The medieval view about nature, inherited from classical Greece and Rome, was that everything was composed of four elements: fire, earth, air, and water. These elements had two characteristics: hot/cold and wet/dry. So fire was hot and dry, air was hot and wet, earth was cold and dry, water was was cold and wet. The body was also seen as composed of four elements: blood, phlegm, yellow bile, and black bile. Hartnell also includes the Muslim empires in his discussion of the middle ages, because both Christian Europe and the Muslim Middle East shared a classical heritage. There was a fair amount of trade between the two areas, and, germane to a discussion of the body, the Muslim empires were known for their medical learning (situated, as they were, at the junction of the trade routes with Asia and India).

One of the important values of the middle ages was transmitting the knowledge received from ancients. University-trained doctors slowly built up a wide breadth of knowledge from the important texts. Only the rich could afford to go to university, nor would expounding on a treatise be of much help in an emergency situation, so their clientele were the rich. More practical tradesmen were surgeons, midwives, apothecaries, and dentists, who may have not had a guild, and some of whom traveled around selling their services.

The body had roughly four areas of differing honor. At the bottom were the anus and genitals, then the stomach (since it was necessary for life, albeit the contents unattractive), then the vital organs, including the heart, and most important, the head. One of the primary differentiating factor between man and the animals was thought to be that man stands upright, since the head is attracted to heaven due to its airy components, and it was thought to govern the body through logic, seen by the Greek philosophers as more heavenly and perfect. One of the legendary Classical monsters were the Blemmyae, a race at the edge of the world who had no head; rather, their face was in their chest. Because their head was missing, they were thought to be unethical. (Other monsters were the Panotii, with ears so large they wrapped around the body; the Cynocephali, with dog’s heads; and the Scipodes, who had a single, large foot, which they hopped with and used like a umbrella to shade the rest of their body.)

Cures for head maladies addressed the imbalance of humors. A recipe against headaches said to mix up a dozen or so spicy ingredients (ginger, galangal, nutmeg, pepper, etc.) in vinegar and gargle. The hair, face, and skin all told of one’s mental state, so Manjun, a legendary man gone insane as a result of being prevented from marrying his lover, was illustrated as emaciated with unkempt hair. Similarly, a red-head was obviously a hothead.

Because of the importance of the head, in the rare case that someone was beheaded, it was to make a point. Society was seen as a sort of body (the Body Politic), with the king at its head. Usually someone who committed a capital crime was hanged, but rebellion might result in a beheading, as a visceral reminder that the king was the head of the Body. On the other side of the spectrum, saints who were beheaded might pick up their head an put it back on (reinforcing their holiness), and the head of John the Baptist was venerated, kept at Amiens, among other places that claimed his head, and with sculptures of his head on a platter in places that could not claim his head.

The five senses (depicted in the six tapestries of The Lady and the Unicorn) were seen as the ways that the body interacted with the environment. Aristotle thought that objects sent out rays that the eye perceived (Ibn Sina said the image was projected onto the eye, like on a mirror), while Euclid and Ptolemy thought that the eye sent out the rays; medieval opinion was therefore divided. Humorally, the healthy eye was cold and wet, hence cures trying to return it to this state used roots, like onions, fennel, and garlic. Cataracts were thought to be cloudy materials gathering, so poking the cornea with needles was one remedy. Before glasses became available in Europe in the 14th century, there were a lot of blind people, who had little choice of either family charity or begging, and blind beggars were seen as a nuisance in cities. All three monotheistic religions thought that blindness was a test of morality; suffering through it was success.

The sense of smell could indicate sanctity: saints frequently had a sweet smell, while demons smelled like fire.

Ears were thought to have a canal of stationary air (stilled via hairs) that resonated with the incoming sounds. Like other sensory organs, the spiritus conveyed the sounds to the brain. Boethius classified music into three types: musica instramentalis, the normal music made with instruments; musica humana, the harmonies between the body and the soul; music mundana, the music of the world, the harmonies between the movements of the planets, the changing seasons, etc. Sacred spaces had music (Hildegard von Bingen said that imposing silence on a church would forfeit your salvation, and she thought that heaven had music.) Bells in the church, the loudest sounds people would hear, were thought to frighten away demons, and they often had names of saints inscribed around the edge for this effect. Broken bells were sometimes buried, and sometimes bells were taken prisoner.

