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.