I struggle to remember what day it is. I came to the medical center Saturday morning, preparing to meet my fellow residents in the hospital cafeteria, and to “run the list,” where we review our patient registry and assign the scut work for the day. As the junior-level resident, I knew most of the “dirty work” would be done by me over the weekend, and because the orthopedic hand team was on call for the trauma center, I knew I was at risk for a brutal sixty-hour slugfest. All it takes is a little bad luck for a call weekend to go to crap, and as soon as I sat down with my pancakes and my list, my trauma pager beckoned me to the trauma bay.
The first trauma patient had been in a motorcycle accident, and most of the bodily destruction was centered on his right arm. His right hand was a jumble of open fractures, exposed tendons, pumping macerated vessels, and dog-eared skin flaps. I knew at a glance his surgery would take hours, and the day was just starting. Additional hand-injured patients steadily arrived in the emergency room, and as day turned to night, there was no abatement of suffering. By Sunday morning, there was almost a chance I could take a quick nap, but someone’s bagel knife mishap mandated that I descend down to the emergency room for a consult. The waves of traumatized patients, in a never-ending flow, pulsed through the ER, and my job was to stabilize, evaluate, and prepare the wounded for surgery and, if not otherwise detained, report to the operating room to surgically assist.
Late Sunday night, at my wits’ end, not having slept all weekend, a twenty-four-year-old Central-Pennsylvania lumber mill worker was flown in on an air ambulance helicopter. Four fingers on his right hand were sawed off where they attach to the palm, and the giant saw blade had mangled all the digits into oblivion. All we could hope to do was surgically clean the wound edges, and over time, fashion a “mitten-hand” that he might use as a club. His family arrived later by car; it is always difficult to deliver the sobering news that nothing miraculous can be done to salvage a limb. But it is only 1996, after all.
Sunday night blurred into Monday morning, which meant Morning Conference, followed by assisting in the OR during total joint replacement operations. I still have managed no sleep, and my fatigue is oppressive. Very few people understand true exhaustion and the consequent short-circuiting of the brain and bone-deep achiness. I have always performed well during stretches of sleep deprivation, but at fifty hours, habituation and willpower start to mean nothing. Wakefulness requires extreme concentration; alacrity is an impossibility. Like the urge to gag when food-poisoned or the impulse to squint with a flash of mirrored sunlight, the mind’s insistence to power down at ultra-weariness means that your body will collapse, earthward, in a flash, underneath you. In what feels like a bus crash while you’re napping, the paroxysm of awakening snaps your head around, your lungs gulping for air, your sea legs stumbling for firm footing in Wonderland, and your arms reaching for ballast. Often during residency, this seemingly drug-induced warfare with the primitive part of my brain (demanding rest, seeking solace, needing, above all else … nothing) would happen in the operating room while we were trying to operate. By dint of a miracle I have made it through a marathon of surgeries today, and now, as I piece together the events of the weekend, I remember the final thing I need to do today is to revisit that lumberman who lost the fingers of his right hand.
Dr. Pellegrini is my chairman, the person who presently controls my minute-to-minute existence. I’ve come to realize that every episode of the television show ER and every movie about surgical residents, despite their best efforts to dramatize the draconian aspects of a chairman and his residents, vastly undersells the boss’s power and the young medical doctors’ helplessness and feelings of inadequacy. I meet “The Boss,” as we call Dr. Pellegrini, and my chief resident Jeff Wood on the fifth floor, understanding that the patient’s family has now gathered in his room. Walking down the dark hallway, I am the only one who has been awake for three days. One night, under similar circumstances of sleep denial, I was actually falling asleep while walking down an empty hospital corridor, crashing against the hand rails, stumbling like a frat boy on his way home from hazing. The extra jolt of adrenaline—accompanying my boss—keeps me upright, but I bitterly regret that I didn’t bring extra socks or underwear with me Saturday morning. I am certain that I stink like a post-call intern, and the swampass from my three-day underwear and the sweaty feet entombed in cushionless, sodden socks make me even more desperate to trek home and collapse.