The mouth received taste, but it also sent out speech. The mouth was a point of connection with the divine. Well-spoken saints, such as St. Anthony of Padua, might have their jaw used as a relic. Kissing relics was seen as more potent form of touch. Dental hygiene was actually pretty good, although since the rich could afford more sweet things, their teeth may have been poorer. Dentists did need to pull teeth, and when they did, the goal was to find the tooth-worm that was causing the pain (recognized by the end of the period as the exposed nerve) and extract it. The pulled tooth was the dentist’s property, and some dentists kept the teeth they removed on a long string.

What lay under the skin was rarely seen. Master surgeon Henri de Mondeville wrote a book with an illustration of a man without his skin (carrying it on a pole), so that you could see the color of the muscles and the white of the subcutaneous fat in areas like the breast. Dissections were rarely permitted (if you cut up a body, how would it be bodily resurrected?), although by the late medieval period this was beginning to change. In 1286 an autopsy of a man who died from an unknown disease suspected to be caught from chickens was performed (as well as a dissection of a chicken; abscesses were found on both the man’s and the chicken’s hearts). In 1302 an autopsy of Azzolino degli Onesti, thought to have died of poisoning, was performed, and the suspects exonerated on the assumption of a natural death when internal bleeding near the heart was discovered. In Bologna, anatomy dissections were performed, at most once a year (in cooler weather), on deceased criminals, with a lector reading the positions of the organs from the book and the surgeon verifying them.

Color of the skin was used to denigrate one’s enemies. Christian Europe saw dark skin as representative of the darkness, evil, within. Muslims used European whiteness as proof of their cowardice in battle. The Luttrel Psalter illustrates a fictional joust between Richard I and Saladin, the latter having dark blue skin and being unseated by Richard. When Christ is illustrated naked, he is often portrayed with pure white skin. Somewhat relatedly, clothes (a “second skin”) were legally controlled, so that the lower classes were not permitted to wear upper class clothes. Prostitutes sometimes had to wear hoods of black or yellow (and sometimes trimmed with bells to warn people they were coming). In Cairo, under the Mamluks, Jews had to wear yellow and Christians blue.

Skin was also important in writing, since parchment was calf skin that had been scraped and processed. Small defects were sewn up to keep from getting larger, although sometimes they were left and worked into illustrations. The resulting parchment can last for thousands of years; the best paper lasts for only about 250.

Bones were rarely seen, since it is necessary to boil the body to remove the flesh. Manuscripts did have illustrations of varying accuracy, although interpretations sometimes require creative thinking: The Anatomy of the Human Body (Mansur ibn Ilyas, 1488) has the skeleton viewed from the back, not the front. Books had illustrations for handling bone-related injuries, although veterinary medicine was not usually written, but rather passed down from farmer to son. The Mamluk court had veterinary books for its staff, though.

Bones of saints were used as relics, and skulls of patrons of a monastery were sometimes buried in or under the walls. Tombs of ordinary rich people were often elaborate. In Europe, sarcophagi were sculpted elaborately, often with themes of death. Alice Chaucer has a normal medieval effigy on the top of a beautiful young woman, but you can under the top one, another stone effigy of her desiccated body, with the skin shrunk over the bones and her breasts desicated. It suggested the biblical principle that despite our earthly success, after death we are a soul awaiting judgment. Along similar themes is Lydgate’s poem “The Dance of Death”, where Death asks various people to dance and they try to get out of it unsuccessfully. Europe had many murals of this dance of death, such as the Parisian cemetery Les Innocents and the Church of the Holy Trinity in Hrastovlje in Slovenia. Similarly, there is a rosary bead with the front of a couple kissing (with the man’s hands straying towards the woman’s breast, and her hand either stopping or encouraging him), and on the back a skeleton with a banner saying, in French, “recognize in me what you will soon be”; life passes quickly.

