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Constantine Africanus

( Originally Published 1911 )

Probably the most important representative of the medical school at Salerno, certainly the most significant member of its faculty, if we consider the wide influence for centuries after his time that his writings had, was Constantine Africanus. It is interesting, too, for many other reasons, for he is the first representative, in modern times, that is, who, after the incentive of antiquity had passed, devoted himself to creating a medical literature by translations, by editions, and by the collation of his own and others' observations on medical subjects. He is the connecting link between Arabian medicine and Western medical studies. The fact that lie was first a traveller over most of the educational world of his time, then a professor at the University, of Salerno who attracted many students, and finally a Benedictine monk in the great abbey at Monte Casino, shows how his life ran the gamut of the various phases of interest in the intellectual world of his time. It was his retirement to the famous monastery that gave him the opportunity, the leisure, the reference library for consultation that a writer feels he must have near him, and probably also the means necessary for the publication of his works. Not only did the monks of Monte Cassino itself devote themselves to the copying of his many books, but other Benedictine monasteries in various parts of the world made it a point to give wide diffusion to his writings.

As a study in successful publication, that is, in the securing of wide attention to writings within a short time, the career of Constantine and the story of his books would be extremely interesting. Medieval distribution of books is usually thought to have been rather halting, but here was an exception. It was largely because Benedictines all over the world were deeply interested in what this brother Benedictine was writing that wide distribution was secured for his work within a very short time. His superiors among the Benedictines had a profound interest in what he was doing. The great Benedictine Abbot I)esiderius of Monte Cassino, who afterwards became Pope, used all of his extensive influence in both positions to secure an audience for the books—hence the many manuscript copies of his writings that we have. It is probable that Constantine established a school of writers at Monte Cassino, for he could scarcely have accomplished so much by himself as has been attributed to him. Besides, his works attracted so much attention that writers of immediately succeeding generations who wanted to secure attention for their works sometimes attributed them to him in order to take advantage of his popularity. It is rather difficult, then, to determine with absolute assurance which are Constantine's genuine works. Some of those attributed to him are undoubtedly spurious. What we know with certainty, however, is that his authentic works meant much for his own and after generations.

Constantine was born in the early part of the eleventh century, and died near its close, having lived probably well beyond eighty years of age, his years running nearly parallel with his century. His surname, Africanus, is derived from his having been born in Africa, his birthplace being Carthage. Early in life he seems to have taken up with ardor the study of medicine in his native town, devoting himself, however, at the same time to whatever of physical science was available. Like many another young man since his time, not satisfied with the knowledge he could secure at home, he made distant journeys, gathering medical and scientific information of all kinds wherever he went. According to a tradition that seems to be well grounded, some of these journeys took him even into the far East. During his travels he became familiar with a number of Oriental languages, and espeeially studied the Arabian literature of science very diligently.

At this time the Arabs, having the advantage of more intimate contact with the Greek medical traditions in Asia Minor, were farther advanced in their knowledge of the medical sciences than the scholars in the West. They had better facilities for obtaining the books that were the classics of medicine, and, with any desire for knowledge, could scarcely fail to secure it.

What was best. in Arabian medicine was brought to Salerno by Constantine and, above all, his translation of many well-known Arabian medical authors proved eminently suggestive to seriously investigating physicians all over the world in his time. Before he was to be allowed to settle down to his literary work, however, Constantine was to have a very varied experience. Some of this doubtless was to be valuable in enabling him to set the old Arabian teachers of medicine properly before his generation. After his Oriental travels he returned to his native Carthage in order to practise medicine. It was not long, however, before his superior medical knowledge, or, at least, the many novelties of medical practice that he had derived from his contact with the East, drew upon him the professional jealousy of his colleagues. It is very probable that the reputation of his extensive travels and wide knowledge soon attracted a large clientele. This was followed quite naturally by the envy at least of his professional brethren. Feeling became so bitter, that even the possibility of serious personal consequences for him because of false accusations was not out of the question. Whenever novelties are introduced into medical science or medical practice, their authors are likely to meet with this opposition on the part of colleagues, and history is full of examples of it. Galvani was laughed at and called the frogs' dancing-master; Auenbrugger was made fun of for drumming on people; Harvey is said to have lost half of his consulting practice because they were advancing ideas that their contemporaries were not ready to accept. We are rather likely to think that this intolerant attitude of mind belongs to the older times, but it is rather easy to trace it in our own.

