Difficult times call for an explicitly personal approach to academic writing, argues medievalist Hope Doherty.
In these difficult times, many are struggling to engage with academic work. The global hardship of this pandemic— especially for vulnerable people such as the homeless, those with disabilities, those with unsafe home environments, and also because of institutional variance in how far employees are being cared for— seems to necessitate an explicitly personal approach to any writing that happens during this time.
I was due to write a report for The Polyphony on a Medical Humanities conference in Oxford, which I could not attend due to concerns about coronavirus. Instead, it was agreed I’d produce a piece on how medieval studies relates to the medical humanities. As a second-year PhD student, I do not feel qualified to illustrate how and why an account of contagious illnesses in the Middle Ages would be timely. What I can do is write an account of how I came to understand late medieval medicine in England when I was working on a particular medical manuscript back in 2018, while myself experiencing a period of intense mental illness, with the aim of demonstrating how the academic and the experiential are not discrete, separable areas of life— and this has perhaps always been the case.
In the later Middle Ages, university-educated physicians started making English copies of medical texts that had previously only been in Latin, therefore making them available to a much wider, lay audience. For example, Henry Daniel was an Oxford scholar who wrote his Liber Uricrisiarum in English, and it is the first academic medical text in English (c.1375-82). Scholars have stressed Daniel’s awareness of the need for vernacular accessibility to medical texts, particularly uroscopic ones. Uroscopy was the study of urine, and was considered a hugely important diagnostic method in the later Middle Ages. With English medical texts, many laypeople could learn how to make medicines and treat themselves.
I worked on the manuscript pictured above, CUL MS Dd.10.44, in 2018, which is full of medical texts entirely in Middle English. It is a plain volume, neatly presented but without illustrations. It has rubricated letters, but no other coloured ink throughout. The yellow pages, indicating sheepskin, have not been bleached, and the pores of the sheep are clearly visible, suggesting the manuscript was produced cheaply. Such characteristics are common in university books— though the vast majority of medical manuscripts are undecorated— and the handwriting also conforms to the letter-forms expected in late-fourteenth or fifteenth-century university bookhands. This manuscript also contains many uroscopic texts, and a complete translation into Middle English of a scholarly medical text that was studied by physicians at Oxford. I started to think that perhaps this manuscript was one of the ones copied out by university physicians, out of compassion to those who could not afford licensed medical care of their own.
Scholar of medieval medicine Linda Voigts has called this sort of copying a ‘groundswell of Englishing’ that took place in the fifteenth century, when unprecedented amounts of English medical manuscripts were produced. In 1421, a physicians’ petition asked that no one be allowed to practice physic unless he had studied at university, in order to quell fraudulent medical practice; in Oxford, this happened even earlier, with the 1350 statute prohibiting the practice of medicine by lay and non-Latinate persons being renewed in 1400. The reality was more mixed: being a fraudulent or ‘quack’ doctor did not necessarily preclude a university education— see, for instance, Chaucer’s Physician— and the role of women in medicine, such as midwives, was bolstered by the late-medieval trope of the Virgin Mary as a physician, even though women could not attend university. Legislation against fraudulent medicine was largely unenforceable, but it is important to recognise this hostility from some physicians towards more affordable forms of care.
Most people in the Middle Ages would not have been able to afford a university-trained physician, so these translated texts would have brought medicine to many more people, especially after rates of literacy dramatically increased during the fourteenth century. It’s possible to judge how far a manuscript was used pragmatically— like an instruction manual for making medicines or even for carrying out operations— by the condition of the pages. Dd.10.44 is full of patches of what may be spilled bodily fluids, and in this picture there is what may be a splotch of medieval or early modern blood. That this plain, cheap volume has survived, along with many others like it, suggests that that the information within it was highly valued.
Physicians knew their care only reached the privileged, and created these texts seemingly because of a charitable project to bring legitimate medical knowledge to the non-Latinate population. It was this population, too, who would have formed the audience to vernacular tales of wounding, illness, responsibility, guilt. Miracle tales are immensely diverse and often are only ‘miraculous’ because of the presence of Christ, Mary, or a saint; they often have ambivalent endings without clear resolutions. These tales often depict, whether there are physical manifestations or not, what we would now recognise to be mental illnesses. In one particular miracle story, the Virgin Mary stipulates that a sinful man may be resurrected to atone for his sins in life, but only if he bears a scar to remind him of his guilt. In several mystery plays, Lazarus is raised, only to feel guilty for his survival. In the romance text Sir Gawain and the Green Knight, Gawain is tested, and receives only a wound instead of a beheading due to his error being only a minor one; instead of accepting his positive judgement and survival, Gawain rejects all praise and wears this wound as a badge of shame.
Retrospective diagnosis is not generally helpful, but I think it is important to recognise that in the Middle Ages physical and mental illness were not separate. For instance, Piers Plowman has an account of one man who is suffering extreme mental distress (and sin) because of his various medical ailments such as cramp and plague, and most of the personified sins have visible illnesses. Writers were interested in exploring trauma and shame through ideas of illness and wounding in literature, and while these portrayals were often stigmatised— with sinners bearing scars, being ostracised from their communities, completing acts of penance and so on— a representation of some kind which articulated the potential horror of embodiment was sought and achieved. Indeed, Monica Green has noted that medieval bodies may have been ‘more scarred than we would ever imagine’, due to medical practices of phlebotomy, cautery and scarification to balance the humors and curb inclination to sin.
