Islamset - Tracing islamic influences in an illustrated anatomical manual

TRACING ISLAMIC INFLUENCES IN AN ILLUSTRATED
ANATOMICAL MANUAL
Dr. Ynes viole O'Neill,
U.S.A.

Over seventy-five years have passed since Karl Sudhoff, then professor of the history of medicine in the University of Leipzig, published the text and illustration of a medieval anatomical treatise he discovered in two Bavarian monastic manuscripts. Since then, considerable scholarly attention has been directed toward interpreting the drawings, weighing the treatise's significance and pondering its origins.

The last subject is both important and vexing. Since the treatise is the earliest illustrated anatomical manual known in the Latin West, determining its source would yield essential data about the origins of anatomical illustration whose continuous tradition played a significant role in the development of the anatomical sciences in Western Europe. After studying the treatise and its drawings for over fifteen years, I have recently focused my research on the problem of its origins. I now believe that the treatise derived from an Eastern, probably an Islamic model. The purpose of this paper, therefore, is to review my findings in the hopes that Moslem scholars will aid in the important task of solving this enigma whose elucidation would cast light on the influence of Islamic physicians in the development of Western anatomical studies.

Several years ago, in a paper read at the Annual Meeting of the American Association for the History of Medicine, and subsequently published in the Bulletin of the History of Medicine. I demonstrated that the medieval anatomical treatise Sudhoff believed to consist of only the five drawings and texts he found in two Bavarian manuscripts, and which he titled the Funfbilderserie, consisted initially of a connected group of graphics depicting not five, but nine sets of human organs. The critical evidence for this demonstration was the nine part nexus still integrally preserved in a late twelfth or early thirteenth century manuscript presently part of a codex in the Gonville & Caius College Library, Cambridge.

Nine pages of drawings appear in that manuscript. They are arranged in precisely the order announced in a preface found in the Bavarian copies and published by Sudhoff. The traits of these drawings indicate that the Cambridge copy represents the treatise as it was originally conceived and designed by the author.

The text of that preface reveals its author's intention of giving an account of human anatomy according to the descriptions of Galen, including accounts first of the arteries, second of the veins, third of the position of the bones, fourth of the nerves, fifth of the muscles, sixth of the male genitalia, seventh of the stomach, the liver and the belly, eighth of the womb, and ninth of the brain and the eyes.

Though the drawings in the Gonville & Caius manuscript present those systems in precisely that determined sequence, the sketches in the only other manuscript known to contain all nine sets of drawings are disordered. Thus, the illustrations in the renowned medical codex, Ashmolean 399 of the Bodleian Library, Oxford are dispersed in no particular order throughout several texts. Most of the graphics in the Cambridge and the Oxford codices, excepting only the sketch of the brain and the eyes, appear also in a fifteenth century medical compendium presently at Welcome exemplar, however, drawings not originally part of the series are interspersed among the genuine ones.

The single innovation in the Ashmolean series is the sketch of the heart emerging from sheathlike lungs. This cardiopulmonary depiction is the sole design lacking a congruent sketch in the Cambridge series. Other organs depicted on the same page, the five lobed liver overlapping the stomach, embellished with an emerald gall bladder, the diagrammatic sketch of the windpipe running into the lungs, the isolated verdant gall bladder and the tan colored spleen, all correspond to figures drawn on the seventh page of the Gonville and Caius series.

By comparing the two manuscripts containing the illustrations of the nine part series, therefore, we have discovered that the normal order is disrupted in the Oxford series, and all captions on the figures with the exception of the inscriptions on the matrix sketch have been eliminated. If this obliteration can be interpreted as scribal innocence or ignorance, how may the unique depiction of the heart enclosed in spathose lungs be explained? The comparison of the two exemplars, while confirming the thesis that the treatise comprised nine illustrated sections has both uncovered new questions, and provided new clues concerning the treatise's origins and transmission into Europe.

To further explore these indications, let us consider another specimen. Sudhoff believed he had discovered the earliest example of the treatise in a twelfth century copy written at the Benedictine monastery of Prufening. This manuscript is now preserved among the treasures of the Bavarian State Library at Munich. Consisting of some 230 handwritten pages, Codex 13002 is a huge folio work most of whose pages are devoted to glossaries and exegesses.