In Constantine's day men had ready to hand a very serious weapon that might be used against innovators. By craftily circulated rumors the populace was brought to accuse him of magical practices, that is, of producing his cures by association with the devil. We are rather prone to think little of a generation that could take such nonsense seriously, but it would not be hard to find analogous false notions prevalent at the present time, which sometimes make life difficult, if not dangerous, for well-meaning individuals: Life seems to have been made very uncomfortable for Constantine in Carthage. Just the extent to which persecution went, however, we do not know. About this time Constantine's work attracted the attention of Duke Robert of Salerno. Tie invited him to become his physician. After he had filled the position for a time a personal friendship developed, and, as has often happened to the physicians of kings, he became a royal counsellor and private secretary. When the post of professor of medicine at Salerno fell vacant, it is not surprising, then, that Constantine should have been made professor, and from here his teaching soon attracted the attention of all the men of his time.

Constantine seems to have greatly enhanced the reputation of the medical school, and added to the medical prestige of Salerno. After teaching for some ten years there, however, he gave up his professorship—the highest position in the medical world of the time—apparently with certain plans in mind.

The first dentist who filled teeth with amalgam in New York, some eighty years ago, had to flee for his life, because of a hue and cry set up that he was poisoning his patients with mercury.

He wanted leisure for writing the many things in medicine that he had learned in his travels in the East, so as to pass his precious treasure of knowledge on to succeeding generations; and then, too, he seems to have longed for that peace that would enable him not only to do his writing undisturbed, but to live his life quietly far away from the strife of men and the strenuous existence of a court and of a great school.

There was probably another and more intimate personal reason for his retirement. Abbot Desiderius of the Benedictine Abbey of Monte Cassino, not far away, had become a close and valued friend. Before having been made abbot, Desiderius and Constantine probably were fellow professors at Salerno, for we know that Desiderius himself and many of his fellow Benedictines taught in the undergraduate department there. Desiderius enjoyed the reputation of being one of the most learned men of the time when his election to the abbacy at Monte Cassino took him away from Salerno. His departure was a blow to Constantine, who had learned by years of friendship that to lie near his intimate friend, the pious scholarly Benedictine, was a solace in life and a never failing incentive to his own intellectual work. Desiderius seems, indeed, to have been a large factor in influencing the great physician to write his books rather than devote himself to oral teaching, since the circulation of his writing would confer so much more of benefit on a greater number of people. Perhaps another element in the situation was that Desiderius was desirous of having the learned physician, the travelled scholar, at Monte Cassino, for the sake of his influence on the scholarship of the abbey, and for the incentive that he would be to the younger monks to apply themselves to the varied field of knowledge which the Benedictines had chosen for themselves at this time.

Whatever hopes of mutual solace and helpfulness and of the joys of intimate close friendship may have been in the minds of these two most learned men of their time, they were destined to be grievously disappointed. Only a fcw years after Constantine's, entrance into the monastery at Monte Cassino Desi- derius was elected Pope. The humble Benedictine did not want to take the exalted position, hut it was plainly shown to him that it was his duty, and that be must not shirk it. Accordingly, under the name of Pope Victor III, he became one of the great Popes of the eleventh century. One might think that he could have summoned Constantine to Hone, but perhaps he knew that his friend would prefer the quietude of the cloister, and then, too, probably he wanted to allow him the opportunity to accomplish that writing for which Constantine and himself had planned when the great physician entered the monastery.

All that we know for sure is that some twenty years of Constantine's life were spent as a monk in Monte Cassino, where lhe devoted his time mainly to the writing of his books. One bond of union there was. Each of the works, as soon as completed, was sent. off to the Pope as long as he lived. On the other hand, though busy with his Papal chilies, Pope Victor constantly stimulated Constantine, even from distant Rome, to go on with his work. There were messages of brotherly interest and solicitude just as in the old days. The great African physician's best known work, the so-called " Liber Pantegni," which is really a translation of the " Khitaab el Maleki " of Ali Ben el-Abbas, is dedicated to Desiderius. Constantine wrote a number of other books, most of them original, but it is difficult now to decide just which of those that pass under his name are genuine. Many were subsequently attributed to him that are surely not. his.