Our three-man team meets with the patient and his family in his room, conveying the stark reality that his life is forever rocked by one accident. He knows, as a blue-collar worker, his future is permanently jeopardized. I would like to think I’m an empathetic person, particularly for a surgical resident, but in this moment I am cruelly reduced to a psychology class test-subject of sleeplessness; all I want is to lie down. I can’t care about anything else, and (I’m ashamed to admit) I think to myself, this guy is part of the reason I was up all night. The patient’s family, all working-class people who smell of cigarettes, fried foods, and musty dampness, grasp the situation, with heads bowed in reticent submission. We agree that another operation will take place tomorrow, to further clean up the stump of his hand remaining.
Exiting the room, with heavy sighs emanating from my chest, I determine to make a beeline for home. Now in the dark hallway, I hear the patient’s father calling out, asking for a minute. Jaw clenching, I know I could explode in desperate anger, “WHAT NOW? There is nothing more to be said.”
The father, in worn-out flannel and dungarees, with muddy Red Wing boots and a mop of thick bristly hair, pauses. I’m thinking, I bet he’s only fifty years old, when he hesitatingly starts, “Sorry to waste your time, but I got a question.” Please—please for mercy’s sake—be quick, I think to myself.
His leathery, sun-weathered skin and raspy voice belie years of chain-smoking and laboring outdoors, but his kind eyes reveal a humble decency. “I’m not a smart guy, and I don’t know nothin’ about doctor stuff, but …” he trails off. I wait, and my whole body aches with fatigue. “I’ve lived my life, I’m forty-three years old, and it kills me to see my boy with a wrecked hand and no future.”
He extends his roughened, calloused hand, each finger thick with power from years of exertion, and softly asks, “Would it be possible to take the fingers from my hand and put them on my boy?”
Five thousand years ago, in South America, Africa, and Asia, primitive peoples simultaneously—and without communication—formulated the process of harvesting wild cotton, spinning it into cotton thread, and weaving it into material.1 As beautifully detailed in Sven Beckert’s Empire of Cotton, its ascension as the material that launched the Industrial Revolution is a study of global shipping, capitalism, slave trading, and the realization that cotton itself was an ideal multipurpose material. The saying “Success has many fathers” may suggest that multiple inventors vainly claim credit for another’s innovation. Read a different way, the phrase highlights the fact that almost all discoveries and inventions occur to different people simultaneously.2 Whether it’s the airplane, the light bulb, scientific theories (evolution, relativity, calculus), toilet paper, or the hypodermic needle, “inexorable technological progress” means that great ideas come into full bloom, awaiting harvest, in multiple places at the same time.
The concurrent development of ideas can be explained by a certain path dependence, the concept whereby innovation occurs along a particular, predictable course. “There’s not much point in mining uranium till you have invented steel, cement, electricity, and computing, and understand nuclear physics.”3 Inventions that are proposed far too early sound fanciful, like a “time machine,” but innovation usually happens at just the right time, when all the necessary ingredients are available. The evolutionary biologist Stuart Kauffman coined the term “adjacent possible” to explain how biological systems are able to morph into more complex systems by making incremental and less energy-consuming changes in their makeup.4 Steven Johnson, in Where Good Ideas Come From, applies the concept of the adjacent possible to science, culture, and technology. “The adjacent possible is a kind of shadow future, hovering on the edges of the present state of things, a map of all the ways in which the present can reinvent itself … each new combination ushers new combinations into the adjacent possible.”5
This book, in essence, is about the adjacent possible. The rise of surgery, in retrospect, followed a simple pattern: enhanced connectivity among scientists and physicians fueled discovery and communication, small groups of investigators learned how the human body functions, doctors in the 19th century untangled the cellular basis of disease processes, and 20th century surgeons discovered remedies. Each advancement (with its own sub-advancements) rested upon an earlier breakthrough.
The first major foundation in the rise of medicine is, surprisingly, the invention of the printing press. The printing revolution (called an “integral part of the general history of civilization”6), was a classic coming-together of many technologies, but there awaited a major insight to make the printing press a reality—and it’s not what you think.