The first eight pages of the codex, on which the anatomical manual that Sudhoff studied are written, differ in form and content from its subsequent contents.

Many clerks were employed in writing this quarto, a fact indicating that its component parts were highly regarded by the abbot who commissioned it, and the monastery for and in which it was produced. These observations assume importance when we realize that much of the graphic material contained in it was considered innovative in 1165 when it was written. Illustrative of these conclusions, as well as of the general style of the quarto is the microcosmos figure, originally designed to serve as its title page.

The figure is drawn in high romanesque style. Its captions stem from the Elucidarium, a work composed by Honorius of Autun in the third decade of the twelfth century. Drawn by a brother monk of the artist who copied the text and drew the illustrations of the five picture series, the microcosmos figure, when compared with the drawings of the anatomical treatise, leads us to two significant determinations.

The First is that the scribes of the Prufening scriptorium were well able to depict the human body more naturalistically than the five picture series would indicate. The reason the scribe of the anatomical treatise chose not to do so was probably that he hesitated to deviate from the models he found in the text he was copying.

The second conclusion is that though the bodies of the figures in the five picture series may well have been copied from a stylized prototype, the heads were changed so as to correspond to the Prufening style. The heads of the figures in the anatomical section of the quarto resemble the head of the microcosmos and of other human figures despicted in this, as well as other portions of the tome. Confirmation of this finding is found in the drawing of the arterial figure where the text is written over and intrudes on the right cheek of the "artery-man". This defect seems to be the result of the scribes inability to fit the desired Prufening head into the portion of the drawing allotted for the rounder, less detailed shape he had envisaged when he copied the text. ________________________________________________________________

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While preserving the squatting posture of the figures, the Prufening scribe altered the style of their heads. Why did he modify only that feature? I would argue that he made this alteration in order to disguise the treatise's origins, that what the scribe or his abbot were seeking to conceal was that the text and its drawings derived from a Moslem source.

This thesis is partially substantiated by drawings in certain Islamic manuscripts preserved at the India Office in London, the Bodleian Library at Oxford, and the Bibliotheque Nationale in Paris. In each of these collections, Sudhoff and Seidel found examples of figures bearing a definite resemblance to the European illustrations he had previously published. These figures are not rare in the Islamic world, and several copies are to be found even in the United States. An example is the splendid Mansur treatise in the Trent Collection at Duke University, where the captions are written in both Persian and Arabic, and to the familiar five full anterior views, a sixth, that of a gravid woman, is added.

Figures depicting systems of the body posed in squatting attitudes can also be found in Chinese medical writings, as a skeleton and an acupuneture figure appended to a manual for coroners originally composed in the thirteenth century demonstrate. Versions of the squatting figures are also to be found in Tibetan medical writings, though these are believed to derive from Chinese influences. As the Eastern figures demonstrate, the problem Sudhoff believed to be a local or can be shown to be multicultural or even of global proportions.

Throughout his prolonged study of the treatise, Sudhoff maintained that what he termed the five picture series was devoid of Arabic influences. Not having found Arabic words in the texts he edited, he contended that the treatise originated in Alexandria, that its prototype was a short anatomical text book composed in Greek during the third century B.C., and that the text and its illustrations must have been transmitted from antiquity via Byzantium to the Bavarian monastery of Prufening, where he believed the earliest Latin exemplar was written.

The argument supporting the Alexandrian origin of the treatise is impaired by the fact that Galen, the only authority mentioned in the text, lived five centuries after the hegemony of Alexandria. Sudhoff's thesis is also damaged by the fact that the prototypal text he imagined has never come to light. Its absence and the lack of independent documentation attesting to its existence casts doubt on the hypothesis that such a document was ever written.

Discovery of the Gonville and Caius copy of the treatise strikes other telling blows at Sudhoff's theories. Though be believed the Prufening version to be the earliest example existent in the Latin West, we now know that the Cambridge copy either antedates that bowdlerized version, or is itself a copy of the treatise closer to the original one. Having proved that the original treatise contained nine sections, and having found a copy with nine sections in precisely the order specified by the author, one must conclude that the complete version more closely approximates the prototype than does any abbreviated version.

