Symptomatic Subjects. Julie Orlemanski

early and important attempt at explanation was undertaken in the shocking plague year of 1348. Writing at the behest of the French king, the medical faculty at the University of Paris located the disease’s “distant and first cause [remota et primeva causa]” in the astrological conjunction of three planets in 1345, which led to the poisoning of the atmosphere and to the corruption of susceptible bodies.⁵⁹ The doctors enumerated other possible causes as well: winds blown from alien places, earthquakes releasing rotten vapors in the earth, unseasonable weather, and complexions that were especially hot and moist. This causal proliferation reflects the range of factors known to influence human sickness. It also registers the doctors’ uncertainty, “for a sure explanation [certa ratio] and perfect understanding [perfecta cognitio] of these matters is not always to be had.”⁶⁰ The effort to reckon with an abundance of causes is entirely characteristic of late medieval etiological thought. In the first lines of their prologue, the physicians even pitch their report in terms of an idealized psychology of causal inquiry: “Seeing things which cannot be explained [effectibus quorum causa latet], even by the most gifted intellects, initially stirs the human mind to amazement; but after marveling, the prudent soul yields to its desire for understanding and, anxious for its perfection, strives with all its might to discover the causes of the amazing events [effectuum mirabilium causas].”⁶¹ This lofty philosophical opening should not, however, obscure the decidedly practical and social concerns motivating the king’s charge and the faculty’s recommendations for prevention and cure.

      Between the mid-fourteenth century and 1500, 281 plague tractates are known to have been composed, typically explaining the causes of the disease and recommending a variety of precautions and treatments.⁶² Etiologically, most share the Parisian faculty’s tactics; they link the planets’ influence to the corruption of the air, while adding information about individual complexions and regimen, occasionally with a nod to God’s power.⁶³ The genre was seized on by English readers. The tract of the otherwise unknown John of Burgundy (also called John of Bordeaux and John de la Barbe) was by far the most popular plague work in late medieval England. Probably compiled in 1365, it circulated in various Latin versions and gave rise to at least six independent Middle English translations.⁶⁴ Something like forty-six witnesses to Middle English translations and adaptations survive from before 1500.⁶⁵ As one Englishing explains, while the “influence or impressioun of the hevenly or high bodies” makes the air “corrupt” and “pestilencial in effect,” this environmental change is “nat al-only [not the only] cause of moreyne [plague].”⁶⁶ The treatise cites Galen for the general principle that “the body suffrith no corrupcioun but if [unless] the matier of the body be prompt or redy.”⁶⁷ So, it is not only the heavens above but flesh “stuffed ful of humours that bien [are] mystempered” that together create the conditions for plague.⁶⁸

      John of Burgundy’s treatise stresses the importance of the causal understanding it provides. For instance, in the words of the Middle English translation, whoever “han nat drunken of that sweete drynke of astronomy” will not be able to “put to this pestilencial sores no parfit remedy” because those who “knowe nat the cause and the qualite of the sikenes, they may not hele it, as saide the prince of medicyne, Avicen.”⁶⁹ Averroes is also cited, with the Aristotelian truism that “a man knowith nat a thyng but if he knowe the cause both fer and nygh [distant and proximate].”⁷⁰ In this vernacular rendering, such scholastic promotions of causational knowing reached new readers and charged etiological knowledge with the urgency of survival.

      John of Burgundy’s treatise includes an acknowledgment of God’s power: whoever follows its advice may survive “if the helply [merciful] wil of God be with hym.”⁷¹ Likewise, the Parisian doctors duly state that “any pestilence proceeds from the divine will [epidimia aliquando a divina voluntate procedit].”⁷² Indeed, naturalist explanations did not contradict the supernatural etiologies that were ubiquitous in sermons and chronicles, where plague was cast as divine punishment for humankind’s sins. However, the intellectual energy of both the Parisian faculty and John of Burgundy was occupied with routing that ultimate divine cause through the intricate etiological apparatus of the physical world.

