Dealing with translations of translations

In 1982 an article tracing the evolution of the clinical trial was published in the Bulletin of the History of Medicine (Lilienfeld 1982). This article has been a useful source of several of the records included in the James Lind Library. One of these is the quotation of a passage from the writings of the 14th century Italian poet Petrarch in which the design of a controlled clinical trial is clearly conceptualised. However, a British science journalist, Robert Matthews, recently suggested that some key elements of this conceptualisation had been omitted both from the image of the facsimile of the manuscript in the James Lind Library and from the translation of the key passage. The current article investigates the history of successive versions of the key passage, shows how the English translation came to be incomplete and inaccurate, and provides a new English translation and interpretation of the key passage.

Petrarch was famously a relentless critic of physicians. Following the great plague of the mid-fourteenth century, Petrarch became bitterly critical of doctors and all their works. An exchange of letters with Pope Clement VI in 1351, when Petrarch advised him to avoid consulting doctors during his illness, and the response of one of the Pope’s physicians in 1352, led to Petrarch’s composing in 1353 his most famous and extended attack, the four books of the Invectiva contra medicum. This may be translated either as ‘An attack on a doctor’ or as ‘An attack on medicine’. Modern references to this work sometimes abbreviate the more complete titles given in earlier sources; for example, in the version of the collected works published in Basel in 1554 and 1581, the title is Invectivarum contra medicum quendam Lib IIII; that is ‘Four books of attacks against a certain doctor’ (my italics). In his subsequent writing, Petrarch insisted on the distinction saying that he was not attacking medicine but rather its practice by particular physicians. But this claim conceals more than it reveals. For details see modern scholarly analyses of the Invectiva – for example Struever 1993; Trone 1997; Quillen 1998; Carlino 2005; Wallis 2010; Park 2014.

Siraisi (2001) says: ‘In the Contra medicum Petrarch deployed his unparalleled mastery of Latin rhetoric in a stream of vituperation. In particular, medicine is repeatedly attacked for its pretensions to rhetorical and philosophical learning, although it is allowed a modest place as a mechanical art.’ Petrarch elevated moral over natural philosophy and, as a consequence, poetry and rhetoric as both more effective and more desirable occupations than were efforts to influence the course of nature by mechanical manipulation.

By this time in his life, Petrarch was collecting his correspondence into books, on the model of the letters of Cicero and, between 1361 and 1373, he collected what became a book of the correspondence of his old age. The book appeared in manuscript then in various printed editions with a variety of titles. In the first printed edition, that of 1501 (Petrarca 14th century), it is called Epistole rerum senilium. C.xxviij. divise in libris xviii ‘Letters concerning matters of old age. 128 [letters] divided into 18 books’. In the Basel edition of 1581 (Petrarca 14th century) it is Epistolarum de Rebus Senilibus, Libri XVI. ‘Sixteen books of letters concerning matters of old age’. In more modern times the title is often given simply as Seniles, the title I shall use here. As the titles suggest, the collections are not uniform in their content or in the numbering of the letters. For the avoidance of doubt, the letter of interest here is the third letter in the fifth book of both the collection published by di Asola in 1501 and the manuscript Biblioteca Marciana Lat. XI, 17 / Francesco Petrarca, which was reproduced in facsimile in 2003 (Petrarca 14th century). In the latter, a note in the left margin in a later hand labels the letter Lib IV ep. 4, but, in the manuscript, it is the third letter of the fifth book as can easily be verified.

Against this background we now turn to this third letter of the fifth book of the Seniles which was addressed to Giovanni Boccaccio, a fellow poet. The printed editions have short titles summarising the content at the head of each letter which differ across the editions and were presumably added by the editors; that in the 1501 edition is: Ad eundem de audacia et pomposa medicorum habitum ‘To the same [i.e. to Boccaccio to whom the preceding two letters were addressed] on the proud and presumptuous behaviour of physicians.’

