In addition to his explication of Christus medicus, as previously quoted, Arderne includes a few philosophical snippets and generally advises the surgeon to learn a stock “of gode taleȝ and of honest that may make þe pacientes to laugh, as wele of the biblee as of other tragedieʒ.” The purpose is to “induce a liʒt hert” in the patient. 198 Inducten, or “induce” in modern English, is a verb that means both to “persuade” and to “induce”; and in medical contexts, specifically to “introduce something into the body.” 199
By aligning the stages of medical treatment with the stages of confession, Arderne and Lanfranc further position physical suffering in terms of spiritual health. Lanfranc uses the word “penaunce” as a synonym for “pain.” 200 Just as medieval confessants undertook various forms of penance—almsgiving, physical mortification, and prayers—to cleanse themselves of sin, so medieval surgical patients also undertook “penance” as treatment for their illnesses. Similarly, Arderne uses the word “satisfaccion” [satisfaction], which in confessional contexts refers to the satisfactory repayment of acts of penance for sins, to denote rigid adherence to his instructions. He recommends that the surgeon advise the patient as follows:I dout noʒt, oure lord beyng mene [intermediary], and ȝif þou wilt competently make satisfaccion to me, as sich a cure—noȝt litle to be commended—askeþ [requires], þat ne þingis y-kept þat ow to be kepte, and y-lefte þat ow to be lefte, as it is seyde, I shal mow bryng þis cure to a loueable ende and heleful [good and healthy conclusion]. 201
Like confession, surgery is painful and embarrassing in the short term; however, it promises greater health when patients put their faith in their cures and submit wholly to the surgeon/confessor. Pastoral texts convey these ideas through the image of the “vomit of confession.” For example, as one fifteenth-century sermon explains, it is “boþe peynefull and schamefull for the tyme þat hit lasteþ” but the sufferer will be healthier for a “longe tyme after if he rule hym afterward frome suche foule exceses.” 202 This comparison is particularly utile given the nature of Arderne’s practice. Arderne is aware of the fear and particularly the embarrassment related to his work, and thus warns surgeons against alarming patients during their initial evaluation. On the first visit, for example, surgeons should not put their fingers in the patient’s anus, nor should they display their surgical instruments. Fear and distrust are physiological forces, yet careful rhetoric, effective metaphor, and skillful interactions establish trust and increase the potential efficacy of cures.
Surgeons, like priests, must distinguish between patients and penitents to determine the best course of treatment. For confessors, this meant determining spiritual fortitude. For surgeons, this meant discerning both their particular complexions and their physical fortitude. This was not simply a matter of rehearsing a textbook response matching the symptoms, just as priests should consider other factors rather than simply assign a standard penance matching the sins. Throughout their texts, Lanfranc and Arderne employ the concepts of the weak heart and the strong heart to indicate physical fortitude. Weakness of heart is caused by a deficiency in vital heat and blood, and those with a phlegmatic and melancholic complexion are characterized by weak-heartedness. As in modern English, the heart is both metaphorical and material. To be strong-hearted is to be courageous (derived from the Latin for heart [cor]), and to be weak-hearted is to be weak. 203 However, this emotional or psychological condition can be determined by physiology. Despair or fear results in a physiologically contracted, weak heart.
