Medicine and the Seven Deadly Sins in Late Medieval Literature and Culture

by Virginia Langum

  Excuses related to medical theories such as complexio are highly problematic in confessional contexts. The sins most commonly implicated in these arguments are the most corporeal of sins, gluttony and lechery; and priests and other pastoral writers often dwell on these sins at length in regard to complexio and the necessary constraints of the body. Indeed, some texts specifically warn against how sinners claim to have different complexions according to the sins they have committed. 153 However, rather than merely exposing inconsistency, the pairing of injunctions against false excuses with advice to priests to consider complexions is more likely to advocate the responsible use of medicine. Whereas medicine in the wrong hands can justify sin and imperil the soul, medicine can be used correctly to save souls. The weakness of the human body requires concession, not capitulation.

  The relationship between the material body and sin is also articulated and explored in passages related to astrology. Physicians, natural philosophers, and even pastoral theologians understood a connection between the stars and human behavior. The extent of “astral determinism,” however, varies between authors. The writer of a fifteenth-century sermon compares the seven sins with seven astral signs by way of “metaphoricall consideracioun.” 154 However, these same signs are causally linked with temperaments in scientific texts such as The Wise Book of Philosophy and Astronomy: “he schall be happy & disposed to do good or yuell aftir þe influence of þe constellacioun of þat planete in þe wiche he is born ynne.” 155 After a long discussion of each planetary sign, including constructions such as “whoso is borne in þat signe shall be a wikkid man & a traytour & an yvell deth he schall deie” and “whoso is borne in þat signe schall haue many angurris & tribulacionys,” the text argues for the role of free will in ultimately determining behavior:But neuer þe lattir it is to knowe þat noon of hem constraynyth a man to doo good or yuell, forwhi by a mannys owne fre wille, & þe grace of þe good kommyng bifore, & by his good leuyng & prayers, he may doo good þough he were disposed to doo yvell aftir þe nature & þe influence of his planete. On þe same maner, euen þe contrarie, by a mannys owne fre wille, & by þe cowetyng of a mannys owne herte and his eye, he may doo yvell þough he were disposed by his planete to do good. 156

  Despite insisting on free will, priests address the pull of the planets in confessional manuals, suggesting that the temptation of sinners to ascribe blame for their sins externally is a serious concern.

  The extent to which astrology is believed to affect a person’s disposition toward certain behavior and acts and the extent to which it conflicts with the Christian notion of free will is debatable. In response to the rise of Aristotelianism at the University of Paris, 219 condemnations were issued in 1277, some of which pertain to determinism:104. That the differences of condition among men, both as regards spiritual gifts and temporal assets, are traced back to the diverse signs of heaven.

  154. That our will is subject to the power of the heavenly bodies.

  160. That it is impossible for the will not to will when it is in the disposition in which it is natural for it to be moved and when that which by nature moves remains so disposed.

  163. That the will necessarily pursues what is firmly held by reason, and that it cannot abstain from that which reason dictates. This necessitation, however, is not compulsion but the nature of the will.

  167. That there can be no sin in the higher powers of the soul. And thus sin comes from passion and not from the will.

  168. That a man acting from passion acts by compulsion.

  169. That as long as passion and particular science are present in act, the will cannot go against them. 157

  These propositions were condemned to safeguard the potential for the will to triumph over the stars and the passions. 158 However, while the will might always, in theory, overcome the dispositions, popular theology clearly bears witness to the strength of the stars.

  Metaphor as Medicine

  In addition to medicine’s serving theology, medical texts apply the metaphor of Christus medicus and penitential language to effect material healing in the body. Just as religious and poetic writers existed in the discourse community of medicine and surgery, so medical and surgical writers existed in the discourse community of religion. 159 Particularly in regard to such heavily stigmatized diseases as leprosy, surgeons understood the moral load of the disease and the social significance of their positions. Guy de Chauliac, for example, exhorts the surgeon to comfort the leprosy patient, saying that leprosy is “saluacioun of þe soule.” The surgeon should also offer examples from the Bible, “if þe world haue hem in hate, neuerþelatter God haue hem not in hate. Ʒe, but he loued Lazer, þe leprouse man, more þan oþer men.” 160 Here the surgeon adopts the role of spiritual counselor, with such advice not only humane but also practical in the context of medical healing, allowing the patient to “stande in pees” rather than fall into despair.

