In the past few months, we’ve discussed some of the paths Constantine the African’s works took throughout the Latin West. In these posts, one recurring theme has been that monastic houses played a vitally important role in disseminating Constantine’s works, reshaping medieval Latin medicine in the process. But the eager reception of these works was not confined to the spread of medical theory, changes in the confection of drugs, or the practice of medicine. Though we do not yet know the full impact of Constantine’s works, they appear to have played a substantial role in reshaping conceptions of the body and illness. Constantine exerted considerable influence on medieval society and culture, touching everything from the teaching of medicine in universities to literary conceptions of lovesickness, and so the breadth of Constantine’s impact on the Latin West can scarcely be captured in a single blog post. But if we confine our view to twelfth-century monasteries, two examples—one in France, one in England—will illustrate just how deep these influences went.

In the first half of the twelfth century, the illustrious Benedictine and then Cistercian monk William of St.-Thierry made substantial use of medical texts when he synthesized a work on the nature of the body and the soul. In the first half of this text, which concerned the nature of the body, William drew extensively from Constantine’s works, even naming Constantine’s work on pharmacological degrees, the Liber graduum. (Constantine’s name is not attached to the work here, however, nor William does not cite Constantine by name elsewhere in the text.) Nor was William’s treatise a mere scissors-and-paste job. In quoting from a work on the nature of human beings by Alfanus of Salerno—a southern Italian archbishop who was, in fact, one of Constantine’s patrons—William appears to have carefully “updated” some of the terminology with reference to Constantine’s works. For example, (though somewhat confusingly to us), Alfanus had referred to the esophagus as the stomachus and the stomach as the venter, but William modified Alfanus’ text to bring it into closer line with Constantine’s (and modern) usage.

Given William’s time and place, the fact that he drew from Constantine’s works is not completely surprising—other thinkers in the schools of northern France (where William had studied) also made use of Constantine’s works. The Theorica Pantegni’s discussions of natural philosophical subjects (like the nature of the elements) appear to have been one avenue by which ancient thought reached the vibrant schools of northern France. But it is striking that William of St.-Thierry numbered among these avid readers. After all, William of St.-Thierry is probably best known today as a caustic critic of venomous novelties in theology and philosophy; with Bernard of Clairvaux, he played an influential role in the condemnation of Peter Abelard at the Council of Sens in 1141. That he proved to be such an eager reader of Constantine’s works may be an illustration of the broad readership of Constantine’s works among both innovative natural philosophers and censorious theologians. On the other hand, given how quickly Constantine’s works spread to monastic houses, it may have been the case that it was monastic readers who turned natural philosophers onto Constantine’s texts rather than the other way around.

That monastic readers like William of St.-Thierry continued to read Constantine’s works throughout the twelfth century can hardly be doubted, and Constantinian influence crops up in surprising places. By the second half of the twelfth century, in fact, a collection of miracles for Thomas Becket by William of Canterbury reckoned to be “one of the most spectacular productions in the history of English miracle collecting”¹ gives extensive evidence for the way that Constantine’s texts informed the understanding of illness and miraculous cures.

Though a murky figure in many respects, the Christ Church monk William of Canterbury tells us that he himself was at Canterbury Cathedral when the troublemaker Thomas Becket was killed at the king’s instigation in 1170. The massive collection of miracles that he compiled in the 1170s, comprising over four hundred stories, attests to the rapid popularity and dramatic posthumous power of the martyr.

But it is not merely for its size that William’s miracle collection is remarkable—its many miracles make ostentatious use of contemporary medicine, and Constantine the African’s influence is particularly apparent. Where descriptions of miraculous healings in other texts contented themselves with the names—or even vague locations—of pains and illnesses, William appears to have striven for precision and exhaustive detail. William drew directly from Constantine’s works, using both his terminology and direct—and lengthy!—quotations. For example, in describing a priest who experienced vertigo when travelling (dizziness or perhaps, here, seasickness) William felt compelled to explain the nature of the ailment in some detail, with an explanation taken directly from the first book of the Viaticum, Constantine’s handbook of practical medicine.²

But even a brief examination of William’s miracle collection illustrates that his engagement with contemporary medicine was more complex and multifaceted than these verbatim quotations of Constantine might suggest. For one, his knowledge of medicine appears to have gone beyond Constantine’s works: in categorizing the types of epilepsy, William drew on medical terminology that does not appear in Constantine’s texts.³ And elsewhere, William’s relationship with Constantine give us access to the monk’s perspective on health, healing, and the body.

