The Medieval Review 15.06.24

Kirkham, Anne, and Cordelia Warr, eds. Wounds in the Middle Ages. The History of Medicine in Context. Farnham, Surrey: Ashgate, 2014. pp. xvi, 254. $124.95 (hardback). ISBN: 9781409465690 (hardback).

Reviewed by:

Winston Black
Assumption College

It is a clear indication of how much the study of medicine in the Middle Ages has changed in the last few decades that most of the essays in the collection under review concern not physical "wounds, wounding, and wound healing" but rather wounds as textual constructs, signifiers of ideas, or objects of religious devotion (1). The title, Wounds in the Middle Ages, may thus seem misleading, but the editors do well to remind readers in their introduction that the wounds known best in the Middle Ages were Christ's and that wounds suffered in mundane accidents or military engagements were frequently understood in a Christian context. This volume is thus situated comfortably in the growing field of the intersection between medicine and religion in the Middle Ages, best known in the Anglophone world from the works of Joseph Ziegler, Irina Metzler, Valerie Flint, and Iona McCleery, among others.

The editors, Anne Kirkham and Cordelia Warr, have collected ten essays based on papers presented in 2011 at the symposium "Wounds in the Middle Ages" at the University of Manchester. Most of the essays treat sources and episodes from the twelfth through fifteenth centuries, although the first and last essays carry their themes into the twentieth century (respectively, wound management in the Great War and dismemberment in the comic film Monty Python and the Holy Grail). Kirkham and Warr, both of the University of Manchester, have divided the volume into six thematic parts, which unfortunately creates two "parts" of the volume with only one essay each. Those two parts frame the volume and create a roughly chronological sequence as "Part I: A Medical Overview" and "Part VI: The Modern Imagination."

Given that illness and injury in the Middle Ages have so often been interpreted metaphorically, both then and now, the editors have usefully placed first the most pragmatic and medically-grounded of the essays, Jon Clasper's "The Management of Military Wounds in the Middle Ages." Clasper, a surgeon and professor of trauma and orthopaedics, traces in a superficial manner the continuities and developments in wound management from Egyptian antiquity to the twentieth century, with a focus on later medieval surgeons and their innovations. He outlines the technical and transhistorical aspects of wound healing, as a counterpoint to the other contributors of this volume, who focus primarily on textual wounds. Clasper takes a Whig approach to the history of wound management, describing the activity of ancient and medieval physicians in terms of advances and pioneers, culminating in the achievements of Ambroise Paré in the sixteenth century. While Clasper is well read in the primary and secondary sources from the ancient, Islamic, and medieval traditions, his discussion would have benefitted from the inclusion of Michael McVaugh's The Rational Surgery of the Middle Ages (2006).

The following six essays, divided into three parts, all treat ideas about wounds as they are represented variously in hagiography, theoretical medicine, romance, and legal theory. At the start of Part II, "Miraculous Wounds and Miraculous Healing," Cordelia Warr explores in her essay "Changing Stigmata" the differences between early modern descriptions of the stigmata of St. Francis of Assisi and the better-known descriptions from the thirteenth century of Elias of Cortona, Thomas of Celano, and Bonaventure. Through a close analysis of the Spanish Franciscan Antonia Daza's Historia de las Llagas de Nuestro Seráfico Padre San Francesco... (1617), Warr demonstrates that the hagiographical tradition of Francis's stigmata was hardly static and was subject to medical debates about the nature of wounds in general, and the shape and bleeding of Francis's wounds in particular. Daza is adamant that Francis's wounds were real and bled profusely without ever forming scars, an idea that contradicts both the older accounts that described the stigmata as nail-shaped scars or protrusions and other early modern accounts that emphasized the absence of blood from Francis's wounds. Thus Francis's constant bleeding for two years after his stigmatization served as proof for Daza of a miracle. Warr convincingly places Daza's explanation at the intersection of early modern religious debates about the faking of stigmata and the contemporary "increased emphasis in detailed medical observation" evident in works like Vesalius's De humani corporis fabrica (1543).

Louise Wilson takes a more typical approach to the intersection of medicine and religion in her essay, "Miracle and Medicine: Conceptions of Medical Knowledge and Practice in Thirteenth-Century Miracle Accounts." She introduces the reader to the understudied canonization proceedings and miracle collection of St. Edmund of Abingdon copied in Auxerre, Bibliothèque Municipale, MS 123G, not long after Edmund's death in 1240. Wilson uses the miracles of a single saint to show that hagiographical authors held no single or simple attitude towards physicians and medical cures, but demonstrate a range of shifting opinions about the validity of physical medicine in relation to spiritual medicine. She concludes with the now standard arguments that descriptions of miraculous healing from the thirteenth century and after presuppose a certain degree of theoretical medical knowledge on the part of the authors and audience and that religious and medical "explanatory frameworks" were not always in competition but could fruitfully coexist even in a hagiographical context (81).

