Medical humanities and translation

Vicent Montalt

Historical intersections

A paper published recently in Le journal des médecines cunéiformes (Arboll 2019) reports on a 2,700-year-old cuneiform tablet from ancient Iraq written in Akkadian, describing medical treatments, and containing a drawing of a demon which Assyrians and Babylonians called Bennu, and which was thought to cause epilepsy. It is the earliest illustration of devilish associations with this condition. The term bennu might also have been used to describe ‘convulsions’ (Arboll 2019: 5). At the time, healers were responsible for expelling what they understood as supernatural forces and treating the medical symptoms they caused with drugs, rituals or incantations. The Assyrians and Babylonians believed that there was a connection between the moon, epilepsy and insanity (Arboll 2019). They also believed that the one who knew the true name of things, and of the demons that modified them, possessed magical powers; by pronouncing the true name of a thing one would become the master of it and could rule over it (Lain Entralgo 1958: 47). The power of naming things and the art of the word - ars dicendi - are crucial aspects of both these ancient forms of medicine and the contemporary ones, although in different ways.

Before science reached the point when it became able to demonstrate the mechanisms of disease, supernatural forces often provided causal explanations. It was perfectly acceptable and believable to state that convulsions due to epilepsy - a neologism originating in classical Greece with which we now name the disease - were in fact caused by the gods, or indeed, in some cases, by the devil himself.

The oldest detailed account of epilepsy is on a Babylonian tablet dating as far back as at least 2000 все. According to the Cuneiform Digital Library Initiative,² the earliest known medical text dates from the third dynasty of Ur (also c.2000 все) and is written in Sumerian. Other early (14th century все) Sumerian texts have been found at Hattusa (Bogazkale, Turkey), but it is not known whether they were originally composed in Sumerian or copied and translated from Babylonian originals - an open question that seems to suggest a very remote origin of medical translation.

From the viewpoint of medical humanities and translation, what is most relevant about this archaeological discovery is the critical importance of interpreting the meaning of the cuneiform tablet and its magical-medical content through a hermeneutically complex process of translation and exegesis. The whole of the first section of the paper mentioned above (Arboll 2019) consists of a semantic analysis of the Akkadian words referring to illness, diagnosis and symptoms, and the various translations into English provided by different scholars. One of the most frequently recurring expressions is ‘[Akkadian word] can be translated as [English word]’. Finding the meaning and making sense of the cuneiform writing require not only translation as a mere lexical tool to establish direct equivalences -in this case between Akkadian and English - but also a translational frame of inquiry in which remote concepts and explanations are critically scrutinised, re-contextualised, reformulated and brought to the here-and-now of new target readers.

In Western medical traditions, supernatural views of medicine can be traced back to ancient times through The Iliad and The Odyssey of Homer (8th century все), who composed his epic poems some four or five centuries before Hippocrates. In his seminal book La curación por la palabra en la antigüedad clásica (The Therapy of the Word in Classical Antiquity, 1958), Pedro Lain Entralgo, a Spanish psychiatrist and classical Greek scholar, outlined the presence and role of therapeutic speech in Greek culture. Together with surgical, pharmaceutical and dietetic methods, disease was also cured with charms, spells and incantations. Spells were linked to imperative or coercive intentions when trying to modify phenomena, such as averting the action of a demon or staunching the flow of blood. Charms were used when the dominant intention was to plead for help from divine powers. In these pre-Homeric traditions, words used therapeutically could sometimes be accompanied by music. According to Lain Entralgo (1958), the use of such words in Homer’s epic poems was not always of a magical nature. Sometimes words were used to evoke in the patient a state of mind that would help them to cope with the effects of the illness. Both in magical and non-magical uses of the word the purpose of the healer was to achieve a psychosomatic change in the patient. In current linguistic terminology, these are examples of the performative power of language in action, language as a force capable of transforming minds and bodies. Current uses of language in healing include, for instance, cognitive behaviour therapy (CBT) and mindfulness in psychiatric medicine.