In recounting the cures of two sufferers of leprosy, for example, William interweaves quotations from the Viaticum, drawing a forceful contrast between earthly medicine and more efficacious, divine remedies. “ ‘I have never,’ said Galen, ‘seen someone thoroughly healed from leprosy unless they drank wine into which a serpent had fallen and decayed.’… But we have seen two,” William states emphatically, “cleansed from head to toe and without a single sign of leprosy (nec signum lepre reservantes) who did not take any medication but water and the blood of the martyr…” William’s Galen quotation here is taken from Viaticum Book VII, as is the typology of leprosy he gives later in the chapter: “He [Thomas Becket] cures every leprosy, not only tyria, leonina, but also elephantia and alopecia—and whatever other sort of leprosy a physician (physicus) can devise. He also cures spiritual leprosy (which is even worse), that is, the variety of vices that pollute the integrity of the soul…”⁴ William’s use of the Viaticum here shows us that not only were Constantine’s texts being read and digested, their assumptions about health and illness must have prompted discussion and debate.⁵

William’s use of and engagement with medicine, particularly as a lens for understanding miracles, presages the medical precision and scrutiny that would often play a role in formal canonization proceedings in later centuries.⁷ Our knowledge of medicine in twelfth-century hagiography and miracle collections remains limited, however, and it is hard to say whether William’s embrace of Constantinian medicine would have made him unusual among his contemporaries in England or Europe. Winston Black has recently shown that English monasteries were keenly engaged with Constantine’s works, while Sally Crumplin and Margaret Coombe have noted strong medical influences on vitae written by the monk Reginald of Durham. And as we saw with William of St.-Thierry, Constantine’s works were eagerly read in twelfth-century monasteries across Europe, and by influential figures. Exceptional as these two Williams appear now in their embrace of Constantine’s works, then, they may merely be the tip of a twelfth-century iceberg.

A special thanks to Rachel Koopmans, whose work and notes on medical influences on William of Canterbury were of foundational importance for this post.

Further Reading:

• Robert Bartlett, Why Can the Dead Do Such Great Things? (Princeton: Princeton University Press, 2015).
• Sally Crumplin, “Modernizing St. Cuthbert: Reginald of Durham’s Miracle Collection,” in Signs, Wonders, Miracles : Representations of Divine Power in the Life of the Church: Papers Read at the 2003 Summer Meeting and the 2004 Winter Meeting of the Ecclesiastical History Society, ed. Kate Cooper and Jeremy Gregory (Rochester: Boydell Press, 2005), 179–91.
• Rachel Koopmans, Wonderful to Relate: Miracle Stories and Miracle Collecting in High Medieval England (Philadelphia: University of Pennsylvania Press, 2011).
• Ana Isabel Martín Ferreira, ed., Tratado médico de Constantino el Africano: Constantini Liber de elephancia ([Valladolid]: Universidad de Valladolid, 1996).

1. Koopmans, Wonderful to Relate, p. 139.

2. Miracula S. Thomæ auctore Willelmo Cantuariensi II.87, ed. Robertson, in Materials for the History of Thomas Becket, vol. 1, pp. 248-249.

3. The terms he did use (including catalempsia and analempsia as well as epilempsia), did occur in Gariopontus’ handbook of medicine, the Passionarius, which we’ve had occasion to mention before.

4. Miracula S. Thomæ auctore Willelmo Cantuariensi IV.20, ed. Robertson, in Materials for the History of Thomas Becket, vol. 1, pp. 332-333. See also the discussion in Koopmans, Wonderful to Relate, pp. 186-7.  Given the divergences between William’s quotations here and Constantine’s text, we may be able to determine which manuscript of the Viaticum William made use of.

5. For further discussion of William’s engagement with medical subjects, see Koopmans, Wonderful to Relate, pp. 181-200.

6. For the martyr’s self-assessment, see Robertson, Materials for the History of Thomas Becket, p. 164, cited in Bartlett, Why Can the Dead Do Such Great Things?, p. 349. For further discussion of mementos from Becket’s shrine, see Bartlett, 441-442.

7. Bartlett, Why Can the Dead Do Such Great Things?, pp. 350-1.

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).