Symptomatic Subjects. Julie Orlemanski

phisik maintained some of the bookish and philosophical associations of its Latin cognate, its semantic range also broadened and loosened. It continued to denote natural philosophy, as physica had in classical Latin, as well as medical science, as it had come to do in medieval Latin. Yet it also designated the medical profession, a medicinal substance, a medical treatment, a healthy practice, and a healthful regimen.⁴⁷ It was sometimes used in contradistinction to surgery, which was understood to be a manual craft and therefore lower in the hierarchy of arts. Yet the mildness of phisik’s academic connotations is clear from its ready exchangeability with the originally Anglo-Saxon (and therefore markedly non-Latinate) term leechcraft. For instance, a translation of Guy de Chauliac speaks of the body’s role in “alle lechecrafte or phisic,” and John Paston complains about the cost of “my lechecrafte and fesyk.”⁴⁸ The banns advertising a fifteenth-century medical practitioner proclaim, “Here is a man that is a conyng [knowledgeable] man in leche-craftis, bothyn in ffysykke & surgere.”⁴⁹ Rather than marking a strong distinction between vernacular handicraft and Latinate science, phisik was an index of their overlap. If, in the two centuries preceding, physica had fitted healing to the systemicity of scholastic education, Middle English phisik adapted those academic ambitions to the decidedly unsystematic conditions of learning outside universities—and to the hopes for health that various categories of readers harbored.

      The messy, makeshift, and profoundly generative labors of medical writing undertaken in late medieval England answered to two overarching purposes: the organization of information and the social accommodation of suffering. Medicine was simultaneously a system for explaining the entanglement of bodies in the material world and a set of techniques for managing that entanglement. “Iff mens bodies wern of irn [were made of iron],” speculates one work of Middle English medicine, “thei needen no rule of helth.”⁵⁰ But human bodies were not iron. The remedy books so popular in the later fourteenth and fifteenth centuries were produced in and for communities that faced high levels of illness and infirmity. Nutrition and sanitation conditions contributed to the prevalence of diseases like tuberculosis, influenza, malaria, typhus, smallpox, and dysentery—to say nothing of the plague, which recurred periodically in England from the mid-fourteenth century to the seventeenth.⁵¹ Conditions like toothache, blindness, skin disease, paralysis, gout, kidney stones, and bone fractures further added to what Paul Slack calls the “burden of sickness,” or the costs imposed on a society by the poor health of its members.⁵² It is in light of such corporeal precarity that practices of vernacular medical learning took on their full significance. And it is against the shadowy background of the period’s largely unrecorded habitus of everyday embodiment—the lived varieties of physical care and embodied self-relation that were themselves reflective and imaginative undertakings—that medieval writings about the body should assume their meaning for us now.

      The Body’s Causes

      What models of embodiment did this newly accessible archive of theory-rich medical learning entail? Broadly based on the writings of Galen and his Arabic and Latin heirs, this system of ideas held that human physiology was made from the same components as the rest of the universe—namely, the elements (earth, water, air, and fire) endowed with their respective qualities (hot, cold, wet, and dry). The four bodily humors (black bile, phlegm, blood, and choler) were called the “children” of the elements, and they combined in each person to produce her unique complexion. Elements and humors could not be observed directly but they underlay observable things. Their qualities of heat and moisture did not merely differentiate the natural world but gave it its dynamism, drawing each element toward its proper place and in the process fueling physical change. The Middle Ages did not have an “ontological” concept of disease—that is, there was no entity, like a microorganism, that disease was understood to be—so medieval pathology dealt instead with the patterned conditions of the human body as the result of causal factors. A wide range of influences could affect an individual’s physiology—from the planets to daydreams, from the west wind to the scent of flowers, from sexual intercourse to the recitation of prayers. Not germs but the world itself “infected” the permeable microcosm.

      The most common medical framework for explaining the hidden dimensions of the body was a triad of categories known as the “naturals,” the “contra-naturals,” and the “non-naturals” (res naturales, res contra natura, res non naturales). Ubiquitous across the medical corpus, this scheme provided countless thinkers with a ready means of thinking about somatic structure and alteration. Res naturales encompassed what was intrinsic to the body: “the elements, the mixture [of qualities] [commixtiones], the humors [compositiones], the members [of the body], the powers [virtutes], the faculties [operationes], and the spirits.”⁵³ Contra-naturals opposed the health of the body; they were diseases and their symptoms. The non-naturals stood in between, neither good nor bad in themselves. They were the quotidian factors that influenced sickness and health: “The first is the air which surrounds the human body, [then] food and drink, exercise and rest, sleep and waking, fasting and fullness, and incidental conditions of the mind.”⁵⁴ This widely known system propounded a model of corporeality as an amalgamated composite, knit together by the constant interchange of physical forces and stuffs. Bodily changes could be analyzed into a series of micro-events, each with its own contingencies. Imagining etiology might entail zooming in to the body’s constituents or zooming out to trace someone’s path through the world.

      The Zodiac Man, a diagrammatic aid to bloodletting common in late medieval English manuscripts, offers an image of the body’s susceptibility to such a cause-struck world (Figure 2). The man’s naked body literally crawls with the symbols of the zodiac, representing the influence on various body parts of the moon’s path through the heavens. Painted in lavish color in many of the folded physicians’ calendars that were unique to late medieval England, the image was likely intended to be seen by patients and practitioners alike during consultations.⁵⁵ Its effect, one imagines, was multivalent: bespeaking bodily vulnerability but also medicine’s learned mastery of that vulnerability; diagramming practical information while emblematizing, with strange acuity, the feeling of a body not quite under human control. Like the Wellcome Wound Man, the Zodiac Man is aesthetically arresting as well as informational. It suggests how newly accessible scientific information might have redounded on images of the body in an era when creaturely life was being reconceived within a web of material forces and technical explanations.

      One particularly urgent occasion for etiological imagination was the Black Death. The epidemic ravaged Europe between 1348 and 1350, killing perhaps a third of England’s population in its course, with mortality rates much higher in some communities. A second massive outbreak hit in the early 1360s, and a total of thirteen epidemics on a national scale occurred in England between 1349 and 1485, along with numerous regional outbreaks.⁵⁶ In the course of its devastation, the plague posed a number of etiological puzzles to medical thought.⁵⁷ At least in its bubonic form, it was characterized by unusual and distinctive symptoms, reinforcing authorities’ sense that this was something new. Because it occurred in so many places at once, it could not be explained solely with reference to the elements and humors, nor on the basis of local environmental factors. Physicians agreed that it must have its origins in the heavens, in celestial events that could poison the atmosphere on such a vast scale. At the same time, differentiation in the plague’s effects also needed to be explained. After witnessing the first outbreak in England, the French physician and astrologer Geoffrey of Meaux announced his intentions “to write something about the cause of this general pestilence, showing its natural cause, and why it affected some countries more than others, and why within those countries it affected some cities and towns more than others, and why in one town it affected one street, and even one house, more than another, and why it affected nobles and gentry less than other people, and how long it will last.”⁵⁸ To explain the plague, Geoffrey would need to grapple with causes at multiple scales, accounting for the disease’s massive reach as well as its variability across regions, between social groups, and even from household to household.

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