      This emphasis on natural and especially astrological causation sometimes raised hackles, despite (or because of) its evident popularity. For instance, Dives and Pauper, a moderately popular Middle English dialogue on the Ten Commandments from the early fifteenth century, pushes back against naturalist presumption.⁷³ In the section on the First Commandment, Dives mocks those who consider themselves astrological experts. They believe, he declares, “Noon hungyr [famine], noo moreyn [plague], noo tempest, noo sekenesse, noo werre [war] shal falle [befall]” unless caused by the heavenly bodies and predicted by the astrologers’ calculations—“for, as they seyn, the bodyis abovyn rewlyn [rule] alle thyngge here benethyn.”⁷⁴ Such explanatory naturalists, according to Dives, make God “more thral [lowly] and of lesse power than ony kyng or lord is upon erthe.”⁷⁵ Later, it is the remarkable diversity of natural phenomena that provides a further reason to doubt astrological causes—because, on this account, the planets cannot account for such variation. Ironically, Pauper’s description of the plague sounds at first very much like that of Geoffrey of Meaux:

      Sumtyme is moreyn general, sumtyme parcyal, in on contree nought in anothir; sumtyme in on toun and nought in the nexte; sumtyme in the to syde of the strete and nought in the tothir. Sum houshold is takyt up al hool; at the nexte it takyt noon.⁷⁶

      [Sometimes plague is general, and sometimes partial, in one country and not in another; sometimes in one town and not in the next; sometimes on the near side of the street and not on the other side. Some household is completely devastated; at the next, no one is struck.]

      Rather than pursuing an ever more intricate causal explanation to account for these variations (as Geoffrey of Meaux does), Dives and Pauper reject the utility of any such account and recommend turning to God instead.

      Pauper prefers demons to celestial conjunctions as the intermediary explanation for pestilence: devils often “have leve [permission]” from God, for reason of “mannes synne,” to “doon [create] wondres, to causen hedows [terrible] tempest, to enfectyn and envenymen the eyr and causen moreyn [plague] and syknesse, hunger and droughte.”⁷⁷ Strikingly, the dialogue even wades into the murky overlap between causation and semiotics. Pauper is eager to show that natural signs—especially the position of the planets—may signify without acting as causes. After all, he reasons, condensation on a stone “is tokene of reyn [rain]” but “nought cause of the reyn.”⁷⁸ Just so, by means of the planets’ positions, someone gains knowledge not “as be [by] causis but as be tokenys, for God made hem to been tokenys to man, beste, bryd, fysh and othere creaturys.”⁷⁹ Here is a passage of vernacular theory on the semiotics and etiology of the natural world.

      As the example of Dives and Pauper suggests, medicine (together with natural philosophy) existed in a changeable, sometimes volatile relation with God’s omnipotence and the health of the soul. The impulse to regulate medicine’s and religion’s tangled jurisdictions is nowhere more evident than in the 1215 decree of the Fourth Lateran Council stating that “physicians of the body [medicis corporum]” must “warn and persuade” their patients “first of all to call in physicians of the soul [medicos animarum].”⁸⁰ The statute justifies itself in terms of the well-being of patients: because “sickness of the body may sometimes be the result of sin [infirmitatis corporalis nonnumquam ex peccato proveniat],” it follows that once spiritual health (spirituali salute) has been seen to, patients “may respond better to medicine for their bodies; for when the cause ceases so does the effect [cum causa cessante cesset effectus].” Moreover, the writers explain, some patients, when their physicians advise them “to arrange for the health of their souls, [they] fall into despair and the more readily incur the danger of death.”⁸¹ Yet if all physicians did this, there would be no reason for fear. A final sentence dispels any ambiguity about the relative claims of body and soul: “Since the soul is much more precious than the body, we forbid any physician, under pain of anathema, to prescribe anything for the bodily health [pro corporali salute] of a sick person that