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Early History of
Medical Translation

This article explores how Western medicine originated in Greece 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 physicians) in the course of two spectacular translation movements. These translations formed the basis of medical curricula in the earliest universities in Europe.

Ancient medicine

The earliest records of ancient medicine that we have are the Edwin Smith papyrus from the 17th century BC and the Ebers papyrus from the 16th century BC. The Ebers papyrus is complete and of particular interest to dermatology since it contains significant references to skin diseases and cosmetic issues [1]. These references show that the Egyptians recognized ailments such as dermatitis, pustules, scurf, scabies, sores and ulcers. Egyptian medicine influenced Greek and Mesopotamian medicine, and much of the Hippocratic corpus is thought to be of Egyptian origin. The ancient medical works that were most influential for the development of Western medicine are attributed to Hippocrates, Celsus, Dioscorides and Galen.
Hippocrates (ca. 460 - ca. 370 BC) was born on the Greek island of Kos. He supported the concept of the four humors and believed that an imbalance of these resulted in disease. He classified skin disorders as ‘idiopathic’ (localized to the skin) or as exanthema; this was due to imbalanced humors breaking out through the skin. Exanthema was classified further as phymata (boils and tumors), lopoi (dry and scaly conditions such as psoriasis and pityriasis) and helchodia (moist conditions such as vesicles and pustules) [2].
Celsus (c. 25 BC - c. 50 AD) was a Roman gentleman and the author of De Re Medicina, the only surviving part of a large encyclopedia. It has been suggested that he was a wealthy man of letters who accumulated medical information to help care for his slaves and other retainers. He took a practical approach to treatment and described ulcers, clavus, warts, vitiligo and alopecia as well as many other skin diseases [3].
Dioscorides (c. 40 - 90 AD) was a Greek pharmacologist and botanist, who wrote De Materia Medica, a comprehensive five-volume pharmacopeia with at least 700 entries on plants and medications. Most of these plants were used to treat skin diseases [4].
Galen (AD 129 to ca. 216) was born in Pergamon (now Bergama in Turkey). He began to study medicine at the age of sixteen and learnt anatomy in Smyrna and Alexandria. Although he was a distinguished physician and a prolific author, his approach to cutaneous lesions was theoretical rather than practical, probably because he interpreted them as expressions of an imbalance of the four humors [5].

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. However, the advances made by the Graeco-Roman pioneers were not completely forgotten. Some of the Hippocratic and Galenic texts were translated into Latin in Italy: at a medical school in Ravenna between the 6th and 7th centuries AD [6], in Cassiodorus’s Vivarium in Calabria [7] and at Monte Cassino, where St. Benedict founded the first of the Benedictine monasteries in 529. In the ‘Dark Ages’ the texts were used primarily as practical guides for treatment, with little consideration of the scientific or theoretical basis of medicine. However, their translation in the Middle East contributed to a flowering of Islamic medicine in the Middle East and ultimately their preservation in the Western world.

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. A number of Arabic physicians translated ancient Greek medical texts into Syriac and Arabic in the early Middle Ages. But Middle Eastern contributions to medicine were not limited to translations of early Greek authors. Physicians such as Al-Razi and Avicenna not only studied and summarized Hippocratic and Galenic texts – they also made independent and significant contributions to medical science. By the mid-eighth century, these efforts were encouraged and supported by the Abbasid caliphate and the upper echelons of Arabic society in Baghdad, which at that time was a major cultural and trade center in the Middle East. The most celebrated and prolific of the Baghdad translators was Hunayn ibn Ishâq (809-875), who was 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 [8]. Many of these Arabic texts found their way into impressive libraries in Moorish Spain [9].

"they also made independent and significant contributions to medical science."

The medieval period and the Arabic-Latin translation movement
Constantine the African (1020-1087) was the first important translator in the transfer of Graeco-Arabic science to the West [10]. He was born a Saracen (North African Muslim) in Carthage, and translated many of the Arabic medical texts into Latin – probably at the Benedictine monastery of Monte Cassino, where he converted to Christianity. He was one of the most important scholars in the revival of scientific medicine in the West [10]. Constantine’s work was followed by the Arabic-Latin translation movement in Spain, which flourished in the twelfth and thirteenth centuries. It involved monks and scholars from many parts of Europe who translated Arabic texts from magnificent libraries (such as those in Toledo and Cordoba) into Latin and Castilian [11]. These included 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.

