pain in the later middle ages - cohen

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Towards a History of European Physical Sensibility: Pain in the Later Middle Ages

Esther Cohen

Science in Context / Volume 8 / Issue 01 / March 1995, pp 47 74DOI: 10.1017/S0269889700001897, Published online: 26 September 2008

Link to this article: http://journals.cambridge.org/abstract_S0269889700001897

How to cite this article:Esther Cohen (1995). Towards a History of European Physical Sensibility: Pain in the Later Middle Ages. Science in Context, 8, pp 4774 doi:10.1017/S0269889700001897

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Science in Context 8, 1 (1995), pp. 47-74

ESTHER COHEN

Towards a History of EuropeanPhysical Sensibility:

Pain in the Later Middle AgesThey are and suffer; that is all they do:A bandage hides the place where each is living,His knowledge of the world restricted toA treatment metal instruments are giving.

They lie apart like epochs from each other(Truth in their sense is how much they can bear;It is not talk like ours but groans they smother),From us remote as plants: we stand elsewhere.

For who when healthy can become a foot?Even a scratch we can't recall when cured,But are boisterous in a moment and believe

Reality is never injured, cannotImagine isolation: joy can be shared,And anger, and the idea of love.

W. H. Auden, Sonnets from China, Sonnet 14.

The Argument

The study of pain in a historical context requires a consideration of the culturalcontext in which pain is sensed and expressed. This paper examines attitudestoward physical pain in the later Middle Ages in Europe from several standpoints:theology, law, and medicine. During the later Middle Ages attitudes toward painshifted from rejection and a demand for impassivity as a mark of status to aconscious attempt to sense, express, and inflict as much pain as possible. Painbecame a positive force, a useful tool for reaching a variety of truths. While thisattitude stemmed from the religious wish to identify with Christ's passion, itpermeated and affected all spheres of cultural expression and investigation. Latemedieval medicine accepted pain, trying to relieve it only when it became danger-ous to the patient. Given the existence of analgesic medicines at the time, thisattitude is comprehensible only within the cultural context of that period.

* My thanks to Gigi Santow, Mary and Kenneth Gergen, Mayke de Jong, and Kenneth Stow fortheir help and suggestions.

48 ESTHER COHEN

Introduction

Ever since Eve was sentenced to bring forth children "in sorrow," physical pain hasbeen considered an integral part of the human experience within the Judeo-Christian tradition. The Christian myth of origin linked suffering with the Fall,thus making it inseparable from human destiny. Physical pain was the price paidfor original sin, and physical pain redeemed the same sin. The entire history of thehuman race was encompassed within a symbolically charged cycle of suffering.

No human culture can ignore the pain factor. Barring rare cases of congenitalinability to perceive pain, it is a universal sensation, shared by all humans possess-ing functional nervous systems. The instinctive reaction to pain — crying out,weeping, making a sad face — is as universal a human quality as smiling from joyor pleasure (Schiefenhovel 1995). And yet this natural reaction is overlaid withcultural dictates. No two human cultures have prescribed precisely the samebehavioral reaction to pain. Indeed, the original premise of the anthropology ofpain is that while all humans must face pain, the difference lies in the manner inwhich various cultures dictate and formulate responses to the sensation. As a rulesuch attitudes are part and parcel of a total perception of the human body and itsplace within the cosmological framework. But whatever the reaction, or the meansof coping with pain evolved by each culture, they are all based on the premise thatthe avoidance of pain is a basic human instinct. "The only universal feeling aboutpain is that no normal human likes it" (Zborowski 1969, 31).

Cultural systems have no choice but to deal with pain. It is not only a universalsensation, it is also impossible to convey or share. "Man is born unto labor," statedJob (Job 5:7), but all scientists dealing with the experience have come up againstthe barrier of the utter loneliness of pain. It is essentially an individual experience,unsharable and intransmissible (Bakan 1968, 59-67). Though clinical researcherscompiling "pain questionnaires" have constructed a complex vocabulary to des-cribe the infinite varieties of physical suffering, they too are aware of the loosenessand idiosyncrasies affecting all description of the pain experience, and the conse-quent impossibility of any absolutely objective measurement (Melzack 1983a,1-5; Melzack 1983b, 41-47). Furthermore, people of different cultural-ethnicbackgrounds are apt to respond differently and use different terms to describetheir experiences (Zborowski 1969, 236-45).' In other words, all attempts todescribe pain and all reactions to pain are filtered through the cultural norms ofboth sufferer and observer.

In fact this filtering is essential. A sensation so universally experienced and soimpossible to share could constitute a dangerous crack in the fabric of any culturalstructure. Cultures are essentially the interpretations and structuring of shared

1 Since the publication of Zborowski's work, anthropologists of pain have taken issue with hisethnic stereotypes, arguing that culture was only one of an entire complex of individual factors —physical, psychological, and cultural — dictating pain reactions. See Kleinman et al. 1992, 1-3.

Pain in the Later Middle Ages 49

experiences (Geertz 1973), and the intransmissible nature of the pain experiencemakes it imperative that all cultures impose certain patterns of prescribed reactionsto it. For unless pain is structured, assimilated, and given meaning within thenetwork of cultural symbols, responses, and social ties, it might be a disruptiveelement. The nature of pain might well compare with that of the equally individualand intransmissible mystical experience. Though the latter is shared by only asmall elite, and only as the result of strenuous voluntary seeking, socially orientedreligions have consistently suspected mysticism precisely because of its intrinsicallyindividual nature. Pain is far more dangerous. Far from being confined to a smallmarginal group, it is part and parcel of every human being's destiny from birth todeath. It is not limited to those who seek the experience voluntarily, nor can it beproscribed or deliberately avoided. It is thus a factor every culture must contendwith in its own way.

The historical study of pain in the past has met with an additional difficulty. It isnot enough to distinguish between different cultural-ethnic groups and theirreactions. All cultures evolve with time, and attitudes towards pain have changedand developed through the ages even within the Western cultural tradition. Whilemodern researchers are aware that their results have been filtered through acultural lens, the historian must contend with a triple filter. First, as now, people inthe past used the vocabulary and gestures inculcated in them by their heritage toexpress the physical sensation (Scarry 1985,3-11). Second, unlike the anthropolo-gist, the historian cannot record these expressions. The only evidence available tous was subsequently filtered through the media of writing and iconography, intowhose durable mold the expressions were cast. In the process of recording, theformal rules of the text were imposed on the original expression — and these rules,we must remember, also change over time. Is it enough then to analyze these textsaccording to contemporary rules in order to reach the underlying experience, or atleast its original expression? Not quite. The historian must also contend with theexistence of a third filter, that of time and altered cultural norms. The relativity ofattitudes toward basic human emotions — love (both erotic and parental), mourn-ing, anger — and the changes over time in their modes of expression have beenstudied by historians and philosophers alike. Foucault, Badinter, and Duby areonly the best-known spokespeople of this approach. By the same token, I wouldargue, expressions of pain in the past were not only conveyed in a different form.The very experience was probably conditioned by the same cultural matrix thatdictated the forms of expression.

It is thus impossible for the modern historian even to attempt any objectiveassessment of pain in the past. Moreover, research has shown that now too thesubjective, psychological context of pain is an integral factor of the experience atall times.2 The very tolerance level of people enduring pain under anxiety-free

2 "Cognitive-affective processes are an integral part of the total pain experience" (Melzack 1983a,3).

5 0 ESTHER COHEN

conditions (such as laboratory tests) was found to be much higher than that of ill orwounded people, whose physical sensations were aggravated by fear of death andannihilation (Beecher 1952, 157-62, cited in Zborowski 1969, 16). If the physicalexperience of twentieth-century sufferers has been so significantly affected by thecontext of the pain, it is fairly safe to assume that the feelings of people in the pastwere equally affected by the specific circumstances of their distress. Fear of thepain and its associations undoubtedly aggravated it, while acceptance probablyreduced the sensation. And fear or acceptance are part of the cultural-historicalcontext that is indeed within the historian's domain.

