THE DEEP ROOTS OF THE NHS
By David E P Dennis, FCIPD LCGI RAF
Despite all the controversy about Covid-19 pandemic politics, cancer and other huge waiting lists, insufficient PPE, we in Britain at least, seem to pass slowly through the fire though not unscathed, Now, we have to deal with the utter sadness of so many deaths and help the world itself to recover. At the time of writing scientists warn us to be wary of the so-called Third Wave Indian Variant. Here in Britain, our salvation has been science and the great help and selfless care and dedication of the NHS and their wonderful staff.
But how did the staff know what to do? Where did the medical practices come from?
You can imagine the dreadful episodes of disease and infection 100,000 years ago. Maybe even then those far-off people, who are us, knew about the plant salves and how to treat their wounds. Perhaps there were ‘nurses’ back then – people who others turned to in desperation, as some sore or bone break caused agony after the hunt.
We use palaeontology and archaeology to seek answers from times before written history. Then, as writing began, evidence emerged that the Sumerians used medicine and cared for the sick (Teall, 2021). Later, the Greeks attempted to rationalise disease into simple categorical causes and thinkers in Arab lands of the Middle East and North Africa took these ideas up. But to what extent were Greek medical ideas changed by translation into Arabic and Latin – and how did they eventually reach UK medical practice and the NHS? This fascinating question requires an examination of Greek medical ideas in historical, geographical, and ideological contexts, as they flowed through translation, in diluted, damaged, or enhanced forms, to Arabic and Latin cultures.
Historians agree that Ancient Greek civilisation began in the Bronze Age, ending when Romans conquered Greece in 146 BCE. During that long period, Greek became the common language for intellectuals across Europe, the Mediterranean, North Africa, and parts of Asia. Greeks (Mycenaean, Macedonian, Hellenistic, and Greco-Roman) had developed and accepted a naturalistic view that the universe was composed of earth, air, fire, and water. Superimposed upon that matrix was a four-part common-sense medical concept of humorism, attributed primarily to Hippocrates, in which the effects of illness on wellbeing were obvious. For example, we know that vomiting produces a caramel yellow substance called in Latin – chyme and in Greek – khumos, which is partly digested food. To the Greeks, this together with the products of diarrhoea, was a covariant warm substance called ‘yellow bile’. Other body products often seen in illness and seldom in wellbeing were phlegm (cold), blood and black bile. The latter might be external wound-dried blood or dark ‘coffee-grounds’ digestion third-stage vomiting. These four ‘humors’ were linked imaginatively to the seasons. Humoral imbalances were ‘controlled’ by medicinal, often herbal, drugs and by ‘vomiting, purging, or the production of urine’ or ‘bloodletting’. The Hellenes, Arabs and European Latins easily understood this human concept. Yet, how was it vectored, changed or intact, from culture to culture?
While Greece and Egypt were being overwhelmed by Latin-speaking armies and Greek medical knowledge was being centralised in Rome and Alexandria, the diverse tribal sheikdoms of Arabia were still using speculative folk medicine and worshipping desert stone navigation markers, for understandable reasons. Only in 622 AD did the founder of Islam, Muhammad, begin unifying conquests of the Arabian tribes. After Muhammad passed, the Arabic-speaking Moors invaded Christian Spain in 711 AD and stayed in dominant or weaker states for the next 800 years. Roman Latins absorbed Greek medical ideas, eventually passing to Islam where they found their way back to the Latin world through many pathways, in a partly changed form, effected by intellectuals and translators. The problems they faced were these.
The root of the Greek language is a unique 3,400-year-old stem of the earlier Indo-European language group, yet with a Phoenician originated alphabet via Linear B. Arabic has a central Semitic Iron Age root coming out of the Anti-Lebanon mountains and Mesopotamia, yet its script is directly formed from Nabbatean Aramaic. The root of Latin is also Indo-European but heavily altered by Etruscan Iron Age peoples – the original occupants of Europe post-Africa. Written Latin is a combination of Etruscan and Greek scripts. Each verbal language is not linked to its written language by origin – a translational nightmare. People conversed, but few could write. Higher learning was still developing. Critical to the question, educated translators might not be medically trained and therefore in danger of mistranslating vital concepts. There were also religious objections. Overall, effective translators were hard to find.