The letter was occasioned by Boccaccio’s having written to Petrarch some time earlier – Petrarch cannot now recall when – to say he had been ill but had recovered ‘….by the grace of God and with the help of a doctor.’ Petrarch had replied expressing his astonishment that his friend should hold with such a common error and insisting that it was the Grace of God and his sound constitution that had cured him and that the physician had done nothing – indeed, ‘had the power to do nothing beyond the ability of a chattering gossip with nothing to do but waste time and no cures to offer’. But now Boccaccio has replied to Petrarch’s letter and Petrarch is no longer astonished at his recovery because now he has been told that ‘during your illness you by no means had recourse to a physician’. The letter continues over pages, denying the usefulness, competence and sometimes the honesty of doctors and saying that, if they are ill, they are not so foolish as to follow their own remedies.

In the course of this diatribe Petrarch calls as witnesses a few doctors and cites their admissions about the ineffectiveness of their remedies. It is one of these witnesses that has been quoted as an early example of division of a collection of similar patients suffering from the same disease into two equal groups to be exposed to different regimens of treatment – or non-treatment – and the outcomes compared.

Given Petrarch’s famously low opinion of the practice of medicine we may wonder whether the ‘famous doctor’ whose opinion is quoted in the letter was real or was a fiction – a rhetorical device to give weight to Petrarch’s own opinion by putting it in the mouth of a physician who enjoyed a good reputation among his professional peers. Since, at present, I do not know how this question could be resolved I shall continue to write as though the doctor and his opinion were real, but the reader should bear in mind that we cannot be certain whether we are hearing the view of a real physician or only that of Petrarch himself.

The manuscript in the Biblioteca Marciana in Venice

The following details are abbreviated and summarised from the introductory notes of Susy Marcon to the facsimile edition of the Seniles (Seniles, 2003 pp. XXIII – XXVIII). An enlarged image of the relevant section of the letter is reproduced on the James Lind Library website.

The manuscript of the Seniles in the Marciana Codex Lat. XI 17 is written by at least two different hands on paper dating from the end of the 14th or beginning of the 15th century. Its origin is probably from the region around Verona. The first hand, up to and including folium 3 recto, would appear to be that of a professional copyist writing a late, small, formal Italian gothic rotunda (a script whose letters are more rounded than in other contemporary formal writing) on paper ruled with silverpoint in two columns. Initial capitals of the first part are decorated in colour (rubricated). The text from folium 3 verso to the end is written in a regular gothic script, a small Italian bastarda (a variety of small, cursive – ‘joined-up’ – handwriting). It is probably the work of a single hand, on unruled paper with some ornamentation to the initial capitals added by one or more additional hands in black ink. From its writing and other characteristics, this manuscript may be a personal copy from the time that Petrarch’s manuscripts were being organised and diffused among Venetian humanist circles about a quarter of a century after the poet’s death.

The source of the quotation as it has been used by modern writers

The passage is quoted by Lilienfeld in his 1982 article on the origins of clinical trials. He gives the text taken from an English translation published in 1889 of an earlier French work, but abbreviates it. Here I give the whole passage from Lilienfeld’s source (Minor 1889) for reasons which will appear. I have put in italic the words which Lilienfeld omitted:

I once heard a physician of great renown among us express himself in the following terms: “I cannot ignore the fact that I shall be treated as an ingrate if I lied in regard to an art by means of which I have acquired riches and many friends, but truth should be placed above all affection. I solemnly affirm and believe, if a hundred or a thousand of men of the same age, same temperament and habits, together with the same surroundings, were attacked at the same time by the same disease, that if the one half followed the prescriptions of doctors of the variety of those practicing at the present day, and that the other half took no medicine but relied on Nature’s instincts, I have no doubt as to which half would escape”

The antecedent French version

The title page of the English book from which Lilienfeld derived his quotation, ‘The evil that has been said of doctors’ (Minor 1889) announces the work as a compilation of material translated by ‘T.C. Minor, M.D.’ from a French work published five years earlier ‘Le mal qu’on a dit des médecins’ by ‘Dr S. J. Witkoski’. The title of the French book is correct, but its author was G-J Witkowski (Witkowski 1884). As far as our letter is concerned, Witkowski gives an accurate translation of a text which is consistent with that of the Latin of the Basel Opera omnia of 1581. But he does not reveal either the source or its translator. However, the English translation of Witkowski’s French version is much less than competent, as we shall see.

