Review Article | 1 Copyright © University of Medicine, Tirana AJMHS Vol. 48 (1/2): 1-7 © 2017 Address for correspondence: Gentian VYSHKA, Biomedical and Experimental, Department Faculty of Medicine, University of Medicine in Tirana, Albania. E-mail: gvyshka@gmail.com Abstract The Divine Comedy of Dante Alighieri, and its initial part of Inferno, includes several medical terms and descriptions, whose accuracy sometimes overcomes that of a layman. The genial poet has used locutions illustrating pain and sorrow more than forty times in Inferno alone, with words like dolor, dolente and doloroso, that have caused perplexity among translators. The panoply of translations – here we are dealing only with the English versions – will prove that not only the contextual meaning but also the historical setting might create interpretative difficulties. Without obviously giving medical value for granted to all verses that include words like dolor and its derivates, however Dante's work has been as well under the focus of medical scholars, with many publications of interest. Through comparing the original text mainly with the Oxford's English version, we have tried to bring into the reader's attention the painful sensations that Dante abundantly inflicted upon his characters, as an indirect way to test the poet's perception of this strange and infernal sensation. Keywords: pain, Inferno, Alighieri, neuropsychiatry Medical Humanities: Pain and Infernal Pain in the Verses of Dante Alighieri Gentian Vyshka Biomedical and Experimental Department Faculty of Medicine, University of Medicine, Tirana, Albania Vyshka G. et al. Medical Humanities: Pain and Infernal Pain in the Verses of Dante Alighieri 2 AJMHS Vol. 48 (1/2): 1-7 © 2017 INTRODUCTION The Divine Comedy, a sublime poem comprising several thousand verses, was written by Dante Alighieri in the remote years of Middle Age, as a representation of the author's journey through the Inferno, Purgatory, and Paradise. As with all other renowned authors whose work and geniality pertains to all times and humanity, Dante's work has been studied in details since its publication, and such a study will probably never stop. Medical doctors and health scholars have had their say as well, and this is not the first writer or poet to come under such an attention, with Shakespeare probably being on the top of the list. There have been several authoritarian publications, with medical scholars picking up inside Dante's verses details and descriptions of diseases and medical occurrences of a large variety. For example, elements and depictions from conditions such as of epilepsy, narcolepsy, melancholia and musculoskeletal disorders – just to remain within the range of neuropsychiatry – have come into attention (1-5). To add more, even cardiac disorders, syncope and autonomic dysfunctions might have been mentioned in the universal work of the poet (6-8). Recently another source suggested Dante's referring on liver disease as well (9). PAIN IN DANTE'S INFERNO: DOLOR OR NOT DOLOR Dante uses the words dolor (pain), dolente (painful), doloroso (grieving) more than forty times in Inferno alone (without extending the search into the two other parts of the Divine Comedy, namely Purgatory and Paradise). Our search has been based upon the original version, with one from the hundreds editions available, published 1991 from Marco Derva Publishing House in Italy (10). There is a diversity of English translations; we have based our search on the version published from Oxford University Press (11). In the table below we have numbered all verses of Inferno where the locutions of interest were found, and in the left column the original verse in Italian is copied; the right column of the table contains the English translation as of the Oxford publication (11). Obviously, many of the verses cannot be understood only within the large context of the entire poem, or at least of the Canto pertaining to; however, since philology is a discipline per se, our scope was limited into but a few cases where dolor as pain and dolor as sorrow has apparent neuropsychiatric echoes. Exactly in these cases we have not included merely the verse with the words of interest, but the entire tercet (in the Dante's terzina the lines rhymed in a b a pattern). 3 Vyshka G. et al. Medical Humanities: Pain and Infernal Pain in the Verses of Dante Alighieri AJMHS Vol. 48 (1/2): 1-7 © 2017 Table 1. Verses from Inferno with words 'dolor' and its derivates Italian original (Alighieri) Inferno, quote English translation (Durling) Vedrai li antichi spiriti dolenti... Canto I, verse 116 Will see the ancient suffering spirits... 