These translators of the Middle Ages proved to he not only the channels through which information came to their generations, but they were also incentives to study and investigation. It is when men can get a certain amount of information rather easily that they are tempted to seek further in order to solve the problems that present themselves. There are three great translators whose work meant much for the Middle Ages at this time. They were, besides Constantine in the eleventh century, Gerard of Cremona, in the twelfth, and the .Jewish Faradj Ben Salim, at Naples, in the thirteenth. Gerard did in Spain for the greater Arabian writers what Constantine had accomplished for those of lesser import. Under the patronage of the Emperor Frederick Barbarossa, he published translations of Rhazes, Isaac Judaeus, Serapion, Abulcasis, and Avicenna. His work was done in Toledo, the city in which, during the twelfth and thirteenth centuries, so many translators were at work making books for the Western world.

Constantine did much more than merely bring out his translations of Arabian works. He gave a zest to the study of the old masters, issued editions of certain, at least, of the works of Hippocrates (" Aphorisms ") and Galen (" Microtechnics "), and, in general, called attention to the precious treasure of medical lore that must be used to advantage if men were to teach the rising generation out of the accumulated knowledge of the past. Pagel, in Puschmann's " Handbook," does not hesitate to say that " a farther merit of Constantine must be recognized, inasmuch as that not long after his career the second epoch of the school of Salerno begins, marked not. only by a wealth of writers and writings on medicine, but, above all, because from this time on the study of Greek medicine received renewed encouragement through the Latin versions of the Arabian literature. We may think as we will of the worth of these works, hut this much is sure, that in many ways they brought about a broadening and an improvement of Greek knowledge, especially from the pharmacopeia standpoint."

Probably the best evidence that we have for Constantine's influence on his generation is to be found in what was accomplished by men who acknowledged with pride that he was their master, and who thought it a mark of distinction to be reckoned as his disciples.

Among these especially noteworthy is Johannes Afflacius, or Saracenus (whose surname of the Saracen probably means that he, too, came from Africa, as his master did). He was the author of two treatises on " Fevers and Urines," and the so-called " Cures of Afflacius." Some of these cures be directly attributed to Constantine. Then there is a Bartholomew who wrote a " Practica," or " Manual of the Practice of _Medicine," with the sub-title, " Introductions to and Experiments in the Medical Practice of Hippocrates, Constantine, and the Greek Physicians." Bartholomew represents himself as a disciple of Constantine. This " Practica " of Bartholomew was one of the most commonly used books of the twelfth and thirteenth centuries throughout Europe. There are manuscript commentaries and translations, and abstracts from it not only in the Latin tongues, hut especially in the Teutonic languages. Pagel refers to manuscripts in High and Low Dutch, and even in Danish. The Middle High Dutch manuscripts of this " Practica " of Bartholomew come mainly from the thirteenth century, and have not only a special interest be of their value in the history of philology, but because they are the main sources of all the later hooks on drugs which appeared in very large numbers in German. They have a very great bistoricoliterary interest, especially for pharmacology.

To Afflacius we owe a description of a method of reducing fever that is not only ingenious, but, in the light of our recently introduced bathing methods for fever, is a little startling. In his hook on " Fevers and Urines," Afflacius suggests that when the patient's fever makes him very restless, and especially if it is warm weather, a sort of shower bath should be given to him. lie thought that rain water was the best for this purpose, and he describes its best application as in rainy fashion, mod() plurioli. The water should be allowed to flow down over the patient from a vessel with a number of minute perforations in the bottom. A number of the practical hints for treatment given by Afflacius have been attributed to Constantine.

Constantine's reputation has, in the opinion of some writers, been hurt. by two features of his published works, as they have come to us, that we find it difficult to understand. One of these is that his translations from the Arabic were made mainly not of the books of the great leaders of Arabian medicine, but from certain of the less important writers. The other is that it does not seem always to have been made clear in the manuscripts that have come down to us, whether these writings were translations or original writings. Some have even gone so far as to suggest that Constantine himself would have been quite willing to receive the credit for these writings.