Unfortunately, there is no modern scholarly critical edition of the Latin text of the Seniles so one must rely upon early printed texts or transcribe the manuscript source. Best would be to do both and compare the results to establish, as far as possible, the most reliable text, and this is what I have done. The best printed text is believed to be the earliest, printed in Venice for, and published in 1501 by, Torresino di Asola, father-in-law and surviving partner of Aldus Manutius. A larger collection of Petrarch’s works was published in Basel in 1554 with another edition of the same text in 1581. I am grateful to Dr Teresa Webber, Reader in Palaeography and Fellow of Trinity College in the University of Cambridge, for transcribing all of the relevant passage of the manuscript text for me.

Comparison of the printed texts of 1501 and 1581 with the transcription of the passage from the manuscript reveals that the 1501 printed text and the manuscript text of the passage are very similar but not identical; also, in the Latin edition of 1581 five words are missing from the last sentence. It also becomes apparent that the competent French translation in Witkowski (1884) must be from a Latin text that does not include these five words. As a consequence, the French translation and the derivative English version also take no account of them. As we shall see, their omission portrays the ‘famous doctor’s’ pronouncement as much less specific than it was in the manuscript.

Here is the Latin text of the 1501 printed edition with abbreviations expanded and the words missing from the 1581 printed edition of the text in bold underlined:

…. Deum ac memoriam meam testor, audisse me olim Medicum magni apud eos nominis sic dicentem: Ego aiebat non ignoro, me ingratum dici posse, detrahentem arti, unde mihi opes atque amicitias quaesiui, ueritas tamen cunctis affectibus praeferenda est. Itaque sic sentio, hoc affirmo, si centum aut mille homines, unius aetatis ac naturae, et unius uictus, uno simul omnes morbo correpti essent, eorumque pars dimidia consilio utetur Medicorum, talium quales habet aetas nostra, alia uero sine ullis Medicis, naturali instinctu et propria discretione se regeret, nulla mihi dubitatio est, quin ex illis plures morerentur plures ex istis euaderent.

Differences between the manuscript and the printed edition of 1501

The 1501 printed text of the last sentence which describes the first half of the group being advised by doctors runs: pars dimidia consilio utetur Medicorum, talium quales habet aetas nostra ‘half follows the advice of Doctors such as our age has….’. This presents no problems. But the corresponding text in the Marciana manuscript is: pars dimidia consilio verteretur. Talium quales habet etas nostra. This text translates as ‘half turns to the advice. Such as our age has….’ which does not make sense. (The spelling etas for aetas is a mediaeval variant and is trivial). It seems certain, then, that the scribe who wrote the Marciana manuscript omitted a word since, as it stands, there is no noun to which talium quales can refer. From the grammar, it would seem that a genitive plural noun is required (to agree with talium). If we suppose the word to be Medicorum, inserted after the verb verteretur and the period removed, we have ‘half turns to the advice of Doctors such as our age has…’ which means essentially the same as the printed text of 1501. Of course, we do not know the source of the text used for Torresino di Asola’s edition of 1501 and whether it contained Medicorum, or whether an editor inserted this word which could reasonably be guessed from the context. In either event, it seems reasonable to emend the transcription from the manuscript to ‘pars dimidia consilio verteretur Medicorum talium quales habet etas nostra...’ It is then unimportant to the sense whether we choose the manuscript verteretur or the printed utetur as the verb. I have preferred to use the manuscript version since it is the earlier of the two available to me.

