A guest post by Taylor McCall

Have you ever wondered how your bones fit together? How the muscles, veins, nerves, and arteries curve around them, spreading blood and sensation throughout your body as your heart pumps? What about the position of your spleen, or the location of your lungs?

Questions about human anatomy are fundamental to our collective experience, and medieval medical writers and students were just as curious about our insides as we are. Like many forms of knowledge, however, they had a different way of approaching anatomical learning. As we’ve discovered in many of the posts on this blog, Constantine the African’s importance to medieval medicine was his determination and ability to introduce Arabic medical texts previously unseen in the West, and anatomy is no exception.

Although anatomy was not considered a discipline in its own right until much later, the Islamic authors before Constantine took after Galen of Pergamum (129–c. 216 CE) in promoting the importance of understanding the physical makeup of the human interior. Galen believed one could not adequately practice medicine without a firm knowledge of anatomy. For many reasons, human dissection had fallen out of practice after a brief period in the first half of the 3^rd century BCE in Greece.¹ Although Galen did not dissect human corpses, he conducted numerous public anatomies on animals with similar organs to humans, such as pigs and apes, and continually asserted the importance of anatomical knowledge for medical practice in his writings. The scope of Galen’s influence in both the East and the West is evidenced by the hundreds of texts written by him, claiming to be written by him, or somehow connected to him that survive from the millennium and a half following his death.

Many of Galen’s writings were summarized, simplified, and amassed into medical encyclopedias, most notably by the Islamic encyclopedists working in the Middle East before Constantine. Constantine’s most famous translation, the Pantegni, was a rendition of ‘Alī ibn al-‘Abbās al-Majūsī’s Arabic Kitāb Kāmil aṣ-Ṣināʻa aṭ-Ṭibbiyya, “The Complete Book of the Medical Art.” As we have discussed, this was mostly based on Galen’s writings. It dedicated two of its ten books on medical theory to anatomy, making it the most advanced anatomical knowledge available from the end of the 11^th century until the late 12^th.

So, what did anatomical knowledge and learning look like during Constantine’s time? Human dissections are not documented until the early 14^th century, initially taking place in the universities of southern Europe, although we do have evidence of pig dissections occurring well before. The influence of the Pantegni is evident in these so-called “Salernitan Demonstrations,” a series of texts guiding a dissector through the anatomy of a pig.² Written in southern Italy (possibly Salerno, although this is not certain) over the course of several decades, the Demonstrations are in dialogue with each other, as subsequent authors disagreed with previous versions of the text and added their own instructions.

At the same time, we see another type of anatomical text emerge, seemingly out of nowhere in a monastic manuscript created in 1165: a brief treatise accompanied by the earliest known anatomical images in the West.

Each of these five squatted figures represent the five “simple” systems of the body according to Galen: the veins, arteries, bones, nerves, and muscles. A descriptive prose text neatly frames each image and small captions decorate their interiors. Visible within the vein and artery figures are internal organs Galen asserted were particularly associated with each system. The vein figure includes a ring of semi-circles in the center of the chest, labelled as the diafragma (diaphragm), as well as the large poly-lobed liver on the right side of the body, from which the veins were believed to emanate. The abstracted stomach and intestinal tract curls through the left side of the body. Directly to the vein figure’s left is the artery figure, featuring the heart (as a small oval at the base of the trachea on the body’s left side), the liver again on the right, and the spleen on the left.

Unusually, we have a firm date and location of the creation of this particular copy of these images: they were made in 1165 in the Benedictine monastery of Prüfening, Bavaria, Germany. These five anatomical figures were included in a prefatory cycle of images spanning a wide range of topics: from other medical materials like cautery scenes, the end of which are visible at the upper left of the above image, to religious and moralizing diagrams, all placed before a copy of the Salomon Glossaries, a dictionary attributed to Salomo III (d. 919), abbot of St. Gall and bishop of Constance. The manuscript is very large (it measures almost 2ft tall and over 1ft wide) and would have been an important production by the monastery’s scriptorium; indeed, the prefatory materials include a dedicatory scroll describing the history of the monastery and the manuscript’s production. The inclusion of medical materials alongside religious speaks to the priorities of this particular community. Tending to the ill and wounded was one of the primary directives of the Benedictine order, and the images here perhaps indicate their emphasis on the health of the body as well as the spirit.