  Medical texts frequently adopt religious language, often specifically penitential imagery. The idea of metaphorical language in science has been studied extensively in the last few decades. Many thinkers have challenged the alleged capacity for language to transmit science transparently. 161 As David Edge has argued, metaphor provides a material means by which to discuss the non-material: “we cannot think about the matter otherwise, because otherwise there is no ‘matter’ to think about.” 162 I argue that metaphor in medicine serves medicine in a conventional sense, elucidating certain medical conditions and procedures that require figurative language to be understood. However, in a more radical sense, we can see that metaphor functions as medicine if we examine the major works of two late medieval surgeons: the English surgeon John Arderne (d. 1392) and the Italian Lanfranc of Milan (d. 1306) who practiced in France. Arderne’s specialist text on anal fistula survives in 40 medieval manuscripts; 11 in Middle English, in which there are four separate translations, the first dating from the late fourteenth century. 163 Lanfranc’s surgical manual is more general in focus, covering the anatomy and treatment of the entire body. There are at least eight copies of Lanfranc’s manual in Middle English. 164

  When we think about metaphors in medicine in current language, we tend to focus on military imagery. Whether employed unconsciously or consciously, or assessed critically or uncritically, war is the dominant rhetorical domain in medicine. 165 Society wages campaigns against cancer, patients fight hostile pathogens, doctors give orders, and so on. Certain conceptual metaphor theorists have argued that metaphors such as TREATING-ILLNESS-IS-FIGHTING-A-WAR represent ways of structuring ideas that are timeless, pre-linguistic, and pre-cultural. 166 Other scholars, however, have attempted to historicize such metaphors. Various origins have been offered for the introduction of military metaphors into medicine: the seventeenth century, the American Civil War, and the advent of germ theory are a few examples. 167

  Medieval medical texts employed a range of metaphors, some of which are military. For example, harmful substances in the body are described as “enemies,” and knightly qualities of bravery and fortitude describe both ideal patients and ideal physiologies. These military metaphors may be considered both in terms of the practical context of battlefield surgical practice or as part of the larger medieval conceptualization of sin and the fortress of the body. 168 In a prevalent tradition, the body defends the soul as a fortress against attack by enemies such as the devil and personifications of the seven deadly sins. 169 Indeed, the language of sin and confession occurs more frequently in medieval medical texts than straightforward military imagery.

  The language of sin might seem immediately apparent to modern readers of medieval medical texts, in which terms such as “vices” and “virtues” describe properties of organs, bodies, medicines, and physiological processes. Likewise, certain herbs and remedies are “blessed” while others are “evil” and “wicked.” Although some historians of medicine warn against infusing these terms with the moral meanings of “good” and “evil” instead of reading them as simple denotations of “
positive” and “negative,” others argue for their greater signifying power:it is plausible to assume that the Christian connotations of these words helped, at least subconsciously, to dismantle the boundaries between the physician and the cleric in the eyes of the medical practitioner and his clients … By using the term peccatum (sin) in a medical context, the physician put himself, at least linguistically, on the same level as a priest, in that each could be seen as offering a way to heal peccata. 170

  Remembering the interpretive community of practitioners in medieval England—specifically the porosity of the boundary between physicians of the soul and those of the body—the ambiguity of these concepts seems more likely. Medical texts are suffused with the language of confession. Both Lanfranc and Arderne give the surgeon the role of the confessor. At the beginning of his surgical manual, John Arderne constructs himself as confessor, stating:ȝif pacientes pleyne [complain] that ther medicynes bene bitter or sharp or sich other, than shal the leche sey to the pacient thus; “It is redde [read] in the last lesson of matyns of the natiuitè of oure lord that oure lorde Ihesus criste come into this world for the helthe of mannes kynd to the maner of a gode leche [doctor] and wise. And when he cometh to the seke man he sheweth hym medicynes, som liȝt [light] and som hard; and he seiþ to the seke man, ‘ȝif þou wilt be made hole [healthy] þise and þise shal thou tak.’” 171