Whatever environmental forces (ice ages?) necessitated the strengthening of social bonds among our primitive ancestors, there was a critical development of language and art that accelerated over the last thirty thousand years. But it is only in the last five thousand years that the written word has existed, which means that humans have spent 99.9 percent of our existence without writing. In the midst of the Renaissance, before science was invented, the greatest handicap humanity faced in conquering disease was the inability to share intellectual discoveries with a broad group of scholars. Hand-copied manuscripts, written on papyrus, were magnificently inefficient in conveying new information to investigators in far-flung municipalities. For medicine to flourish, and for surgery to become real, what was needed (to paraphrase Steve Jobs at the introduction of the iPhone) was a breakthrough communications device.
Coinciding with the invention of writing—around 3000 B.C.E.—the Egyptians made an ingenious utilitarian discovery for a ubiquitous plant: papyrus. Prior to domesticated crop production, the wetlands were replete with papyrus reeds—tufted three-sided emerald plants that held a peculiar interior that would change their society for millennia. Papyrus was used throughout the Mediterranean, but its production remained an Egyptian monopoly, and other than the Dead Sea Scrolls, its relics have only ever been discovered in Egypt.
The library at Alexandria was initiated by Ptolemy, the Macedonian Greek who became the ruler of Egypt in the 3rd century B.C.E. Besides being in a major cultural center and port, the library’s great advantage was being close to the papyrus production centers. “Every ship that called in the port of Alexandria was searched for [writing materials], and any that were found were copied for the library. Ptolemy wanted works on any subject, poetry or prose, and three centuries later, the library was the repository of 700,000 scrolls.”7
The ruler of Pergamum (in Asia Minor, the future home of Galen) aspired to build a magnificent library in the same era, but sensing a rival, Ptolemy refused to send papyrus to the Anatolian city. According to Pliny, the people of Pergamum were forced to innovate and create a new writing surface that was durable, thin, and in abundant supply. The invention was to be known as pergamum, and was made from animal hides that had been soaked in lime, scraped, and dried. The skins were then placed on a stretcher, further scraped and smoothed with stones. The final product is incredibly thin, and under the right conditions, is flexible and ages well.
Throughout Europe, pergamum retains its name in every language, but in English it is known as “parchment.” The three main sources of parchment remain sheep, goat, and calf, but the finest material is known as “vellum,” particularly when it is made from calfskin (most exceptionally, when it is fetal calfskin!). Parchment is still made worldwide, and uses include special manuscripts (like reproducing a diploma on a real “sheepskin”), collectible books, and bookbinding.
Soon after the life of Jesus, the Romans replaced the codex, a wooden tablet notebook, with parchment. Papyrus was not an appropriate substitute, since folding and sewing weakened it at the spine.8 The rise of the parchment codex is linked to the rise of Christianity; all early Christian documents found in Egypt have been codices, whereas contemporaneous pagan documents were almost always scrolls. (The Latin word for scroll is volumen.) Unlike papyrus, “parchment could be made anywhere and preserved well in a wide range of climates. But like papyrus, it was labor intensive, and it was even more expensive to make—it could take as many as two hundred animals to make a single book. [The use of parchment] indicated that a document was important and meant to last.”9
Johannes Gutenberg was born around the year 1400 C.E. in the city of Mainz, Germany. Founded as a Roman garrison shortly after the death of Julius Caesar, Mainz had grown into a small town of significance by the 15th century, and was one of the key Jewish centers of learning in Europe. The plague had swept through Mainz decades earlier, and as was typical for the era, the Jewish community was blamed (charged as “well poisoners”) and hundreds of Jews were burned alive in the city square. The plague had reduced Mainz from twenty thousand to six thousand inhabitants,10 leaving the Rhinelanders searching for scapegoats and vulnerable to excesses of the church, which was at its peak of corruption.