This setting, it must be stressed, is not a medical one. Pain is not a medical factbut a human one. Even given the modern prevalence of medical care and ideas — aphenomenon unprecedented in human cultures — people do not resort to physi-cians in order to express pain. Nor does the medical profession dictate the modesof expression. It is a primal human event, and its context belongs to the realm ofgeneral human culture. While medical opinion forms an integral part of this cul-ture, it is more apt in this instance to be influenced by the context than to shape it.

In order to study attitudes toward physical anguish I have adopted an integrativeapproach, attempting to examine a number of disciplines either dealing with orexpressing physical sensations. The multifaceted nature of human experience isbound to influence the thinking and writing of people at any given time. The mostdedicated and abstruse of philosophers exists within a given reality, eats its food,smells its smells, wears its clothes, and feels the same aches and pains other humansfeel. The same is true of the poet, the painter, the physician, and the surgeon.Beliefs concerning the human body and its sensations cannot therefore be classifiedas "history of science" and left there. They belong in the history of the entire scopeof human experience and reactions to that experience.

However, one must be careful to distinguish among types of disciplines and,consequently, the sources they provide us. Disciplines attempting to describe andconvey the pain experience are bound to approach the subject in a mannerdifferent from those investigating the nature, meaning, and uses of pain. Theformer, comprising all expressive art forms, are bound to convey their message byuse of specific artistic codes, thus providing us with an insight into the culturalimperatives dictating the manner of both venting and describing physical anguish.The latter — philosophy, medicine, and law — attempt to place the pain experiencewithin certain conceptual frameworks regarding human destiny, history, andphysiology. Consequently, their explanations and prescriptions must be viewedwithin the context of these frameworks. Thus seen, they illuminate strategies ofpain control and manipulation, addressing the most basic question of all: shouldone ease or aggravate other people's physical pain at all, or merely recommendtoleration?

As all our evidence has been filtered through the cultural-temporal lens of theEuropean context, it is important first to examine various culturally conditionedresponses to pain in Western society. By analyzing the varieties of pain expressions


and attitudes we may achieve an integrated profile of contemporary approachestoward the experience of pain. It is not the purpose of this paper to provide anyconclusive answers. Exhaustive research on the subject remains to be done.Rather, I would like to delineate the cultural context of late medieval pain-relatedattitudes and to attempt the formulation of a thesis explaining the coalescence ofone coherent attitude.

To understand the uniqueness of the attitude toward pain in the later MiddleAges, an attitude I have termed philopassianism, it might be useful to examinesome of the prevalent cultural attitudes toward pain. Each culture evolves a set ofimperatives dictating the correct responses of its members in any given painsituation. Though these imperatives are not invariably obeyed, they largely doshape behavior in the face of physical suffering. Modern Western culture, on thewhole, considers physical pain an evil best avoided, or at least alleviated. Thegrowth of anesthesia during the past century, not only in surgery but also in otherphysically traumatic situations, is proof of this attitude. Even such situations aschildbirth, where pain is culturally acceptable, have become occasions for the useof sedation.

While rejection might not be the universal attitude among medical practitioners,it is the culturally prevalent one. Physical suffering is not considered inevitable orunavoidable. On the contrary, modern Western culture seeks as much as possibleto eradicate all types of pain. The pain inflicted by medical treatment (be it surgeryor merely a dental filling) is invariably anesthetized beforehand. One expects thetreatment of any sickness automatically to include an alleviation of pain symptoms.Even nonmorbid painful situations, such as premenstrual cramps, have becomethe object of pharmaceutical attention. The painkilling industry is a fact of majoreconomic proportions in modern Western culture.

One might argue that only a culture that had developed its pharmacopoeia tothe present extent could afford this attitude. The choice not to suffer is, after all,predicated on the existence of means that can put a term to suffering. But thatwould be placing the cart before the horse. Many primitive societies are familiarwith the analgesic qualities of various plants, yet they do not resort to them insituations in which modern Westerners would automatically demand relief. Moreimportant, in many societies the acceptance of pain is a cultural imperative. Thisattitude concerns not only involuntary pain but, more significantly, deliberatelyand ritually inflicted pain. The ability to withstand severe pain without recoiling isoften a test in rites of passage and initiation (Zborowski 1969, 40).

The infliction of mutilation and pain, especially in rites of passage to maturity, isnot a universal factor. It is most common in societies that sanction violence ingeneral and whose members are likely to be exposed during their lifetime toviolence. Such rites are almost invariably practiced on males, expected both toinflict and to suffer violently induced pain during their lifetime. In all thoseceremonies, the young men undergoing pain are expected to manifest impassivity— in other words, to endure without flinching.

52 ESTHER COHEN

This phenomenon is not limited to American Indian and Australian tribes. Evenpain-rejecting modern society will demand impassivity under certain circumstan-ces. Young football players might automatically be injected with Novocaine at thedentist's, but are expected to sustain sports injuries without crying out. The normis restricted not only to specific circumstances but also to specific age, sex, andsocial groups. Vocal and physical expressions of anguish permissible to littlechildren or to women of various ages — crying, groaning, screaming — are notsocially acceptable for grown men outside a hospital ward. Finally, impassivity isoften a yardstick of social status, displays of pain sensitivity being considered bothvulgar and ill-mannered.

Impassivity consists in the ability to tolerate pain without any visible or audiblereaction. It does not entail insensitivity to pain. On the contrary, the virtue ofimpassivity lies in the strength manifested by the sufferer who feels the painwithout showing it. The capability of transcending pain completely, or impassibili-ty, is a different category. Eastern religions have made impassibility a goal attai-nable after long and arduous spiritual discipline. The ultimate aim of this trainingis not merely transcendence over pain but an overall freedom from physicalsensations. In the West, impassibility was merely a dispensation from pain withouttotal insensibility. Furthermore, it was never considered something any personcould achieve by training. It was a miraculous quality, a gift from heaven grantedonly occasionally to saints and martyrs.

The three attitudes — rejection, impassivity, and impassibility — do not excludeone another. A combination of any two or of all three can be found in varioushistorical and cultural settings. For example, cultures demanding impassivityduring rites of passage may well allow sedation (and thus rejection of pain) insickness or surgery. By the same token, no culture expects impassibility from all itsmembers or attributes it to them. Indeed, such a norm would fly in the face ofhuman nature. Impassibility, whether congenital or acquired, is invariably thehallmark of a small elite, while the rest of society conforms to other pain-relatedbehavioral norms.

All three reactions are founded on the basic premise that pain is a negative force.One must do one's best to deal with it, but one need not seek it. In this, all threecultural attitudes accord with basic physiological instincts that dictate the shunningof pain (Schiefenhovel 1995). The rise and development of philopassianism in thelater Middle Ages and early modern period is therefore an extraordinary pheno-menon. It is the complete opposite of the instinctive human reaction to pain: thedeliberate, conscious attempt to feel as much physical anguish as possible. It isboth diametrically opposed to human instincts and unique within the history ofhuman cultures. Philopassianism is emphatically distinct from modern masochism.One did not seek pain in order to derive sensual pleasure from it. The physicalsensation was invoked because it was considered useful, not pleasurable. The usesof pain were manifold, depending on the circumstances and the object. In thewidest sense of the term, it might be said that pain was seen as an avenue to


knowledge. Knowledge of the body, of the soul, of truth, of reality, and of God.Whether self-inflicted or caused by others, physical pain was a way of affirming theboundaries of identity.