Plato recognised the therapeutic power of the word and its emotion-stirring qualities, and allowed it a place in his Republic (c.375 все). However, he excluded poets and playwrights from his ideal Republic, because he believed no good could come from words that excited passions and obscured reason. Aristotle, on the other hand, thought that emotional catharsis had therapeutic value. According to Lain Entralgo (1958), Aristotle’s Rhetoric (4th century все), a treatise devoted to the power of the word, may be considered as a therapeutic oratory. For Aristotle, any doctor whose words were capable of producing psychological reactions in certain patients similar to those of tragic poems, would be more effective than one who only considered therapeutic practice as a silent art: muta ars. In Aristotelian verbal catharsis, the action of the word can be of such intensity that it can work as if discourse itself were a drug (Lain Entralgo 1958: 338-343).

Just a few centuries after the inscription on the Akkadian clay tablet mentioned above, Hippocrates wrote On the Sacred Disease (с.400 все), where he dismissed the religious origin of epilepsy and other diseases in favour of natural causes accessible to rational thought and understanding:

It is thus with regard to the disease called Sacred: it appears to me to be nowise more divine nor more sacred than other diseases, but as natural cause from the originates [,v/c] like other affections. Men regard its nature and cause as divine from ignorance and wonder, because it is not like to other diseases. And this notion of its divinity is kept up by their inability to comprehend it [...].

According to Dicciomed* the medical term prior to Hippocrates was hires nosos, the sacred disease; and, one of the first tasks Hippocratic doctors undertook was to rename it avoiding any religious connotations. They adopted the medical term ‘epilepsy’ from Greek epi- (over, upon) and -lepsi (take). Even this intentionally more descriptive, biomedical word retains traces of its magical origins, as if sufferers were ‘taken over’ by some supernatural power. Interestingly, Hippocrates’ view of epilepsy as a brain disorder, and not as a divine punishment, did not begin to take root until the 18th and 19th centuries, the intervening 2,000 years being dominated by the earlier supernatural views.

The Hippocratic tradition thus departs from the magical and religious, focuses on the physical in its understanding and explanation of disease, and, despite Plato and Aristotle, abandons the possibility of curing by the word. Physis, the knowledge of nature in classical Greece, takes centre stage and medicine gradually becomes a muta ars-or, as Petrarch puts it, herha, non verba [herbs, not words]. Nowadays, the muteness of the corpses on which medical students get to know human anatomy shape their purely physical concepts about

the human body during their university training. For centuries, this orientation away from words and discourse has greatly influenced healthcare, and in particular, doctor-patient communication.

The emergence of Hippocratic medicine as muta ars in classical Greece and its subsequent historical development driven by physis - and apparently excluding ars dicendi -eventually gave rise to current biomedical science. However, when examined from the perspective of the history of translation, medicine can hardly be defined as muta ars but its opposite, ars dicendi. Translation has been a historical driving force of scientific advancement. Over the centuries, the development of medical knowledge has depended on the transmission of discoveries and ideas through texts across languages and cultures, starting in Ancient Mesopotamia, which, at the moment, is as far back as we can go for material evidence. Modern science and medicine are indivisible from translation; in fact, they began as translation (Montgomery 2000). At every milestone, ‘translation was the key to scientific progress as it unlocked for each successive inventor and discoverer the minds of predecessors who expressed their innovative thoughts in another language’ (Fischbach 1993: 90). In historical terms, translation has been defined as the borrowing or appropriating of the findings of others (Delisle and Woodsworth 1995), a process that often involved innovation and further development, as is the case of Islamic medicine drawing on Hellenic medical tradition to form its own (Savage-Smith 1997). Likewise, medieval and early modern scholars in Europe drew upon Islamic traditions and translations as the foundation of their medical undertaking. It was through Arabic translations that the West learned of the Hellenic medicine (Savage-Smith 1997).

Historically, translation has always been entangled in the process of knowledge production, albeit in rather covert ways. In contrast with the so-called ‘diffusionist’ models of knowledge production and distribution, Delisle and Woodsworth (1995: 101) point out that ‘The translators of history should not be regarded as passive conduits of specialised information, but rather as agents fully implicated in the works they reformulated in another language.’ The very process of circulation produces new knowledge. Wisnovsky (2017) argues that even when translators declare themselves to be faithful interpreters, individual acts of recreation and transformation inevitably occur during the process of translating a philosophical work from one language to another. Drawing on Aristotle’s categories of textual kinesis or motion, he shows that in Greek-Arabic translation of philosophical works in the Middle Ages, the interplay between translating, commentating/glossing and transcribing/copying has caused expansions, contractions and mutations in concepts and arguments that can explain some substantive developments of philosophy in general, and natural philosophy and medicine in particular.