A Fantasy Pharmacy: The Arabic Pharmacopeia Arrives in the Latin West

How do you document a revolution? Not a coup d’état or anything political. No, a revolution in thinking, an alteration in practice. The adoption of a whole new way of doing things. Here’s one way.

In the British Library in London, there is a manuscript, Sloane 1621, a collection of medical recipes, that was owned in the Middle Ages by the Suffolk monastery of Bury St Edmunds. Yes, the same house that owned two of the manuscripts Winston Black talked about last month that helped introduce the medicine of Constantine the African to England. Sloane 1621 was almost certainly created elsewhere, somewhere on the Continent, and then it passed to Bury where it continued to collect new insertions. Michael Gullick, who has studied the manuscript most intensely, perceived the work of at least twenty-one different hands contributing over a half century between the mid-eleventh century and the early part of the twelfth. In those decades, we find traces of a revolution.

The Norman Conquest of England in 1066? Psshh. Okay, alright. Maybe that was a factor. But the revolution I’m talking about had its origins much further away than the English Channel.1 The revolution I’m talking about is the creation of a new “fantasy pharmacy”: substances whose medicinal powers were so unique that one simply must have them in one’s storehouse or infirmary, so that their marvelous properties could be drawn on in case of fever or incapacitating headaches or any of the other ills that normally befall the human body. This was a “fantasy pharmacy” because it likely was one that, at least initially, most individuals or institutions in Europe could have only imagined having, even a wealthy house like Bury.

What does our Sloane manuscript have to tell us about this revolution? Gullick describes two main hands that write out the opening 39 leaves of the volume, and then contribute various sections later on. Scribe A writes first, and then Scribe B copies up to the recto (front) side of leaf 38 (hereafter I’ll use “f.” for folio, “leaf”). He then leaves the rest of the quire (to f. 39 verso) blank. All the content copied by Scribes A and B were compound recipes, and all of them look quite typical for early medieval Latin medicine. The ingredients were all the same kinds of things that could be found in the Mediterranean area under the Romans. It is after Scribe B drops off that things get interesting.

In the blank lines that Scribe B left at the bottom of folio 38, Scribes d and then e take over. These two hands appear nowhere else in the manuscript. Gullick judges them both to date from around the middle of the eleventh century, and to show a Continental character, suggesting that the manuscript had not yet passed over to England. (I’m not convinced of this last point. As we know, not a few Continental “hands” went with their attached bodies across the Channel after the conquest.) Together, they copied out one very long recipe, taking up more than five pages all together. At the bottom of f. 39v, Scribe e switched from full lines of text to an itemized list: the ingredients, nearly 150 of them. Usefully, the list is alphabetized. Here are the ‘M’s:

London, British Library, MS Sloane 1621, f. 40v, part of the list of ingredients of a compound remedy.

Myrrh (mirra) and mastic were both resins that would have come from the Arabian peninsula and Mediterranean, respectively, and were as readily available in Antiquity as they likely were in the 11th century.2. Malabatron (a cinnamon-like plant) and mandrake (mandragora) would likewise have been known, even if not universally available, in the early Middle Ages. Even musk (muscatum) and myrobalans, substances imported from India or Tibet, were not completely new. But they were, likely, still extremely rare in any part of Europe in this period, and their inclusion in this one list is quite extraordinary.

In the ‘A’ section of the list, we similarly see ingredients that would have been familiar in the early medieval pharmacopeia. But we also begin to see something new. Ambergris (ambra, a secretion of sperm whales) and antimony (antimonium, the sulfide mineral stibnite) both appear here. The appearance of antimonium is especially intriguing, because Constantine is credited as having introduced that neologism into Latin.

London, British Library, MS Sloane 1621, f. 40v, some the ingredients beginning with the letter ‘A’ in a compound remedy. New here are ambra (ambergris, in the first line), and antimoniu (antimony) in the bottom line.

At the end of the list, come two additional clues that we’re dealing with something quite extraordinary:

London, British Library, MS Sloane 1621, f. 41r: the final lines of a list of pharmaceutics, ending with the newly imported substance, sugar (zaccara). In the second line from the top, the Arabic word uzifur (cinnabar) appears.

In the second line is uzifur, an Arabic word (perhaps originally from the Persian) for cinnabar, a kind of mercury sulfide. In the final row, the last item, zaccara, is sugar. A crop that originated in New Guinea, sugar had moved westwards over the course of the early medieval centuries and by the eleventh century was widely cultivated in various locales in and around the southern Mediterranean.3 Sugar would also appear in recipes as candi (rock sugar) and sciroppi (syrups) – and yes, now you know where those two words come from!

The recipe for which these items are the ingredients is a compound medicine called Antidotum Esdre maius. And it captures a moment of transition, of revolution. The record of pharmaceutics in early medieval medical manuscripts show that Latin medicine and Islamic medicine had gone quite separate ways in their development. As Brian Long has already told us, the Islamicate world expanded in the eighth, ninth, and tenth centuries, uniting a wide swath of the Old World from the Iberian peninsula to Central and Southeast Asia. So, too, did the pharmacopeia expand, bringing in substances that had already been adopted in local medical traditions. In the eleventh century, Europe finally began to participate in this larger network of medical trade.

It was, of course, a trade not simply in things (materia medica) but also knowledge. In fact, our Sloane manuscript suggests that the knowledge came first. The European adoption of the expanded Islamic pharmacopeia entailed three stages: first, the importation of recipes that used the new ingredients as part of compound medicines; second, the importation of the ingredients themselves, a process requiring a network of merchants skilled in trading the substance; and third, a growing lore of what each substance did individually and why it had a particular medicinal value. In other words, Europeans learned to desire a “fantasy pharmacy” before it ever existed in reality in Europe’s emporia.

The written recipe would have been the “advance advertising” for this new system of medicine, and that’s exactly the role our Sloane manuscript plays. We will recall that Scribes d and e, who copied out the Esdra recipe, appeared nowhere else in the manuscript. Sloane 1621 has a catch-as-catch-can character: most of the other scribes besides the main scribes A and B also wrote only a couple of recipes here and there. And we can prove, in fact, that Scribes d and e were copying an already set text (and not their own pharmaceutical creation), because the entire recipe appears word-for-word in two other manuscripts produced around the same time on the other side of the Alps.

One manuscript is Copenhagen, Det Kgl. Bibliotek, Gamle Kgl. Samling, MS 1653, most famous for its striking images of the fetus-in-utero from the treatise on women’s medicine by a late antique author, Muscio. It also has a second treatise on women’s medicine, this one associated with the Egyptian queen, Cleopatra. The latter half of Copenhagen 1653 is filled in with two long antidotaria, that is, collections of antidota, compound medicines. Similarly, Monte Cassino cod. 225 contains two long antidotaria. In both manuscripts, the Antidotum Esdre maius is the longest recipe. And both manuscripts were copied at the great Benedictine monastery of Monte Cassino, Constantine’s home for perhaps two decades after his arrival around 1076. Indeed, Monte Cassino 225 contains the first “polished” version of Constantine’s translation of Ḥunayn ibn Isḥāq’s Isagoge, the basic introduction to Galenic medicine as it was interpreted in the Islamic world.4

Although no explanation of the name is offered here, in other versions of the recipe it is said that “The Greater Esdra was composed when the prophet Esdra was sent into Babylon in exile.” In fact, recipes called Esdra were commonly found in early medieval compendia from the ninth century on. This Antidotum Esdre maius, however, is different from its early medieval predecessors in including all the new ingredients from the Islamicate world we flagged above.

The beginning of the list of ingredients in the recipe for Esdra in Copenhagen, Det Kgl. Bibliotek, Gamle Kgl. Samling, MS 1653, late 11th century, f. 159v. Note that in the left margin, a slightly later hand has written Confita nigra Constan[tini] (“Constantine’s black concoction”). Perhaps a reference to an alternate recipe that Constantine preferred?
The scenario I am imagining, therefore, is that our Sloane Scribes d and e, having been presented with a copy of an elaborate recipe—a veritable panacea that promised its efficacy against pains of the head and the belly, bites of both snakes and scorpions, leprosy and kidney stones—eagerly copied it down while they had the text in front of them. The only change the Sloane copyists made was in putting the ingredient list at the end of the recipe, whereas the Monte Cassino scribes put it in the middle.

Where did our Sloane scribes find an exemplar for this recipe? Did they travel all the way to Monte Cassino? Not necessarily. There’s no reason recipes like this couldn’t have circulated on scraps of parchment, passing by hand from one religious house or secular court to another. Did the Sloane scribes have access to all the ingredients? That seems unlikely. Did they even understand what all these ingredients were? I rather doubt it. The whole, rather chaotic volume of Sloane 1621 speaks of “for future reference” ambitions.

Maybe calling what we see in Sloane MS 1621 a “revolution” is too strong. Maybe this was a slow transition, a growing fascination for drugs whose smells, colors, tastes, effects, could only be imagined by those first hearing about them in northern Europe in the later eleventh century. The pages in Sloane 1621 with the Esdra recipe are still fairly clean, unmarked by later annotations or commentary. As Gullick notes, no additions at all were made in the manuscript after the early twelfth century; although preserved for centuries in the Bury library, the volume elicited no further interest. Perhaps it did just remain a fantasy pharmacy.

But we should note: it was into this same house that Constantine’s larger corpus of writings soon entered. And at Bury, as Winston Black has shown us, Constantine became a star! Constantine’s works at Bury not simply listed all these same drugs (and more!) but explained their properties. Although not documented there, it is possible that the Bury monks also had his treatise De gradibus—on the “degrees” (that is, the intensity) of different medicinal substances—which was one of his “bestsellers” throughout Europe.5 The De gradibus was used almost immediately after its composition for a medical poem written by someone in the Loire Valley styling himself “Macer” (after an ancient Roman poet), which was known as De viribus herbarum: “On the Properties of Herbs.”

“Macer” was, to be honest, not yet that adventurous in his pharmaceutical fantasizing. He focused on substances already familiar to Latin readers. He did, however, use the descriptions from the De gradibus to talk about the Indian imports zedoary and galangal, which had been known in the early medieval pharmacopeia but likely remained rare.6 It would be “Macer’s” successors, in the twelfth century, who more heartily incorporated into their medical practice the new luxury items of sugar, lapis lazuli, ambergris, musk compounds, and the several kinds of myrobalans. All these and more would appear in medical texts later, as a second wave of Arabic influence reached into Europe and as Europeans became better supplied by merchants and more daring to engage with what had first been only a fantasy world of new drugs.