Historical Background

The different attitudes toward physical pain did not emerge concurrently, nor wastheir role in Western culture continuous. Rejection is undoubtedly a new pheno-menon, closely tied to the cultural and scientific developments of the last twocenturies. Conversely, impassivity has a long history in the West. Its reappearancein the last centuries is tied to what Norbert Elias has termed the civilizing process.Like other parallel processes, it first grew normative among the higher classes,becoming integrated in common consciousness only during the last century or so(Elias 1982). Nevertheless, the roots of impassivity lie much deeper than those ofrejection, for it was a well-documented pre-Christian norm. Stoic philosophy(later transmuted into the patristic teachings of Clement of Alexandria) saw avirtue in the ability to ignore, and thus master pain. Apatheia, or the ability to freeoneself completely of one's passions, was the philosopher's ideal. The passions, inStoic terms, were not the physical sensations — inevitable corollaries of possessinga body — but the emotions triggered by such physical stimuli as hunger, pain, fear,or desire (Brown 1988,130-31). Through wisdom one could achieve the control, ifnot the eradication of bodily sensations.

This norm, restricted to rarefied philosophical circles in imperial Rome and lateantique Alexandria, reappeared in a different guise in later centuries. The devel-opment of the noble ethos of the high Middle Ages made impassivity a statussymbol. Pain and its expression were held in contempt as manifestations fit onlyfor the female and the unfree. Dolor was Eve's punishment, and thus both apenalty and a female attribute. It was also practically synonymous with labor,Adam's sentence of manual labor, restricted in practice to the unfree. Thoughchivalric literature abounds in descriptions of battles, wounds, and mutilations,the heroes of these epic poems hardly ever express any pain response to all thismayhem. In short, they prove both their manhood and their nobility by theircapacity for impassivity (Duby 1988, 203-9). There is ample evidence that impas-sivity ceased being the hallmark of nobility during the later Middle Ages and earlyModern period. Kings and peasants, noblemen and workers, were equally permit-ted to give voice loudly to physical anguish. The detailed descriptions of their ownsufferings and illnesses left by Renaissance scholars, who simultaneously perceivedthemselves as noble, reflect the change in attitude.

Impassibility has a shorter history in the West. Paradoxically, impassibility firstappeared within the context of the one religion that had succeeded in socializingthe experience of pain. The centrality of pain to Christianity is of overwhelmingimportance. Pain comprised both the penalty for original sin and the redemption

54 ESTHER COHEN

of humanity. And pain was perceived, most importantly, as a purely humanattribute. All the Christological controversies of late antiquity stemmed from thedilemma created by the belief in Christ's divinity, as a purely divine Christ couldnot suffer in the body, thus redeeming the sins of humanity. For Christianity, painwas thus from the very beginnings a central historical and cosmological forcerather than an individual, evanescent experience. Consequently, it became part ofcommunal consciousness, a fact of great social importance (Bakan 1968, 67).

This was something of a mental revolution in the world of late antiquity. Thesocial codes of the late empire did not consider pain a sensation befitting freemen.The entire health routine prescribed by ancient medicine for gentlemen of positionwas meant to avoid illness and pain (Rousselle 1983, 7-13). Judicial torture wasnormally restricted to slaves and inflicted on freemen only under suspicion oftreason (Mommsen et al. 1922, Digesta 48:14, "De quaestionibus"). The idea thatpain was not only universal and unavoidable, but also necessary for humansalvation revalidated and socialized physical suffering.

A religion that had accomplished such a major revolution regarding the humanbody, that had deliberately made its God into a suffering man, could hardly beexpected to create its heroes in an impassible, super-human mold. And yet that isprecisely what Christianity did. Early Christian martyrs displayed a number ofsupernatural characteristics, all connected with their extraordinary ability towithstand pain. Some were indeed impassible, testifying that they felt no painunder torture (Shaw 1993; Musurillo 1972, 67, 79-91; Brown 1988, 73-75).3

Others were able to withstand an agony fatal to the normal human frame (Musuril-lo 1972,67). Even before their ordeals, martyrs were apparently aware of possessingthis superhuman tolerance, thus facing pain with a courage born of the knowledgethat their experience would not be the utterly lonely normal sensation of pain.They shared the test with each other and with Christ.4

One might well explain the martyrs' impassibility on those occasions in purelyhuman terms. They welcomed their death as a moment of supreme victory, atriumph to be rejoiced in; and their psychological state in the arena could well gofar toward explaining their lack of physiological response. Furthermore, contem-porary accounts of martyrdom were not invariably clear-cut, some stressing themartyrs' suffering, others insisting on their impassibility. But both hagiographyand theology denied this view. Medieval authorities insisted that martyrs wereimpassible because their flesh was materially and supernaturally different fromnormal human flesh. This difference was sometimes visibly and miraculouslymanifested in the absence of all signs of torture on martyred bodies (Musurillo1972, 69).

3 I have deliberately avoided later mythical martyrologies and passions, confining myself to theevidence of contemporary accounts concerning figures of unquestionable historicity.

4 "What I am suffering [dolo] now, I suffer by myself. But then another will be inside me who willsuffer for me, just as I shall be suffering [passurasum] for him," explained Felicitas while enduring thepangs of childbirth prior to her execution (Musurillo 1972, 123-25).


Augustine started the trend by claiming that the dead bodies of all saints wereincorruptible (Augustinus 1899, XIII.20). But the growing stress in later centurieson Christ's own passibility made it impossible to continue attributing impassibilityto his martyrs. Thomas Aquinas attributed this characteristic to two humancategories, both exempt from the laws of nature and neither of them undergoingmartyrdom. Adam and Eve had enjoyed it before the fall, being immune fromsickness, corruption, and death.5 The spiritual bodies of the blessed in Paradisepossessed it to an even greater measure, since they were entirely free of the physicalbody and its passions (LeMay 1955,108-20). According to Thomas, impassibilitywas clearly distinct from insensibility. The blessed retained their senses, being fullyable to smell, see, hear, touch, and taste the pleasures of Paradise. The only feelingthey lacked was pain (Thomas Aquinas 1866, pars tertia, suppl, q. 82). But in sodoing, Thomas and his fellow theologians had removed the possibility of impassi-bility from the human realm. It is no chance that the transformation from anearthly lack of sensation, albeit one belonging to saints, to heavenly experiencewas accomplished during the thirteenth century. By then, Christ's own sufferingshad come to play a central role in the religious imagination, and it had becomeinconceivable that Christ's own witnesses should have been deprived of sharing hisexperience.

Together with other supernatural physical qualities such as incombustibility,6

impassibility became in Baroque imagination a permanent characteristic of theblessed in Paradise. Preachers dwelt ecstatically both on the freedom it grantedfrom pain and disease and on the exquisite pleasures derived from this quality."Impassibility . . . has the delightful quality of enabling every sense to cull anoverwhelming abundance of pleasure from its corresponding excitant" (Zuccarone1671, 325, quoted in Camporesi 1988, 26).

The various attitudes toward pain, therefore, are not only culturally conditioned.They are also dependent on temporal developments within every single culture. Somuch so that, at any given time, those articulating prevalent perceptions (asThomas Aquinas did) are forced to infuse a new meaning into old terms in order toreconcile them with contemporary views. By the later Middle Ages, neitherrejection, nor impassivity, nor impassibility were the goal of those seeking perfec-tion. Their goal was philopassianism.

The Late Medieval Context

A phenomenon so startlingly comprehensive and so unusual certainly requires anexplanation. The simplest argument — namely, that an age afflicted with as many

5 In this, Thomas flatly contradicted Hugh of Saint Victor, who insisted that man before the Fallhad the capacity to suffer, but could choose not to sin and hence not to suffer. (Hugh of Saint Victor1951, bk, 1, pt 5, chap. 18, 107-108).