Gutenberg’s family was involved with the striking of imperial coins in the local mint, and he grew up acquainted with the tools of the trade, including punches, molds, and dies. “The startling conclusion is that Johannes Gutenberg, from his childhood, was in the company of men who could carve a letter in steel that had at least six, and perhaps sixty, times the resolution of a modern laser printer, just at the time that King Sigismund gave Mainz the right to make imperial coins, with a consequent demand for new designs, and new punches.”11
All of the constituent parts needed to craft a printing press were available to a tinkerer in the Rhineland in the early 15th century. Presses, with their massive wooden screws and crank arms, had been used since ancient times to make wine and extract oil, and more recently to squeeze paper dry. Punches were common among craftsmen for making medals, coins, armor, and decorations. Paper had arrived several centuries earlier from China and ink was well known to textile manufacturers. The time was ripe for an innovator who could connect the dots and start a revolution.
Gutenberg grew up in a family of goldsmiths, and would have witnessed the painstaking graving of individual letter punches. It is estimated that it would take a skilled punch-maker an entire day to make a single punch; it would require about three thousand punches for a standard printed page.12 That would require a coterie of ten punch-makers working an entire year to make enough punches to print a single page. “A complete nightmare, economically a nonstarter, totally impractical, ten times worse than working with Chinese.”13 Johannes Gutenberg’s big idea was not moveable type itself, and not even the punch: his breakthrough contribution was the ingenious idea to make a mold and to make the mold reusable.
The fabrication of a recyclable form, or mold, saved breaking the mold every time a letter was cast. Two blocks, in the three-dimensional shape of the letter L were nestled together around the matrix. An iron spring held the divisible form together, and this mitered type had the additional advantage of creating letters that had the same dimensions, thus creating a visually appealing print. The basis of Gutenberg’s media revolution was therefore the process of: punch (patrix), matrix, hand mold, and type. He changed the world—not by “inventing the printing press,” as is commonly concluded—but by inventing a dramatically improved way of rapidly crafting the reusable molds.
Gutenberg was a driven capitalist, but would never profit from his invention. In fact, it appears that he died with little money and scant celebrity. Experimentation with ink, press, and paper continued. Chemicals from gallnuts (bulbs formed on oak trees from wasp larva) were combined with soot, oil, and water to make an ink that was ideal for printing. Paper, and its “sizing” with animal fats, was also modified. Gutenberg and his partners tinkered with the degree of paper dampness, so that a perfectly moistened sheet of paper received well the ink from the punches. It was now time to produce his masterpiece, the printed Latin Vulgate Bible.
In every way imaginable, it is a masterpiece. “Gutenberg would need to match scribal Bibles in beauty and exceed them in accuracy, in two glorious, fat volumes totaling 1,275 pages. There might be a media revolution brewing, but it was essential not to look revolutionary, for otherwise no one would buy.”14 In essence, this was to be presented as a new form of writing, and since medieval scribes were so accurate, it was possible for this new printed book to pass as a magnificent and stately work of scribal art.
Having succeeded at last, with an astounding display of brilliance and perseverance, Gutenberg almost lost everything to his partners and colleagues, only by the skin of his teeth avoiding poverty and obscurity. And having produced one of the greatest publications, he ushered in a revolution—the Reformation—that blew Christian unity apart forever.15
When thinking of the European awakening of intellectual curiosity that started in the 14th century, it is too simplistic to exclusively think of Renaissance artists and their Medici patronage. On a scientific front, the rebirth was characterized by a nostalgia for classical thinking that was in large part fueled by a rediscovery of ancient texts from a most unlikely source.
During the reign of Byzantine Emperor Justinian (527–565 C.E.), no one on earth could have guessed that within a century, the preeminent power in the Mediterranean and near East would arise from within the Arabian Peninsula. Its founder would organize clans and tribes, introduce a new religion, unify the region between the Nile and Oxus under one language, and inspire the preservation of scientific and mathematical knowledge from ancient scholars. The orphaned prophet—who was most likely illiterate16—was born in Mecca, the village that already was a center of religious observation. Today, it is the focal point toward which Muslims face during daily prayers.
At the time of Muhammad’s birth, in 570 C.E., Mecca was already a place of religious pilgrimage owing to the presence of the Black Stone, said to be a meteorite brought by Abraham. Prior to Muhammad’s leadership, an annual truce was declared so that the warring tribes could gather together in Mecca to worship their pagan gods. Importantly, because Mecca was already a point of destination at the time of Muhammad’s birth, the commercialization of the annual pilgrimage had already been developed.
