Knowledge of the East Flows West: Constantine the African

In the second half of the eleventh century, European medicine was in a deep sleep. Confined within monastery walls, it had lost touch with the knowledge of the ancient world. Just then, a mysterious man from Tunisia carrying Arabic manuscripts, named Constantine the African, set foot on the shores of Italy.

Constantine the African and the Construction of Oncological Theory in Liber Pantegni

His arrival was both a migration and one of the greatest “data transfers” in medical history. Oncological knowledge, brought to its peak in the Islamic world by Ibn Sina and Razi, would spread through Constantine’s translations to the Salerno Medical School and from there throughout Europe. In this article, we will examine how cancer was redefined in the West through the theory of “Black Bile.”

A Monk’s Mission: The Translation Revolution

When Constantine first came to Salerno, he realized how inadequate the medical literature in the West was. The Latin world had forgotten the legacy of Hippocrates and Galen. To fill this gap, he secluded himself in the monastery of Monte Cassino and devoted his life to translating Arabic medical texts into Latin.

Liber Pantegni: “The Book of the Whole Art”

Constantine’s greatest work was the Latin translation of “Kitab al-Maliki” (The Royal Book) by the renowned Islamic physician Ali ibn Abbas al-Majusi, entitled Liber Pantegni. This work holds the distinction of being the first comprehensive medical textbook written in Europe.

The work treats cancer as a consequence of a disruption in the body’s overall balance, beyond simply a swelling. Constantine divides cancer into two types: “Occult” (hidden, not yet ulcerated) and “Ulcerated” (ulcerated, an open wound). This distinction would become the fundamental criterion guiding surgical decisions in later centuries.

Cancer Etiology: The Curse of Black Bile

While bringing Galenic medicine back to Europe, Constantine also explained cancer’s cause through “Humoral Pathology.” According to this view, the universe consisted of 4 elements (Earth, Water, Air, Fire), and the human being of 4 fluids (Blood, Phlegm, Yellow Bile, Black Bile).

According to the theory, when “Black Bile” (Melancholia), governed by the spleen, accumulated excessively in the body and “burned” or formed sediment, it hardened the tissue where it settled, disrupted its nourishment, and transformed it into cancer. Cancer was therefore considered a “Cold” tumor. This “Coldness” signaled that the tissue had lost its vital energy.

The Latinization of the “Crab” Metaphor

Constantine translated the word “Sartan” in the Arabic texts into Latin as “Cancer” (Crab). Liber Pantegni explains the analogy as follows:

This translation shaped both cancer’s name and physicians’ view of the disease: “A disease that clings, spreads, and is difficult to remove.”