Ancient societies bound populations to farm estates. Only upper echelon rulers or the professions could cross state/tribal boundaries. For example, warriors (Alexander’s army), doctors of medicine like Galen, a Greek employed by emperors Marcus Aurelius and Commodus in Rome, Rhazes, ibn Sina, ibn Rushd (Averroes) and Benzi. Travelling academics including translators, Dioscorides, Hunayn ibn Ishaq, Al-Ghazali (the Persian Arabic-speaker Algazel), al-Ghafiqi and sailor-traders, could take medical knowledge and pass it on, provided language was not a barrier. Sometimes it was possible to use semiotic hand-pointing and diagrams (Hunayn’s eye diagrams), to enhance understanding between people of different cultures but the overwhelming method of transmission was through writing – books and parchments. Though never error-free, Greek medical texts were read across the known world.
Yes, skilled translators with medical knowledge were needed but here it is necessary to examine the word ‘translation’. This can have two meanings, the common one of changing the coded signs or phonemes of language to new understandable equivalents – but also the ‘cloud-movement’ of ideas – almost a transubstantiation from an old concept to a new state of knowledge. Nowadays Christians talk of the ‘translation of the Host’ in Communion. This essay on the deep roots of the NHS, is more about the latter kind of translation – did something fundamentally new come out of the old during the communion of cultures? Was medical knowledge enhanced by both types of translation? In what order did this occur?
Conduits for the flow of Greek medical ideas into Arabic culture, with minor deliberate or inadvertent alteration, were mediated partly by Syriac translators of Greek into Arabic, by Nestorian Christians (via Abbasid patronage) and by wise Arabs both pre/post Islam. ‘Certainly, no Islamic author attempted to fundamentally revise humoral medicine’ (Ullmann, 1978, p.24). However, ‘translated texts provided the basis for a distinctive Islamic culture of medicine which continued and developed Greek ideas’. So, if Greek ideas were altered or enhanced by Islam, then to what extent?
First, it was necessary for translators to recognise a disease, but ‘there were no Arabic words for many of the diseases and symptoms described in Greek texts’. So, Greek ‘lethargos’ (inactive through forgetfulness) was changed to ‘litharghus’ (fatigue), thus changing the original meaning. Epilepsy, which Greeks knew as a ‘sacred disease’ (worshipful), became altered erroneously to Arabic ‘divine disease’ (God-given). I translated treatments for snakebites verbatim despite a lack of such snakes in Islamic territories. Common words in each language for colours like red were used to describe inflammation. Errors crept in when the Greek for meningitis was altered twice into ‘quaranitis’. Therefore, ‘consciously or unconsciously’, the Arabs altered Greek medicine in a minor way. It was partly weakened because of religious bars on using pigs and alcohol in remedies, and ‘not all Hippocratic works were translated’. Greek medical knowledge was ‘subtly reshaped’. If Greek medical knowledge was reshaped by translation, transubstantiation, and omission by Arabic sources, then what effect did this have when Greek medical ideas were re-routed via the Middle East into Europe?
The high esteem Arabic translators had for Greek learning, embedded as it was in the burgeoning Islamic religion, meant that the warriors invading Spain, a Latin country, would bring in their train, people with Greek medical knowledge, partly altered or enhanced by Arab scholars. ‘Historians now agree that the greatest achievement of Islamic medical writers was to systematise Greek medicine’. Introducing Greek medical ideas into Latin cultures had intellectual cogency – it was not just common-sense or folk medicine but had a deep flavour of emerging science. Huge numbers of books, for example, the 10-volume Mansurian Book of Medicine, were organised by methods developed in Greek culture. Islamic wisdom improved these into remedial tools and sources of some power, aiding understanding of diet, hygiene, anatomy, and other aspects key to medical practice, like diagnosis, therapy, and surgery. Islamic medical knowledge was more detailed and systematic than the earlier Hippocratic ‘first attempts’. It had been stabilised, albeit filtered through religious precepts which removed aspects unacceptable to Islam.