6 A characteristic subsequently transmitted to Protestant myths as well. See Scribner 1987.

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scourges as the later Middle Ages might naturally try to discover some virtue in itssuffering — does not unfortunately hold in the face of chronology. For the roots ofphilopassianism are clearly discernible already in the twelfth and thirteenth cen-turies, long before the plague, wars, famines, and rebellions of the fourteenthcentury. Furthermore, philopassianism is notoriously absent in the early MiddleAges, though the exposure of European populations to pain and disease wascertainly massive then too. Any comprehensive explanation must be far morecomplex. In order to understand philopassianism, it is first necessary to examineat least some of the forms it assumed and the functions it served in late medievalculture.

The Body as Symbolic Entity

Beyond the basic physical fact of the body's existence and sensations, contempor-ary culture saw in it a multivocal symbol functioning on various levels according todifferent contexts. It was a mirror reflecting several religious and scientific verities,a complex of symbolic messages. Each limb was connected with a differentzodiacal sign, and the total shape of each body was equally influenced by astrolog-ical forces (Husson 1978, 84-91; Radbruch 1938). Roger Bacon went so far as tocriticize physicians who "do not study the heavenly bodies upon which all alterationof bodies in the lower world depends... a physician who knows not how to takeinto account the positions and aspects of the planets can effect nothing in thehealing arts except by chance" (Bacon 1924, 144-45). The body's different formsboth defined and manifested social gradations, so that noblemen appeared both inliterature and in medical texts as well-formed and strong, while simple folk bore anugly, malformed appearance (Le Goff 1985, 84).7 Each gesture and motion of thebody, each posture in space, carried symbolic weight, in and out of ritual situations(Schmitt 1990). The human body was thus a microcosm, reflecting the surroundingmacrocosmic elements and spheres of the universe. The same quarternary ordercontrolled both body and universe: the four humors, four qualities, and fourtemperaments of the body reflected the four constitutive elements of nature.Humidity and dryness, heat and cold, were both human and cosmic qualities. Ifwomen, for example, were generally cold and humid in temperament, they wereakin to water also in other aspects, such as their malleability (Singer 1928;Engbring 1940).

Societal and scientific perceptions were intimately tied with religious ideas.When Christianity came to connect body, pain, and salvation, it resorted to

7 See, for example, the description of Marcolf the peasant: "Short and fat of stature. His head wasbig; forehead very wide, red and wrinkled; ears hairy and hanging to the middle of his jaws; eyesprotuberant and runny; lower lip resembling a horse's; beard dirty and bristly like a goat's; handstruncated; fingers short and fat; feet round; nose thick and twisted; lips big and fat; face asinine"(Croce 1978, 170).


knowledge culled from other fields. The most remarkable example of this is aneighth-century Irish table of commutations, prescribing "for saving a soul out ofhell. . . 365 paternosters and 365 genuflexions and 365 blows with a scourge onevery day to the end of a year . . . this commutation for redeeming the soul thatdeserves torments in the body [my italics] has been made according to the numberof joints and sinews that are in a man's body."(McNeill and Gamer [1938] 1990,142). At the same time illness with its associated pain was a disruption of universalharmony. During the early Middle Ages indeed illness and pain were viewed asmanifestations of sinfulness, one theologian going so far as to identify differentdiseases with corresponding sins: leprosy and heresy were one (Hrabanus Maurus1844-64, bk. 18, chap. 5, "De medicina," 111:501-2).

In theological terms, the human body was thus anything but the dead clay andunmitigated pollution described by some dualist religions. It was God's creationand thus an expression of divine will. That God's son should have assumed thehuman form was an excellent reason to see in it a representation of perfection. Itssensations were therefore an ideal vehicle for the divine plan of human destiny.Philopassianism was thus predicated on a perception allowing for no dichotomyof body and soul. The body and its sensations could serve as a tool for highermeans only if the boundaries of the self were coterminous with the physical entityas well as the abstract concept. Perceptions of the human body were thus tied withnotions of both physical and metaphysical reality. But even within this frameworkone could view pain in two opposite manners: either as the wages of sin, to bepatiently born, or as a vehicle of grace, to be ardently sought. During the thirteenthcentury, Christianity turned from the first perception of pain to the second.

Pain and Salvation

Pain came into the Christian world view via the story of Creation, thus beingassociated with women and with punishment for sin. Nowhere in this story is thereany hint that Eve or her descendants might benefit from the pangs of childbirth,either in this world or in the next. Pain had simply become part of human destiny.Rather than an individual experience, it became a factor of cosmic proportions.The Pauline and Augustinian interpretations of the Fall added to the originalpenalty two more corollaries: the weakening of man's ability to withstand thetemptations of evil and his subjection to death. Pain was thus identified withpunishment, sin, and death.

All human suffering, claimed theologians, was ordained by God: "All that wesuffer in this mortal flesh through the infirmity of nature [i.e., the Fall] is ordainedby the just judgment of God as a result of sin"(Letter of Pope Gregory the Great toAugustine of Canterbury, in Beda Venerabilis 1968,78; see also Wood 1981,714).Pleasure might be sinful, but pain was a penalty and thus blameless. The practicalconsequence of this approach was that Christians were enjoined to accept pain as

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inevitable. Though its origins were overshadowed by sin, it had become anunavoidable part of life and thus innocent of either personal choice or blame.

The sufferings of Christ introduced a different note. Christ too had suffered anddied because of man's transgression; but the fault was not his, and his death wipedout mankind's original sin. For the first time, pain was associated with a voluntarychoice leading to salvation. So crucial was the suffering of Christ to orthodoxChristianity that by the fifth century the leaders of the church were prepared toface a major schism for the cause of Christ's humanity and passibility. Theredemption of the entire human race from eternal death hinged on pain.

Nevertheless, Christ of the early and high Middle Ages was not the sufferer onthe cross. Once the theological point had been established, it failed to capture theimagination and sensibilities of those articulating contemporary beliefs.8 TheChrist most often portrayed in the sixth century is Christos Pantocrator, ruler ofthe world, seated on his throne like any Byzantine monarch, hieratic and impassive.Two centuries later in the West, Carolingian illuminations and bookbindingsshow the same tendency. Christ treading upon beasts, Christ blessing the world,Christ seated in glory and majesty, his feet resting on the imperial orb. Even thecrucifixions, rare as they are, fail to convey any sense of suffering or show physicalevidence of wounds and pain (Schiller 1983, 2:110-29).

Poetry sounded the same theme. Theodulf of Orldans, one of the leaders of theCarolingian revival, voiced the aristocratic views of his circle by repeatedly usingin his hymns the term "king," stressing Christ's royal lineage (Raby 1966, 109).9

For the intellectuals who conceived the theological structure of Charlemagne'ssacral majesty it was inconceivable that Christ should be seen as anything but apowerful ruler. Others, less politically-minded, translated this might into a sourceof protection. Gottschalk, perhaps the most individual of all Carolingian poets,prayed to Christ "light of my darknesses," whom he addressed much in the mannerof a client appealing to a contemporary potens, calling him once more a fearful,great king (ibid., 120). Indeed, most churches and monasteries dedicated to Christduring the early Middle Ages were dedicated to Christus Salvator.

High medieval art and literature changed very little in this view. Barring the newemphasis on the Virgin and Child motif, the humanity and passibility of Christ didnot become central to Christian piety until the later Middle Ages. It was only thenthat sculptors, painters, poets, and playwrights began centering their best effortson showing the Man of Sorrows in all the details of his agony. Christ's birth, life,and ministry became secondary to his passion, paling in the shadow of the cross.

8 The one notable exception is the seventh-century legend of Saint Gregory's mass, in which thehost was miraculously transformed into a bleeding finger in order to convince a doubter. Significantly,the finger was transformed by the later Middle Ages into the image of the Man of Sorrows,surrounded by all the instruments of his torture. See Rubin 1991, 121-22, 308-10.