Muhammad exhibited exceptional leadership skills and preternatural genius in unifying his region’s tribes and clans, and in convincing them to abandon their pagan gods. He succeeded in creating the nucleus of the first Islamic society.17 What seems like small-town intrigue centered around a dreamer in the desert would result in a religion and culture that would preserve Greek learning and foster new scientific discovery for centuries.
Islam scholar Seyyed Hossein Nasr has said, “In the same way that the aroma of the frankincense of this land reached the Roman Empire and medieval Europe, the spiritual fragrance of Arabia, holy to Islam, is sensed by Muslims near and far.”18 To further extend the analogy, Islam also infused the world with a curiosity about antiquity, preserved and translated the writings of the ancients, and helped erect the bridge to the Renaissance. The “millennium intervening between the fall of Rome and the scientific revolution was not an intellectual desert. The achievements of Greek science were preserved and in some cases improved in the institutions of Islam and then in the universities of Europe.”19 Another sobriquet for the Arab Peninsula was Arabia Odorifera, and in keeping with the historical use of fragrances to cover up the stench of rotting carrion, the intellectual perfume that emanated from Islamic writers provided some of the only “fresh air” during the Middle Ages.
At the time of Muhammed’s death in 632 C.E., most of Arabia had been organized under his Islamic theocracy. After a few decades of tumult, in which the Sunni and Shia branches were established, the first dynasty—the Sunni Umayyad caliphate—was established in Damascus in 661 C.E. The Umayyads held power for almost a century, and during this time expanded across Northern Africa, Spain, and much of Central Asia. “From the formerly Byzantine lands that they now ruled they began to absorb Greek science. Some Greek learning also came from Persia, whose rulers had welcomed Greek scholars before the rise of Islam, when the Neoplatonic Academy was closed by the Emperor Justinian. Christendom’s loss became Islam’s gain.”20
The Golden Age of Islam began with the overthrow of the Umayyad dynasty by the Abbasid caliphate in 750 C.E. A new town, Baghdad, was built on the Tigris River by the Abbasid rulers and became the largest city in the world. The initial assimilation project by the Abbasids was the incorporation of Persian culture, and the Persians at the time revered Greek culture. As the Abbasid Muslims warmed to Greek philosophy, medicine, and science (if not poetry and drama), they eventually embraced ancient wisdom from other areas as well, including Egypt, China, and India. A flourishing and sophisticated society resulted, with educational and scientific advances across their empire that would serve as the intermediary from the Greek philosophers to the revolutionaries of the early Renaissance.
Al-Mamun (caliph from 813–833 C.E.) sent a delegation to Constantinople to acquire Greek manuscripts, and thus began one of the greatest intellectual transfers in world history; a tradition of translators, beginning with the physician Hunayn ibn Ishaq, and later his son and nephew, translated into Arabic the works of Plato and Aristotle, Galen, Hippocrates, and the mathematical works of Euclid, Ptolemy, and others. Historian Philip Hitti, comparing the staggering growth of wisdom among the Muslim savants to stagnant Europe, has said, “For while in the East al-Rashid and al-Mamun were delving into Greek and Persian philosophy, their contemporaries in the West, Charlemagne and his lords, were dabbling in the art of writing their names.”21
The Golden Age of Arabic learning spanned the 8th to the 13th centuries C.E., and for the first time since Alexander the Great, the vast region was united politically and economically, and the “removal of political barriers that previously divided the region meant that scholars from different regions and ethnic backgrounds could travel and interact with each other.”22 The rise of Arabic science coincides with the spread of Islam from the Pyrenees to Pakistan, and the lingua franca of the day was Arabic, whether the writers were African, Spanish, Persian, or Arabic.