Karine van 't Land opens Part III of the volume, "The Broken Body and the Broken Soul," with her contribution, "The Solution of Continuous Things: Wounds in Late Medieval Medicine and Surgery," in which she demonstrates the potential impact of a theoretical medical model on wound treatment. She traces the medieval definition of a wound as solutio continuitatis, "a dissolution of continuity," that needs to be filled (as opposed to our modern conception of a wound as a break that needs to be closed, usually by stitches). Avicenna was the first to systematically discuss wounds as dissolutions of continuity in his Canon of the eleventh century, and it was through translations of the Canon that later medieval Latin authors also came to interpret wounds as a "dissolution of continuity." Van 't Land thus carefully outlines Avicenna's philosophical distinction of types of wounds and the different treatments proposed for those types. Since the healing of most wounds, according to Avicenna, should be accomplished by filling the wound rather than closing it, the formation of pus was essential to wound healing and the identification of "laudable pus" (103) a necessary skill for the surgeon and healer. A quick look at the notes will show that much of van 't Land's essay is a summary of Michael McVaugh's works on ulcers and surgery, but that dependence nonetheless provides a corrective to Clasper's essay described above. Van 't Land and Clasper's two essays should be read together to provide a complete introduction to later medieval ideas about wound management.

Van 't Land's essay is paired with M. K. K. Yearl's "Medicine for the Wounded Soul," which treads much of the same historiographical territory as Louise Wilson's "Miracle and Medicine," i.e., the influence of medical knowledge on religious texts in the High Middle Ages. Yearl's focus is the twelfth century and she traces the application of medical language and theory to the discussion of souls and bodies in Hugh of Fouilloy's De medicina animae, with reference to William of Saint-Thierry's De natura corporis et animae. Both works systematically apply medical theory to the nature of the soul, especially with relation to the "wounded" soul, not simply as a useful metaphor but in a fashion that suggests their authors saw body and soul as a unity subject to the same medical concepts. Yearl's essay is weakened by her failure to refer to any works from the large field of psychosomatic theory in the Middle Ages, most obviously and accessibly those of Caroline Walker Bynum, which should be an obvious starting point for any discussions of the implications of material medicine for immaterial souls.

Only one essay, Hannah Priest's "Christ's Wounds and the Birth of Romance," addresses wounds in literature, which is surprising considering the vast number of wounds in medieval epics and romance. Priest explores the meaning of wounding in Chrétien de Troyes's Erec et Enide in the context of defining both gender and genre, in the vein of Peggy McCracken's similar treatment of blood and gender in romance in The Curse of Eve, the Wound of the Hero (2003). Priest argues that, among Chrétien's romances, Erec et Enide"offers the most cohesive portrayal of the wounded male body" (148). The wounding of knights in this romance helps the audience define the male gender and, as indicated in the title, associate the knight with Christ as the Man of Sorrows in their shared, public woundings. Priest recognizes that Chrétien significantly predates the Man of Sorrows iconography but convincingly shows the links between the "construction of chivalric masculinity" (138) and a heightened sympathy for the wounded Christ in the later twelfth century. Consequently, the character of Enide can be read sympathetically as a Marian figure, at once the pathetic mater dolorosa and triumphant regina coeli. The suffering and treatment of wounds is thus made central to the construction of gender identities in this foundational medieval romance.

Jenny Benham's "Wounding in the High Middle Ages: Law and Practice" is paired awkwardly with Priest's essay in Part IV, "Wounds as Signifiers for Romance Man and Civil Man." Despite the section's title, wounds are, for Benham, not signifiers of some "civil man" but rather an important area of legal dispute in the High Middle Ages that has not received sufficient study. To begin to remedy this historiographical lacuna, Benham compares the legal contexts of wounding and personal injury in Scandinavian sagas (especially the Eyrbyggja Saga) and law codes such as the Danish Law of Jutland with the more abundant sources from Anglo-Norman and Angevin England in the same period, represented by normative codes like the Leges Henrici Primi, and records of cases like those in the 1218-9 roll for the Justices in Eyre for Yorkshire. She tentatively concludes that there were similarities between Scandinavian and English lands in how cases of wounding were brought to court, heard by a jury of twelve men, and resolved by a fine, but also some differences, such as that the English were generally far less interested in wounding cases than the Scandinavians. All the while Benham reminds us that neither literary nor normative texts may reveal the legal realities of wounding in either culture.

