Symptomatic Subjects. Julie Orlemanski
of theory and abstraction, he warns that “particular cases are and always will be infinite in number, and consequently unknown [quia particularia sunt et erunt infinita et per consequens ignota].”96 And yet, he points out soon after, in a warning against overly abstract theory, “medicine is carried out not on mankind in general, but on every individual in particular [medicina enim non fit homini in universali, sed unicuique individuo].”97 Traces of similar oscillation and compromise are evident even in Galen’s writings, composed in what was already an Aristotelian age. The Greek physician’s disagreements with both sides of his era’s polarized medical culture, the medical “rationalists” and “empiricists,” show him trying to balance the sure knowledge of natural philosophy against the insights of sensory observation and experience.
A related epistemological point is made in no less prominent a place than the beginning of the Metaphysics, where Aristotle states that it is a matter of experience (experientia) “to have a judgment that when Callias was ill of this disease, this did him good, and similarly in the case of Socrates, and so in many individual cases.” However, it is a matter of art (ars) to judge that the treatment “has done good to all persons of a certain constitution.”98 While art is a higher form of knowledge than experience, the imperatives of clinical treatment appear to upend the hierarchy:
For the physician [medicans] does not cure “man,” except in an incidental way [secundum accidens]—but rather Callias or Socrates or someone else called by some such individual name, who just happens to be a man [cui esse hominem accidit]. If, then, someone has the explanation [rationem] without the experience [sine experimento], and recognizes the universal [universale] but does not know the individual [singulare] included in this, he will often fail to cure [curatione peccabit]; for it is the individual that is to be cured [singulare namque magis curabile est].99
This passage should not be taken as a defense of empiricism. Aristotle leaves no doubt that wisdom comes with explaining the causes behind observed facts. But the passage distances such wisdom from practical success. Because healing is a matter of particulars, of this embodied individual, experience might prove superior. While treating the patient as “man” may be essential to medicine’s scientific project, it is a particularized person, designated here by the proper names Callias and Socrates, who wants healing. The passage captures something of the epistemological pathos of medieval medicine, as it weaves from general knowledge to singular scenes of suffering and care, and back again. The flickering between generality and particularity is what the Wellcome Wound Man (discussed at this chapter’s opening) likewise sets in motion—as the image’s diagrammatic universality warps but does not subsume the individuality of the man’s figure and face.
Joel Kaye’s magisterial study of the new “idea of balance” arising between 1250 and 1375 locates medicine at the heart of scholastic intellectual history, despite what would seem to be its problematically practical focus. Kaye’s book follows the vicissitudes of a conceptual model, that of “equalization,” as it was gradually developed and disseminated in scholastic thought. This wide-ranging paradigm, based partly on Galen’s ever self-calibrating body, focuses on the “dynamic interaction” of a system’s working parts and the production of balance as the “aggregate product of the systematic interaction of multiple moving parts within the whole.”100 This model “made possible a form of naturalistic explanation that did not require the existence or intervention of an intelligence or ordering power existing above or outside the sphere that it governed.”101 In other words, the interaction of causal forces themselves produced the qualitative identity of the system in which they participated. Though Aristotle had an intellectual cachet with which scholastic thinkers were eager to associate themselves, Kaye argues that it was Galenic thought that actually acted as a crucial, if partly disavowed, intellectual model: “While the writings of Aristotle are generally taken as the textual point of departure for scholastic speculation, I have found that the most dynamic and productive texts behind the new model of equilibrium came not from Aristotle but from Galen and his continuators, both Arabic and Latin.”102
Symptomatic Subjects picks up where Kaye’s study concludes. In the later fourteenth century, according to Kaye, the scholastic model of equilibrium broke down. He hazards two speculations as to why. The first is the development of a “plethora of competing models,” which dispersed the paradigms’s coherence just as “the university ceased to be the center and arbiter of speculation.”103 The phenomenon of explanatory proliferation, which accompanies the diffusion of intellectual authority beyond the university, creates the conditions of etiological imagination to which I have gestured, especially among lay and vernacular audiences. The second reason Kaye hazards for the breakdown of the scholastic model of equilibrium is what he describes as the widespread “failure of faith in the potential of systematic self-ordering and self-equalization: a failure in the assumption that the process of interior self-ordering can, in itself, replace the ordering power of an intervening or overarching intelligence.”104 Indeed, such distrust in systematic self-balancing is found frequently in the sources discussed in the ensuing chapters of this study, whether in the physician Arnau of Vilanova’s worry over medical contingency or in Arcite’s corrupting body in Chaucer’s “Knight’s Tale.”
Behind such pessimism, Kaye speculates cautiously, may be all the bad news of the fourteenth and fifteenth centuries—plague, labor unrest, authoritarian politics, heterodoxy and its suppression. Yet, I think, just as important to the pessimism expressed in my sources is these sources’ scale. Both practical medicine and imaginative literature tend to think at the scale of the individual. If natural philosophy and avowedly theoretical medicine concentrate on the regularities of the species, medical practice and literary narrative proceed from the exigencies of individuals. It is “the individual that is to be cured,” as Aristotle writes, and it is also the individual who perishes, as all eventually do. The model of equilibrium that Kaye so persuasively identifies does, I think, find its way into the late medieval milieu of phisik—but as something fragilized and perhaps faulty. The self-equalizing model is the occasion for intellectual experimentation in various texts, as the body’s causal determinants are imagined and reimagined. But the numerousness of the factors involved tends to overwhelm powers of comprehension and control. After all, embodiment always turns out to be terminal.
Medicine’s position between theory and practice, between universal and particular, draws it into close alignment with two other intellectual procedures, narration and exemplification. As the causal forces understood to structure the physical world became more multifarious in the later Middle Ages, the task of interpreting individual bodies became more delicate.105 It required picking out the relevant threads of explanation and then charting singular itineraries of implication and consequence. This often happened through narrative, the efficacy of which was increasingly recognized in contemporary trends in academic medical writing.106 Experimenta, or “case histories,” and consilia, or didactic accounts of cases, became increasingly important genres for late medieval physicians and surgeons, as they responded to the perceived inadequacies of systematic theorization.107 Moreover, to put medical principles into action, practitioners had to recognize patients as examples, by discovering each body under examination as an instance of broader medical categories, and so to bring that individual, here and now, into the medicine’s system of interpretation.
Late medieval medicine, then, shares with practices of medieval narrative a vivid interest in the exemplary and explanatory functions of individual bodies. This fascination, with how general principles and overarching laws might (or might not) be legible in the flesh, animates an extraordinary passage from a mid-fourteenth-century devotional work. Henry of Lancaster’s (d. 1361) Anglo-Norman Le Livre de Seyntz Medicines (The Book of Holy Medicines) consistently imagines penitential spirituality through a series of intricately physicalized images of wounds, sickness, treatment, and healing. In this passage, however, his meditations turn to a body marked by learned medicine in particular. Henry prays:
Most sweet Lord, I entreat you that it please you that I may then be cut up and opened up before you [defait et overt par devant vous], my Lord and my master,