As to the first of these objections, it may he said that very probably Constantine, in his travels, had come to realize that the hooks of the great Arabian physicians, Rhazes, Abulcasis Avicenna, and others, already received so much attention that the best outlook for medicine was to call particular notice. to the writings of such lesser lights as Ali Abbas, Isaac Judus, Abu Dschafer, and others of even less note. Certainly we eannot but feel that his judgment in the matter must have been directed by reasons that we may not he able to understand at present, but that must have existed, for all that we know of the man proves his character as a practical, far-sighted scholar. Besides, it seems not unlikely that but for his interest in them we would not at the present time possess the translations of these minor Arabian writers, and that would be an unfortunate gap in medical history.

The other misunderstanding with regard to Constantine refers to the fact that it is now almost impossible to decide which are his own and which are the writings of others. It. has been said that he even tried to palm off some of the writings of others as his own. This seems extremely unlikely, how ever, knowing all that we do about his life; and the suspicion is founded entirely on manuscripts as we have them at the present time, about a thousand years after he lived. What mutilations these manuscripts underwent in the course of various copyings is hard now to estimate. Monastic copyists might very well have left out Arabian names, because they were mainly interested in the fact that they were providing for their readers works that had received the approval of Constantine, and the translation of which at least had been made under his direction. It is quite clear that he did not do all the translating himself, and that he probably must have organized a school of medical translators at Monte Cassino. Then just how the various works would be looked at is very dubious. Undoubtedly many of the translations were done after his death, or certainly finished after his time, and at last attributed to him, because be was the moving spirit and had probably selected the books that should be translated, and made suggestions with regard to them. For all of his monks lie was, as masters have ever been for disciples, much more important, and rightly so, than those writers to whom he referred them.

The whole question of plagiarism in these medieval times, as I have pointed out elsewhere, is entirely different from that of the present time. Now a writer may consciously or unconsciously claim another writing as his own. We have come to a time when men think much of their individual reputations. It was no uncommon thing, however, in the Middle Ages, and even later in the Renaissance, for a writer to attribute what he had written to some distinguished literary man of the preceding time, and sign that writer's name to his own work. The idea of the later author was to secure an audience for his thoughts. He seemed to be quite indifferent whether people ever knew just who the writer was, but he wanted to influence humanity by his writings. He thought much more of this than of any possible reputation that might come to him. Of course, there was no question of money. There never has been any question of money-making whenever the things written have been really worth while. Literature that has deeply influenced mankind has never paid. Publications that have paid are insignificant works that have touched superficially a whole lot of people. To think of Constantine as a plagiarist in our modern sense of the word, as trying to take the credit for someone else's writings, is to misunderstand entirely the times in which he lived, and to ignore the real problem of plagiarism at that time.

With the accumulation of information with regard to the history of medicine in his time, Constantine's reputation has been constantly enhanced. It is not so long since he was considered scarcely more than a monkish chronicler, who happened to have taken medicine rather than history for his field of work. Gradually we have come to appreciate all that he did for the medicine of his time. Undoubtedly his extensive travels, his wide knowledge, and. then his years of effort to make Oriental medicine available for the Western civilization that was springing up again among the peoples who had come to replace the Romans, set him among the great intellectual forces of the Middle Ages. Salerno owed much to him, and it must not be forgotten that Salerno was the first university of modern times, and, above all, the first medical school that raised the dignity of the medical profession, established standards of medical education, educated the public mind and the rulers of the time to the realization of the necessity for the regulation of the practice of medicine, and in many ways anticipated our modern professional life. That the better part of his life work should have been done as a Benedictine only serves to emphasize the place that. the religious had in the preservation and the development of culture and of education during the Middle Ages.

med school

Medicine in Early Middle Ages: School of Salerno

In medical as in civil history there is no real break. A continuous thread of learning and practice must have connected the last period of Roman medicine already mentioned with the dawn of science in the Middle Ages. But the intellectual thread is naturally traced with greater difficulty than that which is the theme of civil history; and in periods such as that from the 5th to the 10th century in Europe it is almost lost. The chief homes of medical as of other learning in these disturbed times were the monasteries. Though the science was certainly not advanced by their labours, it was saved from total oblivion, and many ancient medical works were preserved either in Latin or vernacular versions. The "Anglo-Saxon Leechdoms" of the 11th century, published in the Master of the Rolls series of mediaeval chronicles and memorials, admirably illustrate the mixture of magic and superstition with the relics of ancient science which constituted monastic medicine. Similar works, in Latin or other languages, exists in manuscripts in all the great European libraries. It was among the Benedictines that the monastic study of medicine first received a new direction, and aimed at a higher standard. The study of Hippocrates, Galen, and other classics was recommended by Cassiodorus (6th century), and in the original mother-abbey of Monte Cassino medicine was studied; but there was not there what could be called a medical school; nor has this foundation any connexion (as has been supposed) with the famous school of Salerno.