Both surgical texts highlight the importance of determining whether a patient is weak of heart in order to identify the appropriate treatment. Using a line from Boethius, Arderne writes about cauterization as follows: “ffor to a strong sekeneʒ answereþ a strong medicyne, and namely in strong men. I call, forsoþ, delicate men feble men. ffor al þingʒ bene hard to a waik [weak] hert man. To a strong hert man, forsoþ, is noþing grete.” 204 Although Lanfranc less explicitly draws out the spiritual connections, he shows how “strong” or severe conditions demand “strong” or extreme treatments. 205 Yet “in euery medicyns þat a leche doiþ he schal take kepe [heed] of the strenkþe & of þe vertu of þe pacient.” 206
Regardless of individual physiology, Arderne implies that the weak heart can be bolstered through the use of metaphor. Employing the same quotation from Boethius, Arderne counsels surgeons to offer patients a lengthy cure regardless of prognosis, doubling the estimated recovery time, so that patients do not despair when their health does not improve immediately. As he explains,For it is better that the terme [diagnosis] be lengthed þan the cure. ffor prolongacion of the cure giffeþ cause of dispairyng to the pacienteʒ when triste [trust] to the leche is most hope of helthe. And ʒif the pacient considere or wondre or aske why that he putte hym so long a tyme of curyng, siþe þat he heled hym by the half, answere he that it was for that the pacient was strong-herted, and suffrid wele sharp þingis, and that he was of gode complexion and hadde able flesshe to hele; & feyne [feign] he othir causes pleseable [pleasing] to the pacient, ffor pacienteʒ of syche wordeʒ are proude and delited. 207
If despair causes the heart to contract and become weak, here Arderne persuades the heart in the opposite direction. He further advises the surgeon “ouer that hym ow to comforte þe pacient in monysshyng [adominshing] hym that in anguissheȝ he be of gret hert. ffor gret hert makeþ a man hardy and strong to suffre sharp þingis and greuous.” 208 Having a strong heart, then, is indicated simply by one’s ability to suffer. By convincing the patient to be spiritually strong, he becomes materially strong; and metaphor becomes medicine.
Notes
1.Amanda Porterfield, Healing in the History of Christianity (Oxford: Oxford University Press, 2005).
2.All quotations come from the Latin Vulgate.
3.Richard Newhauser, “Preaching the Contrary Virtues,” Mediaeval Studies 70 (2008): 135–162. The phrase uirtutes contrariae [contrary virtues] occurs in Cassian’s Conferences.
4.Disease in the penitential tradition is surveyed in John T. McNeill and Helena M. Gamer, Medieval Handbooks of Penance: a Translation of the Principal Libri Poenitentiales and Selections from Related Documents (New York: Columbia University Press, 1938), pp. 44–50; John T. McNeill, “Medicine for Sin as Prescribed in the Penitentials,” Church History 1 (1932): 14–26; and Rudolph Arbesmann, “The Concept of Christus Medicus in St. Augustine,” in Traditio, 10 (1954): 1–28.
5.Raymond St. Jacques, “Langland’s Christus Medicus Image and the Structure of Piers Plowman,” Yearbook of Langland Studies 5 (1991): 111–27 (p. 113).
6.Citrome, The Surgeon in Medieval English Literature; Langum, “Discerning Skin,” pp. 141–60; Virginia Langum, “‘The Wounded Surgeon’: Devotion, Compassion and Metaphor in Medieval England, in Wounds and Wound Repair in Medieval Culture, ed. Larissa Tracy and Kelly DeVries (Leiden: Brill, 2015), pp. 269–90.
7.Eric Auerbach, “Figura,” in Scenes from the Drama of European Literature, trans. Ralph Manheim (Minneapolis: University of Minnesota Press, 1984), pp. 11–77.
8.I follow Denis Donoghue in Metaphor (Cambridge: Harvard University Press, 2014), pp. 33–34.
9.I. A. Richards coins these terms in his essay “The Philosophy of Rhetoric,” in Philosophical Perspectives on Metaphor, ed. Mark Johnson (Minneapolis: University of Minnesota Press, 1981), pp. 48–62.
10.Cited in Raymond W. Gibbs, The Poetics of Mind: Figurative Thought, Language, and Understanding (Cambridge: Cambridge University Press, 1994), p. 210.
11.Paul Ricoeur, The Rule of Metaphor (London: Routledge, 2003), p. 302.
12.Ibid., p. 21.
13.Peter W. Travis, “Chaucer’s Heliotropes and the Poetics of Metaphor,” Speculum 72.2 (1997): 399–427 (p. 402).
14.See Langum, “Discerning Skin,” p. 144.
15.Eric Jager, The Tempter’s Voice: Language and the Fall in Medieval Literature (Ithaca: Cornell University Press, 1993), p. 52.
16.David Punter, Metaphor (London: Routledge 2007), pp
. 9–10.