9 The theme goes back to late antiquity. An anonymous fourth-century poetic life of Christ refersto him as "Christ the king," devotes a great deal of attention and detail to his conception, birth andministry, and mentions the crucifixion in one line: "The death of the flesh which he undertookvanquished everyone's death" (Raby 1966, 6).


Two preconditions were necessary for this transformation to come about. First,Christ had to be perceived as human and passible, pitiful and poignant rather thanlordly and intimidating. Second, the connection between guilt and pain, so blat-antly unimportant in the early and high Middle Ages, had to be reaffirmed. Theperception that Christ's suffering atoned for the guilt of humanity was an essentialprerequisite for the development of philopassianism. As Christ had suffered, thosewho believed in him wished to suffer. The ideal of Imitatio Christi, ferventlypreached throughout the period to clerics and laymen alike, insisted that in orderto follow in Christ's footsteps one must carry his cross and feel his pain (see, forexample, The Imitation of Christ [attributed to Thomas a Kempis], bk. 2, chap.12, "Of the king's high way of the holy cross" [Imitatio Christi 1982]). In order toidentify and empathize with the experience of the cross, contemporary saintsdeliberately inflicted a variety of punishments on themselves. They rolled innettles, whipped themselves, stuck nails and thorns in their flesh, and wore variousabrasive or restrictive garments that effectively prevented all possibility of rest(Bynum 1987, 209-11; Vauchez 1981, 174-83).

But all these practices were in reality necessary only for tyros. Expert philopas-sians could duplicate Christ's agony by means of meditation alone. Many mysticstestified to feeling Christ's pains on the cross simply by praying to be granted theexperience or by meditating on it (Bynum 1987,211-12; Kieckhefer 1984, 94). Inextreme cases the saints exhibited psychically induced physical symptoms. Themost common of these was stigmatization, or the appearance of wounds akin toChrist's on the saint's hands and feet. Saint Francis was the first and the best-knownbut certainly not the only one to suffer thus (Bynum 1987, passim). Other physicalsymptoms were less common. The experience of Saint Colette was by no meansunique:

. . . On the holy day of Good Friday, from Matins till the sisters returnedfrom Chapter, she was so immersed in meditation concerning the terriblepains which Christ suffered in his body, that she bore such a severe tormentthat the sisters, upon coming out of Chapter and meeting her, saw a miracletake place in her. It could be seen that her precious face was violently altered,as though skin and bones were broken and crushed, with the nose twistedand folded. Indeed, while the sisters watched, the image of her face returnedgradually, and the nose straightened out, until it was returned to its originalstate. (AASS March 1:561).

Though the most extreme manifestations of philopassianism belong to a smallcircle of dedicated mystics, both male and female, the phenomenon was clearlygrounded in a widespread popular form of piety. Almost every saint and theologianof the period testified to his parents' extreme emotional preoccupation with thesufferings of Christ (Huizinga 1949, 230; AASS March 1:540; Kieckhefer 1984,93). While the offspring of such an upbringing ended up spending their lives inreligion, their parents were neither clerics nor mystics. They were merely devout

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laymen, and not particularly educated ones at that. Though deeply impressingtheir children with their extreme devotion, they were neither exceptional norunique in their environment. The spiritual climate of late medieval Europe wassteeped in the experience of the cross, down to its most minute particulars. Bookslike Henry Suso's The Passion of Eternal Wisdom detailed every step, every blow,every humiliation and every wound that Christ suffered. They also dwelt exten-sively and imaginatively on the specific way by which each of Christ's five senseswas made to suffer on the cross (Suso 1943, 24; Ruysbroeck 1552a, 308).

By the fourteenth century sanctity and suffering had become one. Sanctity wasachieved by imitating Christ, and the imitation of Christ was the imitation of hispassion, not of his life. Within the span of one century philopassianism became thehallmark of all religious experience. It was Henry Suso, one among many, whosummed up the theme in his prayers: "Grant your servant, my king, that I mayfollow you in your passion and carry my sufferings in such a way that I should becrucified with you in order to rule eternally with you" (Suso 1943,48). In strikingcontrast to the early medieval figure of Christ, late medieval iconography saw anew emphasis, that on Christ as the man of suffering, whose depiction clearlyincluded a minute description of the stigmata and other wounds, the blood and thescourging marks. Crucifixions andpietas became the most popular way of showingChrist, and the new vernacular poetry followed suit. The impassive countenance ofthe early medieval Christ gave way to a patently anguished expression (Schiller1983, 2:198-243; Marrow 1979; Barasch 1976; Dronke 1978, 58-63).

But the extreme manifestations of the fourteenth and fifteenth centuries were nomore than the popularization of themes considered already by twelfth-centuryscholastics. Some of these themes indeed concerned directly Christ's example ofredeeming pain. Saint Anselm's highly influential treatise Cur Deus homo (WhyGod became a man) revived the concept of Christ's suffering and death as themeans of human salvation. Other contemporaries were more interested in thesalvation of humans through their own pain. The concept of purgatory, or theplace where people suffered physical pain in order eventually to reach heaven,crystallized roughly at the same time that Anselm wrote his work (Le Goff 1984).

The contemporary growth of the two concepts was no coincidence. The percep-tion of Christ's suffering humanity affected the entire view of the human race,inevitably elevating to a higher level those beings who shared the part of Christ'snature that was becoming his most prominent trait. But with this newly foundvaluation of humanity came a more individual form of piety and a perception ofindividual responsibility. The early Middle Ages had recognized the value ofvicarious responsibility and sacrifice; parents could donate children to a monasteryas oblates for their own souls' salvation. By the twelfth century leaders of monasti-cism were insisting on the monk's individual choice. Individual consent andresponsibility began affecting all the choices of life also outside religion. It was atthe same time that the theology of marriage began insisting quite unequivocallythat no marriage was valid without the free and adult agreement of all the parties


involved. Similarly, punishment for transgressions, borne in the early MiddleAges by the criminal's entire kindred, became increasingly a matter of individualretribution. The value of vicarious pain was of a similar order. By the twelfthcentury, theologians were no longer satisfied with redemption only by virtue ofChrist's suffering. His death exonerated the human race, but not individualpeople. These had to bear individually the pain of punishment in purgatory inorder to reach heaven. More so, they had to choose voluntarily to bear that pain.The discovery of the individual in the twelfth century bore consequences in manyareas of life. The attitude toward pain was only one of them.

All twelfth- and thirteenth-century theologians discussing purgatory agreed oncertain points. They did not know where it was or whether there was actually sucha place. But they were in no doubt as to the reality and nature of purgation. First,sinners suffered physically, from a physical, corporeal fire. The fire "corporeallyand really tortures the souls' bodies."10 Second, it was possible to begin purgationon earth. Whatever one suffered during one's lifetime was remitted from time inpurgatory." Finally, the pains of purgatory were infinitely worse than anythingeven martyrs might suffer on earth. This belief was not confined to theologicalspeculations but vividly illustrated in sermons (e.g., Lecoy de la Marche 1877,31-33).

Purgatory and hell assumed for laymen a terrifying immediacy during the laterMiddle Ages. Vernacular treatises describing the sufferings of hell and purgatory,graphically illustrated with detailed woodcuts, were popular among the earliestprinted books {Legrant kalendrier n.d.; Traictie despaines d'enferet depurgatoire1492; La complainte de I'ame dannee n.d.). Thus even those who had no wish toembrace Christ's sufferings as their own were forced to acknowledge that pain onthis earth was not only salutary but the sole means of avoiding a much worse agonylater on.

