This article explores how Western medicine originated in the Mediterranean island of Kos over two thousand years ago, was lost to Europe with the fall of the Western Roman Empire, but was recovered and developed further by translators (many of whom were doctors) in the course of two spectacular translation movements. The first was centred in Baghdad (at that time a major cultural and trade centre in the Middle East) where almost all non-literary Greek books available in the Byzantine Empire were acquired and translated from Greek to Arabic from the 8th to 10th centuries. The second translation movement was located in Spanish centres such as Toledo, where extensive libraries held many of these Arabic translations, as well as original texts by Arabic physicians. These texts were translated from Arabic into Latin in the 12th and 13th centuries, often by foreign scholars. These translations (together with others from monasteries and the medical school of Salerno in Italy) formed the basis of medical curricula in the earliest universities in Europe. See also ‘Translators in history‘.
Perhaps the earliest records of ancient medicine that we have are from the writings of Homer from about the 8th century BC. He is said to have composed the Iliad while he worked as a deputy chief of medical staff during the Trojan War, and his Iliad contains some detailed medical descriptions (Nutton 2013). However, the ancient medical works that were most influential for the development of Western medicine are attributed to Hippocrates, Dioscorides and Galen.
Hippocrates and his translators
Hippocrates (ca. 460 – ca. 370 BC) was born on the Greek island of Kos. He was the first physician known to have taken a scientific approach to the practice of medicine, and instituted careful and systematic examination of the patient’s condition for the first time. However, none of the sixty treatises associated with his name can be unequivocally attributed to him; they were probably written by several authors from about the 5th century BC to the 2nd century AD.
Some of the earliest known translations of the Hippocratic Corpus are by Sergius of Reshaina (d. 536 AD; see below) who translated twelve of these texts into Syriac, a form of Aramaic (Luttikhuizen 2005, Touwaide 2005). Translations of some Hippocratic texts into Latin were available at about the same time in the Vivarium library established by Cassiodorus (ca. 490-580) in Calabria (Frampton 2008), and some (including the Aphorisms) were translated between the 5th and 7th centuries in Ravenna (Musitelli et al. 1994).
Arabic versions of some of the Hippocratic texts were produced by Hunayn ibn Ishâq and his associates in Baghdad in the mid-9th century (Iskandar 2008b). Some were also translated from Arabic into Latin by Constantine the African (1020-1087) (McVaugh 2008) and later from Greek directly into Latin by translators such as Burgundio of Pisa (d. 1193) and Niccolò da Reggio (b. 1280).
Herophilos and Erasistratus dissected human cadavers around 280 BC and developed a significant body of anatomical knowledge, but only fragments of their writings remain as fragments in the works of Galen and other ancient authors.
Dioscorides and his translators
Dioscorides (c. 40-90 AD) was a Greek pharmacologist and botanist, who wrote that he had lived a “soldier-like life” as he collected information about medicinal plants (Riddle 1980). He wrote De Materia Medica, a comprehensive five-volume pharmacopeia with at least 700 entries on plants and medications. It was in wide use in the mediaeval era and was translated into Latin in about 600 AD, possibly in Ravenna. Later translations into Latin were made in the 9th century in Chartres and in the 10th century in Monte Cassino (Sigerist 1958), where the latter translation appears to have been revised by Constantine the African in the 11th century (Frampton 2008). ‘De Materia Medica’ was translated from Greek into Syriac by Hunayn ibn Ishâq in the 854 AD and from Greek to Arabic by Hunayn’s associate Stephanos. It does not seem to have been a significant part in the medical curricula of the earlies universities until the second half of the 15th century (Grendler 2001).