Acknowledgements: My thanks to Arsenio Ferraces Rodríguez, who very kindly shared with me his transcription of the antidotaria in the Copenhagen manuscript, as well as his comprehensive list of earlier iterations of the Esdra recipe. Thanks also to Winston Black, for information on the pseudo-Macer herbal.

Further Reading:

  • Zohar Amar and Efraim Lev, Arabian Drugs in Early Medieval Mediterranean Medicine (Edinburgh: University of Edinburgh Press, 2017).
  • Debby Banham, “Medicine at Bury in the Time of Abbot Baldwin,” in Bury St Edmunds and the Norman Conquest (Woodbridge: Boydell Press, 2014), pp. 226-46.
  • Winston Black, “‘I Will Add What the Arab Once Taught’:  Constantine the African in Northern European Medical Verse,” in Herbs and Healers from the Ancient Mediterranean through the Medieval West, ed. Anne Van Arsdall and Timothy Graham (Aldershot: Ashgate, 2012), pp. 153-86.
  • Florence Eliza Glaze, “Salerno’s Lombard Prince: Johannes ‘Abbas de Curte’ as Medical Practitioner,” Early Science and Medicine 23, no. 3 (2018), 177–216.
  • Michael Gullick, “An Eleventh-Century Bury Medical Manuscript,” in Bury St Edmunds and the Norman Conquest, ed. Tom Licence (Cambridge, UK: Boydell & Brewer, 2014), pp. 190-225.
  • Anya H. King, Scent from the Garden of Paradise: Musk and the Medieval Islamic World, Islamic History and Civilization, 140 (Leiden: Brill, 2017).
  • Carmélia Opsomer, Index de la pharmacopée du Ier au Xe siècle, 2 vols. (Hildesheim, Zurich, and New York: Olms-Weidmann, 1989).
  • Nicholas Purcell, “Unnecessary Dependences: Illustrating Circulation in Pre-modern Large-scale History,” in: The Prospect of Global History, ed. James Belich, John Darwin, Margret Frenz, and Chris Wickham (Oxford: Oxford University Press, 2016), pp. 65-79.
  • Tsugitaka Sato, Sugar in the Social Life of Medieval Islam (Leiden: Brill, 2015).
  • Romney David Smith, “Calamity and Transition: Re-Imagining Italian Trade in the Eleventh-Century Mediterranean,” Past and Present, no. 228 (August 2015), 15-56.
  • Kathleen Walker-Meikle, “Antimony and Ambergris: ‘New’ Ingredients in the Antidotarium magnum,” 22 October 2015, https://recipes.hypotheses.org/6901.

1. That it was related to the other Norman Conquest—that of Sicily (ca. 1061-1091)—is very likely. Hopefully, that will be a topic we will return to in a future post.

2. Nicholas Purcell offers a fascinating survey of evidence for various types of incense in the ancient Roman world, though he omits medicinal uses.

3. Succarum is not documented in the Dictionary of Latin from British Sources until 1267, about 200 years after the Sloane manuscript. (Sugar compounds, such as zukarum Alexandrinum, zukarum rosatum, and zukarum violatum, show up somewhat earlier, in 1226.) This is an indication how much remains to be researched about the circulation of imported pharmaceutics in medieval Europe, since clearly our medical manuscripts document a much earlier knowledge of these substances.

4. An analysis of the two earliest copies of the Isagoge can be found in Francis Newton, “Constantine the African and Monte Cassino:  New Elements and the Text of the Isagoge,” in Constantine the African and ‘Alī ibn al-’Abbās al-Maǧūsī: The ‘Pantegni’ and Related Texts, ed. Charles Burnett and Danielle Jacquart, Studies in Ancient Medicine 10 (Leiden: Brill, 1994), pp. 16-47. Monte Cassino, Biblioteca della Badia, Cod. Casin. lat. 225, had not yet been digitized; a color reproduction of the stunning “colonnades” of the Antidotum Esdre maius recipe (on pp. 82-83), can be found in Peter Murray Jones, Medieval Medicine in Illuminated Manuscripts, rev. ed. (London: British Library [by] arrangement with Centro Tibaldi, 1998), fig. 51.

5. Monica H. Green, “Medical Books,” in The European Book in the Twelfth Century, ed. Erik Kwakkel and Rodney Thomson (Cambridge: Cambridge University Press, 2018), pp. 277-292, Table 1.

6. Black 2012, pp. 163-166.

A star is born: Reading Constantine the African in Medieval England

A guest post by Winston Black

In the last post, Brian Long asked the important question, “What good were Constantine’s translations?” Yes, it’s impressive that some 1000 medieval manuscript copies survive of Constantine the African’s medical works, but large numbers alone don’t tell us how those books were actually read or used in medical practice. To understand that, we need to look at individual manuscripts for evidence of physicians and students of medicine closely reading and commenting on Constantine’s work. In this post, I’ll look at three medical manuscripts from early twelfth-century England that illuminate how Constantine’s works were copied and read far from his Italian home, and how Constantine himself came to be seen (at least in one of those manuscripts) as a medical “star” alongside the ancient authorities of Hippocrates and Galen.

Anglo-Norman England (the period of direct Norman rule, 1066-1154) is important in the history of medieval medicine because many of the earliest copies of medical works by Constantine or other southern Italian authors were written there. Historians of medieval medicine (like Monica Green and myself) are still exploring the mechanisms by which medical texts moved quickly from Monte Cassino and Salerno in Italy to Normandy and England around the turn of the twelfth century. The easiest answer (albeit still insufficient) is the Norman connection: during the eleventh century Norman nobles and mercenaries conquered both England (William the Conqueror) and southern Italy, including the island of Sicily (Robert “Guiscard” de Hauteville). Thus the dukes and kings of Normandy, England, and Sicily all shared a common language, ancestry, and culture during the twelfth century, which encouraged literary and intellectual connections between those regions. Furthermore, most of the new bishops and heads of religious houses after 1066 (usually appointed by the king or with his cognizance) came from Normandy or the Île-de-France and presumably had closer ties to other continental cathedrals and monasteries. These Frenchmen include Abbot John of Tours at Bath (r.1088-1122) and Abbot Baldwin at Bury St Edmunds (r.1065-1097), whose abbeys produced all of the manuscripts discussed here.

Two Anglo-Norman medical manuscripts (figs. 1-2), which indicate those ties between England and southern Italy, are copies of Constantine’s Pantegni, both copied around 1125 in the wealthy English abbeys of Bath and Bury St Edmunds (now London, British Library, MS Additional 22719 and Cambridge, Trinity College, MS R.14.34). The Pantegni, as we have seen in an earlier post, was a translation of the medical encyclopedia of ‘Alī ibn al-‘Abbās al-Majūsī, d. after 977). These manuscripts of the Pantegni are high-class productions: both have broad margins on finely and consistently prepared parchment, neat and professional scripts, and illuminated initials in red and green ink (usually six lines high). Throughout the Bath Pantegni (BL Add. 22719), the first letter of each sentence or paragraph is also highlighted in green and red ink, a significant level of labor and decoration for a medical text. These are large and valuable books, probably intended for reference in the library rather than for a doctor to carry around.

The Prologue of Constantine the African’s Pantegni Theorica in London, British Library, MS Additional 22719, fol. 3r, probably made at Bath Abbey in the 1120s or 1130s.
The end of Book I and opening of Book II of Constantine the African’s Pantegni Theorica in Cambridge, Trinity College, MS R.14.34 (906), fol. 11r, produced around 1125 in the Abbey of Bury St Edmunds.

Neither of these luxury copies of the Pantegni, however, highlight Constantine’s authorship outside of instances where he named himself in the text. They indicate that powerful religious centers in England valued the Pantegni as a text, but not necessarily that they recognized Constantine as a “star” medical authority.  But in a third manuscript, Bethesda, National Library of Medicine, MS E8 (figs. 3-4), the compilers included numerous short passages from the Pantegni of Constantine as supplements to ancient and early medieval medical texts, and clearly indicate Constantine’s authorship in most of those excerpts.

Bethesda E8 is hardly a beautiful manuscript, but it has been recognized as the oldest European manuscript in the collection of the U.S. National Library of Medicine. It’s a rough and ready medical notebook produced most likely at Bury St Edmunds in the period ca.1110-1150 for use by physicians and teachers. It does not contain one main text, like the copies of the Pantegni discussed above, but is rather a compilation of about forty different short texts or excerpts on medicine and natural philosophy. Much of the manuscript is devoted to Latin translations of Greek works made in Late Antiquity, and in this respect it is similar to medical miscellanies of the Carolingian era. These include excerpts from the Synopsis and Euporista of the Greek imperial physician Oribasius (320-400 AD) and a complete “Old Latin” version of the Hippocratic Aphorisms with an extensive commentary produced in Late Antiquity (6th or 7th century).

Bethesda E8 shows us an eminently practical side to medical books of the twelfth century: it’s a smaller codex (22×14 cm [8.6 x 5.5 in]), probably intended to be carried, and made of whatever parchment was lying around, with leaves differing in size and quality, often with mended tears and holes. At least a dozen different people wrote anywhere there was room, at the ends of texts, on inserted scraps, and in the margins. The scribes were not professionals, but more likely students or practitioners of medicine in the monastery. Most of the texts are practical in nature, focusing on the basic tools a trained physician of the twelfth century needed: lists of antidotes and remedies for specific medical complaints, dictionaries of terms and symbols for pharmaceutical weights and measures, short texts on diagnosis by pulse and urine, and several texts on dietary regimen and the medicinal attributes of foods. The notebook has the information ready in short, memorable texts, and indeed, some are in verse to help with memorization.

The opening of Constantine’s Liber de cirurgiis (“Book of Surgeries”), Book IX of the Pantegni Practica, in Bethesda, National Library of Medicine, MS E8, fol. 149r. (Photo: Courtesy National Library of Medicine.)

