Half way between Rome and Naples is a rocky hill known famously as Monte Cassino. In about 529 Saint Benedict founded an abbey there, the very first of the Benedictine Order. Part of the Abbey was a hospital, probably the first such institution of the Middle Ages. Here the monks took care of the sick according to Benedict’s Rule. Over succeeding centuries Monte Cassino became famous for its collection of medical manuscripts garnered from all over the Mediterranean in a variety of languages and then translated into Latin and carefully copied for aspiring physicians from the countries of western Europe.
What is the connection between Worcester Cathedral Library and the Benedictine Abbey of Monte Cassino? We have already mentioned the fine collection of medical manuscripts held in the Cathedral archives. Among these are two thirteenth-century copies of a Latin medical text called the Theorica Pantegni, Greek words meaning The Theory of All the Arts or all the medical knowledge available at the time. This work was first written two hundred years earlier in Monte Cassino by a monk known as Constantine the African and dedicated to his Abbot, Desiderius. By 1086 Desiderius had left the monastery to become Pope Victor III in Rome, so the Theorica Pantegni must have been written before this date.
What was the Theorica and why was it to prove important for centuries of readers? As the name suggests it is a compendium of medical knowledge, mostly a translation from the Arabic of the Kitab al-Malaki or Royal Book of Ali ibn al-Abbas al-Majusi, Latinised as Haly Abbas, a Persian physician who died in about 990. It also contains material from the classical Greek writers on medicine, all collected and translated by monk Constantine.
Let us try to summarise the contents of the manuscript. First comes the dedication:
Domino suo montis callinensis abbati .D. reverentisimo patrum
imnio totius ordinis ecclestiastici gemme preminenti
.C. Africanus licet indignus suus tum monachus
oculatis intus et exterius celi ascribi animalibus
“To his Lord Desiderius Abbot of Monte Cassino most reverend of the fathers, foremost jewel of the whole church Constantine the African then his monk
though unworthy to be counted among the creatures of heaven having eyes within and without . . .”
Note how Desiderius is referred to as .D. and Constantine as .C., showing how their fame made further reference to their names unnecessary. The decorated D on Domino indicates the start of the text, with similar ornamentation at the other main divisions known as Books. Lesser sections have headings in red ink while individual paragraphs may have a simple capital letter in blue or red ink. Some pages have extensive notes made later in a different and smaller script, sometimes in ink and sometimes in now almost illegible pencil. There are also drawings of fingers pointing to lines of text, and occasional rough drawings of faces or simple animals.
The first book sets out the ancient theory of the four humours: black bile, blood, phlegm and yellow bile. It is now believed that this separation of essential bodily fluids came from the sedimentation of blood done in the open air, showing a dark clot at the bottom – black bile; a layer of unclotted red cells – blood; a layer of white cells – phlegm; and a layer of clear yellow serum – yellow bile. These were thought to be the essential constituents of the body associated with four elements of earth, air, wind and fire, and with four materials of hot, cold, wet and dry.
Book Two of the Pantegni deals with the most basic parts of the body: the skeleton, nerves, veins, muscle, fat, skin, hair and nails. Book Three describes the muscles in more detail, the internal organs of heart, brain, gall and bladder, and finally the breasts and genitals. Book Four examines how all these actually work, introducing the idea of virtus, the power animating the stomach, the womb, the five senses, voluntary movement and breath itself, and how lack of virtus is the inevitable sign of death. Book Five describes external factors affecting the body: the quality of the air in different places, the various types of food, sleep and waking, and sexual activity.
Book Six examines diseases of different parts of the body, and how they are caused. Book Seven centres around the pulsus or heartbeat and its relation to digestion, excretion and the emotions produced in the brain. Book Eight looks at diseases caused by outside conditions, including fevers, leprosy and skin complaints, and poisoning by snakes, scorpions, spiders and mad dogs. Book Nine deals with internal failings such as cramp, paralysis, shortness of breath and diseases of internal organs such as the stomach and the kidneys.
Book Ten, the final part, appears to step back from all the detail. It introduces the idea of the crisis or turning point of a disease, and whether it is possible to predict that a sick person will regain their health or simply die.
The two Worcester manuscripts are of different sizes. The smaller one is catalogued Q.39, and was probably copied in southern France or Italy before finding its way to Worcester. The larger manuscript is catalogued F.70 and may have been copied in England. It is not known when either manuscript came to Worcester, but it must have been thought useful to have two copies of this work to enable Worcester Priory to fulfil its role as a provider of medical treatment for its monks and for the people of Worcester. Both manuscripts show signs of the wear and tear of eight centuries.
This illustration shows how Q.39 has been attacked by worms and also suffered extensive cutting. The little circles are worm holes and the cut has been stitched together. Parchment is cured sheepskin which provides protein for the worms and a firm texture for stitching. The possibly original cover of F.70 is made of oak boards which have been attacked by woodworm.
More than 100 other copies of this work are known. The oldest-known copy, probably actually written at Monte Cassino is held in the National Library of the Netherlands; the University of Helsinki has published an edition of another. Sixteenth-century printed versions exist, showing that this work remained of great importance and practical use throughout the Middle Ages.
We must add a word here about the fascinating story of monk Constantine, known from the land of his birth as ‘The African’. He was a learned collector of manuscripts especially of Arabic medicine. He brought a collection of them to Europe before becoming a monk in Monte Cassino. Worcester Cathedral has much other material produced originally by Constantine, so we will leave the full story for another day!