Pestilence in Medieval and Early Modern English Literature

Byron Lee Grigsby

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781135883836
• Edition: 1
• Topic: Literature
• Subtopic: Literary Criticism
• Index: Literature

Pestilence in Medieval and Early Modern English Literature examines three diseases--leprosy, bubonic plague, and syphilis--to show how doctors, priests, and literary authors from the Middle Ages through the Renaissance interpreted certain illnesses through a moral filter. Lacking knowledge about the transmission of contagious diseases, doctors and priests saw epidemic diseases as a punishment sent by God for human transgression. Accordingly, their job was to properly read sickness in relation to the sin. By examining different readings of specific illnesses, this book shows how the social construction of epidemic diseases formed a kind of narrative wherein man attempts to take the control of the disease out of God's hands by connecting epidemic diseases to the sins of carnality.

CHAPTER ONE

From Sophrosyne to Sin

There are two main reasons why medieval literary critics should reevaluate the role of medicine in literature. The first is that most scholarship about medieval medicine has appeared since 1980; therefore, a lack of material is no longer a valid excuse for misunderstanding medical discourses. The second is that while most of the work about medieval science and literature emphasizes Chaucer and astrology, there is more to science than stargazing. Now that historians know a good deal more about medieval medicine, its relation to society, and its complex role in medieval thought, one can begin to understand how medical discourses interacted with other discourses which in turn shaped social responses to disease. These social responses to disease are influenced by a variety of disciplines, including the medical, theological, and literary.

The best way to explore the interaction of these disciplines is to examine the construction of health from its Greco-Roman roots to its medieval Christianization. Greco-Roman doctors believed in a humoral system where an individual could maintain health through the practice of sophrosyne or moderation. Sophrosyne was both a mental and physical regimen that was believed to keep the humors balanced. Eventually, the concept of sophrosyne was Christianized and immoderation became sin. The relationship between sin and health provided the foundation and the means of interpretation for many authors in the Middle Ages. Throughout this chapter, I will rely on many sources, both primary and secondary, but I am most indebted to the works of Oswei Temkin for providing the foundation of Greco-Roman medicine and the Christianization of that system.

GRECO-ROMAN MEDICINE

Medieval medicine is neither a precursor to our modern medicine nor a simplistic, primitive system. Rather it is an extremely learned theory that makes sense when one considers the information doctors of the period had to rely on. To do medieval medicine justice, it is necessary to reconstruct the development of this system in relation to health and illness. One must first realize that there are few similarities between medieval and modern medicine, especially in regard to the framework through which each approaches illness.

During the medieval period, the body reflected one’s state of health, and medieval doctors relied on the body as text. The body provided medieval doctors with a series of signs and symbols which needed to be read and interpreted in order to provide an effective cure. A modern example of the body being used as text occurs when emergency medical technicians (EMTs) check for unequal pupil size in accidents involving possible head injuries. If one pupil is larger than the other, the EMT suspects a serious head injury, thereby reading and interpreting the injury through the text written in the body. Today, the body as text is rarely used as the only witness to the health of the individual. Instead, medical tests are the means by which health is evaluated (Lupton 98).¹ In most cases, when the body does act as the text, the disease has often progressed very far, making it more difficult to cure.

Medieval doctors had no concept of germs as the cause of illness and no way to test for illness apart from the body itself. Jo Hays writes, “That disease exists ‘out there,’ and that it invades us, is a view that first gained particular currency in the late nineteenth century, especially because the persuasive power of explanations involving bacteria and viruses made those organisms seem the very essence of disease itself” (3). Medieval doctors approached illness through a markedly different framework than modern doctors do. While the body was known to degenerate with age, medieval doctors believed that a healthy body required a state of harmony or balance. An unhealthy body represented an imbalance, usually identified through a change or sign on the outside of the body, either on the skin or from an excreted fluid, such as urine. Thus the body becomes the text which the doctor needs to interpret in order to first diagnose and then cure. In many ways, we can see a parallel type of interpretation whereby a modern doctor receives a series of numbers from a blood test and produces a diagnosis and treatment for the identified illness. For medieval doctors, the body was the test that needed interpretation.

Lacking any concept of viruses or bacteria as causes of illness, medieval doctors were left to reason that certain behaviors led to illness. There were three types of possible illnesses: those caused by the body’s natural degeneration, those the body was predisposed to, and those caused by immoderate living (Temkin, Hippocrates, 9). We have a similar system in that we believe that people who smoke, eat red meat, or sunbathe are more prone to cancer and heart disease. We connect these diseases to either a predisposition, such as a hereditary line for breast cancer or heart disease, or to immoderate lifestyle, such as actions that lead to lung disease or liver cancer. While both medieval and modern medicine have a similar emphasis on personal behavior as a cause of illness, medieval medicine’s difference lies in the idea that certain sins could cause illnesses. The belief that certain illnesses were caused by specific behavior developed from authoritative Greco-Roman medicine, which was itself eventually influenced and modified by Christian thought.