In the Cambridge nine picture series, moreover, the figures are captioned. Important evidence refuting one of Sudhoff's premises is found in them, since they contain literal Latin translations of Arabic expressions. The strange semi-circular objects on the chest of the "muscle-man," for example, are titled "amindula," a literal translation of the Arabic word lauzatan, or almond. This term was used by Arabic physicians to designate the tonsil. The downward slide of these lymphoid masses does little to discount their utility in identifying Arabic influences where Sudhoff maintained none existed.

The treatise's texts also contain enigmas, which might indicate Arabic concepts misunderstood or imperfectly interpreted by the Latin scribes. An example is in the opening passages of the arterial section where the arteries, or pulsating veins, are described as proceeding from one large vessel whose source is a black grain (nigrum granum) in the heart, and as forming a plexus in the head called an anaphusa.

Establishing the author's meaning in this passage has confounded medical historians for decades. Since the single authority invoked in the treatise is Galen, however, we seem justified in looking for clues to explain the account's bizarre features in the Galenic corpus. Galen's most extensive account of arterial inception is in his On the Concordance of Hippocrates and Plato, where he undertook to demonstrate that the nerves originated in the brain, the arteries in the heart, and the veins in the liver.

In this text, Galen traced the arteries to a single vessel arising from a fixed point in the heart and compared the fundamental artery to the trunk of a tree. Furthermore, he explained that the arboreal structure bifurcated, the larger branch passing to the spine and the smaller ascending to the head, where it formed a rete-like plexus. Finally he noted that as the liver was the origin of the veins, the arteries derived from the heart because the seed of the arterial tree was sown there.

In this Galenic text, then, a grain-like object is placed in the heart, if only by analogy, the cardiac region is designated as the source of a vessel from which all the arteries ramify, and the arterial network in the brain is described. The similarity between these ideas and those expressed in the illustrated anatomical manual is unmistakable, but a difficulty arises in tracing a route by which the author of the medieval treatise could have learned of these ideas since no copy of a medieval Latin version is known, and Renaissance scholars are generally accorded the honor of having discovered the Greek text of this Galenic treatise and of first rendering it into Latin.

But the work was well known from earliest times among Islamic scholars. Hunain ibn Ishaq tells us he translated the Concordance from Greek to Syriac, and that previously Ayyub of Edessa had also prepared a Syria version. Subsequently, very likely in the second half of the ninth century, Hubaish rendered the work from Syria to Arabic, thus making it available to Arabic practitioners.

Latin editors suggested the illustrious Ibn Sina used the Concordance as a source for the chapter on cardiac anatomy in his Canon. Ali ibn Ridwan's knowledge of the Concordance is even easier to document for in his commentary on Galen's Ars parva, the Cairo physician described the heart as the root of the arterial tree, compared the large artery to a tree-trunk, and noted that all of the arteries of the body stemmed from it.

The idea of a grain in the heart from which all the arteries radiated, then, seems to have been an acceptable concept in the Moslem world. Since similar ideas do not seem to have reached. Europe by the first half of the twelfth century when the illustrated treatise must have been circulating, the black grain in the heart of the "artery-man" tends to support the idea that its origins were Islamic.

Far easier than supposing an Alexandrian origin for the treatise is postulating a Moslem one, and the problem of transmission is facilitated if certain pertinent historical facts are recalled. England occupied a position of considerable importance in the reception and diffusion of Arabic science during the twelfth century. Beginning with Adelard of Bath, English scholars frequented the Spanish schools during this period and became extremely active in the study and translation of Arabic scientific works.

Following the Conquest, and the introduction of Norman customs into England, monastic, and especially Benedictine interest in the study and practice of medicine flourished. Monks, such as Baldwin, Abbot of St. Edmonds, Bury, who was retained by the Conqueror as his personal physician, and Faricius, Abbot of Abington, who attended Queen Matilda at the birth of her first child in 1101, attest to the development of monastic medicine during precisely the same period when Arabic scientific writings were reaching England from Spain.

