An Eleventh-Century WebMD: The Viaticum of Constantine the African

Up until this point we’ve been somewhat abstract in talking about Constantine the African’s works, as a set of texts that had dramatic effects on other texts. But for a patient who has unexpectedly come down with an unknown illness, of course, the intellectual tradition behind their care is likely to be of little interest: they want to put a name to their affliction and, ideally, cure it. So from the perspective of this hypothetical patient, what good were Constantine’s translations?

To answer this question, we need to have some sense of the places in which medical care occurred, and to understand the kinds of medical training that were available. Medical care was undertaken in multiple settings in the medieval world: in homes, to be sure, and also in monasteries and other institutions that likely attended to both bodily as well as spiritual health. At the highest levels, medical practitioners could be deeply learned and highly skilled experts, but there must have been an entire world of practitioners that is only rarely visible in our written sources.

Only a handful of images depict or illustrate medical practice in the period before Constantine was active in southern Italy; the tenth-century images found in this manuscript, Florence, Biblioteca Laurenziana, MS Plut. 73.41 (here f. 122v), illustrate how to cauterize patients suffering from various illnesses.

If we assume that a practitioner from Constantine’s own eleventh century was literate, how did they approach the treatment of a disease they were unfamiliar with? The answer is surprising, and illuminates the ways that medical care has both changed and remained the same in the intervening centuries. Before the mid eleventh century, the textual resources for medical practice had some limitations: for theoretical medicine, only a handful of formal medical treatises or commentaries would have been available, and even these circulated in modest numbers.

On the other hand, a large, fluid, and fascinating set of remedies was in circulation, often written scrappily on the blank pages and in the margins of manuscripts. But even though the remedies from this period that have been passed down to us may appear humble, we should not discount the possibility that they contain hard-earned empirical wisdom, gleaned from long experience with disease prevalence and herbal and other remedies available in a particular region.

In the eleventh century this situation began to change. Of course, as we have discussed, Constantine the African translated a considerable number of works from Arabic into Latin; but renewed attention was also given to texts that already existed in Latin. A work called the Passionarius, for example, combined a group of earlier texts into a handbook of medical practice. This text circulated in considerable numbers in Europe (and especially in Italy) in the eleventh and twelfth centuries—it was about as popular as the Theorica Pantegni—and in some cases was even furnished with several sets of annotations that clarified and explicated the text. Though its earliest manuscripts lack clear authorial attribution, the work became associated with the prominent scholar Gariopontus (died perhaps before 1056), who was praised by the prominent reforming monk Peter Damian as “a most upright man, superbly educated in the arts and in medicine.”1

What made the Passionarius so popular? Some of the work’s popularity must result from the organization of its presentation. While the empirical remedies that accrued over time in a manuscript might be haphazardly organized, this text followed the time-honored anatomical “head to toe” (a capite ad calcem) organizational scheme. For example, the Passionarius began by describing and giving causal explanations for several different subtypes of headache. Additionally, it presented multiple remedies for a particular illness; for the first subtype of headache, these included environmental remedies (avoiding both bright light and deep darkness), bloodletting, dietary remedies, and multiple compound remedies.

The text and chapter lists of this manuscript of the Passionarius are written in Beneventan, a striking script that flourished in southern Italy in Gariopontus and Constantine’s eleventh century. Vatican, BAV, Archivio Capitolare San Pietro, MS H 44, f. 23r.

But for all its virtues, the Passionarius must have also been challenging. For one, Gariopontus’ terminology had to have been daunting for Greekless readers, describing illnesses with Greek words and phrases; the subtypes of headache it covers are cephalea, cephaloponia, and monopagia. Additionally, the same ailment was sometimes covered in successive chapters, with varying emphases and remedies. This resulted from the way that it combined multiple texts, but it must have stymied those readers who just wanted a quick, unambiguous explanation of a particular illness and some remedies.

If we turn to Constantine the African, whose career in southern Italy appears to have started in the 1070s, we might wonder: did Constantine know Gariopontus’ influential work? This question is harder to answer than we might think: though the Passionarius was listed in a booklist of the monastery of Monte Cassino shortly after Constantine was there, Constantine never referred to it explicitly, and the terminology that Constantine’s works share with Gariopontus was common to the longer history of Latin medicine.

It is tempting to suppose, however, that Constantine’s own handbook of practical medicine, the Viaticum, was intended as some kind of response to the Passionarius. Just as the Passionarius synthesized earlier works, the Viaticum was intended to serve as a handily sized, single-volume handbook of medical practice. Like the Passionarius, the Viaticum presents illnesses and remedies in “head to toe” order. (Instead of headaches, however, it begins with alopecia and hair loss.) The work’s title, Viaticum—which echoes the meaning of the work’s source text, Ibn al-Jazzar’s Zād al-musāfir wa-qūt al-ḥāḍir (meaning “Provisions for the Traveller and Nourishment for the Sedentary”)—suggests it was meant to serve as a portable medical reference for travelers. But where Ibn al-Jazzar’s Arabic text (and the Passionarius) often gave pages of remedies for each illness, Constantine’s translation often condensed these recipes to their essentials: to remedy hair loss from fasting, Constantine tersely lists temperate baths, a moderate diet, the avoidance of salty things, and anointing with poppy or iris oil. At times, however, Constantine’s zeal for compression appears to have led him to cut into the bone, and his text leaves out some of the steps—and sometimes even the quantities!—of the remedies in Ibn al-Jazzar’s text. Was it the case that Constantine felt that Ibn al-Jazzar’s text was a little too long to travel with comfortably? Given Constantine’s book-laden trip across the Mediterranean, he would have been a position to know.