Where did these images and text come from, and how did they arrive in Germany in 1165? The Prüfening copy is not the earliest version, but rather, a copy from a now missing exemplar. We know this because it is missing several image captions and portions of the treatise, known as the Historia incisionis (Account of Incision), that are included in later examples. We will begin by looking for clues as to where they came from in the Historia incisionis. In its introduction, the treatise claims to be based on the writings of Galen. It reads:

In the name of the Father, and of the Son, and of the Holy Spirit, here begins the account of incision described by Galen, most expert of physicians: vein after vein, bone after bone, muscle after muscle, nerve after nerve, and he described them as they are and separated one from the other, in order that the observer might not accidentally err, but might understand in its true nature those things which he can see. Thus the first description is of the arteries; the second, the veins; the third, of the position of the bones; the fourth, the nerves; the fifth, the muscles; the sixth, the genitals; the seventh, the stomach, liver, and belly; the eighth, the womb; the ninth, the brain and the eyes.³

The language implies a witness to a dissection, and these images are sometimes known as “dissected figures.” As you might imagine, given the description above, these five full-bodied are meant to be accompanied by four additional systems, known as the compound systems (which were considered to be made up by the first five “simple” systems). Together, this series and the Historia incisionis text are known as the Nine-System Figure Series.⁴ The origin of the Nine-System Figure Series—both text and image—is still unclear, and we will explore several of the possibilities.

The earliest witness to all nine of the systems appearing together comes from England at the very end of the 12^th century, most likely created in another Benedictine community. The images are drawn in a small, independent booklet of three parchment leaves folded in half (known as bifolia) and sewn together, indicating they circulated as a standalone pamphlet. Each of the nine systems and its associated description is given its own folio; as for the remaining three folia in the booklet, the first folio is partially destroyed but includes a labyrinthine drawing of an eyeball, recipes and verses on the temperaments; and the recto of the final folio features a diagram of the elements and temperaments.

The proportions of the figures are not as careful as we see in the earlier Clm 13002; while that manuscript was a large, meticulous creation to benefit the entire monastery, the small, portable Gonville and Caius booklet indicates a humbler set of circumstances: a smaller community, perhaps. However, the images were copied with great care, and highlighted with bright and memorable colors.

How did the images and text crop up in Germany and then, not fifty years later, in England? Is it an accident of survival that there are no earlier witnesses to the tradition, created in different areas? More fundamentally, we must look at text and image separately. Was the text adapted specifically to fit around the images, or were image and text circulating independently and then fitted together? Were the text and images preserved in the Middle East and translated from Arabic, or were either or both created in twelfth-century Europe?

These are all questions for which we have no concrete answers. However, there is a Constantinian possibility for at least the Historia incisionis that bears discussing. Both of the Cassinese bio-bibliographies of Constantine include in his oeuvre a single work that has no medieval witness: Galen’s De placitis Hippocratis et Platonis (On the Concordance of Hippocrates and Plato, on both lists called the Disputatio Platonis et Ypocratis in sententiis (A Debate between Plato and Hippocrates on Various Opinions)).⁵ The De placitis Hippocratis et Platonis is notable as one of the most complete summaries of Galen’s anatomical writings, and as Ynez O’Neill has pointed out, includes (in its original Greek) a section describing the arteries as branches of a tree, language that is directly echoed in the Historia incisionis but not elsewhere in early 12^th-century sources.⁶

In her extensive research, Monica Green has found no manuscript witnesses of the text; however, it is notable as the only work on the Cassinese lists for which we have no witness.⁷ It is likely that Constantine did in fact produce at least one copy—finished or unfinished—of the text before it disappeared. The text discusses the positions of the veins and arteries, and in particular, the origin of the arteries in the left ventricle of the heart. Galen also reiterates his belief that the brain controlled the body’s movement. While these ideas were summarized in the Pantegni, the De placitis Hippocratis et Platonis provides much more detail of Galen’s opinions, several of which were unknown in the West until the original Greek version was rediscovered and translated in the Renaissance.

If there is a Constantinian origin of the Historia incisionis, how and why did it become connected to the images? It’s important to note that very few medical books were illustrated, especially in the 11^th-13^th centuries. As Green has found in her exploration of medical manuscripts from this period, the illustrations that did occur were remnants of older graphic traditions, rather than new iconographies.⁸ A good example of this are found in herbals, texts discussing the medical properties of plants, the earliest manuscript illustrations of which survive from the 6^th century C.E.⁹ It has been argued that the Nine-System Figure Series was also descended from antiquity, preserved in the Middle East before migrating West. In addition, the four geometric compound system diagrams have received attention for their resemblance to early Arabic anatomical images.¹⁰ If the Historia incisionis was indeed drawn from a now-lost copy of Constantine’s translation of the De placitis Hippocratis et Platonis, it was probably done so in the Cassinese environs, appended to existing or original anatomical imagery, and circulated through Benedictine communities in Germany and England.