Galen and his translators
Galen (AD 129 to ca. 216) was born in Pergamon (now Bergama in Turkey) (Nutton 2013). He began to study medicine at the age of sixteen, and learnt anatomy in Smyrna and Alexandria (Nutton 2013), which had the best library and most advanced medical school in the Western world at that time. Although human cadavers were dissected there in the 3rd century BC, the political climate had turned against dissection of cadavers by Galen’s time, and he learnt anatomy by dissecting monkeys and treating wounded gladiators as a physician in the service of the High Priest of Asia (Nutton 1995). Galen was a prolific author with particular interests in anatomy, pharmacy, physiology and philosophy.
Many of Galen’s works were translated by Sergius of Reshaina into Syriac in the 6th century AD; Hunayn Ibn Ishâq translated many of them from Greek into Syriac, and then from Syriac or Greek into Arabic in the mid-9th century (Iskandar 2008b). Gerard of Cremona (1114-1187), working in Toledo, and Niccolò da Reggio (ca. 1280-ca. 1345), a Greek-Latin bilingual physician from Calabria, translated most of Galen’s works from Greek into Latin (McVaugh 2006) and contributed to the re-introduction of Greek medical knowledge into Europe. A ‘complete’ compendium of the Galenic corpus was compiled in Greek and Latin by Karl Gottlob Kühn from 1821 to 1833; it includes 122 treatises with about 3 million words and 20,000 pages in 22 volumes. Most (if not all) of these translations were compiled from those of earlier translators such as Linacre (c. 1460-1524), Winter (1505-1574) and Chartier (1572-1654). Greek texts that had been lost by this stage were not included (Nutton 2015).
Medical translation in the early Middle Ages (5th to 10th century)
Knowledge of Greek (and the practice of medicine) declined significantly in Europe with the fall of the Western Roman Empire, and their lack lasted until the establishment of the first European universities and medical schools. However, the advances made by Hippocrates and Galen were not completely forgotten.
During this period, Greek texts survived in some parts of Europe and the Middle East. In Europe, they were used primarily as practical guides for treatment, with little consideration of the scientific or theoretical basis of medicine. However, they contributed to a flowering of Islamic medicine in the Middle East.
Ravenna, Cassiodorus and the Vivarium
The ancient Greek texts were studied and translated in two places in Italy: Ravenna in the North and Scylletium (Squillace) in the South. There is good evidence that there was a medical school in Ravenna between the 6th and 7th centuries AD (Musitelli et al. 1994). This suggests that there were teachers of medicine in Ravenna “who had, and probably did, translations of Galenic works, and interpreted them” (Sigerist 1934). This also applies to three Hippocratic texts.
Considerably more is known about the Vivarium established by Cassiodorus (c. 485-583), who was born in Squillace (in present-day Calabria) into a family of civil servants. He had a distinguished political career in the Ostrogothic government, based in Ravenna, and ultimately succeeded Boethius as the praetorian prefect of Italy. During this time he established a monastery known as the Vivarium on the family estates near Squillace (O’Donnell 1979). On his retirement, he returned to the monastery with the intention of developing a programme combining Christian education with secular Greek learning for the benefit of his monks. To this end he compiled his ‘Institutiones’, which included readings from Hippocrates, Galen and Dioscorides (Frampton 2008). These were presumably based on Cassiodorus’s extensive library in the Vivarium, and medical translation from Greek to Latin was carried out by Mutianus, Bellator and Epiphanius. After the death of Cassiodorus in 583, the medical part of the Vivarium collection seems to have found its way to the Benedictine monastery in Monte Cassino. It then provided the basis for several other medical collections in various parts of Europe (Frampton 2008, MacKinney 1937). Later, Monte Cassino had close links with the medical school in Salerno, which was founded in the 9th century and was the earliest medical school in Europe after that in Ravenna.