The older texts in Bethesda E8 were written down in a first phase of production, probably ca.1110-1130, but in the following two decades (ca.1130-1150) later scribes added a range of newer medical texts associated with Monte Cassino and Salerno in the eleventh century. Notable among these is Constantine’s book on surgery from the Pantegni Practica, here called Liber Constantini de cirurgiis, “Constantine’s Book of Surgeries” (fols. 149-158, see fig. 3). Later additions to the notebook include several texts associated with the recently compiled medical curriculum known as the Articella: the De pulsibus of Philaretus, the Prognostics of Hippocrates (translated by Constantine), and excerpts from Constantine’s translations of the De febribus and De urinis of Isaac Israeli. These additions to Bethesda E8 coincide with another Anglo-Norman cleric’s discovery of Constantine: Henry of Huntingdon added material from Constantine’s De gradibus to his herbal Anglicanus Ortus during the 1130s or 1140s. However, unlike the scribes of Bethesda E8, he doesn’t name Constantine and it is not clear if he knew the origin of his new medical material.

Bethesda E8 is important for understanding the reception of Constantine not just because of the presence of his book on surgery and other translations, but also for the many excerpts and notes added to the manuscript which come from the Theorica of Constantine’s Pantegni. The physicians who used this notebook apparently had access to a copy of the Pantegni and used information from it to supplement the older texts in their manuscript. Wherever possible, readers of this notebook added useful passages from nearly every book of the Pantegni Theorica as supplements to, or commentary on, the older medical texts which made up the notebook in its first generation of use (ca.1110-1130). These include Constantine’s commentary on the complexion of the lungs, the humoral qualities of the blood, the bite of a rabid dog, eye problems, and the nature of hellebore as a medicine, to mention just a few cases.

Examples of Constantine the African named as a medical authority in the text and margins of Bethesda, National Library of Medicine, MS E8, an early twelfth-century medical notebook produced at the Abbey of Bury St Edmunds in England.

The manner in which these Constantinian glosses were written into the notebook shows that the physician-scribes revered the authority of Constantine, a fellow Benedictine monk, and wanted to highlight the source of their new information. Wherever possible, his name is given, if only in abbreviation (see fig. 4). Quotations or summaries from the Pantegni are marked CON. or CONST, and other passages indicate more clearly the sort of medicine learned from Constantine: the scribes refer to the “Diet of Constantine”, the “Pills of Constantine”, and “the very best plaster of Constantine”. Some of these recipes do indeed come from the Pantegni, but others appear to be attributed to him merely by virtue of his medical authority.

A comparison of the Constantinian passages in Bethesda E8 with the Bury St Edmunds copy of the Pantegni provides an indication of how Anglo-Norman physicians were reading Constantine in the first half of the twelfth century. Nearly every page of the Bury Pantegni, unlike the Bath Abbey copy, has numerous marginal and interlinear notes and corrections, which show that the text was read closely and collated with another copy of the Theorica to produce the most accurate version for the Bury monastic library. Several of the excerpts from the Pantegni Theorica which were added to Bethesda E8 match with passages in the Bury Pantegni which are marked as important both in the margins and within the text (using small red flags). Figure 5 shows one case, in which Constantine’s passage on the humoral composition of “natural blood” (Sanguis naturalis), that is, blood as it comes out of the body and not as the purified humor sanguis, was highlighted in both of these manuscripts. The marginal note from the Bury Pantegni circled in red provides a summary of the very passage which was chosen to be excerpted in Bethesda E8. Given that both of these manuscripts were probably produced at the same time in Bury St Edmunds, it seems likely (though not definite) that the Bury Pantegni was used by the physician-scribes to supplement their medical notebook.

A comparison of (left) an annotated page in the Bury St Edmunds copy of the Pantegni Theorica, Cambridge, Trinity College, MS R.14.34 (906), fol. 10v, with (right) a passage excerpted from that same work in Bethesda, National Library of Medicine, MS E8, fol. 8v.

Even if the same people did not read or annotate these two manuscripts, their readers saw the value of specific passages in Constantine’s Pantegni. The difference is that the readers of the Bury Pantegni never acknowledged Constantine as the author of the text, while the scribes of Bethesda E8 recognized Constantine as a medical author and authority. By repeatedly invoking his name, they elevate him from a translator or compiler of medical texts to a star in the medical firmament. Part of the medical revolution of the High Middle Ages was acknowledging that a recent scholar, and not just ancient authorities like Hippocrates and Galen, had something important to add to medical learning and practice.

Further reading:

  • Banham, Debby. “Medicine at Bury in the Time of Abbot Baldwin,” in Bury St Edmunds and the Norman Conquest, ed. Tom Licence (Cambridge, UK: Boydell & Brewer, 2014), 226-246.
  • Black, Winston. “‘I will add what the Arab once taught’: Constantine the African in Northern European Medical Verse,” in Herbs and Healers from the Ancient Mediterranean through the Medieval West: Essays in Honor of John M. Riddle. Ed. Anne Van Arsdall and Timothy Graham. Medicine in the Medieval Mediterranean 4 (Aldershot: Ashgate, 2012), 153-185.
  • Burnett, Charles. “Physics before the Physics: Early Translations from Arabic of Texts Concerning Nature in MSS British Library, Additional 22719 and Cotton Galba E IV,” Medioevo: Rivista di Storia della Filosofia Medievale 27 (2002), 53-109, reprinted in Charles Burnett, Arabic into Latin in the Middle Ages: The Translators and their Intellectual and Social Context (Ashgate/Variorum, 2009), Essay II.
  • Gameson, Richard. The Manuscripts of Early Norman England (c. 1066-1300) (Oxford, 1999)
  • Green, Monica H. “Salerno on the Thames: The Genesis of Anglo-Norman Medical Literature,” in Jocelyn Wogan-Browne (ed.), Language and Culture in Medieval Britain: The French of England c.1100–c.1500 (York, 2009), 220-232.
  • Green, Monica H. “Medical Books,” in The European Book in the Twelfth Century, ed. Erik Kwakkel and Rodney Thomson (Cambridge: Cambridge University Press, 2018), pp. 277-92.
  • Gullick, Michael. “An Eleventh-Century Bury Medical Manuscript,” in Bury St Edmunds and the Norman Conquest, ed. Tom Licence (Cambridge, UK: Boydell & Brewer, 2014), 190-225.
  • Henry of Huntingdon, Anglicanus Ortus: A Verse Herbal of the Twelfth Century. Ed. and trans. Winston Black. Studies and Texts 180. British Writers of the Middle Ages and Early Modern Period 3. Toronto: Pontifical Institute of Mediaeval Studies; Oxford: Bodleian Library, 2012.
  • McLachlan, Elizabeth Parker. The Scriptorium of Bury St. Edmunds in the Twelfth Century. Outstanding Theses from the Courtauld Institute of Art (New York: Garland Publishing, 1986; reprint of a 1965 dissertation)
  • Thouroude, Véronique. “Medicine after Baldwin: The Evidence of BL, Royal 12.C. XXIV,” in Bury St Edmunds and the Norman Conquest, ed. Tom Licence (Cambridge, UK: Boydell & Brewer, 2014), 247-257.

An Eleventh-Century WebMD: The Viaticum of Constantine the African

Up until this point we’ve been somewhat abstract in talking about Constantine the African’s works, as a set of texts that had dramatic effects on other texts. But for a patient who has unexpectedly come down with an unknown illness, of course, the intellectual tradition behind their care is likely to be of little interest: they want to put a name to their affliction and, ideally, cure it. So from the perspective of this hypothetical patient, what good were Constantine’s translations?

To answer this question, we need to have some sense of the places in which medical care occurred, and to understand the kinds of medical training that were available. Medical care was undertaken in multiple settings in the medieval world: in homes, to be sure, and also in monasteries and other institutions that likely attended to both bodily as well as spiritual health. At the highest levels, medical practitioners could be deeply learned and highly skilled experts, but there must have been an entire world of practitioners that is only rarely visible in our written sources.

Only a handful of images depict or illustrate medical practice in the period before Constantine was active in southern Italy; the tenth-century images found in this manuscript, Florence, Biblioteca Laurenziana, MS Plut. 73.41 (here f. 122v), illustrate how to cauterize patients suffering from various illnesses.

If we assume that a practitioner from Constantine’s own eleventh century was literate, how did they approach the treatment of a disease they were unfamiliar with? The answer is surprising, and illuminates the ways that medical care has both changed and remained the same in the intervening centuries. Before the mid eleventh century, the textual resources for medical practice had some limitations: for theoretical medicine, only a handful of formal medical treatises or commentaries would have been available, and even these circulated in modest numbers.

On the other hand, a large, fluid, and fascinating set of remedies was in circulation, often written scrappily on the blank pages and in the margins of manuscripts. But even though the remedies from this period that have been passed down to us may appear humble, we should not discount the possibility that they contain hard-earned empirical wisdom, gleaned from long experience with disease prevalence and herbal and other remedies available in a particular region.

In the eleventh century this situation began to change. Of course, as we have discussed, Constantine the African translated a considerable number of works from Arabic into Latin; but renewed attention was also given to texts that already existed in Latin. A work called the Passionarius, for example, combined a group of earlier texts into a handbook of medical practice. This text circulated in considerable numbers in Europe (and especially in Italy) in the eleventh and twelfth centuries—it was about as popular as the Theorica Pantegni—and in some cases was even furnished with several sets of annotations that clarified and explicated the text. Though its earliest manuscripts lack clear authorial attribution, the work became associated with the prominent scholar Gariopontus (died perhaps before 1056), who was praised by the prominent reforming monk Peter Damian as “a most upright man, superbly educated in the arts and in medicine.”1

What made the Passionarius so popular? Some of the work’s popularity must result from the organization of its presentation. While the empirical remedies that accrued over time in a manuscript might be haphazardly organized, this text followed the time-honored anatomical “head to toe” (a capite ad calcem) organizational scheme. For example, the Passionarius began by describing and giving causal explanations for several different subtypes of headache. Additionally, it presented multiple remedies for a particular illness; for the first subtype of headache, these included environmental remedies (avoiding both bright light and deep darkness), bloodletting, dietary remedies, and multiple compound remedies.

The text and chapter lists of this manuscript of the Passionarius are written in Beneventan, a striking script that flourished in southern Italy in Gariopontus and Constantine’s eleventh century. Vatican, BAV, Archivio Capitolare San Pietro, MS H 44, f. 23r.

But for all its virtues, the Passionarius must have also been challenging. For one, Gariopontus’ terminology had to have been daunting for Greekless readers, describing illnesses with Greek words and phrases; the subtypes of headache it covers are cephalea, cephaloponia, and monopagia. Additionally, the same ailment was sometimes covered in successive chapters, with varying emphases and remedies. This resulted from the way that it combined multiple texts, but it must have stymied those readers who just wanted a quick, unambiguous explanation of a particular illness and some remedies.