Monte Cassino, Salerno and the first European medical schools
As we have seen, some early medical translations from Greek into Latin took place in the 6th century in Ravenna, at Cassiodorus’ Vivarium at Scylletium, and in the Benedictine monastery at Monte Cassino. The monks were actively involved in the care of the ill, but they also transcribed and probably translated these documents in the scriptorium. These activities contributed to the development of an early medical curriculum [12], and probably to the establishment of the Schola Medica Salernitana in Salerno, not far from Monte Cassino. The medical school at Salerno thrived between the 10th and 13th centuries and maintained a Graeco-Latin tradition combined with Arabian and Jewish influences. 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 [13]. The influence of the Salerno medical school then declined gradually, and it was eclipsed by the Montpellier medical school by the thirteenth century.

"This was a fundamental text in the early European medical schools"

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 some Arabic texts were added later. The Articella was then adopted as the basis of the medical curriculum in Paris, Naples and Salerno [14], and (in expanded form) in Montpellier and universities in Austria and Germany.
Salerno
Ravenna
Ravenna

Summary

Hippocrates, Galen and their colleagues 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 Al-Razi and Avicenna. Translations from Greek into Arabic that were carried out during the Baghdad movement in the 9th and 10th centuries were collected in libraries in Moorish Spain, where they were translated into Latin and Castilian in the 12th and 13th centuries. These texts re-established a rational basis for medical practice in Europe, and formed the basis of teaching in the earliest medical schools and universities.
References
1. Pusey, W.A., The history of dermatology. 1933, Springfield, Ill.: Thomas. xiii, 223 p.
2. Liddell, K., Choosing a dermatological hero for the millennium. Hippocrates of Cos (460-377 BC). Clin Exp Dermatol., 2000. 25(1): p. 86-88.
3. Rosenthal, T., Aulus Cornelius Celsus - His Contributions to Dermatology. Arch Dermatol., 1961. 84: p. 129-134.
4. Staub, P.O., L. Casu, and M. Leonti, Back to the roots: A quantitative survey of herbal drugs in Dioscorides' De Materia Medica (ex Matthioli, 1568). Phytomedicine, 2016. 23(10): p. 1043-52.
5. O’Malley, C.D., Dermatological origins. Arch Dermatol., 1961. 83: p. 204-213. 6. Musitelli, S., et al., The Medical School at Ravenna. Am J Nephrol, 1994. 14(4-6): p. 317-9.
7. O'Donnell, J.J., Cassiodorus. 1979, Berkeley: University of California Press. xvi, 303 p.
8. Iskandar, A.Z., Hunayn Ibn Ishaq, in Encyclopaedia of the History of Science, Technology, and Medicine in Non-Western Cultures, H. Selin, Editor. 2008, Springer Netherlands.
9. Prince, C., The historical context of Arabic translation, learning and the libraries of medieval Andalusia. Library History, 2002. 18(2): p. 73-87.
10. McVaugh, M.R. Constantine the African. Complete Dictionary of Scientific Biography 2008 30 Nov. 2015]; Available from: http://www.encyclopedia.com/doc/1G2-2830900976.html.
11. d'Alverny, M.-T., Translations and Translators, in Renaissance and Renewal in the Twelfth Century, R.L. Benson, G. Constable, and C.D. Lanham, Editors. 1982, Harvard University Press: Cambridge, MA. p. 421-462.
12. de Divitiis, E., P. Cappabianca, and O. de Divitiis, The "schola medica salernitana": the forerunner of the modern university medical schools. Neurosurgery, 2004. 55(4): p. 722-44; discussion 744-5.
13. O'Boyle, C., The art of medicine : medical teaching at the University of Paris, 1250-1400. Education and society in the Middle Ages and Renaissance v. 9. 1998, Leiden: Brill. xv, 330 p.
14. O'Boyle, C., Articella, in Medieval Science, Technology, and Medicine: An Encyclopedia, T.F. Glick, Livesy, S., Wallis, F., Editor. 2005, Routledge.

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