The symbiosis of body and soul in medieval Christianity seems strained where the body modified by pain appears more potently felt than externally given judgement, even when this judgement comes from divine authorities. Arthur Frank in The Wounded Storyteller has written that ‘The self is unmade in the opposition of the mind’s message of care and the body’s message of pain’, and that the oxymoronic nature of a survival technique that exerts further damage is possible because ‘many ill bodies cease to love themselves’. Often, in medieval literature, the message of care is that given by a moral authority, and the body’s pain is so powerful as to usurp that judgement. Surviving any kind of injury or illness can generate frightening, difficult experiences that medieval texts and readers are trying to understand.
These ideas are interesting when considered alongside the situation in the 21st century, with its chronically underfunded mental health services, ongoing stigma around certain types of mental illness and enduring ‘broken leg’ analogy. When I worked on CUL MS Dd.10.44, what enabled me to keep going with the project in the midst of my own breakdown was knowing that this manuscript had helped people. There is sadly no provenance for this manuscript, but given that there was lots of movement between Oxford and Cambridge in the fifteenth century, it seems plausible that this was a volume translated by a physician. Its relative legibility and neatness compared to other contemporary medical manuscripts suggests it may also have been a lending copy, which would have been passed around and copied from. Every morning I would visit this manuscript in the University Library— in the heavy snow of that particular spring— and feel less alone in thinking about this charitable medicine from hundreds of years ago.
Hope Doherty is a Doctoral Candidate in Medieval Literature at Durham University. The working title of her thesis is ‘Laws, Wounds and Anti-Semitism in Middle English Marian Literature, c.1200-1500’. Hope is affiliated with Durham’s Institute for Medical Humanities, and she co-runs the corresponding medical humanities network for postgraduate and early-career researchers. Hope tweets at @EHopeDoherty
 This conference was run by London Centre for Interdisciplinary Research, held at St Anne’s College, Oxford, 14-15 March 2020.
 Harvey, E. Ruth, Nicholas Everett, M. Teresa Tavormina, Faith Wallis, Sarah Star, Jessica Henderson, Cai Henderson, Winston Black, Hannah Blower, Una Creedon-Carey, Lara Howerton, Shirley Kinney, Iona Lister, Nora Thorburn, Elise Williams, The Henry Daniel Project. https://henrydaniel.utoronto.ca/urines/ (accessed March 27, 2020).
 Jasin, Joanne. 1993. The Transmission of Learned Medical Literature in the Middle English Liber Uricrisiarum. Medical History, 37: 313–29 (314-5).
Hanna III, Ralph. 1994. Henry Daniel’s Liber Uricrisiarum. Lister Matheson, ed., Popular and Practical Science of Medieval England. East Lansing: Colleagues Press, pp. 185-219 (p. 188).
 Clemens, Raymond and Timothy Graham. 2007. Introduction to Manuscript Studies. Ithaca: Cornell University Press, pp. 9, 12.
 This is the Practica brevis, by Johannes Platearius II, originally written in Latin in Salerno in the twelfth century. See Tony Hunt. 1994. Anglo Norman Medicine, Volume I: Roger Frugard’s Chirurgia and the Practica brevis of Platearius. Suffolk ; New York : D.S. Brewer, p. 149.
 Voigts, Linda. 1995. Multitudes of Middle English Medical Manuscripts, or the Englishing of Science and Medicine. Margaret Schleissner, ed., Manuscript Sources of Medieval Medicine: A Book of Essays. Garland Reference Library of the Humanities, v. 1576. New York: Garland, pp. 183-197 (p. 184).
 Getz, Faye. 1992. The Faculty of Medicine before 1500. J. I. Catto and T. A. R. Evans, eds., The History of the University of Oxford: Volume II: Late Medieval Oxford. Oxford Scholarship Online : 2011, pp. 375-405 (pp. 396, 400).
 See Watt, Diane. 2015. Mary the Physician: Women, Religion and Medicine in the Middle Ages. Naoë Kukita Yoshikawa,ed., Medicine, Religion and Gender in Medieval Culture. Cambridge: Boydell & Brewer, pp. 27-44.
 See Clanchy, M. T. 1993. From Memory to Written Record: England 1066-1307. Cambridge, Massachusetts; Oxford: Blackwell.
 For more on the survival of medical manuscripts from this period, see Connolly, Margaret. 2016. Evidence for the Continued Use of Medieval Medical Prescriptions in the Sixteenth Century: A Fifteenth-Century Remedy Book and Its Later Owner. Medical History, 60, 133–54.
 See Getz, Faye. 1990. Charity, Translation, and the Language of Medical Learning in Medieval England. Bulletin of the History of Medicine; Baltimore, Md., 64, 1–17.
 Langland. The Vision of Piers Plowman. B. V. 78-92, 136-137, 385-391; B. XIII. 250, 334-338.
 Green, Monica H. 2010. Introduction. Linda Kalof, ed., A Cultural History of the Human Body in the Middle Ages. Oxford: Berg, pp. 1-17 and 233-35 (p. 3).
 Frank, Arthur W. 2013. The Wounded Storyteller: Body, Illness, and Ethics. Chicago: The University of Chicago Press, pp. 41, 173.
 Parkinson, Hannah Jane. 2018. ‘It’s nothing like a broken leg’: why I’m done with the mental health conversation. https://www.theguardian.com/society/2018/jun/30/nothing-like-broken-leg-mental-health-conversation (accessed March 27, 2020).
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