Ultimately, as historians of medieval manuscripts, we must accept that we are left with accidents of survival, rather than the complete picture, and must do with the pieces what we can. Regardless of its genesis, the Nine-System Figure Series has a rich history that spans the High and Later Middle Ages. In the 13^th century alone, the images and text appear in several very different manuscripts, as basic line drawings and as highly decorative textual accompaniments, as seen in this English version from the end of the 13^th century:

What role, if any, Constantine’s translations played in the development of this particular series of image and text must for now remain a mystery. In the meantime, more work must be done with the images and texts that have survived the ravages of time.

Further reading:

• Corner, George W. Anatomical Texts of the Earlier Middle Ages: A Study in the Transmission of Culture (Washington: Carnegie Institute of Washington, 1927).
• 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.
• Green, Monica H. “Richard de Fournival and the Reconfiguration of Learned Medicine in the 13^th Century,” in Richard de Fournival et les sciences au XIIIe siècle, ed. Joèlle Ducos and Christopher Lucken, Micrologus Library, 88 (Florence: SISMEL-Edizioni del Galluzzo, 2018), pp. 179-206.
• Herrlinger, Robert. History of Medical Illustration from Antiquity to A. D. 1600 (Nijkerk: Pitman Medical & Scientific Publishing, 1970).
• Jones, Peter Murray. Medieval Medical Miniatures (London: The British Library, 1984 [repr. as Medieval Medicine in Illuminated Manuscripts, 1998]).
• McCall, Taylor. “Reliquam dicit pictura: Text and Image in an Illustrated Anatomical Manual (Gonville and Caius College, MS 190/223),” Transactions of the Cambridge Bibliographical Society 16 (2016), pp. 1-22.
• McCall, Taylor. “Illuminating the Interior: The Illustrations of the Nine Systems of the Body and Anatomical Knowledge in Medieval Europe,” (Ph.D. Dissertation, University of Cambridge, 2017).
• O’Neill, Ynez Violé. “The Fünfbilderserie Reconsidered,” Bulletin of the History of Medicine, 43 (1969), pp. 236-245.
• Park, Katharine. Secrets of Women: Gender, Generation, and the Origins of Human Dissection (New York: Zone Books, 2006).
• Sudhoff, Karl. Ein Beitrag zur Geschichte der Anatomie im Mittelalter, speziell der anatomischen Graphik nach Handschriften des 9. bis 15. Jahrbunderts, Studien zur Geschichte der Medezin 4 (Leipzig: Barth, 1908 [repr. Hildesheim: G. Olms, 1964]).

1 For more on the human dissections and vivisections of the Greek anatomists Herophilus and Erasistratus, see the works of Henrich von Staden, and in particular Herophilus: The Art of Medicine in Early Alexandria (Cambridge: Cambridge University Press, 1989, repr. 2007).

2 Corner 1927 produced the first (and still standard) edited translation of the Salernitan Demonstrations.

3 “In nomine patris. et filii. et Spiritus sancti. incipit hystoria incisiones sicut dicit G[alenus] prudentissimus medicorum. venam secundum venam. os secundum os. lacertum secundum lacertum. nervum secundum nervum. et descripsit ea secundum quod sunt et separavit unumquodque ab alio. ne forte erret inspector eorum sed agnoscat ea ita ut videt. Ergo prima descriptio arteriae. secunda[m] venarum tertia positionis ossium. quarta nervorum. quinta lacertorum. sexta veretri septima stomachi. epatis et ventris. octava matricis. nona cerebri et oculorum.” Munich, Bayerische Staatsbibliothek, Clm 13002, f. 2v.

4 Karl Sudhoff first discussed these images in the early decades of the 20^th century. He authored numerous articles on the so-called Fünfbilderserie, the first five images seen in the Munich manuscript, as well as writing extensively on medical illustration in general. His 1908 publication listed here under “Further Reading” is a good place to start if interested in exploring his oeuvre. For the most recent study of the Nine-System Figure Series, see McCall 2017.

5 Phillip de Lacy’s 1981 English translation of the De Placitis Hippocratis et Platonis is available freely online: http://cmg.bbaw.de/epubl/online/cmg_05_04_01_02.php

6 O’Neill 1969. The section referenced by O’Neill in de Lacy’s English translation can be found on pp. 89-91.

7 Green, “Richard de Fournival,” p. 203.

8 Green, “Medical Books,” esp. pp. 284-5.

9 This manuscript, known as the Vienna Dioscorides, was created in about 512 for the daughter of Emperor Flavius Anicius Olybrius, Anicia Juliana. It contains over 500 illustrations of plants and animals and can now be found in Vienna’s Österreichische Nationalbibliothek as Medicus Graecus 1.

10 Emilie Savage-Smith has discussed the similarities between Arabic and Western medieval anatomical diagrams, most notably in “Anatomical Illustration in Arabic Manuscripts’, Arab Painting: Text and Image in Illustrated Arabic Manuscripts (Leiden: Brill, 2007), pp. 147-59.