Part V of the volume, "Wound Surgery in the Fourteenth Century," is the most cohesive in the volume, with the two essays of Naylor and Patijn nicely complenting each other. Ian Naylor's essay "Medicines for Surgical Practice in Fourteenth-Century England: The Judgement against John Le Spicer" also complements Benham's, in that Naylor also explores a legal case of wounding, but Naylor is more concerned with the medical than the legal implications of the case. In 1353 the London masters of surgery and representatives of the London city government found the surgeon John Le Spicer guilty of professional negligence for exacerbating a wound on a patient's jaw. Naylor masterfully uses the brief record of this case as a heuristic tool for exploring the knowledge expected of surgeons in fourteenth-century England (both craft- and text-based), their potential techniques for wound management, and the medicines they had available and their formulations. The patient's wound was considered "incurable" and this case is thus a rare and "invaluable source" (176) for the study of a difficult category of medieval wound. Like Naylor, Maria Patijn, in her essay "The Medical Crossbow from Jan Yperman to Isaack Koedijck," explores a specific method of wound treatment. The Flemish physician Jan Yperman, who was active around 1300 and who wrote a surgical treatise Cyrurgie in the Flemish language, popularized the modification of crossbows for the removal of arrows embedded in a person's body. Patijn uses Yperman's textual description of the "medical crossbow", as well as images of it in manuscripts of the Cyrurgie and other sources, to describe the operation, purpose, and historical development of this shocking method of wound treatment.

In the concluding essay, "The Bright Side of the Knife: Dismemberment in Medieval Europe and the Modern Imagination," Lila Yawn clearly takes the most chances and has the most fun in exploring the topic of medieval wounds and wounding. After a review of graphic and supposedly "medieval" dismemberments in modern movies and literature, such as Monty Python and the Holy Grail, The Lord of the Rings trilogy, C.S. Lewis's Chronicles of Narnia, or Pulp Fiction, Yawn poses the simple question of "how medieval cutting up living bodies really was" (218). In response, she gives a whirlwind tour of nearly two millennia of images and descriptions of amputation, dismemberment, fragmentation, and mutilation from Cicero to Thomas Jefferson. In so doing she demonstrates, as many medieval apologists have already noted, that there is no greater amount or degree of dismemberment in the Middle Ages than before or after, but what leads moderns to equate "medieval" with "dismemberment" is the medieval tendency to celebrate dismemberment and put severed body parts on display, be they of the criminal or of the saint.

The essays in Wounds in the Middle Ages are of uneven quality, as has sadly come to be expected from conference proceedings, and--what is more troubling--show little evidence of shared reading and comparison among the contributors that would make for a more useful collection. The parts are stronger than the whole: some of the essays make interesting and original contributions to the study of medieval medicine and its influence on other medieval cultural constructs (Warr, Benham) and some are specialized examples of the classic model of the history of medicine (van 't Land, Naylor, Patijn) by their exploration of specific medical or surgical techniques of the Middle Ages and their underlying theories. But others (Wilson, Yearl), unfortunately, make the same approaches and conclusions to medieval religious texts (i.e. note examples of medical theory, then explain with reference to rise of scholastic medicine in High Middle Ages) that have been common practice for some quarter of a century now, without questioning the context of the texts under review. For example, is the mixture of responses to medical care in the miracle collection of St. Edmund of Abingdon described by Wilson typical of such collections, merely random, or unique to the thirteenth century? Is the shared Cistercian context of the treatises examined by Yearl relevant (as it no doubt is, from her reference to the works of David Bell on similar authors and texts)? A more serious and obvious problem of these two essays is that neither actually concerns wounds, or tells us anything new about the perception or treatment of wounding (even as a religious metaphor) in the Middle Ages.

Readers of this volume are left neither with conclusions (even tentative ones) about what wounds meant in the Middle Ages, nor with any methods for guiding further research on this clearly important topic. Moreover, I'm left unsure even of what a wound is: though wounds generally bleed, should medieval discussions of bleeding automatically be read as representative of wounds? Are medieval meditations on torture and pain (most obviously the Crucifixion) the same as meditations on wounds? The editors assume in their introduction (3) that medieval descriptions of suffering and torture can automatically apply to a discussion of wounds--this cannot necessarily be the case except when wounds are explicitly described. Perhaps it is the mark of a successful collection of essays to provoke so many questions, but it is not unreasonable also to expect from the editors a more concerted effort to explain clearly the unifying themes of their volume, to maintain a standard of quality among contributors, and to ensure that their contributions are guided into some sort of conversation with each other. Despite these concerns about the collection as a whole, most of these essays will provide stimulating reading for historians interested in medicine, surgery, the body, and religious materiality.

Copyright (c) 2015 Winston Black

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