By the end of the Middle Ages, the love of Christ's passion and the search forindividual purification through pain merged in a perception of the human body asthe one and only medium for salvation and identification with Christ. It was notjust that Christ had once had a body. His body was present every time a mass wascelebrated, in the form of the host; meditations on the eucharist and its corporealnature go back to the twelfth century (William of Saint-Thierry 1844-64). Thefeast and cult of Corpus Christi grew from mid-thirteenth century onward tobecome the central event of late medieval Christianity (Rubin 1991). But evenmore so, Christ was still being crucified every day by evildoers, just as he had been

10 "Ut ignis . . . corporaliter et vere torqueat corpora animarum" (William of Auvergne, late 12thcentury, quoted in Le Goff 1984, 245).

" See Honorius of Autun: "Some undergo purgation in this life; it may come in the form ofphysical pain brought by various ills, or physical trials laid down by fasting, vigils, or other activities,or the loss of loved ones or treasured belongings, or pains or illness, or a want of food or clothing, or,finally, a cruel death. But after death purgation takes the form of excessive heat or excessive cold orany other kind of trial, but the least of these trials is greater than the greatest that one can imagine inthis life" (quoted in Le Goff 1984, 136-37).

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in the past.12 The religious context of pain was immediate and all-embracing.Crucifixion, purgatory, and salvation were all overwhelmingly present to thesenses. And none of these cosmic forces and events could have any meaning unlesspeople possessed bodies capable of suffering. The merging of the concrete and theevanescent was the unique pathway to the abstract truth of the soul.

Pain, Guilt, and Innocence

The matter-of-fact acceptance of pain as an integral part of life in early medievalreligiosity permeated all spheres of human consciousness. When Gregory theGreat stated that individual pain did not stem from individual guilt, but relatedonly to the universal blame of all humanity, he was speaking also for the laity of histime, voicing attitudes expressed in legal systems as well. Early medieval law codescompletely dissociated pain from guilt and punishment. Though the Germaniccodes consist largely of compensation lists for various damages — ranging fromhomicide to simple injuries — the law did not consider inflicting pain as alegitimate cause for claiming indemnity. Damages were always defined by func-tional considerations: breaking a man's arm will incapacitate him for life, butcausing him pain will not. The former thus entitled the injured party to compensa-tion, the latter did not.

In addition, corporal punishment was applied to lay free people only on veryrare occasions. Whipping, a penalty associated with disgrace as well as pain,applied among the free only to defaulting debtors and prostitutes (Boretius andKrause 1883,1:298,335). Only two human categories suffered corporal punishmentas a matter of course: serfs and clergymen (Boretius and Krause 1883,1:6,281,284;Werminghoff 1906-1908, 4, 166, 411). While corporal punishment within themonastic and clerical world stemmed from a longstanding autonomous tradition,it is notable that in the eyes of contemporary laity both groups formed no part ofthe economy of honor and status dictating one's place in society. Again, thearistocratic point of view associating physical pain with degradation shapedsocietal attitudes. Thus any layman forced to undergo a ritual of public penitencewas debarred for life from bearing arms and filling public office. The shame ofpublic penitence was much akin to the shame of corporal punishment (De Jong1992, 33-34).

The religious establishment reacted differently. Since pain was neither culpablenor degrading but merely the lot of humans, there was no reason not to imitateGod's methods by using it as punishment. Applied at first only within the monasticenclave to disobedient monks (Benedict of Nursia 1977, 28, 30, 70), it spreadeventually to penalties prescribed for lay people breaking religious laws. Earlymedieval penitentials resorted more often to fasts and prayers than to whippings,

12 "Sic hodie in mundo agitur: Homines peccatis dediti, suis sceleribus crucifigunt dominum, sicutolim Iudaei & pagani manibus" (Ruysbroeck 1552b, 485).


but they did recognize a variety of physical penalties, all culled from the behaviorpatterns of monastic asceticism. Pronouncing a prescribed number of prayerswhile standing with outspread arms (cross vigil) and sleeping in nettles, on nut-shells, in cold water, or in graves — all appear together with the occasional blowsas penalties for religious transgressions (McNeill and Gamer [1938] 1990, 32-33,142, 144, and passim).

There was a certain logical consistency between the avoidance of painful pun-ishments in the secular sphere and their adoption in religion. All religious punish-ment hinged on penitence and an avowal of guilt. These were expressed essentiallyin self-abasement, which is also a form of degradation. But secular law took nointerest in guilt or repentance. It was interested in keeping the peace through asystem of compensations carefully graded according to status. Degradation anddefamation were reserved for those unable to pay the proper compensation, whowere consequently expelled from normative society. Secular laws therefore con-sistently avoided corporal punishment throughout the early Middle Ages.

Significantly, pain appears in the one domain where legal and religious authori-ties cooperated — the ascertaining of truth when no direct evidence was available.In those cases, truth was discovered by means of an ordeal to which either suspector plaintiff could be subjected. Most tests were autonomic, based on the involun-tary reactions of the human body to usually painful situations. The body was thescroll on which the evidence of guilt or innocence was written. It was not the abilityto carry a hot iron unflinching or to plunge an arm into boiling water for theprescribed time that decided the issue. It was the condition of the scorched limbthree days later that stood proof to the veracity of the person undertaking theordeal. The basic assumption behind the ritual, of course, was that justice wasimmanent in nature and in the human body. Given the proper sanctifying ritualswater, iron, salt, even bread and cheese would reveal the truth by working on thehuman body. The body was the locus of truth.

Foucault wrongly identified the ordeal with judicial torture as two manners ofextorting truth by means of pain (Foucault 1977, 40-41). The ordeal carried noassociation of degradation despite its often painful nature. It was not a standardmode of proof but rather a dramatic mechanism used only when all other proofwas lacking. Plaintiffs unable to substantiate their accusations often volunteeredto undergo an ordeal instead (Lea 1973, 60-63; Bartlett 1988, 15). Legendsmaintained that the innocent remained unscathed and unhurt by the experience(Lea 1973, passim; Bartlett 1988,80), a claim repeated in judicial formulae: "If youare innocent of this charge . . . you may confidently receive this iron in your handand the Lord, the just judge, will free you" (Zeumer 1886, 696-97).

Furthermore, the truth inhered in the ritual and in the human body in general,not specifically in the body of any given plaintiff or defendant. Any participantcould openly name a champion to take his or her place. Once the champion hadritually offered his body as the vehicle for truth, the ordeal was expected to work.The validity of vicariousness stood at the basis of ordeal rituals, coming under

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criticism together with the whole system during the twelfth century. Again, indi-vidual responsibility loomed large also in a field completely unrelated to theology.

Efficacy was the central issue in all the arguments raging for and against ordeals.Did ordeals indeed reveal the truth? Neither supporters nor detractors criticizedthe ordeal for inflicting unnecessary pain on people (Browe 1933; Radding 1979;Bartlett 1988, 70-90; Brown 1975). The one evidence we possess of the physicalreaction is a twelfth-century German manuscript illustration, showing a manabout to take the hot iron. He is supported from behind by his wife, his pose andbared teeth showing his apprehension (Codex Lambacensis 73, fol. 72, reproducedin Zeumer 1886, following p. 672).

One might therefore argue that ordeals were in no way related to the economy ofcorporal pain. But still the overwhelming majority of ordeals used the human bodyin a manner that tested also its pain endurance. In addition, they were mostcommonly used when the accusation concerned the sins of the body, or sexualmisconduct (Bartlett 1988,16-20). Finally, though it was possible to decide manyissues by holding ordeals between books or objects (Lea 1973, 131-37; Cohen1993, 56), in reality courts usually relied on sentient human bodies as witnesses tothe truth. Ordeals were thus an inquiry into truth by means of the human body'spain.

