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.

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 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.

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).