici di Medicina del Periodo Presalernilano , He then started a historical-philologic examination of the codex which he never completed because of his death. Only 3 of the 5 planned articles were published in Italia Medioevale e Umanistica [3-5]. In 1981 Westerink, helped by a group at the State University of New York at Buffalo , published a critical edition of the commentary to De Sectis. In the same year Palmieri published a mediocre edition of Therapeutica ad Glauconem. In 1982 Pritchet published a commentary on De Sectis using the printed editions (Venice, 1490; Ven ice, 1502; Pavia, 1515) ; this work contains many errors and misinterpretations. For example, it errone ously ascribes the comments to Giovanni Alessandrino and states that Burgundione of Pisa was the translator of the commentary, when in actual fact Burgundione was (this still has to be proved) probably only the translator of the text of Galen, whose lemmata have been inserted in the commentary. It would therefore be better not to con sider Pritchet’s work but to return to the Ambrosian co dex. The text of the Ambrosian codex can also be found in 2 fragments of the Karlsruhe codex (Codex Reichenau 120). Both of these codices were written halfway through the 9th century and both appear to derive from an original text of the 6th century, as the Latin used in the codex is that of the 6th century. It can thus be deduced that a medical school existed in Ravenna between the 6th and 7th centuries AD. The school concentrated its attention on the thoughts of Ga len, and in particular on the 4 works that were considered the basis of medical teaching by the School of Alexandria and in the Arab world. na in the 6th century. In this way a map can be drawn of a medieval Italy crossed (from Ravenna to Benevento, to Cassino, and to Salerno) by a line of Greek tradition, which has its roots in the works of Hippocrates and Ga len. The Galenic commentaries outline the essential struc ture of the Ravenna School of Medicine. They also give an introductory note on the medical studies performed at this school. Any further information concerning the medi cal studies would be found in the more advanced and detailed lessons of the Ravenna School of Medicine. As the works by Galen are simply propedeutic in nature, it becomes clear why Agnello dedicates only two brief passages to the discipline of urology in his commen tary to Ars Parva. The first passage reads: ‘In fact the concave and porous parts are attacked by this patholo gy, known as obstruction, when fat and glutinous humor such as clot ted blood and phlegm accumulate there, but this pathology can be caused by unnatural situations, for example a stone in the bladder, in the ureters, or in the urethra. In fact in these hollow organs, fat humor collects. In these cases w e intervene with those preparations that break, extract and thin ... If the obstruction is caused by blood we evacuate the blood by phlebotomy. If it is caused by feces we use an enema. If the cause is a stone we must use preparations that can break it down. If with these preparations we arc unsuccessful we must then use those instruments that are able to move the stone from its posi tion, for example a catheter. If the catheter is also unsuccessful we must then proceed with a surgical procedure that we call lithotomy.’ The second passage reads: ‘In the pathology of the colon the urine may change its character istics or difficulty may be encountered when urinating. This occurs because the colon swells producing the suffering of the urethra and the bladder.’ As can be seen, Agnello knew and probably practised what the doctors of the ancient Greco-Roman period knew and practised (from Eliodorus to Celsus, Galen, Aretaeus and Oribasius). The importance of the Ravenna School of Medicine in the history of medieval medicine can now be appreciated. Above all, it provides a funda mental new source in the interpretation of the great Saler no School of Medicine. References 4 Beccaria: Sulle tracce di un antico canone di Ippocrate e di Galeno. in Italia Medioevale e Umanistica’. vol 2. part 4, 1961. pp Iff. 5 Beccaria A: Sulle tracce di un antico canone di Ippocrate e di Galeno, in Italia Medioevale e Umanistica. vol 3, part 14,1971, pp Iff. 6 Westerink LG: Agnellus of Ravenna: Lectures on Galen's De Sectis. Latin Text and Transla tion. New York, Seminar Classics 609. 1981. 7 Pritchct CD: Iohannis Alexandrini Commentaria in Librum De Sectis Galeni, Recognovit et Adnotatione Critica Instruxit. Leiden. 1982. 8 Temkin O: Studies in Alexandrian medicine. I. Alexandrian commentaries in Galen's De Sec tis ad Introducendos. Bull Inst Hist Med 1935; 3:405ff 319 Downloaded by: Vanderbilt University Library 220.127.116.11 - 10/26/2017 8:58:32 AM 1 Sigerist H: Medical literature of the early Mid dle Ages. Bull Hist Med 1934;2:26ff. 2 Beccaria A: I Codici della Medicina del Periodo Presalernitano. Rome. 1956. 3 Beccaria A: Sulle tracce di un antico canone di Ippocrate e di Galeno. in Italia Medioevale e Umanistica’, vol 1, part 2, 1959, pp Iff.