If we turn to Constantine the African, whose career in southern Italy appears to have started in the 1070s, we might wonder: did Constantine know Gariopontus’ influential work? This question is harder to answer than we might think: though the Passionarius was listed in a booklist of the monastery of Monte Cassino shortly after Constantine was there, Constantine never referred to it explicitly, and the terminology that Constantine’s works share with Gariopontus was common to the longer history of Latin medicine.

It is tempting to suppose, however, that Constantine’s own handbook of practical medicine, the Viaticum, was intended as some kind of response to the Passionarius. Just as the Passionarius synthesized earlier works, the Viaticum was intended to serve as a handily sized, single-volume handbook of medical practice. Like the Passionarius, the Viaticum presents illnesses and remedies in “head to toe” order. (Instead of headaches, however, it begins with alopecia and hair loss.) The work’s title, Viaticum—which echoes the meaning of the work’s source text, Ibn al-Jazzar’s Zād al-musāfir wa-qūt al-ḥāḍir (meaning “Provisions for the Traveller and Nourishment for the Sedentary”)—suggests it was meant to serve as a portable medical reference for travelers. But where Ibn al-Jazzar’s Arabic text (and the Passionarius) often gave pages of remedies for each illness, Constantine’s translation often condensed these recipes to their essentials: to remedy hair loss from fasting, Constantine tersely lists temperate baths, a moderate diet, the avoidance of salty things, and anointing with poppy or iris oil. At times, however, Constantine’s zeal for compression appears to have led him to cut into the bone, and his text leaves out some of the steps—and sometimes even the quantities!—of the remedies in Ibn al-Jazzar’s text. Was it the case that Constantine felt that Ibn al-Jazzar’s text was a little too long to travel with comfortably? Given Constantine’s book-laden trip across the Mediterranean, he would have been a position to know.

In contrast to the Passionarius’ heavy use of Greek terminology, Constantine’s Viaticum may have been translated with the needs of non-specialist readers in mind. He gave the work a Latin title, and he used more Latin and less Greek terminology than Gariopontus and many of his other predecessors. Constantine spoke simply of “hair loss” (capilli cadentes) and trimmed down the Greek terms for headache’s subtypes. Where the Passionarius sometimes spread its discussion of a single illness over multiple chapters, the Viaticum’s coverage was more tightly focused, with chapters that were more clearly focused on a particular ailment.

The composition of the Viaticum appears to have encountered some “quality control” difficulties of its own. Beyond its occasionally odd Latin and a few nonsensical readings, the earliest copyists of the Viaticum appear to have made one major mistake in producing the earliest copies of the text. Its preface makes clear that Constantine had placed a comprehensive, “omnibus” list of all of the chapters of the entire work at the beginning of Book I (likely drawn from a similar chapter list in his Arabic source), but this preface also states that he intended for the seven books of the Viaticum to have their own lists (an organizational scheme that is found in the Passionarius and the earliest manuscripts of the Theorica Pantegni). In our earliest manuscript of the text, however, these subordinate chapter lists were not inserted; when they do begin to be inserted into later manuscripts, they can be cramped and awkward, given far less space than they really required. It is only in the course of the twelfth century that manuscript designers learned to give the Viaticum’s layout the space it required. We can also see evidence of this “retrofitting” of text and layout in the discrepancies between the tables of contents and the rubrics accompanying each chapter, something Mary Wack noticed some years ago when studying the Viaticum’s terminology for lovesickness.

In planning the layout of the Viaticum, Constantine wanted to emulate works like the Passionarius and the Pantegni, as well as the manuscripts of his Arabic source. Like this fragmentary copy of Ibn al-Jazzar’s text, Wellcome MS Arabic A406, the Viaticum gave a list of all of the chapters of the entire work at the beginning.

Even though the Viaticum may not have lived up to its creator’s intentions, this hardly hindered its popularity, and at least 35 full and partial copies of the Viaticum survive from the century and a half after the work’s translation. If it did not prove quite as popular as the Passionarius in this period, it eventually became a massive success: it survives in well over a hundred copies, and was read—and, to all appearances, used—in many of the settings of medieval medicine. It appears to have been used heavily by monks, for example, and received commentaries at universities.

Nor, as we will see next time, was this one of Mark Twain’s little-read classics: as it grew in popularity, the Viaticum would reshape the ways that people thought about the body and its illnesses. More broadly—and although these practices hardly began with Gariopontus and Constantine—their works are echoed in modern attempts to understand and heal the body: like the imagined traveler who read Constantine’s Viaticum, we continue to use the parts of the body as an organizational rubric when we try to self-diagnose on WebMD; just as Gariopontus and Constantine’s readers must have known, words and names can still be sources of comfort to suffering readers.

Further Reading:

  • Demaitre, Luke E, Medieval Medicine: The Art of Healing from Head to Toe (Santa Barbara: Praeger, 2013).
  • Glaze, Florence Eliza, “Galen Refashioned: Gariopontus of Salerno’s Passionarius in the Later Middle Ages and Renaissance.” Ch. 3 in Textual Healing: Essays in Medieval and Early Modern Medicine, ed. Elizabeth Lane Furdell (Leiden: E.J. Brill, 2005): 53-77.
  • Glaze, Florence Eliza, “Gariopontus and the Salernitans: Textual Traditions in the Eleventh and Twelfth Centuries,” in La ‘Collectio Salernitana’ di Salvatore De Renzi, ed. Danielle Jacquart and Agostino Paravicini Bagliani (Firenze: SISMEL/Edizioni del Galluzzo, 2008), pp. 149-90.
  • Glaze, Florence Eliza, “Prolegomena: Scholastic Openings to Gariopontus of Salerno’s Passionarius,” in Between Text and Patient: The Medical Enterprise in Medieval and Early Modern Europe, ed. Florence Eliza Glaze and Brian Nance, Micrologus’ Library, 30 (Florence: SISMEL/Edizioni del Galluzzo, 2011), pp. 57-86.
  • Glaze, Florence Eliza, “Speaking in Tongues: Medical Wisdom and Glossing Practices in and around Salerno, c. 1040-1200,” in Herbs and Healers from the Ancient Mediterranean through the Medieval West, ed. Anne Van Arsdall and Timothy Graham (Aldershot: Ashgate, 2012), pp. 63-106.
  • Horden, Peregrine, Hospitals and Healing from Antiquity to the Later Middle Ages (Aldershot: Ashgate, 2008).
  • Wack, Mary, Lovesickness in the Middle Ages: The ‘Viaticum’ and Its Commentaries (Philadelphia: University of Pennsylvania Press, 1990).
  • Wack, Mary, “‘Alī ibn al-‘Abbās al-Maǧūsī and Constantine on Love, and the Evolution of the Practica Pantegni,” in Constantine the African and ‘Ali ibn al-’Abbas al-Maǧusi: The ‘Pantegni’ and Related Texts, ed. Charles Burnett and Danielle Jacquart (Leiden: E. J. Brill, 1994), pp. 161-202.

[1]Translated by Peter Blum, in the Letters of Saint Peter Damian(Washington, DC: Catholic University Press, 1989),p. 108.

He wrote what?

The medieval liberal arts tradition framed a set of questions that introduced the study of a text. Sometimes called the accessus ad auctores, it gave a simple formula for helping readers and students to “approach” an author:

  • Who wrote this? (discuss the author)
  • Why was it written? (discuss the author’s intent)
  • And so forth …

Constantine the African—our Benedictine monk, African immigrant, and translator of Arabic medicine—laid out a list of Accessus questions at the beginning of the Pantegni Theorica: What is the intent and purpose of the book? What is its title? To which part of formal learning does it belong? What is the name of the author? How is the book divided?

The Hague, Koninklijke Bibliothek, MS 73 J 6 (olim 542), last quarter of the 11th century, at Monte Cassino, f. 1va (detail). This is the oldest known copy of the Pantegni Theorica, and was likely made under Constantine’s supervision. This is the beginning of Book I, chapter 3, which does the formal “accessus” analysis of the book, listing the six key questions that needed to be assessed.

There were other ways to frame these questions, and additional issues that could be raised. But once you covered these basics, you could be said to properly understand a given work.

How might we apply this analysis to the text we would be most inclined to call “incongruous” in the Constantinian corpus: out-of-place, anomalous, not fitting our expectations of what a Benedictine monk would be interested in? That work is the De coitu: On Sexual Intercourse. This was the text (if you’re a regular reader of our blog) whose puzzling omission from the original Cassinese bibliography of Constantine’s works we noted before.

So, to our questions. Let’s start with an easy one: What is its title? Here is our first clue that this work was perhaps not as problematic as we might assume. In the earliest copy, it is called Liber coitus: The Book of Intercourse. No apology, no euphemism. The same holds with every other copy we have examined.

To which part of formal learning does it belong? Medicine, clearly. And that is an important point. Although reproduction (specifically the processes of embryonic formation) and women’s medicine had been topics of discussion in several early medieval Latin texts, there was no medical text devoted solely to sexuality prior to Constantine’s translation of the De coitu. The De coitu examines both the physiology of sexual function and surveys the kinds of dysfunctions and diseases that can occur to the sexual organs. Well, the male organs, at least, since the text has little interest in females.

What is the name of the author? The De coitu translates a work of Ibn al-Jazzār (d. ca. 979), the most commonly translated author in the Constantinian corpus. But we would not know that if Constantine was our only informant. Here, as elsewhere, he suppressed the original author’s name. In 1988, the Spanish scholar Enrique Montero Cartelle discovered that there was another translation of Ibn al-Jazzār’s lost text, found uniquely in a manuscript now at the Vatican Library. This translator preserved the original author’s name.

Vatican, Biblioteca Apostolica Vaticana, Pal. lat. 1123, f. 172r. This is a second, anonymous translation of Ibn al-Jazzār’s treatise on intercourse, made in the later Middle Ages. This translator, unlike Constantine, retained the original author’s name.

How is the book divided? We’ll let you explore that question yourselves. An older English-language translation exists,1 but readers would do well to consult the superb modern edition of the Latin text that Enrique Montero Cartelle produced in 1983. (It has a facing-page translation into modern Castillian. One hopes a new English translation might be produced soon.)