These medieval notions of disease and morality are not simply metaphors; instead, they were seen as literal truths. Only by understanding the authoritative medical tradition through which doctors learned that immorality caused illness can we begin to see the social construction of disease in a variety of discourses. If, for example, one believes that a certain form of moral transgression causes illness, then the only way to alleviate illness is to correct the moral failings of an individual or of a community. In this sense, literature helps to inform people about the consequences of immorality in the hope that people will renounce sin and thereby help to eliminate the epidemic diseases which threaten to destroy the society.

The connections between morality and illness are not a medieval creation, but are rather part of the heritage of Greco-Roman medicine. Prior to Galen, the Greek medical community was split into three sects: the Empiricists, the Dogmatists, and the Methodists. All three sects continued to have followers through the Middle Ages and beyond; however, the unity Galen created between the Empiricists and Dogmatists had the strongest influence on medieval medicine. Each sect had its own beliefs about the cause of illness. The Empiricists believed that “in the treatment of the sick and similarly in dietary prescriptions, it ought to be possible to dispense with speculation and rely completely on experience” (Temkin, Galenism, 15). In this framework, there is no need to learn the theoretical basis for the health of the body; instead, “[t]he successful physician should concentrate on visible symptoms and visible causes and recommend therapy on the basis of past experiences (his own and that of his predecessors) of the efficacy of various remedies” (Lindberg 124).

The Dogmatists, on the other hand, “granted logical arguments a place in medical thought” (Temkin, Galenism, 19). This sect believed that not all medical knowledge could be gained through clinical experience, but must be learned through authoritative texts. The Dogmatists relied on a learned tradition and defended the notion of a microcosm and macrocosm (Temkin, Galenism, 19). The microcosm consisted of the four bodily humors: blood, phlegm, black bile, and yellow bile. Each of the four humors reflected the elements of the macrocosm: air, water, earth, and fire, respectively. The humors also had a temperature and degrees of moisture. Blood was hot and wet, phlegm was cold and wet, black bile was cold and dry, and yellow bile was hot and dry. According to this theory, when a person became sick, one of the four humors was out of balance. To balance the humors, one needed to take a prescription, usually made from some combination of plants or animals. Doctors categorized all plants and animals by their temperature and moisture. Thus, if a patient’s illness was caused by an imbalance of phlegm, which is cold and wet, he or she needed to counteract that humor with its opposite, yellow bile. Therefore, he or she would need to take a prescription made from plants and animals that were hot and dry. According to this system, humans are inherently connected to the natural elements because these elements, not germs, influence health.

Both the Empiricists and the Dogmatists venerated Hippocrates as the central authority on medical knowledge.² But by the first century, the Methodist sect, founded by Thessalus, Nero’s physician, questioned all authoritative or clinical learning (Temkin, Galenism, 31). This sect “rejected both etiological research and experience and inferred directly from the symptoms of disease to the status of the body, which, they thought, was tense or relaxed” (Temkin, Galenism, 31–2). Thessalus also boasted that he could “teach medicine in six months, clearly with complete disregard for the ancients” (Temkin, Galenism, 32). At the same time that Thessalus was founding the Methodist sect, Galen was combining the central tenets of the Empiricists and Dogmatists. Galen believed that authoritative learning was important but must not be accepted blindly; “rather, [medical authorities] are authorities in as far as they are proved right” through clinical experience (Temkin, Galenism, 32). Essentially, Galen saw medicine as a cumulative process in which one studied medical authorities and appended or altered the authoritative corpus through clinical experience.

Galen fought the Methodists because he believed that “they [were] not motivated by love for truth, but by greed and lust and by desire for political power” (Temkin, Galenism, 35). Galen’s rebuke of the Methodist sect demonstrates the emphasis he placed on morality. According to Galen, the Methodists could not be the preservers of medical truth, for they desired worldly goods, and the desire of worldly goods demonstrates a weak character. For Galen, health results from controlling the passions through sophrosyne, or moderation (Temkin, Galenism, 37). The control of the passions, both physical and mental, is what becomes Christianized into concepts of sin and redemption. Against the Methodist’s desire for worldly goods, Galen argued that his own life was an example of moderate living—he used his father’s inheritance to buy only the necessities of life: food, clothing, shelter, and medications (Temkin, Galenism, 37). The rest of his money went toward buying books and training stenographers, calligraphers, and students (Temkin, Galenism, 37). Galen’s argument against the Methodists is a matter of simple logic: if health is the result of moderation, and if the Methodists practice immoderation through the desire for worldly goods, then their ideology cannot be medically sound. Obviously, they do not know the true cause of illness: immoderation. The importance of moderation led Galen, a dietetic physician, to contend that all internal diseases are caused by errors in regimen, and hence avoidable. Oswei Temkin points out that after Galen, “health…becomes a responsibility and disease a matter for possible moral reflection” (Galenism, 40).