Here, then, is a new English translation of the emended transcribed text of the letter. Petrarch speaks first, followed by the reported direct speech of the physician:

… I give God and my own memory as witness that I once heard a Physician of great reputation among them [other doctors] speaking thus: ‘I’, he declared, ‘am not unaware that I may be said to be ungrateful in denigrating that art from which I have sought wealth and friendship; but truth is to be preferred to all affections. Therefore, this is my opinion and thus do I affirm: if one hundred or one thousand men, of the same age and character and [eating] the same diet, one and all affected by the same disease, one half shall turn to the advice of Doctors of the kind that there are in our time, and the other [half] without any Doctors shall follow natural instinct and their own discernment then I have no doubt that of the former [half] many shall die and of the latter [half] many shall escape’.

Why the five words, in bold in the Latin text above, were omitted from the later printed text is, of course, unknown but it may be significant that the passage remains grammatically correct without them, and still makes sense, so their omission would not be obvious to anyone who did not have the complete (earlier) text in front of them.

The 19th century English ‘translation’ is inaccurate

An error in the first sentence of the English version struck me at once; the English speaks of ‘a physician of great renown among us…’ (my emphasis) but the Latin says, quite clearly, ‘… among them…’ (…apud eos..). Let us pursue this. The sentences that Petrarch wrote were (see also standardised text above)

Deu[m] ac memoria[m] mea[m] testor. Audisse me olim medicu[m] magni ap[ud] eos, no[min]is sic dicentem.

‘I give God and my memory as evidence, I once heard a doctor, [of] great reputation among them, speaking thus.’

So the doctor was one of the great – renowned if you will – not among Petrarch and his friends but among other doctors. The phrase might also be translated ‘of great reputation in their opinion’ (see also the lengthy entry on meanings of apud in Lewis and Short, 1879). What is not in doubt is that the good reputation of the physician was among his fellow doctors. The English ‘translation’ misleads us about this, making the doctor renowned in the opinion of his audience and not of his peers.

The use of the present participle in the phrase … sic dicentem ‘speaking thus’ is consistent with the actual presence of Petrarch as a listener. We have already seen that the English ‘translation’ is, itself, a translation from an earlier work in French, ‘Le mal qu’on a dit des médecins’. Examining this, we find that the French author has correctly translated from Petrarch’s Latin the sentence about the doctor who spoke to Petrarch and his companions. The English translator subsequently mistranslated the accurate French.

Continuing, the next sentence of the English version seems odd; the doctor says he may be treated as ungrateful if he lies about his art; but, reading on, he clearly does not lie – quite the opposite, he tells the (disagreeable) truth about it. According to the manuscript, Petrarch wrote:

[Ego] aiebat no[n] ignoro me i[n]gratum dici posse, detrahentem arti unde michi opes atque amicitias quesi[vi] … (see also standardised text above)

‘I’ he affirmed “I am not unaware that it is possible that I shall be said to be ungrateful in denigrating the art from which I have sought wealth and friends….”’

We see that the manuscript has Ego struck out but the sixteenth-century printed texts retain it (see Figure 1 line 3 and Figure 2). The previous sentence finished ‘…sic dicentem’ ‘…speaking thus’ so, logically, it should be followed immediately by the direct speech in the first person. Ego (I) would be appropriate here.

But, for some reason, it seems that Petrarch chose to remind his reader again that he is about to quote direct speech by inserting aiebat ‘he said’ or, better, ‘he affirmed’ or ‘he declared’ followed by the direct speech in the first person. It may well be that the scribe-copyist writing the Marciana manuscript was struck as he wrote by the unexpected verb aiebat, ‘he declared’, and responded by striking out the Ego he had just written. The later sixteenth-century editors dealt with this apparent change of mind very neatly by inserting brackets round aiebat making it an interjection in the direct speech : ‘I’ (he declared) ‘am not unaware that…’. If we now look at the French version we see that the translator into French has elided the hesitation between two styles and simply passed straight from ‘dicentem’ to ‘non ignoro’ ‘...s’exprimer en ces termes: “je n’ignore pas.…”’. No information is lost by this but the sense of immediacy in the letter – of the reader’s presence at Petrarch’s elbow – is no longer there. The French translation continues, relating, accurately, that the doctor believes he may be treated as ungrateful…. si je médis de l’art … ‘if I speak ill of the art’ a perfectly good rendering of detrahentem arti. However, the English translator then turns the correct French rendering into nonsense by mistranslating the French verb médir as ‘lie’; it does not mean to lie, but to speak ill of.

