Here, Henry asks to be made an example like the corpses dissected in anatomical demonstrations at Montpellier. The executed criminals turned over to surgeons are cut open to illustrate what is characteristically human, how veins and nerves and other parts are disposed in the body. Medical learning, here, renders the human body illustrative, exemplary of the natural principles according to which it is formed. But this body is also particular. Les veynes, les nerfs et les autres choses of the anonymous corpse become Henry’s own—ma char et mes veynes and touz mes menbres—which, he explains, are riddled with sin. Like the Wellcome Wound Man, this image trades on the unstable interchange between didactic generality and individual embodiment, between inert exemplification and the urgency of a cure. In a rather fantastic imaginative exercise, Henry identifies himself not with someone sick or suffering but with a corpse—perhaps because, as Augustine’s sermon claims, we know that “we have many things inside us” only because we have seen such things “in butchered bodies.” Here, the dead man, mort par le droit de juggement, becomes the paradoxical avatar of a desire for medicalized healing. In this metaphor, the surgeon’s cut unites violence and cure in a fantasy that anatomical exposure will make the self whole. Healing is tied not to medical therapeutics but to becoming an ensample for autres. The circuit between the reifying estrangement of the dissected corpse and the imaginative reclamation of flesh’s dead weight shows the power of the medicalized body as a literary resource for medieval writers.
Chapter 2
Cause, Authority, Sign, and Book
Phisik in late medieval England was many things. It was written in university textbooks and in the margins of household manuscripts. Its practitioners were learned and unlearned, men and women, variably Latin- and English-literate. Medical care was sometimes a craft and sometimes a science. In the midst of this heterogeneity, however, phisik also fostered a set of ideas and practices peculiar to it. The later Middle Ages saw the dissemination of the medical framework, in which bodies were explained and manipulated as natural things, composite and changeable. Inquiry into the forces that sustained life assumed new relevance as more and more readers came into contact with medical expertise. In order to capture both the widespread tendencies of late medieval medicine and the variability of their expressions, the following chapter examines phisik under four different rubrics: cause, authority, sign, and book. These four words cut different, twisting paths through the thickets of medical discourse, from the classrooms of Montpellier to the small towns of Nottinghamshire, from leprosy’s diagnosis to John Lydgate’s most popular poem. The chapter aims to throw light on some of the central concerns of phisik, including its interests in why bodies change, the grounds of medical authority, how to interpret symptoms, and the best ways to transmit medical knowledge. Together, these topics yield a portrait of the plural and contentious nature of late medieval medicine.
Cause
One of the central projects of medieval medical inquiry was the investigation of causes. Chaucer’s Physician on his way to Canterbury is called a “verray, parfit praktisour [true and perfect practitioner]” in part because he “knew the cause of everich [every] maladye.”1 According to the popular encyclopedia De proprietatibus rerum, compiled by Bartholomaeus Anglicus (d. 1272) and translated into Middle English by John Trevisa (d. 1402), a physician “nedith to knowe causis and occasiouns of eveles [diseases]” because “medicynes may never be sikerliche [securely] itake yif [if] the cause of the evel [disease] is unknowe.”2 These vernacular formulations reiterate a notion expressed by earlier medical writers. In the influential medical encyclopedia known as the Canon, an Arabic work written by the Persian philosopher and scientist Avicenna (Ibn Sina, d. 1037) and translated into Latin by the circle of Gerard of Cremona (d. 1187), knowledge of causes is made medicine’s first task: “Since medicine considers the human body [corpus humanum] from the standpoint of how it is made healthy and how it sickens, and since we can have knowledge of neither unless it is known through its causes [causas], we must in medicine know the causes of health and of sickness.”3 The statement sounds commonsensical: it is useful to know why someone falls ill when reasoning out a cure. But it is also a testament to Avicenna’s Aristotelianism. The Canon self-consciously sought to synthesize Galenic medicine and Aristotelian philosophy. It is no surprise then that the work found eager acceptance among European readers increasingly shaped by Aristotle’s logic and theory of knowledge. Aristotle identifies true knowledge with a knowledge of causes: “We suppose ourselves to know something without qualification (as opposed to sophistically, accidentally) when we judge that we understand the cause upon which the thing depends”; and, more simply, “we know when we understand the cause [tunc scimus cum causam cognoscimus].”4
When Avicenna declared causation the sine qua non of medical knowledge, his statement appeared at the start of a vast and systematic tome. However, the meaning of the claim shifted as the Canon came to be digested by later medical writers. This happened, for instance, when the Italian surgeon Lanfranc of Milan (d. 1306) adapted Avicenna’s dictum in his Chirurgia magna: “Avicenna said that one cannot understand something that has been caused unless we know it by the causes themselves [ut dicit Avicenna, notitia rei quae causam habet non potest haberi nisi per suas causas sciatur].”5 In the hierarchies that organized medieval medicine, surgery was traditionally defined against physica as a lower form of knowledge, more manual and empirical. But Lanfranc’s citation signals his bid to raise surgery’s intellectual profile and to shift it from a craft to an art. In this newly “rational” surgery, which began in northern Italy and spread to France, surgical writers imported scholastic models while at the same time dislodging them from the university curriculum.6 During the fourteenth century, Lanfranc’s treatise together with other works of rational surgery found their way to eager readers in England, and Middle English translations of Lanfranc’s surgical writings survive in at least ten manuscripts. In these Englishings, practical instruction often took priority over theoretical schemes. One Middle English surgery, written in London in 1392, adapted Lanfranc’s treatise by excising its theoretical material and emphasizing the redactor’s own empirical findings.7 “Avicen seith knoulechinge of a thing that hath cause mai nought be knowen but bi his cause [Avicenna says that knowledge of a thing that has a cause may not be known except by its cause],” reads another translation, completed by 1380.8 In the phrase’s new vernacular milieu, the importance of causal understanding is reiterated at an even greater remove from academic contexts. Causation here has less to do syllogisms and more to do with observed relationships and palpable results.
Learned medicine poured huge quantities of intellectual energy into understanding causation. Three major schemes were available to medieval thinkers to explain sickness and health: the Aristotelian, the Galenic, and the Joannitian. All three were deployed within the basic framework of bodily complexion, which was determined by the balance of the four elements and four humors, with their respective qualities of heat, cold, moisture, and dryness. The scheme with the broadest intellectual reach was no doubt Aristotle’s