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.