In contrast to the Passionarius’ heavy use of Greek terminology, Constantine’s Viaticum may have been translated with the needs of non-specialist readers in mind. He gave the work a Latin title, and he used more Latin and less Greek terminology than Gariopontus and many of his other predecessors. Constantine spoke simply of “hair loss” (capilli cadentes) and trimmed down the Greek terms for headache’s subtypes. Where the Passionarius sometimes spread its discussion of a single illness over multiple chapters, the Viaticum’s coverage was more tightly focused, with chapters that were more clearly focused on a particular ailment.

The composition of the Viaticum appears to have encountered some “quality control” difficulties of its own. Beyond its occasionally odd Latin and a few nonsensical readings, the earliest copyists of the Viaticum appear to have made one major mistake in producing the earliest copies of the text. Its preface makes clear that Constantine had placed a comprehensive, “omnibus” list of all of the chapters of the entire work at the beginning of Book I (likely drawn from a similar chapter list in his Arabic source), but this preface also states that he intended for the seven books of the Viaticum to have their own lists (an organizational scheme that is found in the Passionarius and the earliest manuscripts of the Theorica Pantegni). In our earliest manuscript of the text, however, these subordinate chapter lists were not inserted; when they do begin to be inserted into later manuscripts, they can be cramped and awkward, given far less space than they really required. It is only in the course of the twelfth century that manuscript designers learned to give the Viaticum’s layout the space it required. We can also see evidence of this “retrofitting” of text and layout in the discrepancies between the tables of contents and the rubrics accompanying each chapter, something Mary Wack noticed some years ago when studying the Viaticum’s terminology for lovesickness.

In planning the layout of the Viaticum, Constantine wanted to emulate works like the Passionarius and the Pantegni, as well as the manuscripts of his Arabic source. Like this fragmentary copy of Ibn al-Jazzar’s text, Wellcome MS Arabic A406, the Viaticum gave a list of all of the chapters of the entire work at the beginning.

Even though the Viaticum may not have lived up to its creator’s intentions, this hardly hindered its popularity, and at least 35 full and partial copies of the Viaticum survive from the century and a half after the work’s translation. If it did not prove quite as popular as the Passionarius in this period, it eventually became a massive success: it survives in well over a hundred copies, and was read—and, to all appearances, used—in many of the settings of medieval medicine. It appears to have been used heavily by monks, for example, and received commentaries at universities.

Nor, as we will see next time, was this one of Mark Twain’s little-read classics: as it grew in popularity, the Viaticum would reshape the ways that people thought about the body and its illnesses. More broadly—and although these practices hardly began with Gariopontus and Constantine—their works are echoed in modern attempts to understand and heal the body: like the imagined traveler who read Constantine’s Viaticum, we continue to use the parts of the body as an organizational rubric when we try to self-diagnose on WebMD; just as Gariopontus and Constantine’s readers must have known, words and names can still be sources of comfort to suffering readers.

Further Reading:

  • Demaitre, Luke E, Medieval Medicine: The Art of Healing from Head to Toe (Santa Barbara: Praeger, 2013).
  • Glaze, Florence Eliza, “Galen Refashioned: Gariopontus of Salerno’s Passionarius in the Later Middle Ages and Renaissance.” Ch. 3 in Textual Healing: Essays in Medieval and Early Modern Medicine, ed. Elizabeth Lane Furdell (Leiden: E.J. Brill, 2005): 53-77.
  • Glaze, Florence Eliza, “Gariopontus and the Salernitans: Textual Traditions in the Eleventh and Twelfth Centuries,” in La ‘Collectio Salernitana’ di Salvatore De Renzi, ed. Danielle Jacquart and Agostino Paravicini Bagliani (Firenze: SISMEL/Edizioni del Galluzzo, 2008), pp. 149-90.
  • Glaze, Florence Eliza, “Prolegomena: Scholastic Openings to Gariopontus of Salerno’s Passionarius,” 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 Galluzzo, 2011), pp. 57-86.
  • Glaze, Florence Eliza, “Speaking in Tongues: Medical Wisdom and Glossing Practices in and around Salerno, c. 1040-1200,” in Herbs and Healers from the Ancient Mediterranean through the Medieval West, ed. Anne Van Arsdall and Timothy Graham (Aldershot: Ashgate, 2012), pp. 63-106.
  • Horden, Peregrine, Hospitals and Healing from Antiquity to the Later Middle Ages (Aldershot: Ashgate, 2008).
  • Wack, Mary, Lovesickness in the Middle Ages: The ‘Viaticum’ and Its Commentaries (Philadelphia: University of Pennsylvania Press, 1990).
  • Wack, Mary, “‘Alī ibn al-‘Abbās al-Maǧūsī and Constantine on Love, and the Evolution of the Practica Pantegni,” in Constantine the African and ‘Ali ibn al-’Abbas al-Maǧusi: The ‘Pantegni’ and Related Texts, ed. Charles Burnett and Danielle Jacquart (Leiden: E. J. Brill, 1994), pp. 161-202.

[1]Translated by Peter Blum, in the Letters of Saint Peter Damian(Washington, DC: Catholic University Press, 1989),p. 108.

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.