Last we come to the hardest question: What is the intent and purpose of the book? What Ibn al-Jazzār’s intent was we cannot fully discern, since the original Arabic version no longer survives. But we do know that Ibn al-Jazzār was hardly unique in focusing on the topic of sexual physiology and health. This was a thriving genre of medical writing in the Islamicate world.2

As for Constantine’s intent in translating it, of that, too, we are still unclear. Yes, Constantine was a monk. But he was a monk at Monte Cassino, the center of Benedictine monasticism, at the height of the debates about clerical and monastic celibacy swirling around Latin Christendom in the mid-eleventh century.3 It may even have been those debates that fostered an interest in the text. After all, it opens very clearly stating that sexual function was established by the Creator himself to ensure the propagation of all species, “for if animals disliked intercourse, all the species of animals would certainly have perished.” Many of the same frank attitudes towards sexuality can be found in others of Constantine’s works. In fact, we find in later manuscripts of the Constantinian corpus a short work on the potential harms and benefits of sexual intercourse, called (again, rather unimaginatively) the Liber minor de coitu (The Little Book of Intercourse).4

To Constantine’s six questions in the accessus, we could add a seventh: What was its fate? The De coitu is known now in thirty extant copies; the Liber minor in seven. In twelfth-century copies, neither text seems at all incongruous: andrology was just a normal part of medicine. But such frank attitudes toward sexuality were not sustained throughout the later Middle Ages. It is no coincidence that the most thorough work done on Constantine’s views on sexuality was by the Chaucer scholar, Mary Wack. For the De coitu became, ironically, Constantine’s most prominent claim to fame.

Mentioned in passing in the General Prologue to the Canterbury Tales, Constantine’s star turn comes in the Merchant’s Tale. The story is of an old man (January, which used to be one of the latter months in the calendar, hence depicting “age”) who has taken a young wife. On his wedding night, he needs fortification:

Soone after than, this hastif Januarie

Wolde go to bedde, he wolde no lenger tarye.

He drynketh ypocras, clarree, and vernage

Of spices hoote, t’encreessen his corage;

And many a letuarie hath he ful fyn,

Swiche as the cursed monk, daun Constantyn,

Hath writen in his book De Coitu;

To eten hem alle he nas no thyng eschu.

Soon after that this hasty January

Would go to bed, he would no longer tarry.

He drank of claret, hippocras, vernage,

All hot spices to heighten his love’s rage;5

And many an aphrodisiac, full and fine,

Such as the wicked monk, Dan Constantine,

Has written in his book De Coitu

Not one of all of them he did eschew.

The Ellesmere Manuscript of Chaucer’s Canterbury Tales (San Marino, CA, Huntington Library, MS EL 26 C 9, f. 102v, detail). The passage mentioning Constantine appears on f. 108v.

Curiously, in both of his references to Constantine, Chaucer only refers to him by his given name– never mentioning Constantine’s own preferred epithet, Africanus. Of course, Chaucer had a lot to say about sex, but this underscores how Constantine simply serves as a prop in his story. Chaucer seems to have known little about the ways that Constantine modified the sexual ethics of his Arabic sources for a Latin audience (a subject we will return to in a later post). Like Chaucer, we can still be surprised by the extent to which a monk engaged in frank discussions of aphrodisiacs and other sexual matters; and it can be difficult to imagine the importance of monasteries like Monte Cassino as vital centers of intellectual inquiry. The works Constantine translated on sex help us to better understand this, and to see what this translator’s original intent and purpose might have been.

Further Reading:

  • Bassan, Maurice. “Chaucer’s ‘Cursed Monk’, Constantinus Africanus,” Mediaeval Studies 24 (1962), 127-140.
  • Delany, Paul. “Constantinus Africanus and Chaucer’s Merchant’s Tale,” Philological Quarterly 46 (1967): 560-566.
  • Delany, Paul. “Constantinus Africanus’ De Coitu: A Translation,” The Chaucer Review 4, no. 1 (1969), 55-65.
  • Green, Monica H. “The De genecia Attributed to Constantine the African,” Speculum 62 (1987), 299-323.
  • Green, Monica H. “Constantinus Africanus and the Conflict Between Religion and Science,” in The Human Embryo: Aristotle and the Arabic and European Traditions, ed. G. R. Dunstan (Exeter: Exeter University Press, 1990), pp. 47-69.
  • Matheson, Lister. “Constantinus Africanus: Liber de coitu (Liber creatoris),” in Sex, Aging, and Death in a Medieval Medical Compendium: Trinity College Cambridge MS R.14.52, Its Texts, Language, and Scribe, ed. M. Teresa Tavormina, Medieval and Renaissance Texts and Studies, 292, 2 vols. (Tempe, AZ: Arizona Center for Medieval and Renaissance Studies, 2006), vol. 1, pp. 287–326.
  • Montero Cartelle, Enrique, ed. Constantini Liber de coitu: El tratado de andrología de Constantino el Africano. Monografias de la Universidad de Santiago de Compostela 77 (Santiago de Compostela, 1983)
  • Montero Cartelle, Enrique, ed. Liber minor de coitu: Tratado menor de andrología. Anonimo Salernitano. Edicion critica, traduccion y notas (Valladolid: Universidad de Valladolid, 1987).
  • Montero Cartelle, Enrique. “Sobre el autor arabe del Liber de coitu y el mode de trabajar de Constantino el Africano.” Medizinhistorisches Journal 23 (1988): 213–23.
  • Musallam, Basim. Sex and Society in Islam: Birth Control Before the Nineteenth Century (Cambridge: Cambridge University Press, 1983).

1. Delany 1967 translated from the 1536 printed edition of the De coitu.

2. See Musallam 1983.

3. Dyan Elliott, “The Priest’s Wife: Female Erasure and the Gregorian Reform,” in: Constance Berman, ed., Medieval Religion: New Approaches (London: Taylor & Francis Group, 2005), pp. 111-140.

4. The Liber minor de coitu is documented in seven manuscripts overall. One of these, the Durham, Durham Cathedral Priory, MS C.IV.12, s. xii med. (England), was unknown to Montero Cartelle when he edited the text in 1987; it now stands as the earliest known copy of the text. The Liber minor de coitu is also one of the handful of Constantinian texts for which there was a medieval vernacular translation, in this case, into Catalan. See Michael R. Solomon, The Mirror of coitus: A Translation and Edition of the Fifteenth-Century ‘Speculum al foderi’ (Madison, WI: Hispanic Seminary of Medieval Studies, 1990); and Anna Alberni, Speculum al foder (Bellcaire d’Empordà: Edicions Vitel·la, 2007). For the (partial) Middle English translation of the De Coitu, see edition by Lister Matheson.

5. I have slightly emended the translation to better reflect the medieval concept of the “degrees” of medicines. The reference is to pharmaceutically “hot” drugs, not simply warmed-up drinks.

‘But of the Practica of the Pantegni he translated only three books, for it had been destroyed by the water’: The Puzzle of the Practica

When trying to grasp what Constantine the African achieved in just two decades of labor at Monte Cassino in the later eleventh century, we might conjure up an image of the library in which he worked. Although bombed by the Allies in World War II, the monastery of Monte Cassino was subsequently rebuilt. Thus, when we enter the doors of its library today, we can imagine something of the great house as Desiderius, its most famous abbot after Benedict himself, conceived it in the 1070s.

We, can, moreover, repopulate that lost library with a number of the Latin medical manuscripts that Constantine would have had before him: a collection of texts attributed to Hippocrates and Galen from the tenth century; a copy of Book III of Paul of Aegina’s encyclopedia of medicine, perhaps just recently translated from the Greek; maybe even a copy of the text on medicine compiled by the ancient Roman encyclopedist, Celsus. But of the Arabic manuscripts Constantine used, we have nothing left at all.1

Most likely, he had only one copy of each of his Arabic texts. If they suffered any damage, there could have been no easy way to obtain a replacement. And such a loss does seem to have happened. Writing in the middle of the twelfth century in nearby Salerno, the medical author Mattheus Platearius reports that, when Constantine arrived at Cape Palinuro, on Italy’s “boot” just south of Salerno, “a seastorm broke out, and a great quantity of water came into the boat and destroyed a certain part of the Pantegni, namely the Practica.”2 Mattheus was referring, of course, to Constantine’s copy of ‘Alī ibn al-‘Abbās al-Majūsī’s Arabic Kitāb kāmil aṣ-Ṣināʻa aṭ-Ṭibbiyya, “The Complete Book of the Medical Art.”3 This is just the scenario of loss that Constantine would list as a cause for melancholy in his translation of Ishaq ibn ‘Imran’s treatise on that topic.

This story is supported, moreover, by every eleventh- and twelfth-century copy of the Pantegni we have. Manuscripts from the first century of the text’s existence fall into one of two groups. Some have only the Theorica, the first ten books covering basic physiology, anatomy, and disease causation. It was this section of the text that Constantine dedicated to his patron, the abbot of Monte Cassino, Desiderius, who would go on to serve a brief tenure as Pope Victor III, 1086-87.

The Hague, Koninklijke Bibliothek, MS 73 J 6 (olim 542), last quarter of the 11th century, at Monte Cassino, f. 1ra (detail). This is the oldest known copy of the Pantegni Theorica, and was likely made under Constantine’s supervision. The detail shows Constantine’s dedication of the text to his patron, Desiderius, the abbot of Monte Cassino. The holes (which look huge here because of enlargement) are actually tiny worm holes made by burrowing insects.

Some manuscripts of the Pantegni, in contrast, have both the ten books of the Theorica, and also one, two, or three books of the Practica: Book I on general regimen for maintaining health; the first part of Book II on the types of medicines; and the first third of Book IX, on surgery. It is as Platearius said: “But of the Practica of the Pantegni he translated only three books, for it had been destroyed by the water.”

Yet the “puzzle” of the Pantegni Practica goes deeper than Platearius’s story suggests. When we cast our eyes a bit further, looking into the thirteenth century, we find copies of a complete Pantegni: not simply with the ten books of the Theorica and the three books of the Practica (two of them incomplete), but with twenty complete books, covering all the topics that al-Majusi had included in his Arabic original of “The Complete Book of the Medical Art.”

How do we account for this stunning discrepancy? Where did this “complete” Practica come from? Mattheus Platearius gives us another interesting detail: Alfanus (the archbishop of Salerno who had patronized Constantine early in his career and was the dedicatee of Constantine’s translation on stomach disorders) “wished to reimburse” Constantine for his expenses in completing the Pantegni. Maybe Constantine found a new copy of al-Majusi’s original on Sicily, where the Normans were continuing to claim the island from Fatimid and Zirid control. Or perhaps he obtained it through contacts in North Africa.

