Symptomatic Subjects. Julie Orlemanski
the discourse and practice of phisik were the occasions for authority’s especially motley manifestations.36
Jostlings among the sundry models of authority formed the texture of late medieval medical discourse. With the exception of short-lived efforts by elite physicians in the early fifteenth century (discussed below), medical authority was neither newly consolidated nor newly centralized in late medieval England. Centralization came later, for instance, with the founding of the Royal College of Physicians in 1518. While guilds were common for barbers and for apothecaries (often as “grocers”), these trades were only partly medical in concern, and English towns lacked anything like the broadly medical guild that existed, for instance, in late medieval Florence.37 In distinction from the rest of western Europe, English towns also had no tradition of providing physicians with salaries to help care for the poor and sick, nor did the crown fund charitable practitioners.38 Apart from elite clients, then, there was little incentive in England for medical credentials. As a result, providing guidance to the sick remained a much less professionalized endeavor than it did on the continent, where medicine’s secularization was well underway by the later thirteenth century. The numbers of physicians educated in England remained small—fewer than a hundred in total at Oxford before 1500, and about half that number in Cambridge.39 Faye Getz’s study of Oxford medical men in the fourteenth century discovers only four (out of forty) without record of ecclesiastical income, meaning that a minimum of 90 percent held benefices.40 In the fifteenth century, Oxford medical graduates “did not change their essentially clerical and academic nature.”41 In addition to these few clerical graduates, it was often parish priests who were responsible for providing basic medical advice as well as access to written remedies, as manuscript evidence suggests.42
Medicine’s entanglement with many different social roles meant that medical practice, and the authority that grounded it, was often available to local reinvention and negotiation. Though medicine assumed prominence in new contexts and the sheer number of medical manuscripts was soaring, caring for the sick and interpreting exceptional bodies were projects whose proper authorities were not known in advance. This fluidity gave rise to distinctive patterns of health care, including a certain itinerancy in one’s course of treatment, as patients expected to visit multiple practitioners in the pursuit of care.
One writer and practitioner who exemplifies the protean character of English medical expertise is the surgeon John Arderne (b. 1307/8–d. 1377 or after), recently deemed “the most important English person in his field before the seventeenth century.”43 Arderne opens his best-known piece of writing, a treatise on the treatment of anal fistula, with biographical flourish. A Middle English translation of the original Latin reads, “I, John Arderne, fro the first pestilence that was in the yere of oure lord 1349 duellid [resided] in Newerk in Notyngham-shire unto the yere of oure lord 1370, and ther I helid many men of fistula in ano.”44 From there, Arderne lists the satisfied noblemen and clerics whom he cured, starting with “Sire Adam Everyngham of Laxton-in-the-Clay byside Tukkesford” and going on through nineteen further individuals, each named and specified in terms of geography and social rank. “All thise forseid cured I afore the makyng of this boke,” he declares, thereby linking his composition to an impressive and locally detailed career of surgical success.45 Arderne’s Practica is unabashed in claiming the originality and value of his surgical technique, but it also stakes a claim to erudition. Arderne quotes extensively from the corpus of recent Latin practicae, including those by Lanfranc of Milan and Bernard of Gordon. His references indicate the availability of up-to-date continental medical texts for lay readers. Arderne is also the author of De curo oculorum (On the cure of eyes) and a less unified set of materials sometimes titled in manuscripts Liber medicinalium.
Being trained in surgery, a craft, it is unlikely that Arderne attended university. Yet he wrote in Latin, of a sort. Peter Murray Jones describes the surgeon’s language as a “polyglot rather than a consistent Latin,” with passages in Middle English and French, and its grammar “like that of a man thinking in English but writing in Latin.”46 The halting modulations of Arderne’s prose testify to this English practitioner’s belabored but also bravura entry into the learned tradition of European surgery. The Practica’s amalgam of manual expertise and learned synthesis was appealing in late medieval England—at least according to Arderne’s account of the high fees he commanded and according to the large number of extant copies of his writings. A total of forty manuscripts survive. Of these, thirty-two preserve Arderne’s Latin texts in whole or in part; the remaining eight are in Middle English and give evidence of four separate translation efforts.47 Arderne’s name appears more frequently in Middle English scientific and medical texts than does that of any other English practitioner.48 His considerable authority, then, took shape between manual dexterity and erudition, vernacularity and Latinity, medical practice and medical writing.
Several manuscripts of Arderne’s Liber medicinalium preserve a collection of experimenta, or case histories.49 Some of these histories record the details of Arderne’s own patients; others describe illnesses and treatments from a third-person perspective. One of the latter type illustrates the itineraries of care that are characteristic of late medieval phisik. The narrative is not so much the story of a cure as it is a tour of expertise. In it, a chaplain from “Colston faste by Byngham” is suffering from a painful, egg-shaped nodule on his chest. He receives medical advice from three sources in turn. First (in the words of a Middle English translation), “he was tawght of a lady [a quadam domina edoctus] to leye an emplastre ther to,” and on her advice he takes to drinking a honey-based wound medicine, “the drynke of Antioche,” for a “longe tyme.”50 But at a certain point the ineffectiveness of the lady’s remedies becomes evident to the chaplain: “whan he perceyved that the forseyde medicines prevayled hym nowght he wente un to the Town of Notyngham to be leten blood.” With this decision, his pursuit of a cure assumes a new direction: from local environs to nearby town, from nonprofessional woman to craft-trained man, and from noninvasive herbal concoctions to bloodletting.
The chaplain visits a barber (barbitonsor). In the hierarchy of medieval English medical expertise barbers played an emphatically manual role, being distinguished from surgeons in the relative simplicity of the procedures allowed to them. If figures like Lanfranc of Milan, Henri de Mondeville, and John Arderne were forging an intellectual identity for surgery, barbers by contrast tended to be relegated to the position of unreconstructed empirics. But in this story, the barber shows his medical ambition: when he sees the nodule on the chaplain’s chest, he tells his customer that he recommends a more drastic course of procedure, “kuttynge or corrosyve [incision or corrosives].” The chaplain hesitates and decides to speak to an experienced surgeon (sirurgicus expertus) in the same town. This authority figure, who is also called medicus (leche in the Middle English translation), warns against any such violentas medicinas and explains that if the chaplain were to undergo them, “it wolde brynge hym to the deeth with owten ony rekevere [recovery] [usque ad mortem ipsius langorem irrecuperabilem].”51 This is where the experimentum ends: the reader never finds out if the chaplain is cured. Instead the story rests with having sketched a provisional hierarchy of medical advice, a hierarchy emerging dynamically from the chaplain’s itinerary—from a local lady to an overreaching barber-surgeon and finally to (in the Middle English) “awyse Sirurgyan.”
The figure of the domina in Arderne’s story is an interesting one. The title domina—or, in the Middle English translation, “lady”—indicates that this was a woman of means, probably propertied and respected, distinct from the figure of the vetula, or old woman, sometimes ridiculed by male medical writers. Upper-class women seem to have dispensed medicines quite regularly as part of their responsibilities in the household. The fifteenth-century commonplace book produced by the medical practitioner Thomas Fayreford, for instance, records the source of one recipe as Lady Poynings—who is elsewhere listed as one of Fayreford’s patients. Fayreford also cites a successful treatment by “quidam domina,” which succeeded even when “omnes scientes in Londyn” failed.52 A brief letter from Sir John Paston II to his wife attests to her role as both a medical authority and, in this case, a medical