The Muslim period and the Graeco-Arabic translation movement
In the early Middle Ages, there was much greater interest in the Greek medical heritage in the Middle East than in the West. Sergius of Reshaina is an early example. He was a doctor who translated a number of Galen’s works into Syriac in the 6th century (Clagett 1955, Montgomery 2000). Sergius was followed by other notable translators such as Ibn Masawaih (c. 777-857), a doctor from Gundishapur and the father of Hunayn ibn Ishâq (Vadet 2016). Ibn al-Batriq (active 796-806) translated some of the more important Hippocratic and Galenic texts from Greek to Arabic, although his medical translations were very literal (‘verbum ad verbum’) and many were later revised by Hunayn ibn Ishâq. But Middle Eastern contributions to medicine were not limited to medical translation of early Greek authors. Physicians such as Al-Razi and Avicenna not only studied and summarised the Hippocratic and Galenic texts – they also made independent and significant contributions to medical science.
Al-Razi (Abu Bakr Muhammad ibn Zakariyya al-Razi or ‘Rhazes’, 854-925 CE) was born in Rayy, near Tehran (Iskandar 2008a). He was a musician and money-changer until his 30s, but then became the chief physician of the hospital in Baghdad. Like Galen, he was a prolific author. His sources included Islamic authors as well as Hippocrates and Galen, and his major work was a monumental medical encyclopaedia, the Kitab al-Hawi fi al-tibb (Comprehensive Book of Medicine), which was a posthumous compilation of his notebooks and included the first known monograph on smallpox. It was translated into Latin in 1279 by Faraj ben Salim and printed in Europe as the Liber Continens. Al-Razi also wrote a general textbook on medicine, the Al-Mansuri. This was translated into Latin by Gerard of Cremona (see below), and excerpts from the translation became part of the curriculum of Western universities (Iskandar 2008a).
Avicenna (Abū Alī al-Husain ibn Abdullāh ibn Sīnā; 980 – 1037 CE) was born in Bukhara (present-day Uzbekistan), which at that time rivalled Baghdad as the cultural capital of the Islamic world (McGinnis 2010). He was primarily a philosopher, but became a qualified physician at the age of 18. His major medical work was al-Qānūn fī al-Ṭibb (The Canon of Medicine), which was not only a ‘magisterial exposition of Galenic medicine’ (Musallam 2011) but drew on other sources as well, including early Chinese sources on pathology and pulse diagnosis. It was more compact and better organised than Al-Razi’s Comprehensive Book of Medicine, and was used as a medical textbook in many of the mediaeval universities of Europe. One of the earliest translations of the Canon was carried out by Gerard of Cremona, who translated it from Arabic into Latin.
Graeco-Arabic translation movement
“From about the middle of the eighth century to the end of the tenth, almost all non-literary and non-historical secular Greek books that were available throughout the Eastern Byzantine Empire and the Near East were translated into Arabic” (Gutas 1998). This huge enterprise took place primarily in Baghdad and was supported not only by the ‘Abbãsid caliphs but by the upper echelons of Arabic society, although most of the translators were Syriac-speaking Christians. A significant result of this movement was that ancient Greek medical knowledge that had been ignored or lost in the West was revived and rejuvenated in the Middle East and ultimately passed on to Europe and the earliest universities.
Hunayn ibn Ishâq and the Baghdad translators
The city of Baghdad was established in 762 by the second Abbasid caliph, Al Mansur (714-775), who made it the capital of the ‘Abbãsid empire. He founded a palace library in the new capital and supported intellectuals working there, so that Baghdad rapidly became a centre of learning as well as a major trading hub. Particular emphasis was placed on translation by the fifth ‘Abbãsid caliph, Harun al Rashid (c. 763-809), whose library later became the House of Wisdom or Bayt al-Hikma. Support for scholarship and translation was increased still further by Caliph Al-Ma’mun (r. 813-833).