But Alfanus died in 1085. What happened to the project of completing the Pantegni thereafter? The answer is, “We’re still figuring it out.”

The first layer of detective work occurred in the 1990s, in the context of an international conference focused on al-Majūsī and his Latin translator.4 Working on Books II and X, Mary Wack untangled the peculiar histories of both of the Practica’s books on pharmacy, the former on simple (uncompounded) drugs, the latter on compound (mixed) drugs. Something odd was clearly afoot. At the same time, I worked on Book VIII, trying to unravel the sources for the sections on women’s medicine. In 2006, Raphaela Veit then did a similar analysis of Book III, on fevers.

What we found, coming from different angles, was pretty much the same. An anonymous editor had “re-created” the Pantegni Practica. That is, he (she?), feeling that they knew what the full text should have looked like, “re-created” it, using bits and pieces of Constantine’s other writings—the Viaticum, Ishaq al-Isra’ili’s Book of Fevers, etc.—to assemble a text that looked like a “complete art.”

These revelations were stunning, but we still couldn’t explain the genesis of the full ten books of the Practica. Because we were using the Renaissance edition as our reference point, we didn’t realize that there were additional layers we weren’t yet seeing. It has only been in exploring the full corpus of twelfth century manuscripts that it has become apparent how complex the puzzle of the Pantegni, Practica actually is.

In 2015, looking through a mid-twelfth-century manuscript in Pembroke College Library, Oxford, I realized that a hitherto unidentified text, called simply a practica, was in fact a section of al-Majūsī’s original Practica. The passages in the Pembroke manuscript were from Books VI and VII. These, I would later be able to confirm, corresponded with an early thirteenth-century manuscript in Munich that has these books. (The Munich manuscript had been known for some time but only became available for consultation recently). I then discovered a third manuscript, now in Berlin, and a fourth manuscript, now in Uppsala, that had these “lost” pieces of the Practica, too. (You can read about the Uppsala discovery here or, if you prefer Swedish, here.) Additionally, one mid-twelfth century manuscript now in Toledo, discovered by Iolanda Ventura, has a unique copy of the Book X of the Practica, on compound medicines. This, too, seems stylistically to be the work of Constantine.

Berlin, Staatsbibliothek zu Berlin-Preussischer Kulturbesitz, MS lat. qu. 303a, mid-12th century (Italy), f. 2v (detail), Pantegni Practica Book VI, chap. 5: De raucitate (“On Hoarseness”). This, together with manuscripts in Munich, Oxford, and Uppsala, preserves the otherwise “lost” Books VI and VII of Constantine’s translation of al-Majūsī’s original Arabic.

Interestingly, the Munich and Uppsala manuscripts seem to have traces of what would have been the equivalent of Post-it® notes: that an author or editor had left to themselves to signal where different parts of the text were supposed to go. For example, there seems to be a “note” indicating where Book III, on fevers, was supposed to be added. Later copyists had copied these as if they were part of the main text, never realizing that the work they had in front of them was incomplete. Together, these clues suggest that, as Mattheus Ferrarius had noted, Constantine himself appears to have been engaged on the task of completing the translation he had earlier had to leave unfinished.

Pulling these pieces of the puzzle together, we can see that the creation of the Pantegni Practica fell into at least three stages:

  • Constantine’s original translation of Books I, the first part of II, and the first third of IX from the undamaged parts of his Arabic manuscript5
  • Constantine’s translation of other sections of the Practica, the second half of Book II, all of Book VI, most of VII, and all of Book X (from a new copy or “mended” copy of the damaged original?)
  • An unknown editor’s reconstruction of the remaining sections of the Practica from bits and pieces of Constantine’s other works

Exasperatingly, we still can’t pinpoint when and where this last, unknown editor was working. No extant copies of the “re-created” Pantegni Practica have been found that date before the second quarter of the thirteenth century, well over 100 years after Constantine died. Nor does any twelfth-century testimony—either a scholarly book or a library catalog—witness the existence of a “complete” Practica. For now, we will just have to live with this mystery.

Paris, Bibliothèque Nationale de France, MS lat. 6886, s. xiii med. (Italy), f. 133ra, here showing the beginning of Practica, Book III, on fevers, which is the first book created whole cloth out of other Constantinian materials by an anonymous editor. This manuscript is in the running for being the oldest copy of the completed (“re-created”) Pantegni.6

The “re-created” Pantegni gave the text a new lease on life. Fifteen of the thirty-five copies of the Pantegni that survive from the thirteenth century (there are fifty-three from the “long twelfth century”) present the “completed” Practica. These are often imposing volumes, running sometimes up to 200 leaves or more. However, the thirteenth century was also the point that Constantine’s Pantegni encountered its first real rival: the even more imposing compendium of medicine, the Canon of Ibn Sina (Avicenna, d. 1037). This had been translated into Latin before 1187 by Gerard of Cremona, working in Toledo, and although it experienced an initial period of invisibility, it emerged in the second quarter of the thirteenth century to a position of prominence, soon becoming the bedrock of medical curricula in later medieval universities and the writings of learned physicians.7

The Pantegni, retrieved from the sodden manuscript with which Constantine arrived in Italy, never lost its power to attract readers. The Latin encyclopedia was still being copied as late as 1452, and it was printed twice in the sixteenth century: once with just the Theorica and once with the full twenty-book “re-creation.”8 Constantine’s editorial efforts, and the Pantegni’s success, are a testament to the intellectual power of the “complete art” that al-Majūsī had first assembled in Persia, in Arabic, in the tenth century.

Further Reading:

  • Charles Burnett and Danielle Jacquart, “A Catalogue of Renaissance Editions and Manuscripts of the Pantegni,” in Constantine the African and ‘Alī ibn al-‘Abbās al-Maǧūsī: The ‘Pantegni’ and Related Texts, ed. Charles Burnett and Danielle Jacquart (Leiden: E. J. Brill, 1994), pp. 316-51. Our project has doubled the number of twelfth-century manuscripts reported by Burnett and Jacquart; their survey of later manuscripts, however, is, aside from a few new discoveries, largely complete.
  • Monica H. Green, “The Re-Creation of Pantegni, Practica, Book VIII,” in Constantine the African and ‘Ali ibn al-‘Abbas al-Magusi: The ‘Pantegni’ and Related Texts, ed. Charles Burnett and Danielle Jacquart (Leiden: E. J. Brill, 1994), pp. 121-60.
  • Raphaela Veit, “Al-Maǧūsī’s Kitāb al-Malakī and its Latin Translation Ascribed to Constantine the African: The Reconstruction of Pantegni, Practica, Liber III,” Arabic Sciences and Philosophy 16 (2006), 133-168.
  • Mary F. Wack, “‘Alī ibn al-‘Abbās al-Maǧūsī and Constantine on Love, and the Evolution of the Practica Pantegni,” in Constantine the African and ‘Alī ibn al-’Abbās al-Maǧūsī: The ‘Pantegni’ and Related Texts, ed. Charles Burnett and Danielle Jacquart (Leiden: E. J. Brill, 1994), pp. 161-202.

1. An intriguing discovery was made of a tenth-century copy of Ishaq al-Isra’ili’s Arabic treatise on urines, now in the Vatican Library (BAV, MS Vat. ar. 310), that was produced in North Africa. Alas, there is nothing to connect it with Monte Cassino. Instead, it seems to have passed through Spain (and the hands of a Hebrew-literate user) before reaching the Vatican. Our thanks to Arianna D’Ottone for information on this manuscript.

2. The text of Platearius’ account, together with the biography of Constantine by his Cassinese contemporaries, Leo Marsicanus and Guido, can conveniently be found in translation in Francis Newton, “Arabic Medicine in Italy: Constantine the African,” in Mediterranean Passages, from Dido to Derrida, ed. Miriam Cooke, Erdağ Göknar, and Grant Parker (Chapel Hill: University of North Carolina Press, 2008), 115-121.

3. This work actually has two titles, both in Arabic and in Latin. al-Majūsī himself had called it both Kitāb kāmil aṣ-Ṣinā’a aṭ-Ṭibbiyya, “The Complete Book of the Medical Art” and Kitāb al-Malakī, “The Book of the King,” which Stephen of Antioch rendered as Liber regalis.

4. We should, in fact, say “translators” since a second translation of the Kitāb kāmil aṣ-Ṣinā’a aṭ-Ṭibbiyya of ʿAlī ibn al-ʿAbbās al-Majūsī was made around 1127 by Stephen of Antioch, a Pisan notary and philosopher working in the recently conquered Crusader state of Antioch. It is possible that the re-creator of the Pantegni Practica used Stephen’s version as a guide. But neither the chapter numbers or their titles correspond exactly, so any possible influence remains unproven.

5. The completion of the translation of Book IX, on surgery, took a different path and has been understood for some time. For a brief account, see Monica H. Green, “Crafting a (Written) Science of Surgery: The First European Surgical Texts,” REMEDIA, 13 Oct 2015, http://remedianetwork.net/2015/10/13/crafting-a-written-science-of-surgery-the-first-european-surgical-texts/.

6. Paris, Bibliothèque Nationale de France, MS lat. 6886 is also important in being one of three manuscripts that preserve an odd “fourth prologue” to the Pantegni, which connects the text, not with al-Majūsī, but with his contemporary, al-Razi.

7. Joël Chandelier, Avicenne et la médecine en Italie. Le Canon dans les universités (1200-1350) (Paris: Honoré Champion, 2017).

8. Constantine’s Pantegni has received no modern edition. It was printed twice in the Renaissance, and both editions are now readily available in electronic formats: [A. Turinus, ed.] Omnia opera Ysaac, 2 vols. (Lyons: Bert. Trot, in offic. Joh. de Platea, 1515), available at the Bibliothèque Interuniversitaire de Santé, http://www.biusante.parisdescartes.fr/histoire/medica/resultats/index.php?cote=00122&do=livre. This edition has the complete, 20-book version of the Pantegni. Another digital version can be found in the Wolfenbüttel Digital Library, URL: http://diglib.hab.de/drucke/ma-4f-35/start.htm?image=00463. The second edition of the Pantegni presents only the Theorica: Svmmi in omni philosophia viri Constantini Africani medici Operum reliqua … (Basel: H. Petrus, 1539).