  Here Arderne clearly draws on the image of Christus medicus or Christ the physician. When used in the particular context of this surgical text, however, Christus medicus performs two functions. First, it provides a spiritual model for surgery; second, it demonstrates the material importance of metaphor to physical health. Medieval culture inherited the ancient connection between the arts and health, and medieval medical writers often discuss literature, music and art as positively influencing the passions and thereby improving the health of the body. 172

  Mirroring its role in confession, which as we have seen included consideration of the penitent’s complexion, discretion factors into Arderne’s surgical practice both in the injunction to adapt to particular patients and in the flexibility of practice. In fact, many surgical manuals emphasize that not everything related to surgery can be written down. Several times Arderne urges the surgeon to use ingenuity in his treatment and choice of instruments. In so doing, Arderne consciously writes himself and the craft of surgery into Christian meditative tradition, authorizing his advice with a quotation from Boethius: “he is of moste wreched witte þat euer more vseþ þings yfounden and noʒt things to be founden.” 173 The surgeon’s reliance on his own quick wit and evaluation of the particular situation mirror that of the priest in arbitrary penance. We remember that priests were advised to inquire at great length into the particular circumstances of sin. Although penitential manuals offer details and examples, priests, like surgeons, are advised also to be aware of examples that are absent from the manuals. 174

  Several traits of the surgeon as confessor and the patient as penitent emerge in Lanfranc and Arderne’s texts, illuminating the role of the metaphor of confession both in and as medicine: obedience, trust, pain as penance/treatment as satisfaction, and strong medicine for the weak heart. In concert, these individual aspects produce a confident metaphor of the surgeon or physician as confessor, the patient as penitent, and pain as penance. Beyond mere rhetoric, such metaphors might have functioned as real palliative care, both giving meaning to illness and perhaps materially improving health.

  Surgical texts stress the necessity of the patient’s obedience to the surgeon. John Arderne enjoins the patient to be “obedient and bisy [diligent]; ffor why; gret spede of werk standeth in þe paciens and bisynes of þe pacient.” 175 Likewise, Lanfranc notes that “a wounde mai be kept from apostyme [swelling] & an yuel discrasie [humoral imbalance] if þat þe leche be kunnynge & do his deuer [duty], & þe sike man be obedient to þe leche.” 176 “Obedience” is further used to describe the positive responsiveness of the body or affected body parts to the surgeon’s treatments. Lanfranc, for example, describes “evil wounds” as those to which “sharp humours run” and which are not “obedient to natural heat.” 177 Therefore, the obedience of the patient is implicitly linked with the obedience of the body, suggesting that the patient is complicit in the progress of his health and disease.

  This mutuality is expressed by John Arderne as follows: if “the pacient is gode herted and abydyng, it is noʒt to drede [fear] þat-ne þe lech schal spede [be effective] wele in þe cure of it if he be experte.” 178 One historian of medicine has described this pactum between the surgeon and the patient as “essentially penitential: like that required of the Christian by the confessor, when the patient is required to suffer the pains prescribed as necessary for the recovery of his spiritual health.” 179 Such a confessional pact is found in a late medieval English sermon: “For a worthy satisfaction two things are necessary: discretion on the part of him who imposes it, and obedience on the part of him who receives it.” 180 After probing the circumstances of the sin and the nature of the sinner, the priest assigns penance.This enjoined penance the penitent must receive in obedience and carry out in its totality. However much a person may show his wounds to a wise physician and however good a plaster he may receive, unless he takes it and puts it on his wound, he will never be healed by it. In the same way, however much a man may show his sins to a skillful and wise priest—and however salutary a penance he may receive from him, unless he will apply it and carry it out in deed, he will never be healed by it. 181

  Similarly, Arderne recommends impressing upon the patient the importance of the relationship between surgeon and patient before treatment. In the prologue to his surgery, he includes a model speech to deliver to the patient:Witte [know] ȝour gentilnes and ȝour hiȝnes, and also ȝour godehertynes [courage], þat þe gracious perfeccion of þis cure ow not only to be recced [regarded] as now to þe possibilite of my gode bisynes [abilities], bot also to ȝour gode and abydyng pacience. And for-alsmich be it noȝt hidde to ȝow þat if ȝe be vnobedient and vnpacient to my commandyngs, lustyngþe tyme of wirchyng [grudging the time the cure takes], ȝe may falle in-to a ful gret perile or tary longer þe effecte of þe cure. Therfor beþ-war, For he þat is warned afore is noȝt bygiled. Paynful things passeþ sone when at the next foloweþ glorious helthe. 182

  The critical urgency of this spiritual advice, similar to that found in penitential manuals, is suggested by its placement among practical matters such as how to select an operating room with good light.