Hunayn ibn Ishâq (809-875; also known as Johannitius) was the most celebrated and prolific of the Baghdad translators and flourished during al-Ma’mun’s reign. He was a Nestorian Christian, a doctor and the author of several books on medical topics. Together with some of his relatives and other collaborators he translated about 90 of Galen’s works from Greek into Syriac and about 40 into Arabic, as well as some of the Hippocratic texts (Iskandar 2008b). In particular, he wrote a synthetic exposition of classical Greek medicine based on Galen’s Ars Medica, known in Europe as the Isagoge Ioannitii ad Tegni Galieni (‘Hunayn’s Introduction to the Art of Galen’), which was eventually incorporated into the Articella as part of the curriculum of the earliest medical schools.
Medical translation in the mediaeval period and the Arabic-Latin translation movement
Constantine the African (1020-1087) was active after the Graeco-Arabic translation movement and was the first important translator in the transfer of Graeco-Arabic science to the West (McVaugh 2008). He was born a Saracen (North African Muslim) in Carthage, and worked and travelled as a merchant. During a visit to Salerno in southern Italy, he discovered that there was no Latin medical literature in Salerno. He returned to North Africa, where he studied and practised medicine for three years before travelling back to Salerno with a collection of Arabic medical texts, which he then translated into Latin – probably at the nearby monastery of Monte Cassino where he had converted to Christianity. He was among the first to translate Hippocratic treatises and other medical texts from Arabic into Latin, and one of the most important scholars in the revival of scientific medicine in the West (McVaugh 2008).
The Arabic-Latin translation movement flourished in the twelfth and thirteenth centuries – mostly during Haskins’ ‘Renaissance of the Twelfth Century’ (Haskins 1927a) – and was analogous in some ways to the Baghdad translation movement. Sometimes referred to inaccurately as the ‘Toledo School of Translators’ (Santoyo 2006), it involved Jewish scholars, monks from the Order of Cluny and scholars from other parts of Europe who translated Arabic texts from libraries such as those in Toledo and Cordoba into Latin and Castilian (d’Alverny 1982, Montgomery 2000). These included texts by Muslim scholars and physicians as well as Arabic translations of original Greek medical texts. By this stage some of these original Greek texts had been lost and were only preserved in their Arabic translations.
Gerard of Cremona (c. 1114–1187) was one of the most prolific translators of this period (Burnett 2014). He worked and probably died in Toledo, and is said to have translated at least 87 books from Arabic, of which 24 were medical texts, mostly by Galen, Al-Razi and Avicenna (Lemay 2008). According to Haskins, “more of Arabic science passed into Western Europe at the hands of Gerard of Cremona than in any other way” (Haskins 1927b). It has been suggested that some of the medical translations attributed to Gerard of Cremona, including Avicenna’s Canon of Medicine and some works of Galen, were actually done by the astrologer Gerard of Sabbioneta, but there is little evidence for this.
Mark of Toledo is documented as having been a canon at the cathedral of Toledo from 1193 to 1216 and is one of the few translators of the Arabic-Latin movement apart from Gerard to have translated medical texts, including Galen’s On Pulses, On the Usefulness of Pulses, and On Obvious and Hidden Movements, of which the Greek text has been lost (Burnett 2005).
Monte Cassino, Salerno and the first European medical schools
As we have seen, some of the earliest medical translations from Greek into Latin took place in the 6th century in Ravenna and at Cassiodorus’ Vivarium at Scylletium. In the same era, St. Benedict retired to Monte Cassino and founded the first of the Benedictine monasteries there in 529. The monks were actively involved in the care of the ill, but they also transcribed and probably translated documents in the scriptorium. These activities were a primary focus of the religious community and contributed to the distribution of medical knowledge throughout Europe. They also contributed to the development of an early medical curriculum (de Divitiis, Cappabianca, and de Divitiis 2004), and presumably to the establishment of the Schola Medica Salernitana in Salerno, now regarded as the first medical school in Europe. Monte Cassino is about 150 km northwest of Salerno, and there were strong links between the monastery and the medical school.
