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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;
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
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 [1] in which he wrote (page
‘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
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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.’
‘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
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-
de Bastiani
The Medical School at Ravenna
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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 [2], 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 [6], 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) [7]; 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
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
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.
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;
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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.
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