Inside Investigations: Anatomical Texts and Images in the 12th and 13th Centuries

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 3rd 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 11th century until the late 12th.

So, what did anatomical knowledge and learning look like during Constantine’s time? Human dissections are not documented until the early 14th 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.

The Five-Figure Series, Munich, Bayerische Staatsbibliothek, Clm 13002, ff. 2v-3r. 1165, Prüfening, Bavaria, Germany. From L-R, top-bottom, the images are: veins, arteries, bones, nerves, and muscles. The entire manuscript is digitized in full: http://daten.digitale-sammlungen.de/0010/bsb00104093/images/index.html?fip=193.174.98.30&seite=1&pdfseitex

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.

The Veins and the Arteries, Munich, Bayerische Staatsbibliothek, Clm 13002, f. 2v (detail). 1165, Prüfening, Bavaria, Germany.

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 12th 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.

From L-R: The Veins, Arteries, Bones, Nerves, Muscles, Male Reproductive System, Stomach and Organs of the Abdomen, Female Reproductive System, and Brain and Ocular System. Cambridge, Gonville and Caius College, MS 190/223, ff. 2r-6r. c. 1200, England.

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 12th-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 11th-13th 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 6th 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 13th 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 13th century:

The Muscles, Oxford, Bodleian Library, MS Ashmole 399, f. 22r. Late 13th century, England. Ashmole 399 is fully digitized online here.

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 13th 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 20th 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.

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.

Ego Constantinus africanus montis cassinensis monacus

Constantinus Africanus (Constantine the African) is likely the most famous medieval writer most people have never heard of. At latest count, we can identify at least 1000 extant manuscript copies of his three dozen writings on various aspects of medicine. Those writings, collectively, probably comprise over one million words. To put that in perspective, the most famous Benedictine monk of the Middle Ages, Benedict of Nursia, is represented in only about 300 extant copies of his Rule describing the monastic life. Most of Constantine’s contemporary writers at Monte Cassino, the motherhouse of the Benedictine order, are known from only a handful of extant copies.

So who is Constantine the African? And why are we launching this blog devoted to him and his works? First and foremost, Constantine was the first to render a major body of Arabic science into Latin. Yes, a few works of mathematics and astronomy had become known in Europe in the 10th century. But no one had yet attempted what Constantine did: bringing a whole science, from introductory textbooks to works of great complexity, into the Latin language. Once translated, these works could—and did—circulate all over Europe. They transformed medical theory and practice in the lands we think of as western Europe, giving it a medical vocabulary and certain common concepts that we can still recognize in biomedicine today.


This is from the preface to Constantine’s translation of Isaac Israeli’s (d. 932) book on urines. In the 4th and 5th lines, Constantine identifies himself: “Quem ego constantinus affricanus montiscassinensis monachus. latinȩ linguȩ ad transferendum destinaui dare” (“which [book] I, Constantine the African, monk of Monte Cassino, committed myself to translate into the Latin language”). Source: Vatican, Biblioteca Apostolica Vaticana, MS Urb. lat. 1415, f. 1v (detail).

In several of his writings, Constantine identified himself with the title we’ve used here: Ego Constantinus africanus montis cassinensis monacus. “I, Constantine the African, monk of Monte Cassino.” Constantine’s self-naming raises a host of intriguing questions. All evidence suggests that he did indeed come from “Africa,” which here means the North African territory of “Ifriqiyah,” and Constantine appears to have come from the territory of modern Tunisia in particular. Ifriqiyah had come under Muslim rule in the eighth century, as part of the general expansion of Islam across North Africa. But what can we infer from the name “Constantine”? It was, after all, the name of one of the most famous converts in Christian history, the fourth-century emperor Constantine. Was Constantine, then, an Arabic-speaking Muslim who converted to Christianity? Or did Constantine come from an Arabic-speaking Christian community in North Africa? Scholars have been unsure how to untangle this aspect of Constantine’s background, though we will suggest a solution to this puzzle in a later post.

What matters for today is that our Constantine was a native Arabic speaker. And he was thoroughly immersed in Arabic medicine. In later posts, we’ll talk more about the period of efflorescence in Arabic medicine that Constantine was able to draw upon when he crossed the Mediterranean in the eleventh century, bringing a cache of medical books with him (at least one of which was partially lost). In fact, as we’ll show, Constantine captures, in his own life story, larger trends unfolding at the time that would bring the economies and cultures of the Islamic, Christian, and Jewish societies in the Mediterranean more tightly into contact.


In this passage from Book I of the De melancholia (On Melancholy), a translation of Ishaq ibn ‘Imran’s treatise on the same topic, Constantine follows his source in identifying “the sudden loss of his learned books” as the reason someone might fall into the despair of melancholy. Source: London, British Library, MS Burney 216, f. 95ra (detail).

So, why launch this blog now? First of all, today, the 22nd of December, is Constantine’s obit day—the day his death was celebrated at the Abbey. One of the few pieces of concrete biographical information we have for him was the entry of his name into Leo Marsicanus’s calendar at Monte Cassino, listing his death date as December 22. In what year that happened, we’re not sure. It would have been before 1098 or 1099, the date of the calendar, though beyond that we can’t be more precise. He was said to have “died full of days,” and from his surviving works we can see what extraordinary success he had in laying the foundations for a full curriculum of medical learning.


The Cassinese Calendar, written at Monte Cassino in 1098-1099, under the direction of Leo Marsicanus, who first started the monastery’s chronicle. The second line of this entry for the 22nd of December (the 11th kalends of January) indicates the date of death for Constantinus monachus medicus. Source: Vatican, Biblioteca Apostolica Vaticana, MS Borg. lat. 211, f. 13r (detail).

A bigger question is why, if Constantine has been invisible for so long, is he suddenly coming into view? There are a lot of reasons for this, some having to do with the recent growth of history of medicine as a major subdiscipline in medieval studies, some having to do with the amazing new possibilities for manuscript research that allow us access to so many copies of Constantine’s still-unedited works. One reason we are particularly delighted to share our new understanding about Constantine in this blog is because in his life story and in his widespread effects on European culture, he gives us the opportunity to see a “global Middle Ages.” Constantine’s own travels may have been confined to the Mediterranean. But the medical system he brought into Latin drew upon medical theory first articulated in antiquity but expanded and refined in the Islamic world. And it drew on the pharmaceutical lore of medical practitioners across central Eurasia, North Africa, and beyond.

This blog is co-authored by Monica Green and Brian Long. We are both historians of medicine and are both editing and studying Constantine’s many writings. We will be joined from time to time by guest bloggers as well. Our aim is to begin to share our findings about Constantine: new manuscripts we’ve discovered; new information about Constantine’s Arabic sources; new leads about the impact of Constantine’s work in transforming the landscape of learned medicine in Europe. Almost every aspect of medicine would indeed change under Constantine’s influence. The life and works of this singular African monk therefore afford us the opportunity to peer into the heart of one of the most transformative periods of history.

Further Reading:

There isn’t a lot published on Constantine the African yet, and as we’ve noted, most of his works have not yet been edited, let alone translated into modern languages. Here are a few publications that can give you a hint of how interesting his life and times were.