A transcription of one twelfth-century manuscript, now in Helsinki, is available here: Outi Kaltio, ed., Constantine the African, Theorica Pantegni: Facsimile and Transcription of the Helsinki manuscript (Codex EÖ.II.14) (Helsinki: The National Library of Finland, 2011), http://urn.fi/URN:ISBN:978-952-10-7055-6. Note, however, that the Helsinki manuscript has only the text of the Theorica, and even then is missing all of Book I and the end of Book X.

“Once settled in this monastery, he translated a great number of books from the languages of diverse peoples”: The Constantinian Corpus

For European science and medicine, the Long Twelfth Century (from roughly 1050 to 1225) is characterized by the eagerness with which translations were made from Arabic and Greek into Latin. Constantine was at the vanguard of this movement, and we have already introduced him as the first translator of Islamic medicine into Latin. But Constantine also stands out among the translators of this period as a rare immigrant to Europe. With one exception, all the others were Europeans who traveled to other language zones, learned a second (or third) language, and then turned those skills toward Arabic or Greek science.1 Constantine, in contrast, was not simply translating texts. He was translating himself.

In proudly adopting the epithet Africanus in his “verbal seal”—ego Constantinus africanus montis cassinensis monacus—Constantine took his immigrant status as a lifelong badge. Indeed, it may be from Constantine himself that his Cassinese biographers got his stories of fabulous adventures that allegedly took him to Cairo, India, and Ethiopia. It is hardly surprising that Constantine’s first biographers at Monte Cassino claimed that, once he joined the monastery, “he translated very many books from the languages of diverse peoples.” We actually have no evidence that Constantine traveled beyond the sea corridor linking southern Italy to Sicily and North Africa. But there remains a pressing question: just how many languages did he know? And how extensive, really, was the corpus of texts he produced at Monte Cassino?

So far as we have yet been able to determine,2 Constantine knew only two languages: Arabic, his native tongue, and Latin, a language for which he required “polishing” from an editor.3 One must guess that he also acquired a bit of the local Italian vernacular of southern Italy, but neither it, nor the form of French spoken by the new Norman overlords of southern Italy, were languages used for medical writing in this early period. It is surprising, therefore, that among the works attributed to Constantine by his biographers—at least two of whom likely knew him personally—there are works that are not translations from Arabic.

The truth of the matter is that we are still in the process of figuring out exactly what happened at Monte Cassino in the years between Constantine’s arrival ca. 1076 and his death, “full of days,” toward the end of the century. Indeed, as we will see in subsequent posts, the development of what we now consider the Constantinian corpus began before Constantine’s arrival and continued after Constantine’s death. At least one element of his corpus apparently wasn’t completed until the end of the Long Twelfth Century. But we get ahead of ourselves.

In a biography of Constantine, begun around 1105 by his contemporaries, Leo Marsicanus and/or his continuator, Guido, and then incorporated into Peter the Deacon’s collected biography of Cassino’s most famous personalities in the 1140s, we find twenty, and then (in Peter’s version) twenty-three, works ascribed to Constantine. Interestingly, these lists do not capture all the works we know Constantine was responsible for. For example, one of the works with his distinctive “verbal seal” that is missing from the Cassinese booklists is his text On the Stomach (De stomacho), which he dedicated to one of his patrons, the archbishop of Salerno, Alfanus (d. 1085).

Constantine’s dedication of his treatise On the Stomach to his patron, archbishop Alfanus of Salerno (d. 1085). This copy was made in England in the later 13th century. Credit: Oxford, Pembroke College, MS 21, f. 1ra.

Why Peter listed three more works than the earlier biographers did is an important question. The reason for Peter’s inclusion of the text on surgery (Chirurgia) may be because, by the time he was writing in the 1140s, the text, which had been left unfinished at Constantine’s death, had now been completed. The Surgery is actually Book IX of the second part, the Practica, of Constantine’s translation of ʻAlī ibn al-ʻAbbās al-Majūsī’s Arabic Kitāb kāmil aṣ-Ṣināʻa aṭ-Ṭibbiyya, “The Complete Book of the Medical Art.” For reasons we’ll hear more about in next month’s post, Constantine only translated the first third of Book IX. Between the time Leo and Guido were writing, soon after Constantine’s death, and when Peter was writing, two other translators had come along to complete his work: one a recent convert from Islam, Johannes, and the other someone named Rusticus, son of Bella “and by profession a physician,” from Pisa. What their connection was with Monte Cassino is unclear, but one of the few manuscript witnesses to the translation still resides in a thirteenth-century copy at the abbey.

This passage falls at the point of transition between Constantine’s portion of the translation of the Surgery (Pantegni, Practica, Book IX) and the completion by Johannes, a converted Muslim, and Rusticus of Pisa. Berlin, Staatsbibliothek zu Berlin Preussischer Kulturbesitz, MS lat. fol. 74, 12th century, f. 261r. This Berlin manuscript, and one still in the library of Monte Cassino (cod. 200), are the only independent witnesses to this completed translation.

The second text added to Peter’s list, but missing from Leo and Guido’s, is more puzzling since we don’t have any reason to think that Constantine didn’t finish it himself. This was the De coitu, on sexual intercourse. It is certainly as Constantinian as many others we ascribe to him, since its Arabic original can be assigned to the 10th-century physician from Qayrawan, Ibn al-Jazzār, whom we have met before. In fact, there is a second book on sexual intercourse (literally called, “The Little Book of Intercourse”) that seems also to come from Monte Cassino, and both texts circulate with other elements of Constantine’s works. We must assume (given the monks’ vows of celibacy) that interest in this topic stems either from lay patrons of the monastery or from debates on-going in the eleventh century about celibacy or marriage.4

The third new text on Peter’s list, the Prognostics, is important to flag for a different reason. Like the De coitu, we have no reason to doubt (in the absence of stylistic analyses) that it is an authentic translation by Constantine; it is certainly translated from Arabic. But it is distinctive in a sense. One of the methods we are using in our work on Constantine’s transformative impact on medicine in the Long Twelfth Century is to look for patterns in the circulation of his texts in manuscripts from the period. The Prognostics almost never circulates on its own, nor is it found in larger collections of Constantiniana. Rather, it is found with one or more of a group of texts historians of medicine call the Articella, the “little art.”

This basic Latin medical teaching curriculum, which would go on to form the foundation of medical teaching all across Europe for the next 400 years, was, we know now, assembled at Monte Cassino. And it was a multilingual endeavor. Here are the basic components:

  • Ḥunayn ibn Isḥāq’s (Latinized as “Johannitius”) Isagoge – translated from Arabic
  • the Hippocratic Aphorisms – translated from Greek
  • the Hippocratic Prognostics – translated from Arabic
  • the Hippocratic Regimen in Acute Diseases – translated from Arabic
  • Philaretus’s On Pulses – translated from Greek
  • Theophilus’s On Urines – translated from Greek
  • Galen’s Tegni (also known as the Ars parva or “the Little Art”) – translated from Greek

Constantine translated Ḥunayn’s Isagoge, a basic summary of Galenic medicine—though that, too, is missing from the Cassinese biographers’ lists.5 The translation of the Regimen in Acute Diseases was also from Arabic, making Constantine the most likely suspect as its translator. Yet it, too, is missing from the Cassinese lists.

What of the Greek texts in the Articella? We have no reason to believe that Constantine knew Greek well enough to translate them himself, though he may have acquired some limited command of the language in a monastery where Greek speakers were a regular feature. It is surprising, therefore, that his biographers attributed Galen’s Tegni to him. Who was (or were) these other translator(s) from the Greek? That remains one of the great mysteries of medicine in late eleventh-century Monte Cassino!

Paris, Bibliothèque Nationale de France, MS lat. 7102, s. xii in. (Bobbio), ff. 35v-36r, showing the opening of the new translation, from the Greek, of the Hippocratic Aphorisms made, apparently, specifically for use in the Articella collection. Several pages of this copy are a palimpsest over the Old Latin Aphorisms translation.6

The Articella collection is not the only part of what we now consider the Constantinian corpus to display signs of a fusion of Arabic, Greek, and Latin traditions. We will have more to say about these intersections in coming posts. For now, though, we should stress that despite this more complicated picture of the Constantinian corpus, we still believe that Constantine was the guiding presence that brought this impressive new body of medical literature into being. This corpus was Monte Cassino’s signature contribution to medical history, and its “Constantinian seal” would remain fixed on European medicine until the end of the Middle Ages.

Further Reading:

  • Green, Monica H. “Gloriosissimus Galienus: Galen and Galenic Writings in the 11th– and 12th-Century Latin West,” in Brill Companion to the Reception of Galen, ed. Petros Bouras-Vallianatos and Barbara Zipser (forthcoming). (Still in press, but feel free to request an advance copy.)
  • Green, Monica H. “Medical Books,” in The European Book in the Twelfth Century, ed. Erik Kwakkel and Rodney Thomson (Cambridge: Cambridge University Press, 2018), pp. 277-92.
  • Matheson, Lister. “Constantinus Africanus: Liber de coitu (Liber creatoris),” in Sex, Aging, and Death in a Medieval Medical Compendium: Trinity College Cambridge MS R.14.52, Its Texts, Language, and Scribe, ed. M. Teresa Tavormina, Medieval and Renaissance Texts and Studies, 292, 2 vols. (Tempe, AZ: Arizona Center for Medieval and Renaissance Studies, 2006), vol. 1, pp. 287–326.
  • Montero Cartelle, Enrique, ed. Liber Constantini De stomacho: El tratado ‘Sobre el estómago’ de Constantino el Africano. Estudio, edición critica y traducción (Valladolid: Ediciones Universidad de Valladolid, 2016).
  • Newton, Francis. “Constantine the African and Monte Cassino: New Elements and the Text of the Isagoge,” in Constantine the African and ‘Ali ibn al-Abbas al-Maǧusi: The ‘Pantegni’ and Related Texts, ed. Charles Burnett and Danielle Jacquart, Studies in Ancient Medicine 10 (Leiden: Brill, 1994), pp. 16-47.

1. The other known medical translators into Latin in this period were Rusticus of Pisa and Johannes agarenus, who completed Constantine’s translation of al-Majusi’s surgery, ca. 1113-15; Stephen of Antioch (fl. 1127), a Pisan who worked in the recently established Crusader state of Antioch; Gerard of Cremona (d. 1187), who worked in Toledo; Burgundio of Pisa (d. 1193), who traveled to Constantinople, but made his translations of Galen’s Greek texts once home in Pisa; and Mark of Toledo (fl. 1193-1216). Mark may have originally been from Toledo, which remained a multi-lingual environment for quite some time after its conquest by Christians in 1085.