The medical school at Salerno thrived between the 10th and 13th centuries and maintained a Graeco-Latin tradition combined with Arabian and Jewish influences. Alfanus was the archbishop of Salerno from 1058 to 1085; he translated the Hippocratic ‘On Airs, Waters and Places’ and supported Constantine the African, who arrived in Salerno in 1077. Within a few years, Constantine had become a Christian and joined the Benedictine community at Monte Cassino, where he also received support from the Abbot, Desiderius. There is no evidence that Constantine taught in Salerno, but his translations were an important component of the Salernitan curriculum and formed the basis of the Articella. This was a fundamental text in the early European medical schools, in particular at Montpellier, Paris and Bologna (O’Boyle 1998). The influence of the Salerno medical school then declined gradually, and it was eclipsed by the Montpellier medical school by the thirteenth century.
The Articella initially included five texts. These were the Isagoge (‘Introduction’), a shortened version of a text written by Hunayn ibn Ishâq; the Aphorisms and Prognostics of Hippocrates, the Urines of Theophilus and the Pulses of Philaretus. Galen’s Tegni was added by the middle of the 12th century, and Arabic texts such as the Viaticum of Isaac (Ibn al-Jazzar) were added somewhat later. The Articella was then adopted as the basis of the medical curriculum in Paris (O’Boyle 2005).
The settlement of Montpellier in Southern France was first documented in 985 AD. Graduates of the Salerno medical school were said to be teaching there as early as 1000 AD (Kaadan and Angrini 2010) and the Montpellier medical school was formally established in 1181. It is said to be the oldest medical school still in operation. Montpellier had strong trading links with the Levant, involving the import of spices and medicinal herbs; some of the merchants had medical knowledge and had read translations of Hippocratic texts (Devine and Summerfield 1998). The curriculum for medical students at Montpellier included Avicenna’s Canon (Siraisi 1987, Weisser 2011) and the Ars Medicine, which was updated and transformed into the Ars Commentata (or Articella) in the 1250s, when university medical teaching was becoming fully institutionalised (O’Boyle 1998).
The Paris medical school was founded as a guild of masters, and developed from the cathedral school of Notre Dame (Haskins 1923). Some idea of the medical curriculum in Paris at the end of the 12th century can be gained from a list of text books ascribed to Alexander Nequam (1157-1217) (Haskins 1927b, Wallis 2010). Avicenna’s Canon is not mentioned in this list, and seems to have been introduced into the curriculum about halfway through the 13th century (Siraisi 1987). The Parisian curriculum appears to have served as a model for other universities, such as Naples and Salerno in the latter part of the 13th century (O’Boyle 1998).
The Bologna medical school was founded in about 1200 as a guild of students (Bullough 2004, Haskins 1923), although the University itself is older. At first teaching was based on the Articella, but by 1405 the four-year curriculum was based almost entirely on the works of Hippocrates, Galen and Avicenna, listed in detail in a translation by Faith Wallis (Wallis 2010). Dissections of human cadavers were carried out in the presence of students; one of the teachers was Mondino dei Luzzi (c. 1275-1326), the first person known to have dissected human cadavers since Herophilos and Erasistratus at the turn of the 4th and 3rd centuries BC and the author of a popular textbook, ‘Anatomia corporis humani’, which was in wide use until well into the sixteenth century.
Hippocrates, Galen and their colleagues in Greece established the first rational basis for the teaching and practice of medicine. During the Dark Ages their principles were largely forgotten in the West but not in the Middle East, where they were applied and extended by physicians such as Sergius of Ra’s-al-‘Ayn, Al-Razi and Avicenna. Their summaries and translations from Greek into Arabic, together with those of Hunayn and the Baghdad movement in the 9th and 10th centuries, were collected in libraries in Muslim Spain, where they were translated into Latin and Castilian in the 12th and 13th centuries. These texts re-introduced a rational basis for medical practice in Europe and formed the basis of teaching in the earliest medical schools and universities.
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David Tracey PhD, DipTrans CIoL