So the English version, by mistranslating the (correct) French translation of Petrarch’s Latin, makes nonsense of the doctor’s reason for believing he may be thought ungrateful by linking it to his lying about, and not to his denigration of, the art of medicine which has been profitable to him.

Continuing to compare the English version with the Latin we find all goes well enough down to the group who follow the doctor’s advice, except that the English speaks of ‘habits’ where the Latin – and the French, translating correctly, are more specific, ‘diet’. But, then, for the other group it says: ‘… the other half took no medicine but relied on Nature’s instincts’ The Latin, however has ‘…naturali instinctu et propria discretione se regeret….’: ‘were to conduct themselves by natural instinct and their own discretion…’.The guiding instincts are not those of a personification of wise Nature but simply the untutored instincts of the patients themselves. Perhaps, in the end, this amounts to much the same thing. But the Latin gives specific credit both to Nature – the ‘natural instinct’ – and to the patient’s own wisdom and his voluntary choice. The patient’s voluntary contribution – presumably how he chose to treat himself – is missing from the English version. The French version, as usual, translates competently and expands perceptively, spelling out the patient’s active contribution ‘… se laissassent seulement guider par l’instinct naturel et se traitassent comme ils l’entendraient.. .’ Once again, the English translator produces a much less than competent version of a competent intermediary.

Now, everyone’s conclusion from the French and English translations is that, by saying he knew which group would survive, the ‘famous doctor’ meant that it would be those who avoided medical advice. Without questioning the correctness of this conclusion it is worth pointing out that the passage in English as quoted by Lilienfeld does not provide any evidence at all that this was the famous doctor’s view. Until now, this conclusion could be drawn only from the context of the rest of the letter. Of course, Lilienfeld was concerned with the methodology of the comparison using equal numbers of similar patients treated in two different ways rather than with the supposed outcome, but he diminished the credibility of his source by not describing the context of the assertion and omitting part of the ‘famous doctor’s’ speech.

But now that we have an accurate transcription of the text of Petrarch’s letter we see that the previous translators were working from an incomplete text. We need make no assumptions or interpretations; the famous physician gave his clear opinion – that many of those who trusted doctors would die and that many of those who avoided them would escape death.

The moral

If there is a moral, it is to beware of translations of translations and of separating a quotation from its context. Even printed texts of impeccable pedigree – Erasmus, among other scholars, commended the Basel editions of Petrarch published in 1554 and 1581 – may not always faithfully reproduce the original manuscript sources, as we have seen in our example.

The safest course is to follow the advice William Harvey gave John Aubrey in the seventeenth century (Dick 1962). Aubrey quotes Harvey’s advising him in another context to ‘goe to the Fountain head…..’ Following the twisting path to a source may be difficult but one is sometimes rewarded at the end by a clearer view of the spring water.

Acknowledgements

The editors of the James Lind Library and the author are grateful to:

Marina Davoli at the Department of Epidemiology Italian National Health Service, Local Health Unit, Rome E, and Gaetana Cognetti at the Regina Elena National Cancer Research Institute Library for initiating the search;

Paolo Flores D’Arcais, philosopher, and Director of “MicroMega”, an Italian cultural, political, scientific and philosophical magazine, for identifying the document;

Franco Nasella of the biomedical library at the University of Tor Vergata, Rome for locating a copy of the document;

Dott.ssa Daniela Scialanga, of the Biblioteca Angelica, Rome, for providing a photocopy of the facsimile text; and

Dr Teresa Webber, Reader in Palaeography and Fellow of Trinity College in the University of Cambridge, for transcribing the relevant passage in the manuscript.

This James Lind Library article has been republished in the Journal of the Royal Society of Medicine 2016;109:347-353. Print PDF

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