17.Travis, “Chaucer’s Heliotropes,” p. 406.
18.Cited in Giles Constable, “Medieval Latin Metaphors,” Viator 38.2 (2007): 1–20 (p. 3).
19.Aquinas, Commentary on the Sentences. Dominican House of Studies. Prologue Qu. 1, a. 5., ad. 3
20.Aquinas, Summa Theologica, I, qu. 1, art. 9.
21.Paul de Man, “Semiology and Rhetoric,” in The Princeton Sourcebook in Comparative Literature, ed. David Damrosch, Natalie Melas and Mbongisensi Buthelezei (Princeton: Princeton University Press, 2009), pp. 208–226 (p. 211).
22.See Deborah Lupton, Medicine as Culture: Illness, Disease and the Body (London: Sage, 1994), p. 59.
23.Janet Martin, Soskice, Metaphor and Religious Language (Oxford: Clarendon Press, 1985).
24.David Punter uses this phrase to describe how metaphors rely on social understanding in Metaphor, p. 104.
25. A Late Fifteenth-Century Dominical Sermon Cycle, ed. Stephen Morrison, EETS o.s. 337, 338 (Oxford: Oxford University Press, 2012), vol. 1, p. 105. There are at least seven known manuscripts of this cycle in medieval England.
26.Ibid., p. 105. For the same image, see Fasciculus Morum, p. 473. Fasciculus Morum: a Fourteenth-Century Preacher’s Handbook, ed. Siegfried Wenzel (University Park: Pennsylvania University Press, 1989). This late fourteenth-century or early fifteenth-century pastoral manual exists in 28 manuscripts and was probably written by a Franciscan friar. See also Siegfried Wenzel, Verses in Sermons: Fasciculus Morum and its Middle English Poems (Cambridge, Mass.: Mediaeval Academy of America Press, 1978), pp. 13–41.
27. A Late Fifteenth-Century Dominical Sermon Cycle, vol. 1, p. 102.
28.Ibid., vol. 1, p. 102.
29.Ibid., vol. 1, p. 103. Or in Fasciculus Morum, a prophylactic, purgative and healing diet (p. 465).
30. Jacob’s Well, ed. Arthur Brandeis, EETS o.s. 115 (London: Kegan Paul, Trench, Trübner & Co., 1900), p. 178. The text exists in a unique manuscript.
31.Langum, “Discerning Skin,” p. 153.
32.Wenzel, “Preaching the Seven Deadly Sins,” pp. 154–56.
33. A Late Fifteenth-Century Dominical Sermon Cycle, Vol. 1, p. 312.
34.Ibid., Vol. 1, pp. 313–5.
35.Bodley 649 contains two sets of sermons. The first set consists of 25 sermons, 23 of which are macaronic and edited in A Macaronic Sermon Collection from Late Medieval England: Oxford, MS. Bodley 649, ed. and trans. Patrick J. Horner (Toronoto, 2006). The other two are entirely in Latin. The second set consists of 20 additional sermons, all but three of which are in Latin. See Siegfried Wenzel, Latin Sermon Collections from Later Medieval England: Orthodox Preaching in the Age of Wyclif (Cambridge: Cambridge University Press, 2005), pp. 84–7 and Wenzel, Macaronic Sermons, pp. 50–2.
36.See for example, Rita Copeland, Pedagogy, Intellectuals and Dissent in the Later Middle Ages: Lollardy and Ideas of Learning (Cambridge: Cambridge University Press, 2004).
37.Kantik Ghosh, The Wycliffite Heresy: Authority and the Interpretation of Texts (Cambridge: Cambridge University Press, 2004).
38. A Macaronic Sermon Collection, pp. 133–134.
39.Natalie Calder compares the treatment of the Lollards in the sermon collection with the Digby lyrics in “‘The Puple is Godes, and Not ȝoures’; Lancastrian Orthodoxy in the Digby Lyrics,” The Review of English Studies 65.270 (2013): 403–420.
40.See Wenzel, Macaronic, pp. 268–307.
