Symptomatic Subjects. Julie Orlemanski
appear to the physician or the sick person. The treatise subtracts the semiotic quality of the symptom insofar as it happens to the patient. By reserving the symptom’s signifying power to the medicus, the Isagoge testifies to its place in a self-consciously learned tradition of healing, where interpretive authority rests with the educated practitioner. The distinction of sign from accident, even though “they have a single physical appearance,” also opens on to a much broader issue, namely, what authority (if any) the person bearing a symptom has to interpret it. Does the immediacy of her perspective yield any special insight, or is it disqualifyingly close? How does first-person knowledge rate alongside systematized expertise? Questions like these, about embodied experience and medical authority, are negotiated in many of the texts discussed in the chapters to follow.
It is the symptom’s medium, the living body, that gives the semiotic category its distinctiveness.23 Consciousness has only dim awareness of the biological processes that support its existence—the thickening of mucus membranes, the secretions of glands, the regulation of the heartbeat, and so on—processes that during the Middle Ages were categorized under the body’s “natural” and “vital” powers. Usually these processes carry on beneath the level of direct awareness, but in illness they spring to notice. Pain and bodily malfunction exaggerate the felt distinction between one’s sense of self and one’s corporeality, lending the body a kind of aggression: my stomach hurts; my stomach hurts me.24 In a sermon from the early fifth century, Augustine captures something of this phenomenological insight when he seeks to define illness’s opposite, health. “What is health?” he asks and answers, “Sensing, feeling nothing.”25 He continues, clarifying: “It isn’t just not to feel, as a stone doesn’t feel, as a tree doesn’t feel, as a corpse doesn’t feel; but to live in the body and to feel nothing of its being a burden, that’s what being healthy is.”26 In health, according to Augustine’s account, the body fades from concern, in what for him is a faint foretaste of resurrection. By contrast, symptoms, in their disturbance of somatic operation, trouble the body’s easy absorption into the self and insist that we feel its burden.
Strikingly, as the sermon continues, Augustine links the body’s obtrusion in sickness to the alien quality of medical discourse:
Indeed, we have many things inside us, in our entrails; would any of us know about them unless we had seen them in butchered bodies? Our guts, our innards, which are called intestines, how do we know about them? And then, precisely, it’s good, when we don’t feel them. When we don’t feel them, after all, when we are unaware of them, is when we are healthy. You say to someone, “Observe the esophagus.” He answers you, “What’s the esophagus?” Lucky ignorance! He doesn’t know where he keeps what is always healthy. If it wasn’t healthy, he would feel it; if he could feel it, he would be aware of it, and not for his own good.27
Here the very strangeness of medicine’s perspective and jargon is made into a premonition of suffering. Physiological vocabulary speaks for parts thrust into awareness by discomfort and breakdown. Augustine’s remarks dramatize how illness’s felt disjunction between body and self functions as an opening for discourse, when medicine’s language and gaze find their way into self-perception. To imagine our insides, according to Augustine, we project the sight of corpses inside ourselves, mingling our most private sensations with the observation of dead flesh. The passage’s brief imagined dialogue—Observe the esophagus. What’s the esophagus?—emphasizes the difference that perspective makes in speaking about the body. The terms of physiology seem alien to the healthy man; they name what he does not even know he has. But if he falls ill, he will need to speak in medicine’s idiom. On Augustine’s account, then, first-person experiences of sickness estrange us from our bodies and drive us to find new languages to describe them, to come to terms with what he calls the body’s burden.
None of this is to imply, however, that the Middle Ages had a dualistic conception of body and self. Christian theology and natural philosophy insisted on the ultimately embodied nature of human identity, albeit from different angles.28 Scholastic Aristotelianism taught that the soul was the substantial form of the body, and the incarnational theology central to late medieval devotion foregrounded the inextricability of flesh and salvation. But medieval culture, with its many ways of articulating corporeality, simultaneously spoke about what could not be directly identified with the body—self, subject, soul, spirit, person, reason, will. Through myriad explanations and practices, such terms were then re-related to the self’s materiality. Embodied subjectivity was negotiated between physical determination and willful agency and among the many historically specific ways of describing that interplay.
Returning to Chaucer’s Summoner, we can see that he exemplifies a number of key aspects of what it’s like to inhabit and respond to the observable disturbances of the flesh. Symptoms, as the Summoner’s portrait shows, are both material and social, taking shape between physiology and the expectations that frame it. His face is symptomatic because it is scabby and fyr-reed but also because of the fear that children express when they see it. As readers make their way through his portrait, his anomalous body catalyzes etiological speculation. Details of his life are drawn centripetally around his swollen, carbuncled features. We are called to fit his symptoms into a network of causes running both inside and outside his body and through various moments of biographical time. Etiological inference, it seems, is good at establishing correspondences between body and world but less adept at deciding the priority of cause and effect, or determining the relative fixedness, or fluidity, of embodied identity. And so, symptoms pose riddles of agency. They cannot be controlled merely by someone’s intending: the Summoner cannot directly will his skin fair or his complexion balanced. But symptoms respond to altered circumstances, to changed behaviors and habits. Phisik offers a backdoor to agency, through the manipulation of bodily causes, though in the case of the Summoner’s pharmaceutical self-fashioning, the seven medicines mentioned in the portrait all fall short.
These would-be remedies of quicksilver, lead oxide, brimstone, borax, white lead, and cream of tartar are all topical treatments to be applied to the skin. The superficial nature of the cures is of a piece with the Summoner’s preference for shallow pleasures over spiritual depths and for easy fixes over moral labor. But the remedies’ topicality may also say something meaningful about how the Summoner addresses himself to his body. It is from the outside that he tries to fix his symptomatic visage—from the same vantage that the gawking children aferd of his face look at him and, for that matter, from the position of the appraising narrator and readers. Like Augustine’s account of how someone comes to name her own intestines or esophagus, it is by way of others’ gaze that the Summoner recognizes his appearance as frightful, symptomatic, and in need of alteration. What could have been a mere accidental quality, a reddened roughness of the skin, assumes the role of stigma. The friction that Chaucer famously evokes between each pilgrim’s social role and that role’s idiosyncratic performance becomes in the Summoner’s case a friction at his own bodily surface, between his materiality and his desires, between what others see and what he wishes them to see. It is a resistance that, one imagines, is perceptible in the medicated abrasion of his skin, raw with borax, mercury, lead, and brymstoon—a corroded redness that is finally inextricable from the symptoms he treats.
English Phisik
The sense that saucefleem’s remedies might be near at hand and bodily infirmity susceptible to medical know-how are hopes that Chaucer’s Summoner would have shared with many in late medieval England. Medical discourse was on the rise. In the later fourteenth century, readers began to seek out and produce unprecedented numbers of texts addressed to the tasks of understanding and caring for human bodies. England’s growing culture of medical literacy and care was in many ways unique—a bricolaged, miscellaneous, and constantly renegotiated set of practices.
The absence of even incipient structures of regulation and professionalization distinguished England’s medical marketplace from the contemporary situation elsewhere in western Europe. The Royal College of Physicians was not founded until 1518, and medieval Oxford and Cambridge had only paltry medical faculties: “At Oxford … fewer than 100 men left any record of medical study [before 1500]. This was about one percent of recorded students. Cambridge’s body of medical students was about