In no way does the General Prologue force such questions, which after all were among the most contentious of the Middle Ages and edged swiftly into disputes about inclination and free will.11 It is part of the narrator’s blithe tact not to dwell on matters like these. Tensions between choice and disposition, or between individual and type, are allowed to remain suspended, and in this way Chaucer’s General Prologue is similar to the medical discourse that partly undergirds it. Both phisik and Chaucer-the-pilgrim leave aside dogmatic pronouncements to concentrate on the intricately particularized individuals at hand. But in the process of doing so they end up instantiating a distinctive way of seeing the world, focused on persons’ jointly material and semiotic constitutions and how these constitutions might be read.
The co-implication of natural impulse and human action is raised in no less prominent a place than the first lines of the General Prologue. It is “Whan that Aprill” moves the nectar in the flowers and sets the mechanisms of spring into lush operation, “Thanne longen folk to goon on pilgrimages.” The temporal coincidence of season and devotion allows nature and religion to share the stage, and the mischievous rhyme between the songbirds’ corages (where they feel Nature’s prick) and the people’s pilgrimages needles a connection that remains unsettled and unsettling throughout the Canterbury Tales, namely, the link between what we are (our longings, our actions, our bodies, our identities) and the forces in which we are enmeshed, like the prickling warmth of April and our answering flesh. These are the relations, between conditions and causes, that medieval medicine addresses as well. The more that readers of the General Prologue wish to pin down a given character—to diagnose the Summoner, interpret the Wife’s gapped teeth, determine whether or not the Physician is blameworthy, or know if the Pardoner is “a geldyng or a mare” (691)—the more urgently do uncertainties about causation, agency, and the stability of signs circulate. But the breezy narration, like complexio’s manifestly flexible apparatus, keeps radical incoherence out of sight. Both the General Prologue and medieval physiological theory generate a sense of knowing that trails off in the details, leaving room for indeterminacy. In Chaucer’s hands, this trailing off nourishes the impression that each pilgrim has a subjectivity in excess of the available grids of explanation.12 He invites his readers, then, to follow the advice of Galen (d. c. 210 CE), who declares that interiority can be known “if not by means of an absolutely firm kind of knowledge [disciplinam certam], then at least by ‘artful’ conjecture [secundum coniecturam quandam artificialem].”13
Throughout this book, I use the term symptom to name a somatic disturbance that, in its departure from expectations of bodily appearance or function, provokes interpretation. Symptoms appear when we regard bodies as animated systems of signs that refer to the nonconscious or only partly conscious processes in which material selves are entangled. Symptoms need not be medical. Miraculous indices of God’s favor appear frequently on medieval bodies, and romances are full of characters whose bodies mutely testify to their noble origins, like the light pouring from the mouth of Havelock the Dane. For their construal, symptoms require not only that interpreters work back from effects to cause but also that they make a decision among explanatory systems. Hermeneutic instructions are not in symptoms—not in the body’s pallor, excretions, pulse, or pain—but rather in the discursive environment where the body is embedded and becomes legible. The General Prologue pulls readers through a shifting series of discourses—moralistic, satirical, courtly, penitential, exemplary, physiognomic—to interpret the pilgrims’ figures. In the Summoner’s portrait and the “artful conjectures” it inspires, medicine’s primary operations of diagnosis, etiology, and treatment blend seamlessly into the structuring themes of the General Prologue, like the tensions between natural impulse and human action, type and individual, and sign and self.
My broad definition of the symptom, as an involuntary bodily sign, is at odds with the word’s narrow use in medieval Latin (symptoma, sinthoma) and in Middle English (sinthome), where it almost always appears in the context of learned medicine.14 The ancient Greek term originally meant a mischance, something that happens to or befalls someone, and it is relatively late in the development of Greek medical writing that sumptōmata came to denominate those bodily phenomena from which disease is inferred.15 In the twelfth century a transliterated form of the Greek word made its way into Latin translations of classical medical writings, to denote a quality or condition of the body—as in the Liber de sinthomatibus mulierum, or the “Book on the Conditions of Women,” as Monica Green translates it.16 From Latin, the word eventually entered medical writing in Middle English. More often, medical writers and translators employed the terms accidens (in Middle English, accident) and significatio (signe or token) to name the indices of disease. “Accident” forms a neat etymological counterpart to the Greek sumptōmata: from ad and cadere, it also means a falling to, or something that befalls, which gives it its philosophical sense as a contingent attribute.
Medieval theories of the natural sign (signa naturalia) are one framework for understanding the symptom’s yoking of causation and signification. According to Augustine’s foundational De doctrina christiana, the division between natural signs and conventional signs (signa data) is a basic distinction of semiotic theory. Whereas words proceed from a desire to communicate via a mutually recognized system of signs, signa naturalia make something known “without a wish or any urge to signify [sine voluntate atque ullo appetitu significandi].”17 Augustine’s examples are smoke, an animal footprint, and the face of someone angry or sad. Smoke “means” fire because smoke is caused by fire; the face indicates the mind’s feelings independently of the will (etiam nulla ejus voluntate).18 Relations of signifier and signified map onto relations of effect and cause. Augustine acknowledges briefly that such signifying is not itself merely natural; it depends on someone’s “observation and memory of experience with things [rerum expertarum animadversione et notatione].”19 Roger Bacon, in his 1267 treatise De signis, elaborates on this point. Bacon was one of the leading interpreters of the “new” Aristotle and a controversially original thinker in natural philosophy. In De signis, he notes that “according to the order of nature [ordinem naturae] one thing is the cause of another without having a relation of themselves to a knowing power, but solely from the fact of their relation with one another.”20 In other words, causes produce effects regardless of whether anyone knows about them. But signification works differently: “By contrast, the relations of sign, of signified, and of the one to whom signification occurs are applied through a relation to the mind apprehending [animam apprehendentem].”21 Despite the symptom’s natural, causal entailment, its legibility depends on learned systems of signs. For accidens to become significatio, the “mind apprehending” must track its meaning.
One of the foundational texts of medieval medical study, the Isagoge of Joannitius (Hunayn ibn Ishaq, d. 873), illustrates how the gap between causation and signification comes to be charged with social import. In its discussion of different categories of symptoms (de generibus significationum), it makes one distinction that depends not on the signs’ bodily location or timing but rather on the vantage from which the symptoms are perceived. “There is a distinction between signs and accidents,” the treatise states, even though “they have a single physical appearance”—namely, “to the patient [infirmo] these are accidents [accidentia], while to the doctor [medico], they are signs [significationes].”22