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Constantine Africanus






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. He 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 he 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 Cassino, 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 Desiderius 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 especially 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;--all 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.[10] 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. He 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. 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 be 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 few years after Constantine's entrance into the
monastery at Monte Cassino Desiderius was elected Pope. The humble
Benedictine did not want to take the exalted position, but it was
plainly shown to him that it was his duty, and that he 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 Rome, 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 he 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 duties, 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 be 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, but
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 he 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, but 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 because of
their value in the history of philology, but because they are the main
sources of all the later books on drugs which appeared in very large
numbers in German. They have a very great historico-literary 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 book 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. He thought that rain water was the best for this
purpose, and he describes its best application as in rainy fashion,
modo pluviali. 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 be said that very probably
Constantine, in his travels, had come to realize that the books 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 Judaeus, Abu Dschafer, and others of even less note.
Certainly we cannot but feel that his judgment in the matter must have
been directed by reasons that we may not be 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, however, 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 he 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 he 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.






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