The House of Wisdom, founded by the caliph al-Mamun, became the world’s center of learning. Whereas Alexandria had been the previous intellectual capital, with Greek and Roman manuscripts written on locally sourced papyrus, Baghdad become the new chaperone of philosophical and scientific inquiry, with conversion of all documents into Arabic, scribed on locally manufactured paper.23 One of the early assimilations that occurred at the House of Wisdom was the adoption of Hindu numerals (1–9) as well as the base-ten system and the concept of “zero.” An Arabic system of expressing abstract formulas (to the consternation of high school students everywhere) was introduced by al-Khwarizmi, which he termed al jabr, or algebra. The Abbasid Muslims incorporated the world’s catalog of knowledge, including alchemy, mathematics, science, and law. As Islamic libraries flourished and dwarfed European libraries, the scientific and cultural stagnation of the Western Middle Ages ground on.
The earliest figure in the Arab tradition was Yaʿqūb ibn Isḥāq aṣ-Ṣabāḥ al-Kindī (known as al-Kindi, or in Latin, Alkindus), born in Basra (present day southern Iraq) of noble Arabic descent, and called the “philosopher of the Arabs.” Al-Kindi was a polymath and was critical in translating Aristotle, the Neo-Platonists, and Greek scientists and mathematicians.
One of the most important medieval physicians was a Persian-born scholar named al-Razi (Latin: Rhazes), who was trained in Baghdad. Not confined to translating, Rhazes described smallpox and measles, and critically, was the first to seriously challenge the authority and infallibility of Galen. For instance, Rhazes postulated that fever was merely a defense mechanism and not an issue of humoral imbalance. His contribution was stunning; he was a “thinker explicitly questioning, and empirically testing, the widely accepted theories of an ancient giant, while making original contributions to a field.”24
Another Persian-born Arabic speaker was ibn Sina (known as Avicenna, 980–1037 C.E.), widely considered the greatest physician since Hippocrates. Avicenna claimed to have memorized the Koran by age ten, and was a polymath, writing prodigiously on philosophical, scientific, and medical topics. He famously published The Canon of Medicine, a compilation of medical knowledge in a massive multivolume work that was later translated into Latin and would be a classic in the West for centuries. The Canon of Medicine was the main textbook throughout European medical schools (Montpellier, Bologna, Paris), even into the 17th century.25 “Lecturing in 1913, Sir William Osler described Avicenna as ‘the author of the most famous medical textbook ever written.’ Osler added that Avicenna, as a practitioner, was the prototype of the successful physician who was at the same time statesman, teacher, philosopher, and literary man.”26 Avicenna, “the fountainhead of authority in the Middle Ages,”27 was perhaps the greatest ambassador from the rich cultural enlightenment of the Islamic world.
Three thousand miles to the west of the House of Wisdom lay Andalucía, modern day Spain, which the Muslims termed al-Andalus. While eventually collapsing in 1492, Muslim rule in Spain had enveloped the Golden Age of Islam, and had precipitated vast cultural, scientific, linguistic, and architectural traditions that exist to this day.
Abu al-Qasim al-Zahrawi, also known by his Latin name Albucasis, (936–1013 C.E.) was born and raised near Córdoba (he descended from the Ansar tribe of Arabia), and is regarded as the greatest surgeon of the Middle Ages. “Because surgery was less burdened than other branches of medicine by ill-founded theory, [Albucasis] sought to keep medicine separate from philosophy and theology.”28 Al-Tasrif (completed about 1000 C.E.) was the result of almost fifty years of medical practice, and contained the earliest pictures of surgical instruments in history. For over five hundred years, his encyclopedia of surgery was the standard reference in the universities of Europe. Albucasis stated, “Whatever I know, I owe solely to my assiduous reading of books of the ancients, to my desire to understand them and to appropriate this science; then I have added the observation and experience of my whole life.” If Albucasis scribed his eminent work in Arabic, how did it find its way into Latin?
Constantinus Africanus (Constantine the African) was born ca. 1020 in Kairouan, Tunisia, a city near the Mediterranean coast that had become one of the great centers of Islamic scholarship. Constantine studied medicine first in Tunisia, but traveled extensively (startling, for his time) to Baghdad, Syria, India, Ethiopia, Egypt, and Persia. While making his way back to Carthage (present day Tunis), Constantine passed through Salerno, Italy (near Naples), which, at the time, was considered the leading center of medical teaching in Europe. Unimpressed, Constantine returned to Tunisia, likely expecting never to return to Salerno. However, within a few years, he was suspected of sorcery and sent into exile. An avid book collector, Constantine the (Muslim) African brought with him his treasure trove of Arabic translations of classical Greek works, Islamic medical tomes, advanced international medical training, and his facility for many languages.