The rise of judicial torture is roughly contemporary with the first appearances ofthe imitation of Christ in the early thirteenth century. Once the church forbade theparticipation of the clergy in ordeals (1215), they quickly fell into desuetude. Theprocess has been ascribed both to the discrediting of ordeals as a mode of proofand to the growing influence of Roman law. Once ordeals were no longer consi-dered proof, the only valid mode remaining, according to Roman law, was eitherconfession or the testimony of two full witnesses (Langbein 1977, 4-5; Ullmann1944, 129-30). Since criminal acts rarely left any but circumstantial evidence —insufficient by Roman standards —judges had no choice but to fall back on thecriminal's confession, usually extorted by means of torture.

Torture used pain in a manner different from the ordeal. The entire practice wasbased on the consciously inflicted effects of agony on the human frame. In sharpcontrast to the exuberant, unrestrained embracing of pain as part of a religiousexperience, judicial pain was meticulously and exactingly measured in degrees andduration. It was also employed with great circumspection and awareness of itsintrinsically punitive character. Aware that a man under unrestrained torturewould probably confess to anything, law codes forbade the use of leading questionsprecisely in order to protect the innocent from falsely confessing under duress.Torture was meant to extract information that no innocent person could know.Furthermore, torture was to be employed only in cases of capital crimes (i.e.,crimes to be punished by execution or mutilation), because in any more trivial casethe pain of torture would have exceeded the presumed penalty (Langbein 1977,5;Peters 1985, 50; Ullmann 1944, 127). The body was once more the locus of truth,but of a different kind. While in the ordeal the body served as a witness of guilt or


innocence, under torture it was used to extract the facts of the case in the form ofconfession. Torture was never prescribed arbitrarily, unless there was already acorpus of evidence (indicia) in existence against the suspect. A great deal ofdiscussion was devoted to the quality and amount of evidence necessary for a judgeto order a suspect's torture.

The differences between Roman and medieval judicial torture clearly reflectcontemporary influences, particularly religious ones, on legal practice. Romanlaw allowed torture only against slaves and in cases of treason. At the same time itwas perfectly permissible to torture not only a suspect but also a potential witnessin order to extract the facts of the case. Guilt and innocence had nothing to do withit (Mommsen et al. 1922, Digesta 48:14). But such an attitude was inconceivable ina Christian context, which invariably tied pain, confession, guilt, punishment, andsalvation in one cohesive scheme. Late medieval courts could torture any person,regardless of status, against whom there was enough evidence to warrant such aprocedure. At the same time only a suspect could be tortured, because the "queenof proofs", as jurists called it, was a personal confession.13 The importanceattached to this act undoubtedly stemmed from the centrality of confession andcontrition in the religious scheme of salvation.

The religious element was also clearly visible in the last form of judicial pain,that of punishment. Semantic changes witness the connection between the two.While late antique Latin used the term dolor for usual pain and passio for thesufferings of Christ and his martyrs, during the later Middle Ages a new termemerged:poena, with its French, German, and English derivatives, denoting bothpain and retribution. The usage was common in religious literature, plays, andsermons, as well as in juridic texts. Though the connection between punishmentand pain is always almost universal, it was fairly rare in the early and high MiddleAges. But in late medieval Europe pain and punishment gained the added dimen-sion of salvation. Causing a malefactor to suffer was not a matter of retribution. Itwas meant to ease his way to salvation by subjecting him on earth to some of thesufferings he would otherwise have to bear in purgatory. As Jan Ruysbroeckremarked, Christ had chosen to die between two thieves in order to show thatpenitence and suffering could redeem the most hardened criminal (Ruysbroeck1552b, 508). Corporal punishment — in itself or prior to capital execution — wastherefore part of the same perceptual scheme that tied suffering, truth, andsalvation together.14

This perception found expression in the growing tendency to identify condemnedcriminals with the dying Christ. By the fifteenth century theologians stressed thatcrucifixion was a criminal execution, and one reserved for slaves at that. In the

13 So central was the analogy to religious confessions that courts jealously guarded the fiction of"spontaneous" confession. Before confessing the suspect was released from torture and allowed torecover for a while, then brought to court to give his voluntary confession.

14 Notably, medieval executions were remarkably free of torture, which only became common inthe early modern era. See Foucault 1977, chap. 1.

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central Middle Ages condemned criminals were denied the eucharist becausepresumably it stayed inside the body for three days after ingestion, and "it wouldbe a scandal if Christ, who is believed still to be in the gullet, should be delivered tothe gallows." Theologians then refused to admit that Christ too had died on thegallows. And yet by the end of the fifteenth century similarly condemned criminalswere indeed receiving the eucharist (Alain de Lille 1965, 2:141-42; Cohen 1993,198-201). By then the connection had been made, and it was fitting for Christ'sbody to be inside the dead criminal, on the gallows.

Pain and Healing

Surgeons and physicians do not exist in a perceptual void. They are, and alwayswere, very much the product of their times. The furniture of their minds is acomposite of contemporary reality and culture with acquired, traditional learning.All fourteenth-century physicians absorbed from early childhood the stories ofpassion and martyrdom, and watched the ubiquitous Corpus Christi processions,public whippings and executions. Together with the writings of Constantine theAfrican and Avicenna, they read or heard all the Lenten sermons explaining thepurpose of Christ's agony and death. Presumably, these views would affect alsotheir practice of medicine.

One thing at least is certain. While late medieval medicine stood helpless in theface of the plague and other causes of mortality, some means of relieving pain wereat hand, and had been known from antiquity. Even semipopular encyclopedicworks, such as Vincent of Beauvais' Speculum naturalis and BartholomaeusAnglicus' De rerumproprietatibus gave detailed instructions concerning the anal-gesic uses of various plants (Bartholomaeus Anglicus [1601] 1964, 227-365;Vincent of Beauvais 1624, 624). Their sources were the orthodox sources ofthirteenth-century medicine — namely, classical and Arab medicine. There is noquestion that late medieval physicians knew how to relieve pain, albeit not veryeffectively. The questions remain as to the extent to which killing pain waspracticed and the circumstances in which it was either applied or avoided.

The greatest stumbling block in the way of answering this question is the natureof late medieval medical writing. Here an analogy with the growth of law isilluminating. Like jurists, late medieval physicians legitimized their knowledge byrelying on ancient wisdom. Where a jurist quoted (often wrongly) the Code ofJustinian, a physician cited Galen, Dioscorides, Constantine the African, andAvicenna. How much of this repetitive theoretical knowledge found its way intopractice is open to question. Even practically trained surgeons of no academicbackground tended to cite ancient authorities. In both law and medicine the gapbetween theory and practice was apparently growing during the later Middle Ages(Riddle 1974; for law, see Cohen 1993,28-39, 71-73). But while legal practice, asopposed to theory, was carefully recorded in court protocols, medicine has be-


queathed few equivalent sources to juxtapose with the prescriptive text, and casehistories rarely found their way into medical texts, only as consilia.

It is therefore possible only to delineate the dimensions of the problem. First,one must distinguish between the writings of physicians and of surgeons. It was notmerely a question of a different training but also the fact that surgeons oftenknowingly and deliberately inflicted pain in their procedures. Already Augustineof Hippo noted that "sometimes physicians ministering to the health of the bodyperform things there which are gruesome to see," and that "the cures and remediesare themselves torture." Since this statement prefaced the description of a surgicalprocedure, his words could well apply to the work of medieval surgeons (Augusti-nus 1899,1.18, VIII.22). Second, one must distinguish also between the treatmentof disease-associated pain, wound-related pain, and pain resulting from the treat-ment itself. The difference in approach to each type of pain might provide someindications as to accepted contemporary norms.