Galen’s emphasis on immoderation as a cause of illness appealed to early Christians. Temkin notes, “By A.D. 350 [Galen’s] acceptance as the leading authority was clearly established, and from about that time his position was secured in Alexandria, once more the center of medical learning” (Galenism, 61). Greco-Roman medicine held that illness was a consequence of immoderation; this view fit nicely into a Christian framework. Consequently, Greco-Roman medicine was not rejected by Christian thinkers but was Christianized.

THE CHRISTIAN ADOPTION OF MEDICINE

Numerous historians have demonstrated how early theologians Christianized Greco-Roman medicine. Both Nancy Siraisi in Medieval and Early Renaissance Medicine (1990) and Carole Rawcliffe in Medicine and Society in Later Medieval England (1995) provide helpful and accurate introductions to the Christianization of medicine. In Hippocrates in a World of Pagans and Christians (1991), Oswei Temkin examines the relationship between secular and monastic medicine as Christian institutions adopted Hippocratic ideas about the body, illness, and health. Darrel Amundsen’s Medicine, Society, and Faith in the Ancient and Medieval Worlds (1996) explores the boundaries between Christianity and medicine as drawn by both historians and medieval people. Finally, in The Birth of the Hospital in the Byzantine Empire (1985), Timothy Miller demonstrates how early Christians subsumed pagan sites of healing in order to replace one religion with another. By first exploring Miller’s work with Christian healing places, I show how Christianity attempted to fulfill some of the social responsibilities implied by Greco-Roman belief. I then demonstrate how the boundaries between medicine and theology were relatively thin during the medieval period by examining the role of medicine in penitential literature and monastic life. While these thin boundaries existed throughout the Middle Ages, around the twelfth century medicine started to become institutionalized, and thus became more secular. But it never fully lost its connection to Christian thinking, especially the connections between illness and sin.

The Christianization of medicine is most evident in the replacement of the medical-cult god, Asklepios, with the Christian God, Jesus. Asklepios was a Greco-Roman god who passed on methods of healing and medical knowledge to his believers. According to Timothy Miller:

When in the archaic period the god Asklepios emerged as the deity of the healing art, myth wove him into the chain of knowledge passed from generation to generation. Zeus taught Apollo; Apollo taught Asklepios; the deified Asklepios, in turn, passed the torch of medical knowledge to mortal doctors. By the fifth and fourth centuries B.C., Greek physicians regularly called themselves the Asklepiads or the Sons of Asklepios. (31)

Hippocrates considered himself one of the sons of Asklepios, and Galen believed that he was cured of an illness by Asklepios (Temkin, Hippocrates, 41). Whether through the passage of knowledge or through direct healing, the Greco-Roman medical system had a direct connection to the heavens. This connection played an important role in validating medicine as a divine craft.

The cult of Asklepios continued from the Greek to the Roman age. New shrines to Asklepios appeared throughout the Mediterranean (Miller 38). Archeological excavations and literary analysis provide information on how this cult worked. As Miller states,

When a suffering person arrived in the town, he usually had to find some kind of lodging on his own. Then, he walked or was carried to the sacred shrine and entered the temple precinct. There, he made some sacrifice to Asklepios and withdrew to a section of the temple area where he could sleep. This was the famous incubation. Often the suppliant simply found a comfortable spot or brought along a mat to lay on the floor. But some temples, such as the ones at Epidauros and Phocis, maintained special buildings where the sick could sleep. While the suppliants slept, Asklepios worked his wondrous miracles in three ways. The god might simply cure the suppliant in his slumber so that he awoke in perfect health. Or, he might appear in a dream and instruct the sufferer to perform a specific action, often of a bizarre nature. Finally, he might recommend an accepted medical remedy. (40)

The cult of Asklepios continued to flourish throughout much of the fourth century. It eventually collapsed under an attack on pagan shrines by the emperor Theodosius (379–95 A.D.). Interestingly, the cult of Asklepios was not destroyed but replaced by the cults of Christian healers, the most important being Christ (Miller 33).