Constantine synthesized (at times, freely plagiarized) Arabic medical knowledge and finished a number of medical books in Latin, including treatises of surgery, prognostics, medical practice, the urinary tract, gastrointestinal disease, and medical instruments. His best known and most voluminous work was the Liber pantegni, the first fully comprehensive medical text in Latin.29 By the time that Constantine was working on the Pantegni, he had converted to Christianity and was a Benedictine monk at the Monte Cassino monastery (between Naples and Rome), and he would spend the last decade of his life on his project of rendering medical textbooks in Latin.
Constantinus Africanus represents the change that was occurring in the world: a Mediterranean Muslim, convert to Christianity, who translated Arabic works into Latin presaged the return of Italian provinces to Christian control, the ascendancy of Latin scholasticism, and the domination of the West in medical education. Salerno would become known as the “first medical school in the world” (Greeks, Egyptians, and Arabs would contest this claim), and some would describe Constantine as the Muslim who ignited the Renaissance.
The second major figure in the translation movement was Gerard of Cremona (1114–1187 C.E.). While Constantine was an outsider who brought his external works and languages into Latin culture, Gerard was an insider (born in Cremona, Italy, the same city that gave us the Stradivarius) who left Italy for Toledo, still under control of the caliphate of Córdoba. Toledo was a city full of manuscripts and libraries, with ancient classics in Arabic and the newer works of the great Albucasis.30 For the next forty years, Gerard translated treatises on mathematics, algebra, astronomy, philosophy, and medicine. It may be possible that a “second” Gerard of Cremona was active in medical translation; schools of translation were common, and when it comes to scholarly works of antiquity, many authors usually contributed. “Gerard’s translation of the Great Arabic medical encyclopedias like Avicenna’s The Canon of Medicine opened the eyes of medical scholars in the West to the fact that medicine was a rational science that could be studied logically and methodically, which had a sound foundation in philosophy and the natural order.”31
The combined work of Constantine and the translators in Toledo sparked an interest in learning that been in hibernation throughout Europe for a millennium. The popularization of paper by the Muslims, combined with sourcebooks—now in Latin—fueled an intellectual awakening. For the thousand years that spanned the codex as the standard manuscript format until the 15th century, all Western books were copied by hand.32 Scribes would often gather at a monastery’s scriptorium, where copying of religious texts occurred under close supervision of a chief calligrapher. Until Gutenberg’s innovation, book production remained exceptionally tedious and costly, but the mechanization of book production dramatically unlocked the ability to disseminate new ideas.
“The Renaissance was one of those few historical periods that discovered itself, rather than being defined by hindsight.”33 It would have been obvious to any curious soul that it was an era of unique access. The connectivity that pulsed through Europe exposed the great minds to classic works and the insights of other savants. In turn, mutual access to the cognoscenti inspired discussion, fueled dissent, and triggered widespread criticism of authorities.
The slow dissemination of information from master to apprentice was permanently altered in the 15th century. The foundations of medicine and surgery were built by Hippocrates and his followers 2,500 years ago; Galen expanded upon these writings in the early Christian era, but his authority was little challenged in Europe and only slightly meaningfully in the Islamic House of Wisdom. The work of Latin translators and the introduction of paper energized scholasticism and prompted the rise of universities in Salerno, Bologna, Padua, Paris, Montpellier, and Oxford. And in the mid-1400s, just as Constantinople fell to the Turks and churches were converted into mosques, the printing press unleashed a torrent of insights, observations, astrological tables, philosophical ponderings, religious arguments, political criticism, and thoughts about the human body—its form, function, and malfunction—and when surgery might work. The world’s first great printed medical textbook would be lovingly produced in 1543 by a genius, age twenty-nine, and it would change medicine, and the world, forever.