  The surgeon shared this moral responsibility for the success of treatment, as the patient’s obedience was a corollary of his trust in the healer. Emphasis on the psychological relationship between patient and surgeon is expressed in the inclusion of prologues and chapters that outline the necessary qualities of surgeons. Such passages emphasize that surgeons must have not only the necessary surgical training but also the ability to display this training through the use of jargon and complicated terms. 183 Arderne advises the surgeon to study and to be “occupied in thingis that biholdith [pertain] to his crafte” so that he “shal boþ byholden [be held to be] and he shal be more wise.” 184 The surgeon’s reputation and speech are external manifestations of his abilities. Public perception not only shapes opinion of the surgeon’s abilities; it has a material impact on his healing.

  Surgical texts also outline appropriate behavior, grooming, and dress. Much attention is paid to proper dietary habits. What the surgeon feeds himself and what he feeds his patients—in a material and figurative sense—are of utmost importance. Surgeons materially feed their patients healing diets. However, surgeons also nourish patients with their words. John Arderne’s Practica includes an extensive passage on the surgeon’s drinking habits. He writes that “aboue al … it profiteth to [the surgeon] that he be founden euermore sobre; ffor dronkenneʒ destroyeth al vertu and bringith it to not.” 185 However, Arderne’s exhortation to ensure bodily sobriety is followed by an exhortation to maintain sobriety of demeanor and speech,
as he warns the surgeon to “abstenence [abstain] he fro moche speche, and most among grete men; and answere he sleiʒly [wisely] to thingis y-asked.” The concern is that inappropriate speech might “blemish” the “good fame” of the surgeon. 186

  As in pastoral writings on the vices and virtues, speech in surgical texts serves as an index of character. As well as general talkativeness [multiloquium], particular kinds of speech are proscribed in surgical prologues. Many of these speech acts correspond to those in pastoral writings on the sins of the tongue, as illustrated below. 187

  For example, the texts proscribe bawdy talk [turpiloquium]: Lanfranc advises the surgeon to “speke … noon ribawdrie [ribaldry] in þe sike mannis hous,” and Arderne exhorts against “harlotrie als wele in words.” 188 Next come joking [scurrilitas] and boasting [iactania]: in Lanfranc, “praise he nouʒt him-silf wiþ his owne mouþ;” and Arderne urges the surgeon “be noʒt … bosteful [boastful] in his seyingis.” 189 Backbiting [detractio] is admonished—Lanfranc tells the surgeon that “thou myʒt be no bacbitere” 190 —and both urge against flattery [adulatio] (in Lanfranc, “thou myȝt be no flatere” 191 ), lying [mendacio] (in Lanfranc, “thou myʒt be … no liere” 192 ) and insulting [convicium] (in Lanfranc, “thou myʒt be … no scornere,” and in Arderne, “skorne he no man.” 193 ) Both writers urge against sowing discord [seminatio discordiarum], along with grumbling [murmur]; quarrelling [contentio] (in Lanfranc, “ne chide not wiþ þe sike man ne wiþ noon of his meyne [company]”; 194 and swearing [blasphemia] (in Arderne, “he shal speke … withoute sweryng”). 195 Revealing secrets [revelatio secretorum] is also to be avoided: in Arderne “discouer neuer the leche vnwarly [incautiously] the counselleʒ of his pacienteʒ,” and in Lanfranc, the surgeon is to be “privy as a confessour” [discreet as a confessor]. 196 This emphasis upon the surgeon’s speech not only reflects the general cultural interest in speech fostered by the Fourth Lateran Council but also aligns the surgeon with the confessor. 197