'Per me si va ne la città dolente'... Canto III, verse 1 Through me the way into the grieving city... Per me si va ne l'etterno dolore... Canto III, verse 2 Through me the way into eternal sorrow... Che tu vedrai le genti dolorose / c'hanno perduto il ben de l'intelletto... Canto III, verses 17-18 Will see the grieving peoples / who have lost the good of the intellect... Parole di dolore, accenti d'ira... Canto III, verse 26 Words of pain, accents of anger... De la valle d'abisso dolorosa... Canto IV, verse 8 Sorrowful valley of the abyss... E tanto più dolor, che punge a guaio... Canto V, verse 3 But so much more suffering that it goads the souls to shriek... O tu che vieni al doloroso ospizio... Canto V, verse 16 O you who come to the dolorous hospice... Or incomincian le dolenti note... Canto V, verse 25 Now the grief-stricken notes begin... Menò costoro al doloroso passo! Canto V, verse 114 Led them to the grievous pass! E quella a me: «Nessun maggior dolore / che ricordarsi del tempo felice / ne la miseria; e ciò sa 'l tuo dottore... Canto V, verses 121-123 And she to me: "There is no greater pain / Than to remember the happy time / in wretchedness; and this your teacher knows. Pigliando più de la dolente ripa... Canto VII, verse 17 Taking in more of the sorrowing bank... Chi m'ha negate le dolenti case! Canto VIII, verse 120 Who has denied me the sorrowing houses? Cigne dintorno la città dolente... Canto IX, verse 32 Girds the grieving city all about... Si fan sentir coi sospiri dolenti? Canto IX, verse 126 Who make themselves heard with anguished sighs? Li frodolenti, e più dolor li assale... Canto XI, verse 27 The fraudulent ...greater pain assails them... Che fé Cicilia aver dolorosi anni... Canto XII, verse 108 Who gave Sicily such grievous years... L'Arpie, pascendo poi de le sue foglie / fanno dolore, e al dolor fenestra... Canto XIII, verse 101-102 The Harpies, feeding on its leaves/ give it pain and a window for the pain. Poi sen portar quelle membra dolente... Canto XIII, verse 129 Then they carried off those suffering members... Soffi con sangue doloroso sermo? Canto XIII, verse 138 Puff out with blood your sad speech? La dolorosa selva l'è ghirlanda... Canto XIV, verse 10 The grieving wood is a garland around it... Tale scendeva l'etternale ardore / onde la rena s'accendea, com' esca / sotto focile, a doppiar lo dolore... Canto XIV, verses 37-39 So the eternal burning was coming down / and the sand caught fire, like tinder beneath / the flint, to double the suffering. Sarebbe al tuo furor dolor compito... Canto XIV, verse 66 Would be suffering of a measure with your fury... Vyshka G. et al. Medical Humanities: Pain and Infernal Pain in the Verses of Dante Alighieri 4 AJMHS Vol. 48 (1/2): 1-7 © 2017 Ne' quali 'l doloroso foco casca... Canto XVII, verse 53 On which the painful fire falls down... E per dolor non par lagrime spanda... Canto XVIII, verse 84 Who does not seem to be shedding any tears for the pain... Ch'e' fanno ciò per li lessi dolenti... Canto XXI, verse 135 They are doing that for the sufferers in the stew... Barbariccia, con li altri suoi dolente... Canto XXII, verse 145 Curly Beard, grieving with his fellows... Quant' i' veggio dolor giù per le guance? Canto XXIII, verse 98 Whose great pain ... trickling down your cheeks... Pur el pareva dal dolor trafitto... Canto XXVII, verse 12 Still it seemed transfixed with pain... Oh me dolente! come mi riscossi... Canto XXVII, verse 121 Oh wretched me! How I trembled... La fiamma dolorando si partio... Canto XXVII, verse 131 The grieving flame departed... Di Puglia, fu del suo sangue dolente... Canto XXVIII, verse 9 ...Apulia, groaning poured forth their blood... Quand' avem volta la dolente strada... Canto XXVIII, verse 40 Once we have circled through the suffering road... Qual dolor fora, se de li spedali... Canto XXIX, verse 46 What the suffering would be, if the sick from the hospitals... Del mar si fu la dolorosa accorta... Canto XXX, verse 19 Of the sea, going mad, she barked like a dog, her grief had so twisted her mind. Tanto il dolor le fé la mente torta... Canto XXX, verse 21 Dopo la dolorosa rotta, quando... Canto XXXI, verse 16 After the dolorous rout... Eran l'ombre dolenti ne la ghiaccia... Canto XXXII, verse 35 The grieving shades, livid, were in the ice... Disperato dolor che 'l cor mi preme... Canto XXXIII, verse 5 ...Desperate grief that already presses my heart... Nel doloroso carcere, e io scorsi... Canto XXXIII, verse 56 Our dolorous prison, and I perceived... Ambo le man per lo dolor mi morsi... Canto XXXIII, verse 58 Both my hands I bit for rage... Poscia, più che 'l dolor, poté 'l digiuno... Canto XXXIII, verse 75 Then fasting had more power than grief... Lo 'mperador del doloroso regno... Canto XXXIV, verse 28 The emperor of the dolorous kingdom... Sì che tre ne facea così dolenti... Canto XXXIV, verse 57 So that he made three suffer at once... DISCUSSION It is obviously not a simple duty to translate the dolor of Dante, whose variegate shapes mirror the extraordinary genius of the author. Dolor for Latin speaking people and for the lately derived languages has in fact a diversity of