A random survey of some contemporary medical writings, though, only under-lines the complexity of attitudes. There was no generalized policy among profes-sional healers regarding any of the three categories. On the one hand Arnaldus ofVillanova claimed that people hardened to pain could better withstand drastictreatment, and Jacques $espars spoke disapprovingly of a man who drank himselfto death rather than suffer pain (Arnald of Villanova [1922] 1968, 19; Jacquart1980,60). On the other hand there is no dearth of recipes and prescriptions to easeheadaches, toothaches and various other illness-induced forms of suffering. Indeed,Ambroise Pare's most detailed treatment of pain appears in the context of medica-tion (Arnald of Villanova [1922] 1968, 57; Hieatt and Jones 1990; Aldobrandinoda Siena [1911] 1978:, 33,41; Pare [1840-41] 1970, 3:547-51). The tenth-centurytreatise Quomodo visitare debes infirmum, still popular at the end of the MiddleAges, insists that the physician's first duty on visiting the sick is to assess the typeand amount of pain, though primarily as a diagnostic device (Sigerist 1941).

Nor was pain resulting from wounds invariably sedated. Mondeville clearlydistinguished between tolerable and intolerable pain, an indication of his awarenessof the problem. Guy de Chauliac warned that pain in wounds of nerves andtendons could be severe enough to cause damage, insisting that sedation mustprecede any further treatment for fear of spasms. Two centuries later, AmbroisePare prescribed sedation for all wounds — not in order to ease the patient butbecause pain was a source of inflammation (Gui de Chauliac 1979,2:84-88; Par6[1840-41] 1970, 1:442).

The evidence concerning surgical anesthesia is equally contradictory. Somemedical historians have noted that "from the fourteenth century onwards, there isan increasing amount of criticism of the use of preoperative sleeping draughts byprominent surgeons" (De Moulin 1974,559), while others described "the increasinguse in the late middle ages of alcohol-based anesthetics in surgery, as well assoporific sponges, sedative drinks, ointments and opium" (Gottfried 1986,237).l5

15 Unfortunately, the author provides no references for this assertion.

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There is no mention of sedation as part of surgery in Henri de Mondeville's work.He openly discouraged the use of painkillers, arguing that they were dangerous insurgery. At the same time, though, he "bitterly complained that most of hiscontemporaries had made pain into the necessary indicator of therapeutic efficacyin surgical matters." Pare too recommended only a tight ligature around themember to be amputated in order to desensitize it, rather than drugs, and a carefuland quick procedure to minimize the pain (Pouchelle 1983, 127-28; Pouchelle1979; Pare [1840-41] 1970,2:222, 3:549). Even Pare, though, stated categoricallythat in cases of very great pain nothing in his pharmacopoeia could help, and thatin those cases one had to resort to painful procedures, such as cauterization orphlebotomy, so that "dolor sit medicina doloris."(Pare [1840-41] 1970,2:114-15,3:549).

The overall impression is that surgeons were indeed aware of the pain caused bytheir procedures but were equally conscious of the dangers inherent in the use ofthe available analgesic means, as well as of their limited usefulness. There is aplethora of prescriptions for deadening pain, primarily by means of soporificsponges soaked in alcohol-based anesthetics and placed under the patient's noseduring the operation (Daems 1970). The fact that patients were tied down prior tosurgery as late as the eighteenth century indicates that even if used, these anestheticsdid little to alleviate the pain of surgery (Siraisi 1990 171-72; Gottfried 1986).16

The inefficiency of anesthetics is probably the reason why surgeons avoideddiscussing the problem of surgical pain in their treatises.

Even according to the evidence of medical or surgical textbooks it is thusimpossible to generalize about the attitude of late medieval medicine to pain.Surgeons did acknowledge its existence and dangers, but usually recommendedalleviating measures only in cases where pain might cause damage. Just as often,they saw it as a useful indicator of illness, an inevitable side effect of drastic cures,and a toughening, salutary sensation. Did the laity share this view?

The idea that late medieval and early modern people were less sensitive to painthan present sufferers has long been exploded (De Moulin 1974). Contemporarywriters have made their views amply clear. Petrarch's statement that "pain issomething unpleasant, cruel, horrible, bitter, sad, unnatural and offensive to thesenses" is sufficiently eloquent (ibid. 1974, 560). Francis Bacon saw it as thehealer's duty to alleviate pain not only as a corollary of the cure but as an end initself (Bacon 1973, 114). Were they voicing a common attitude?

One of the richest sources for lay views of the relationship between pain andhealing lies in miracle collections. Since 90 percent of all miracles were thaumatur-gic, these texts provide a great deal of information concerning pain. Healing waslargely in the hands of God and his saints, whose help was in any case cheaper than

16 The composer Marin Marais, who was operated on in 1725 in order to extract his gall bladder,left a remarkable musical record of the sensations of a patient tied down and operated on with noanesthetics, called "Tableau sur Poperation"(K.iefer 1963). My thanks go to Myrna Herzog, violist-da-gamba, who brought this piece to my attention.


that of physicians. Though living saints sought to sense pain, suffering laymen whodespaired of medical aid invoked the help of dead miracle-working saints. Therecords of the original infirmities leading the patient to seek saintly help did notdwell so much on pain as on incapacity: wounds, blindness, lameness (Chennafand Redon 1983, 53-86).

The widespread fear of the pain inflicted by the surgeon's knife, prompting anappeal for saintly interference, is a recurrent motif. Numerous pilgrims turned tosaints for help because they recoiled from the pain of surgery. And yet, when thesaints healed, their methods often resembled those of surgeons. Many miraculesreported that the cure was presaged by great pain. Sometimes the patient dreamtor saw a vision of the saint operating on him and, waking up from the pain, foundhimself healed. Others sensed the pain, in a state of full consciousness, as a verysharp pang immediately preceding a dramatic cure. As one shrinekeeper noted:"We saw many similarly tormented before the cure"(Finucane 1977,66,68,88-89;Jacquet 1983).

Medicine was thus hardly another expression of philopassianism. First of allone must consider the age-old identification, shared by healers and sufferers alike,of illness with pain and health with its surcease. Even the most dedicated philopas-sian milieu could not entirely obliterate the instinctive human reaction to pain. Nodoubt both physicians and patients sought relief from pain, either as part of a cureor for its own sake. But at the same time the theological validation of sufferingplayed a significant role. It made the pain of sickness more bearable and the pain ofhealing more acceptable. The dearth of effective physical painkillers was thusoffset by a mental attitude that not only accepted pain as inevitable but also sawcertain merits in it.

Conclusion

Beyond the expressions manifested in high culture, philopassianism was an integralpart of the common consciousness, an awareness so widespread and universal as tobe considered axiomatic by contemporaries. It was not a theory or even anarticulated belief. As pain was a fact of life, so was its positive, eager acceptance.But given the clear differences between religious, legal, and medical attitudestoward pain in the later Middle Ages, is one justified in viewing medicine withinthe contemporary cultural context? Clearly, the minds of physicians valued theirscientific heritage and their professional calling just as much as if not more thanthe surrounding culture. And yet, there are certain elements that cannot beunderstood outside this cultural matrix.

First and foremost among these is the idea that pain might be useful. It was ameans to many ends: truth, guilt or innocence, bodily health, and spiritual salva-tion. This idea, shared by jurists and physicians alike, must have influencedmedical practice as much as it influenced the legal process. Alone among all the

70 ESTHER COHEN

fields of knowledge we have reviewed, only these two professions could manipulatepain, ease it or inflict it. Theologians might explain pain, art and poetry mightdepict it, but medicine and law had to make decisions concerning pain on a dailybasis, and obviously during the later Middle Ages their decision was, more oftenthan not, to inflict pain rather than soothe it. In other words, they deliberatelychose to use it. Such a decision, inconceivable nowadays, made sense only withinthe philopassian cultural context.

Perhaps the most important factor of all is the ubiquitousness of pain during thelater Middle Ages. Pain was part of all conscious processes, religious and scientificones included. Philopassianism, with its multifaceted cultural manifestations andits attendant professional developments, was the formulation and expression ofthese processes. It was a coherent, multivalent attitude toward physical pain thatfitted both the perception and the reality of the time in which it grew.

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