Early Christian writers considered medicine to be divinely sent and sanctioned.³ Origen (185–254 A.D.) writes, “And surely there can be no doubt about medical knowledge. For if there is any knowledge [that comes] from God—which will be more so than the knowledge of health, in which the virtues of herbs as well as the qualities and differences of [the] humours are discerned?” (qtd in Temkin, Hippocrates, 130). Origen implies that because God has power over the natural world, the knowledge of plants and the makeup of the body’s humors is divine information given to man. Therefore, medicine is divinely sent and sanctioned. As Temkin notes, “Christian theology, the biblical symbolism of disease, and biblical examples of disease of the soul transformed the pagan medicine of the soul into a spiritual medicine” (Hippocrates 177). Once medicine became spiritual, it was only a small move to the belief that the illnesses of the body reflected the state of the soul. But the move required the adoption of medicine under the auspices of theology.

Between the third and sixth centuries, Christianity embraced a connection between illness and sin and furthered the unity between spiritual and physical medicine. In the Old and New Testaments, disease was often a punishment to individuals who transgressed God’s law; consequently, Christ becomes the physician who can cure both spiritual and physical diseases (Jeffrey 614). While Christ was thought to be the perfect physician, his followers also gained acclaim as healers and curers. David Lyle Jeffrey recognizes, “The apostle Luke, one of the four evangelists and author also of the Acts of the Apostles, is referred to by Paul as ‘the beloved physician’ (Col. 4:14)” (614).⁴

CHRIST, APOSTLES AND PRIESTS AS DOCTORS

The image of Christ as the perfect doctor finds a permanent place in Christian thought with the writings of Saint Ambrose (339–97 A.D.) and Saint Augustine (354–430 A.D.). According to Christian tradition, Christ was both the savior of souls and healer of bodies. In De interpelatione Job et David, Saint Ambrose writes that Christ “heal[s] our wounds… He heals those that are willing and does not compel the unwilling” (qtd in Jeffrey 614). Saint Augustine also demonstrates the physical and spiritual healing of Christ. For example, in On Christian Doctrine, Augustine states:

But you, O Lord, abide forever, and you will not be angry with us forever, for you have mercy on earth and ashes, and it has been pleasing in your sight to reform my deformities. By inner goads you aroused me, so that I did not rest until you stood plain before my inner sight. By the secret hand of your Physician [Christ] my swelling wound subsided, and day by day my mind’s afflicted and darkened eyes grew sounder under the healing salve of sorrow. (168)

Like the members of the Asklepios cult who received healing through dreams, Augustine believes God healed him through a vision. What the healing God does for Augustine is spiritual and not physical, but the portrayal of Christ as a physician is unmistakable. More importantly, the last sentence demonstrates the addition of Christian practice into the healing process—the need for contrition. Only sorrow for one’s sins invokes the healing power of God.

The Christian Church also approved patron saints to govern medical knowledge and practice. Saints Cosmas and Damien provide the clearest connection between medicine and theology. According to tradition, both saints were well known for their medical expertise when an individual came to them with a leg so infected that “the saints had to cover their noses, for he already stank, because his bone too was festering” (Temkin, Hippocrates, 166). The two saints attempted to turn the sufferer away, but through his insistence, they accepted him into their homes. That night, angel Raphael came to the saints and told of a dead man “whose right lower leg they should give to the wounded man.” (Temkin, Hippocrates, 166). The saints did as the angel told them, and the man was cured. According to Temkin, the hagiog raphy of Cosmas and Damien “explain[s] the appellation of ‘anargyroi’ (literally, ‘without money’). The anargyroi were physician-saints who cured without any remuneration” (Hippocrates 166). The legend also demonstrates that the Church controlled medical knowledge, and it was sent down willingly from God.

Cosmas and Damien also demonstrate the unification of disease and sin and the importance of contrition for the alleviation of sin. Saints Cosmas and Damien’s day of remembrance is 27 September, and the prayer for the patron saints reinforces that the sins of the soul are found in the infirmities of the body. The prayer states, “May this bodily infirmity be to them a spiritual medicine of the soul. What previously in health they did amiss now let them repent in their sickness. Help them after their present infirmities to deserve to possess heavenly consolations” (Beck xiii). The presence of disease suggests a period of moral reflection as the individual finds the reason for the sickness of the soul as refracted through the body. During the first six centuries of th...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Acknowledgments
• Introduction
• Chapter One
• Chapter Two
• Chapter Three
• Chapter Four
• Chapter Five
• Chapter Six
• Conclusion
• Notes
• Works Cited