Symptomatic Subjects. Julie Orlemanski

complainant, against three surgeons accused of an “alleged error of treatment of the wound in the muscles of the thumb of the right hand.”⁶⁴ Eight physicians and surgeons made up the advisory jury, among whom were some of the most prominent medical men of late medieval England. The ruling recounts that “on 31 January last past, the moon being consumed in a bloody sign, to wit, Aquarius, under a very malevolent constellation,” William Forest was seriously wounded in the muscles of his hand. On February 9, “the moon being in the sign of Gemini, a great effusion of blood took place.” John Harwe, a “free surgeon,” and two barber-surgeons, John Dalton and Simon Rolf, were involved in stopping the flow of blood, “which broke out six several time in a dangerous fashion, and on the seventh occasion, … the wounded man preferring a mutilated hand rather than death, the said John Harwe, with the consent of the patient, and for lack of other remedy, finally staunched the blood by cautery, as was proper, and thus saved his life.” The advisory jury, “having diligently considered and fully understood the matter, on the evidence of the parties and the sworn testimony,” determined that the surgeon and barber-surgeons “had acted in a surgically correct manner and had made no error, and that therefore they were absolved of all charges made against them by the said William.” In addition, “They further imposed upon the complainant perpetual silence in the matter and, so far as possible, they restored to the defendants who were guiltless and had been maliciously and undeservedly defamed, the full measure of their good reputation, as their merits in the case required. Further they declared that any defect, mutilation or disfigurement of the hand was due either to the constellation aforesaid or some defect of the patient or the original nature of the wound.” The ruling illustrates how the power to narrate mattered in late medieval medicine. William Forest is enjoined to silence, and his own version of events is left out of the ruling. As someone bearing the mark of both injury and treatment, he is forbidden from offering his own account. The jury’s gag order as well as the wish to restore the defendants’ reputations imply the fragility of the surgeons’ standings. A patient’s words mattered in London’s medical marketplace. Although the ruling seems one-sided, with professional self-interest and allegiance stacked against the claimant, it is likely that William Forest soon had the chance to tell his story after all. The comminalte lasted just eighteen months before dissolving under pressure from the powerful guild of barber-surgeons.

      The ruling also exemplifies how in late medieval England specialized knowledge of medical causation could trump other explanations. The jury’s linking of astrological details with the “great effusion of blood” depends on the members’ command of a learned system of correspondences between the positions of the stars and bodily flux. This esoteric system underwrites the judgment that the “malevolent constellation” is responsible for Forest’s dangerous bleeding and so for the mutilating treatment, rather than any incompetence on the surgeon’s part. When the expert jury deems that Harwe acted in a “surgically correct manner,” they and he are announced to share this specialist proficiency, which exceeds the patient’s understanding of the situation and so undercuts his account of causation and blame. As in the Isagoge, so in this case: “to the patient [infirmo] these are accidents, while to the doctor [medico], they are signs.”⁶⁵ Faye Getz remarks of the case, “The fact that physic could offer an astrological explanation of this sort in the legal sphere is remarkable. Before this the layman was considered a sufficient arbiter in medical matters that came before the law, and the common law sufficient precedent.”⁶⁶ If lay judgment usually sufficed, elite practitioners in London briefly created an alternative scenario, where they effectively wielded medical astrology in the elite regulation of London’s medical practice. Yet the institution of the comminalte did not last, and Forest likely regained the right to tell his version of events, perhaps even armed with some of the expertise then circulating so plentifully in medical manuscripts. Medicine’s explanatory systems were gaining ground, even if who was able to call on those systems, with what authority, remained a matter for contestation.

      Sign

      The perceptible qualities of bodies vary among individuals and among groups, and they also shift across an individual’s lifetime. In the Middle Ages, some bodily characteristics were perceived to be fixed, like those codified through species, race, gender, or innate complexion.⁶⁷ Other traits were understood to shift with the body’s ever-fluctuating internal state. Humors tinted the complexion; fever warmed the flesh; indigestion roiled the stomach; lethargy weighed the limbs. Changes like these were clinical signs. Diagnosis was the branch of pathology concerned with bodily signs, and Latin medical manuals included it alongside the other learned operations of medicine: nosological definition, etiology, prognosis, and therapeutics.⁶⁸ Handbooks generally advised that diagnosis should proceed by examining the patient’s appearance, querying her personal history and experience of the illness, scrutinizing her excreta (especially urine), and feeling her pulse.⁶⁹ One symptom could point to many pathologies, and it was only via constellations of symptoms that disease could be reliably identified.

      Symptoms are signa naturalia. While natural signs depend on direct or indirect causal relations, causation alone does not make a sign. Signification also requires a “mind apprehending [animam apprehendentem],” as Roger Bacon observes.⁷⁰ Learned traditions of bodily interpretation thus needed to train apprehending minds to recognize what features were meaningful as well as what they meant. This section focuses on two very different frameworks for late medieval corporeal hermeneutics: the diagnosis of leprosy and the practice of physiognomy. Examinations for leprosy regarded the body in terms of pathological change, while physiognomy interpreted it for fixed characterological disposition. Yet both practices faced similar uncertainties as they set about trying to parse living bodies into signifiers and to fix those signifiers with stable meaning. Uncertainties included how to recognize signs as signs, how to weigh conflicting signs against one another, who had the authority to interpret particular bodies, and what models of causation and selfhood undergirded these interpretive systems. Both leprous symptoms and physiognomic indices catalyzed the production of intricate textual aids to address such questions.

      Leprosy was one of the most overdetermined bodily states of the later Middle Ages. It was regarded alternately as a medical, legal, moral, exegetical, thaumaturgical, and institutional matter, and according to surviving evidence, those diagnosed with leprosy played a variety of roles in medieval communities.⁷¹ As Luke Demaitre has convincingly shown, medical writers in the later Middle Ages adopted a strongly naturalistic approach toward the disease.⁷² Physicians and surgeons left out scriptural and moralistic glosses almost entirely and instead focused on material causes, diagnosis, and therapeutics. Nonetheless, leprosy’s fraught status still mattered profoundly. Because serious social and legal consequences could follow from diagnosis, learned medicine developed an especially elaborate apparatus for identifying the disease. Scenes of examination could become flashpoints for conflict, and diagnosing leprosy emerged as a particularly high-stakes exercise in medical semiotics.

      The official examination of someone suspected of having leprosy was called a iudicium, or “judgment,” and those who were responsible for carrying it out were aware of the quasi-judicial character of their determinations. From the second half of the thirteenth century in France and Germany and on the Iberian Peninsula, university-trained physicians hired by city governments tended to be in charge of iudicia. However, because England had many fewer physicians and no tradition of retaining them for purposes of public health, priests and common-law juries remained the leading examiners of those suspected of the disease. This meant that a broader and more heterogeneous fraction of the population was responsible for diagnosis, and their authority was far from unimpeachable. For instance, William Mustardere, rector of Sparham in the late 1460s, diagnosed his parishioner John Folkard with leprosy, urging the man to “withdrawe hym from the compayne of other men.”⁷³ Following this, Folkard “‘manassed [menaced]’” the priest, warning him “that he shuld repent that ever he made any such noyse,” and Mustardere soon found himself thrown in jail.⁷⁴ Carole Rawcliffe observes that “the false or malicious imputation of leprosy might also result in a suit for defamation.… Mistakes could thus inflict lasting damage on the person making as well as receiving the diagnosis.”⁷⁵

      It is likely that such nonprofessional examiners were among