41.Ibid., p. 50.
42.For background, see Andrew E. Larsen, The School for Heretics: Academic Condemnation at the University of Oxford, 1277–1409 (Leiden: Brill, 2011).
43.Getz, “The Medical Faculty Before 1500,” pp. 374–405.
44.Joan Greatrex, The English Benedictine Cathedral Priorities: Rule and Practice, c. 1270–1420 (Oxford: Oxford University Press, 2011), pp. 172–3.
45.Alan Coates, “Benedictine Monks and Their Books in Oxford,” in Benedictines in Oxford, ed. Henry Wansbrouh and Anthony Marett-Crosby (London: Darton, Longman, and Todd, 1997), pp. 79–94 (p. 80).
46. Macaronic Sermon Collection, p. 27.
47.Ibid., p. 34.
48.Ibid., p. 34.
49.Ibid., p. 144.
50.Ibid., pp. 144–5.
51.Ibid., p. 146.
52.Ibid., p. 146.
53.Cited in Wenzel, “Preaching the Seven Deadly Sins,” p. 151.
54.For another extensive English example, see The Chastising of God’s Children, in which the writer draws upon general humoral physiology, if not explicit medical authorities, to analogize the four major types of fevers—quotidian, tertian, quartan and double quartan—to “foure goostli infirmytees.” The Chastising of God’s Children and the Treatise of Perfection of the Sons of God, ed. Joyce Bazire and Eric Colledge (Oxford: Blackwell, 1957), pp. 126–9.
55. Macaronic Sermon Collection, p. 62.
56.Ibid., p. 262.
57.Ibid., p. 276.
58.Gregory the Great, Morals on the Book of Job, ed. Charles Marriott (Oxford: John Henry Parker, 1844–47), V.11.28. For the circulation and manuscript tradition of Gregory’s Morals on the Book of Job medieval England, see Neil R. Ker, “The English Manuscripts of the Moralia of Gregory the Great,” in Kunsthistorische Forschungen Otto Pächt zu seinem 70. Geburtstag, ed. A. Rosenauer and G. Weber (Salzburg: Residenz Verlag, 1972), pp. 77–89.
59.Aquinas, Summa Theologica II.1. q. 102, art. 4. “Since leprosy arises from corruption of the humors, which break out externally and infect other persons, therefore were lepers also considered unclean … the uncleanness of leprosy signified the uncleanness of heretical doctrine; both because heretical doctrine is contagious just as leprosy is, and because no doctrine is so false as not to have some truth mingled with error, just as on the surface of a leprous body one may distinguish the healthy parts from those which are infected.”
60.R. I. Moore, The Formation of a Persecuting Society (Oxford: Blackwell, 1987); R. I. Moore, “Heresy as a Disease,” in The Concept of Heresy in the Middle Ages, eds. W. Loudraux and D. Verhelst (Leuven: Leuven University Press, 1976), pp. 1–11; Reima Välimäki, “Imagery of Disease, Poison and Healing in the Late Fourteenth-Century Polemics Against Waldensian Heresy,” in Infirmity in Antiquity and the Middle Ages, eds. Christian Krötzl, Katarina Mustakallio and Jenni Kuuliala (Farnham: Ashgate, 2015).
61.Thomas Gascoigne, Loci e Libro Veritatum: Passages Selected from Gascoigne’s Theological Dictionary Illustrating the Condition of Church and State 1403–1458 (Oxford: Clarendon Press, 1881), p. 29.
62. Macaronic Sermon Collection, p. 74.
63.Ibid., pp. 436–7.
64.Ibid., p. 438.
65.Ibid., p. 438.
66.Christine Caldwell Ames, Righteous Persecution: Inquisition, Dominicans, and Christianity in the Middle Ages (Philadelphia: University of Pennsylvania Press, 2009), p. 191.
67.Richard Newhauser, “The Love of Money as Deadly Sin and Deadly Disease,” pp. 315–26.
68. Macaronic Sermon Collection, pp. 440–1.
Medicine and the Seven Deadly Sins in Late Medieval Literature and Culture Page 10