2. As we noted in the first installment of the Constantinus Africanus blog, the majority of Constantine’s works have not yet been edited. As more works are scrutinized, we will be developing a better sense of Constantine’s characteristic style.

3. As noted by Francis Newton, Constantine was assisted in his Latin by one of his auditors at Monte Cassino. As recounted in the Cassinese Chronicle, “Adto, who attended Constantine the African’s discussions and was chaplain to the Empress Agnes, took the texts that the aforementioned Constantine had translated out of different languages and put them into Latin in elegant style.” See Newton 1994, p. 24.

4. The critical edition of the De coitu, Enrique Montero Cartelle, ed., Constantini Liber de coitu: El tratado de andrología de Constantino el Africano. Monografias de la Universidad de Santiago de Compostela 77 (Santiago de Compostela, 1983), identified 15 copies of the text. Our project has identified 15 more. See also Enrique Montero Cartelle, Liber minor de coitu: Tratado menor de andrología. Anonimo Salernitano.  Edicion critica, traduccion y notas (Valladolid: Universidad de Valladolid, 1987); and, on the Arabic source of the De coitu, Enrique Montero Cartelle, “Sobre el autor arabe del Liber de coitu y el mode de trabajar de Constantino el Africano,” Medizinhistorisches Journal 23 (1988), 213–23.

5. Newton 1994.

6. For a detailed examination of the text in this copy, including the suggestion that it was made at the Benedictine monastery of Bobbio in northern Italy, see Manuel Vázquez Buján, “Sur les traces de l’ancienne traduction latine des Aphorismes dans le manuscrit Paris, BnF, latin 7102,” Galenos: Rivista di filologia dei testi medici antichi 2 (2008), 107-118.

“In Latin books, I found no author who gave certain and authentic information; therefore, I turned to the Arabic language…”

In our previous post, we stated that Constantine the African was one of the most important authors in the Latin (and thus the Western) medical tradition. But why? What did Constantine’s works offer that earlier texts in Latin– medical works that had been translated from Greek into Latin in late antiquity, for example– had lacked? This question takes us into the heart of the works that Constantine produced, the way he produced them, and the particular place in history that Constantine occupied. The answer, briefly, is that Constantine’s skillful and well-positioned translations drew on centuries of medical scholarship in the Islamic world that synthesized and surpassed the findings of the ancient medical tradition.

In antiquity, Greek authors– and the Greek-speaking Roman physician Galen (d. ca. 216 CE) above all– had produced a sophisticated body of medical knowledge, a set of texts that made substantial improvements upon earlier knowledge of anatomy, physiology, and, to a somewhat lesser extent, therapeutics. In the 600 years after Galen’s death, the production of scientific and medical works in Greek waned to a trickle, but this medical tradition was taken up with avidity by writers in Arabic and Persian after the rise of Islam in the seventh century. More than merely repeating or harmonizing what Galen had already said, this Islamic medical tradition added to and even disputed Galen’s findings in works of considerable sophistication.1 It described illnesses, such as smallpox, that had only been mentioned briefly (or not at all) by Galen; attempted to resolve inconsistencies in his works; and even disparaged Galen’s philosophical pretensions.

Nor was this all. Islamic writers, writing in the richest, most vibrant cities in the Islamic world (and indeed, some of the greatest cities in the Middle Ages), had access to medicinal substances and medical learning that Galen did not. Where cane sugar had been known to ancient medical writers as a rare import, it was readily available to Islamic physicians; where Roman scholars had some vague notions of India, scholars in the Islamic tradition were able to consult Arabic translations of Sanskrit medicine. The medical works that were produced in the Islamic world, then, were not warmed-over compilations of ancient medicine, but works that often broadened the tradition with new resources, observations, and reasoned debate.

Constantine the African’s translations played a central role in introducing medicinal substances from Islamic medicine such as sugar cane into the Latin medical tradition, here pictured in a thirteenth-century copy of the Tractatus de herbis, an expanded version of the Salernitan pharmaceutical treatise, Circa instans. British Library, MS Egerton 747, f. 106r.

On the other hand, the very vitality of the Islamic medical tradition posed its own set of challenges. After short centuries of conquest, Islamic rule was firmly established from the Iberian peninsula (modern Spain) in the west to beyond Persia in the east, and medical writers across this broad territory developed their own traditions. We can easily understand why: practitioners in Córdoba might need to treat illnesses differently from those encountered in Ghazna (in modern Afghanistan) and might draw upon different plant, animal, and mineral substances from which to confect remedies. What resulted was not unchecked chaos: medical scholars shared the same theoretical and methodological framework: Islamic medical writers agreed on the fundamental importance of the four humors, for example, and that humoral imbalance was one of the principal causes of disease. Once you scratched the surface of this tradition, however, its complexities became apparent: Arabic terminology jostled with loan words from Greek, Persian, Syriac, and even Sanskrit, while authors gave varying explanations and remedies for a wide range of illnesses.

Islamic medicine, then, was always characterized by a tension between its centrifugal tendencies and the desire of some scholars to make its complexities orderly and systematic. The great systematizer ʻAlī ibn al-ʻAbbās al-Majūsī (d. after 977), for example, who spent much of his career in Shiraz (in modern Iran), self-consciously tried to improve the overwhelmingly long and disorganized works of his predecessors with a rigorously organized overview of medical theory and practice in twenty books. But medical scholarship did not stand still while al-Majūsī worked, and medical scholarship also flourished elsewhere, as in the vibrant medical tradition of the North African city of Kairouan. Where al-Majūsī’s overview of medicine sought to systematize Islamic medicine, the Muslim physician Ibn al-Jazzār (d. ca. 979) put forward his own view of medicine in works that explained diseases and therapeutics for lay readers while also subtly delineating the moral ramifications of health and disease.

In the tenth and eleventh centuries, the Islamic territories covering a huge swathe of Eurasia, North Africa, and beyond were renowned for their power, wealth, and cultural refinement. But even more than the breadth of the territory controlled, however, the vitality of Islamic civilization is suggested by the fact that centers of major cultural importance could be found at opposite ends of this territory, from Córdoba in Al-Andalus (now modern Spain) to Ghazna (Ghazni, in modern Afghanistan). Map © Ian Mladjov

In contrast with the Islamic medical tradition, the Latin medical tradition was a far more modest affair. The Benedictine Rule, which structured monastic life for much of the Middle Ages, enjoined the care of the sick, but few monasteries took this as encouragement to systematically collect and study the works of medicine then available. Some medical practitioners were highly skilled (and those in Salerno in southern Italy were especially famed), but few efforts had been made before the eleventh century to harmonize their insights with theoretical works of ancient medicine. There can be little surprise, then, that when Constantine the African traveled from North Africa to southern Italy in the mid-eleventh century, he was unimpressed by what he found. What is likely to be one of his earliest works gives his appraisal: he had looked for a book on urines in Latin, Constantine explained, but found no author who gave “certain and authentic information,” and so he turned to Arabic instead.

As in his work on urines, Constantine’s other texts describe the difficulty of mastering medicine from Latin texts in vivid detail. Here, in his translation of a work on fevers (the Liber febrium) from a work of Ishaq al-Isra’ili’s, Constantine explains that the sad state of his student John (including “continual tears” and “the extreme scarcity of want”) had finally convinced him to translate a work on the subject. Kassel, MS Med. 15, f. 1r.

But for all of their virtues, presenting Arabic texts to Latin readers in a comprehensible way was a tall order. For one, Constantine was compelled to bring the rich and diverse Islamic medical tradition into some kind of harmony. At the same time, Constantine had to make these works accessible to his Latin readers. In the Pantegni and the Viaticum, two of his major translations, Constantine was judicious– and sometimes even severe– in pruning what he found in al-Majūsī’s systematized overview of Islamic medicine and Ibn al-Jazzār’s handbook of practical medicine, respectively. At times, Constantine was meticulous in rendering his sources into pithy Latin. In other cases, his compressions are startling: in translating the Viaticum, for example, Constantine occasionally leaves out the quantities in his medical recipes! But despite his omissions– and we will discuss the significance of Constantine’s omissions of the names of al-Majūsī, Ibn al-Jazzār, and his other Arabic sources in a later post– Constantine made a huge amount of medicine accessible and comprehensible to his contemporaries and successors.

When we consider the comprehensive body of texts that Constantine produced (the topic of next month’s post) and the specialized vocabulary he constructed to render them into Latin (which we will also address soon), it is perfectly comprehensible that generations of earlier scholars claimed, with some grandiosity, that Constantine had taught his contemporaries to speak. It might be more accurate, however, to claim that his copious translations presented Latin readers with a synthesis of some of the most refined works of medicine then in existence.

Further Reading:

  • Françoise Micheau, “‘Alī ibn Al-‘Abbās al-Maǧūsī et son milieu,” in: Constantine the African and ‘Ali ibn al-Abbas al-Maǧusi: The ‘Pantegni’ and Related Texts, ed. Charles Burnett and Danielle Jacquart, Studies in Ancient Medicine 10.  (Leiden: Brill, 1994), pp. 1-15.
  • Francis Newton, “Arabic Medicine and Other Arabic Cultural Influences in Southern Italy in the Time of Constantinus Africanus (saec. XI²),” in Between Text and Patient: The Medical Enterprise in Medieval and Early Modern Europe, ed. Florence Eliza Glaze and Brian Nance, Micrologus’ Library, 30 (Florence: SISMEL/Edizioni del Galuzzo, 2011), pp. 25-55.
  • Emilie Savage-Smith, ‘Were the Four Humours Fundamental to Medieval Islamic Medical Practice?’ In: The Body in Balance: Humoral Theory in Practice, ed. by Elisabeth Hsu and Peregrine Horden (Oxford: Berghahn Books, 2013), pp. 89–106.

1. By convention, modern scholars refer to medicine under Islamic rule as “Islamic,” even though Christians and Jews also played a major role in the tradition. Non-Muslims, in fact, wrote a number of the texts that Constantine translated. For further discussion, see Peter E. Pormann and Emilie Savage Smith, Medieval Islamic Medicine, Georgetown University Press (Washington, DC: 2007).