As Islam moved into Latin Europe via Spain, Italy, Sardinia, and Sicily so the Islamic books of newly systemised knowledge were seen by Latin scholars. The problems began again with the need to transliterate where there were no Latin terms for Arabic medical knowledge. The obvious opportunity for any similarity in Greek to Latin roots (scripted in Etruscan) via Indo-European ancient language groups was missing because Greek ideas had already become Arabic ideas expressed in Semitic Nabbatean symbols, quite different to the Greek Phoenician script. Understandably, mistakes were made in translation and thus the already altered ‘qaranitis’, became ‘karabitus’. ‘European practitioners complained that the transliterated names of drugs were quite incomprehensible’.
In a breakthrough, at Monte Cassino, the Saracen monk Constantine Africanus, an Islamic convert to Christianity, began to translate Galen, Majusi, al-Jazzar and ibn Ishaq, without altering systematised Greek medical theories. Then Gerard of Cremona based at Toledo, capital of the Caliphate of Cordoba, worked on Ibn Sina (Avicenna – often a source of error and obscurities) and al-Qasim’s surgery texts. These and others found their way into the emerging universities employing competent remedial translators such as Leoniceno who graduated from the University of Padua and taught at the University of Ferrara. Niccolo Leoniceno was a brilliant man, whose work should be better celebrated. He was the first academic to write a science paper on syphilis. He wrote or accumulated hundreds of books, pointing the way to the academic route of textual evidence for learning. He had read Pliny’s Natural History and conducted a detailed criticism of his work, pointing out errors in understanding and especially in translation.
There was also an echo of Greek humorism still sounding from Roman times, not translated but absorbed practically into folk medicine treatments. Latin scholars, by then ‘standing on the shoulders of giants’ (Bernard, Newton) both Greek and Arabic, realised Greek medical knowledge was valuable and translated it directly, as well translating the great surge of coherent knowledge coming from Arab contact with Latin cultures. Gradually this massive effort in understanding diverse medical information assembled by different cultures, developed into a science.
In conclusion, the extent to which Greek medical ideas were diluted, damaged, or enhanced by translation into Arabic and Latin can be expressed as follows. For the minor meaning of ‘translation’ – converting symbols into meaning, there were several errors from Greek to Arabic. Basic concepts were preserved although there was less focus on body fluids. When Islamic scholars had systematised the knowledge base in Phoenician script, then Latin scholars made few errors because they had Arabic language roots or knowledge. For the major meaning of ‘translation’ as transubstantiation, Greek humoral theory was taken without significant error into Arab and then Islamic culture. This major transubstantiation reached its apogee when the Arabs systematized and enhanced the Greek medical knowledge onto a platform of great significance including surgery and diagnostics, albeit filtered by Islamic law. Latin practitioners refined this corpus further. Then western and middle eastern cultures continued to build a modern scientific medical system of remarkable excellence. So, overall, Greek medical ideas were not ‘changed’ for the worse by translation (of either type) but were positively changed by coherent preservation of knowledge and enhanced into the lifesaving systems we have today.
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Copyright: David E P Dennis FCIPD LCGI RAF June 2021
References / Bibliography
Ullman, M. (1978) Islamic Medicine, Edinburgh, Edinburgh University Press.
Quotation: ‘…standing on the shoulders of giants.’
Original idea or concept from Bernard of Chartres (12th century) and paraphrased by Sir Isaac Newton in 1675 as, ‘If I have seen further, it is by standing on the shoulders of giants.’
What happened before the Greeks? To go further back to Sumerian times you can read the superb essay by Emily K. Teall, Honors College Graduate, Grand Valley State University: via the Brewminate Website.