The origin of this, the most important source of medical knowledge in Europe in the early Middle Ages, is involved in obscurity. It is known that Salerno, a Roman colony, is a situation noted in ancient times for its salubrity, was in the 6th century at least the seat of a bishopric, and at the end of the 7th century of a Benedictine monastery, and that some of the prelates and higher clergy were distinguished for learning, and even for medical acquirements. But it has by recent researchers been clearly established that the celebrated Schola Salernitana was a purely secular institution. All that can with certainty be said is that a school or collection of schools gradually grew up in which especially medicine, but also, in a subordinate degree, law and philosophy were taught. In the 9th century Salernitan physicians were already spoken of, and the city was known as Civitas Hippocratica. A little later we find great and royal personages resorting to Salerno for the restoration of their health, among whom was William of Normandy, afterwards the Conqueror. The number of students of medicine must at one time have been considerable, and in a corresponding degree the number of teachers. Among the latter many were married, and their wives and daughters appear also in the lists of professors. The most noted female professor was the celebrated Trotula in the 11th century. The Jewish element appears to have been important among the students, and possibly among the professors. The reputation of the school was great till the 12th or 13th century, when the introduction of the Arab medicine was gradually fatal to it. The foundation of the university of Naples, and the rise of Montpellier, also contributed to its decline.

The teachings of the Salernita doctors are pretty well known through existing works, some of which have only recently been discovered and published. The best-known is the anonymous rhyming Latin poem on health, Regimen Sanitatis Salerni, professedly written for the use of the "king of England," supposed to mean Robert, son of William the Conqueror; it had an immense reputation in the Middle Ages, and was afterwards many times printed, and translated into most European languages. This was a popular work intended for the laity; but there are others strictly professional. Among the writers it may be sufficient to mention here Gariopontus; Copho, who wrote the Anatome Porci, a well-known mediaeval book; Joannes Platearius, first of a family of physicians bearing the same name, whose Practica, or medical compendium, was afterwards several times printed; and Trotula, believed to be the wife of the last-named. All of these fall into the first period before the advent of Arabian medicine. In the transitional period, when the Arabian school began to influence European medicine, but before the Salernitans were superseded, comes Nicolaus Praepositus, who wrote the Antidotarium, a collection of formulae for compound medicines, which became the standard work on the subject, and the foundation of many later compilations. An equally popular writer was Gilles de Corbeil (Aegidius Corboliensis), at one time a teacher at Salerno, afterwards court physician to Philip Augustus of France, who composed several poems in Latin hexameters on medical subjects. Two of them, on the urine and the pulse respectively, attained the position of medical classics.

None of these Salernitan works rise much above the rank of compilations, being founded on Hippocrates, Galen, and later Greek writers, with an unmistakable mixture of the doctrines of the Methodists. But they often show much practical experience, and exhibit the naturalistic method of the Hippocratic school. The general plan of treatment is dietetic rather than pharmaceutical, though the art of preparing drugs had reached a high degree of complexity at Salerno. Anatomy was as little regarded as it was in the later ancient schools, the empiric and methodic, but demonstrations of the parts of the body were given on swine. Although it cannot be said that the science of medicine was advanced at Salerno, still its decline was arrested at a time when every other branch of learning was rapidly falling into decay and there can be no doubt that the observation of patients in hospitals, and probably clinical instruction, were made use in learning and teaching. The school of Salerno thus forms a bridge between the ancient and the modern medicine, more direct though less conspicuous than that circuitous route, through Byzantium, Baghdad, and Cordova, by which Hippocrates and Galen, in Arabian dress, again entered the European world. Though the glory of Salerno had departed, the school actually existed till it was finally dissolved by an edict of the emperor Napoleon I in the year 1811.