The most complete and graphically intact Latin copy of the treatise known, the Gonville and Caius version is presently and may always have been in England. The simplest hypothesis concerning its archetype's entry into Europe is to suppose that an illustrated Arabic anatomical manual found its way from Spain into an English Benedictine monastery.

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Either before or after its arrival, the manual was rendered, word by word, into Latin, and its illustrations sedulously copied. Subsequently, it, or one of its facsimiles, was lent to the Benedictine monastery of Prufening where during the second of the twelfth century, the Hirsau reforms, and a series of energetic abbots sponsored the development of an active scriptorium and the acquisition of a distinguished library.

Contemporary events may explain the two major alterations we have noticed in the Prufening copy. The Hirsau reform movement, like the Cluniac on which it was patterned, demanded a return to the prescriptions of canon law regarding celibacy of the clergy, and chastity was particularly stressed. Given this orientation, a zealous abbot may have ordered the four final sections of the treatise expurgated as unsuitable for cloistered eyes. Religious, political, or economic animosities may have also motivated the alterations of the heads in the Prufening series.

In short, this is a more elegant conceptual scheme than Sudhoff's in that it is better able to bring order to a list of prescribed observations. Its additional significance is that it indicates the importance of a channel for the penetration of anatomical concepts into Europe that generally has been ignored. But it is still only a thesis.

If we are ever to truly understand the message hidden in this curious document, we must assemble every shred of evidence existent concerning it. The preliminary groundwork has been laid. The next stage is the preparation of a definitive edition of all known copies of the treatise's text and its illustrations. To date funding has not been made available to complete this vital segment of the project. When it is the work of determining the sources and significance of the nine picture series can proceed. We look forward, with the aid of Moslem scholars, to reaching this goal, and to forging another link between the heritage of Islamic medicine, and the inception of anatomy as the fundamental Western biomedical science.

REFERENCES

KARL SUDHOFF "Studien zur Geschichte der Medizin, I" Barth, Leipzig 1907, pp. 51-59.
Y.V. O'NEILL "Bulletin of the History of Medicine" 51, 538-549 (1977).
CAMBRIDGE, "Gonville and Caius College, MS. 190/223", f. 2r-6r.
BOYD HILL Jr. "Sudhoffs Archiv". 43, 13-19 (1959).
Oxford, Bodleian Library, "Ashmole MS. 399", f. 13v-24r.
Munich, "Cod. lat. Monacensis 13002", f. 2v.
ALBERT BOECKLER "Die Regensburg- Prufeninger Buchmalerei des XII and XIII Jahrhunderts" A. Reusch, Munich 1924, pp. 20-29.
E. SEIDEL and K. SUDHOFF "Archiv for Geschichte der Medizin" 3, 165-187 (1910).
Duke University Medical Center Library, Trent Collection, "Mansur Manuscript", f. 1 r-44v.
PIERRE HUARD and MING WONG "La Medecine Choinoise" Presses Universitaires de France, Paris, 1964, pp. 54-55.
PIERRE HUARD "La Medecine Tibetainne" Latema, Paris, 1968, pl. 3-5.
KARL SUDHOFF "Studien zur Geschichte der Medizin, IVe" Barth, Leipzig 1908, pp. 28-29.
GERHARD BAADER "Sudhoffs Archiv" 57, 281 (1973)
Y.V. O'NEILL "Bulletin of the History of Medicine", 43, 236-237 (1969)
I. MUELLER, ed. "Claudii Galeni De Placitis Hippocratis et Platonis" Barth, Leipzig 1874, pp. 532-533.
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ALI IBN RIDWAN "Commentarius in artem parvam-Articella" H. Lichtenstein, Cologne 1483, f. 158v.
C.H. HASKINS "Studies in the History of Mediaeval Science" Harvard University Press, New York 1924, pp. 113-129.
LOWRIE J. DALY "Benedictine Monasticism" Sheel and Ward, New York, 1965, pp. 306-308.
Y. V. O'NEILL "XXV International Congress for the History of Medicine-Acts" 3, 1038-1040 (1976)