meanings, and not strictly reflecting somatic suffering 5 Vyshka G. et al. Medical Humanities: Pain and Infernal Pain in the Verses of Dante Alighieri AJMHS Vol. 48 (1/2): 1-7 © 2017 alone. Italian authors, departing from the absolute advantage of native speaking scholars, have already explained that (12). In fact, a short overview of the Tab.1 will show how difficult has been for the translator to converge his translating terms over the dolor and dolente: he has been using diversity of words, such as suffering, grief, grieving, sorrow, griefstricken, grievous, anguished, wretched, groaning, rage; and rarely the more direct terms of pain or dolorous, a mot-à-mot translation of doloroso (painful). Right from the beginning of our discussion, we need to acknowledge immense difficulties into approaching the issue. First of all, translations will not strictly albeit unfairly represent the original work in its entirety. Second, we are dealing with a text written more than six centuries before, and whose exegesis is an art per se, far from being a medical discipline. Third, it would be exaggerated, overzealous or even naïve to assign medical value to every word that Alighieri has been using in a certain context, be that dolor, pain, or whatever derives from. Fourth, even scholars dedicated to Dante's universe have difficulties into achieving unanimous conclusions; we might illustrate the issue with the questioning on the veracity or fictional nature of Count Ugolino's cannibalism, an issue debated from scores of authors (13). However we need to focus over some locutions of a certain medical significance, among more than forty quotes summarized in Tab. 1. For instance, Dante understands pretty well that pain might be unrelenting: he speaks about eternal pain (etterno dolore; translated as sorrow). Furthermore, in two cases he underscores the ability that pain has to produce confusion if not Table 2. Unbearable pain and state of mind Entire tercet, Italian Quote English translation (Longfellow) Noi siam venuti al loco ov' i' t'ho detto / che tu vedrai le genti dolorose / c'hanno perduto il ben de 1'intelletto. Canto III, verses 16-18 We to the place have come, where I have told thee / Thou shalt behold the people dolorous / Who have foregone the good of intellect. Del mar si fu la dolorosa accorta / forsennata latrò sì come cane / tanto il dolor le fé la mente torta. Canto XXX, verses 19-21 Of ocean was the dolorous one aware / Out of her senses like a dog she barked / So much the anguish had her mind distorted. Table 3. Alighieri vs. Melzack: the window theory (Canto XIII, verses 100-102) Original version (10) First translation, Durling (11) Second translation, Longfellow (14) Surge in vermena e in pianta silvestra; l'Arpie, pascendo poi de le sue foglie, fanno dolore, e al dolor fenestra. It grows into a shoot, then a woody plant; the Harpies, feeding on its leaves, give it pain and a window for the pain. It springs a sapling, and a forest tree; The Harpies, feeding then upon its leaves, Do pain create, and for the pain an outlet. Vyshka G. et al. Medical Humanities: Pain and Infernal Pain in the Verses of Dante Alighieri 6 AJMHS Vol. 48 (1/2): 1-7 © 2017 making people getting out of their mind: Tab.2 summarizes the tercets integrally. The most emotional episode will nevertheless be spared for one of the last Cantos of the Inferno; when Dante narrates the horrible starving of Count Ugolino and his children in the Canto XXXIII. Maybe not unintentionally he uses the word dolor at least four times in this part. Since a majority of authors have disagreed with the cannibalistic behavior of the disgraceful father, a rational explanation of the verse 75 "Then fasting had more power than grief..." is that Ugolino itself died up slowly, not because of the pain inflicted when looking his children starving (dolor = grief), but from the starvation itself (digiuno = fasting). Another interesting point of view of the poet is his observation over the ability to modulate pain; Dante has intuitively foreseen that the pain can be doubled: a doppiar lo dolore (Canto XIV, verse 39). Much curiosity will produce the existence of mythical monsters, namely the Harpies, already known to the Greek mythology, and able to produce pain; but as well to find a way to throw pain out in laments Tab.3. At least six centuries later Melzack formulated his gate theory of pain, with the neurobiological basis of pain modulation and alleviation of its perception (15). Dante instead has a theory of its own, the window theory, that permits the suffering people to ease their pain through laments and crying, if not simply by ventilating their feelings when oppressed from such an unpleasant sensation. Not in vain another translator (Mandelbaum) has translated the verse 102 (Canto XIII) "...cause pain and for that pain provide a vent." (16). 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