Plato thought that the soul that animated the body was in the head, but Aristotle located it in the heart. Galen thought that the heart was what enabled the body’s healing. Everyone agreed that the heart was the sun of the body, that gave the body warmth. They also knew that body pumped blood out, but it was not until the mid 1500s that it was known that blood formed a closed loop. There were remedies for heart maladies, but they were not considered effective even at the time. The heart was also thought to be the source of the emotion of love, and was a feature in the courtly love songs. The heart could have virtue or vice; St. Anthony of Padua, accompanying a funeral procession of a rich man, got a prophetic word that he had not been a virtuous man, so could not be buried in the church cemetery, and said that, if examined, his body would turn out to have no heart, as an autopsy indeed showed. In one courtly love illustration, a man sent a pear (a erotic fruit) by an estranged lover, is shown kneeling before her giving her his heart (which looks like a pear), while the text talks of his looking at her. Lovers’ hearts were also shown on a balance, although it sometimes turned out that the love was unrequited, with one heart being light and empty (in one, the man points at the woman’s light heart, but she seems unbothered). The emphasis on hearts also was used in our relationship with God. St. Bernard of Clairvaux suggested that we could address prayers to Christ’s heart, and Catherine of Sienna claimed an experience where she and Christ exchanged hearts. The standard heart symbol (♥), however, was not in common use until the early print era.

Blood, both a humor and containing the other three humors, was seen as an effective way of regulating the humors. Bloodletting the hot, wet blood would cool and dry the body, and thus could be done pre-emptively to avoid illness, as well as to restore balance when the imbalance resulted in sickness. Different veins had different effects; the basilic vein near the inner elbow was thought helpful for the stomach and liver, while bleeding the flat vein in the foot followed by the vein in the opposite upper arm was helpful for the genitals. In addition to suggesting being swift, professional, and smiling, to put the patient at ease, books also indicated signs of the zodiac in different locations. The human body occupied a central position cosmologically, so timing could affect the success of the procedure. Books also used Wound Man, a man illustrated with all variety of bloody wounds, to describe how to handle each of the cases.

Blood was central in a long-standing antisemitic claim; in 1144, a dead boy was found east of Norwich, and a monk later claimed that Jews of the city had wanted his blood and had drained it. On the opposite spectrum, Jesus’ blood was held in high esteem. There was obviously the Eucharistic wine transubstantiated into blood, but while Jesus’ body ascended into heaven, he presumably shed his blood at his circumcision, and at the crucifixion when his hands, feet, and side were pierced. This loophole allowed for relics of Holy Blood, including English king Henry III, who brought a rock crystal vase of Holy Blood to Westminster Abbey, which he got in Jerusalem. One devotional book has a double page stained red, and filled with drops, to meditate on the quantity of blood. However, it did not work for everyone; one Frenchwoman said that the transubstantiated blood reminded her of her own menstrual blood, and made the Eucharist difficult for her. There were also a large quantity of communion wafers with a spot of blood that they had bleed; examination of one in 2015 showed the blood to be red mold. (Both the public and the Church were well aware of fraudulent miracles and relics, and cases such as these were carefully investigated, although they did not know about the mold.)

Hands showed up in many places, although there was a bit of contradiction about them. On the one hand, they were the lowest of the senses, being sensual and tangible, compared to the other senses which acted at a distance and were more abstract. On the other hand, Aristotle thought that touch was essential for life, because without touch, you could not interact with the world and, therefore, could not be alive, while the other senses were optional. Swelling of the hands could be used as a diagnostic for illnesses, and of course, the doctor’s hands feeling the body could sense illnesses. (Tools, including medical tools, were seen as an extension of the hands; tools could even have intrinsic agency.) Books were often read with the finger moving under the line being read, but this would also disfigure the book over time, so in the synagogue, the scroll would be read using a pointer in the shape of a hand to trace the line. Somewhat similarly, some reliquaries have the saint with an outstretched hand, not because that is what is in the reliquary, but so that the saint with his blessing hand can be waved over the congregation. Sometimes hands in the margin pointed to important passages, or even just as a bookmark. Guido of Arezzo, around 1000, invented or illustrated a scheme of memorizing the music using notes based on positions of the hand: the tips of the fingers, knuckles, and bottom webbing were assigned a note (his names are still used in solfege today). The Venerable Bede noted that there was a system of counting using the hands (but did not describe it), and there were various signing system, including one that was described for monks in silent orders to communicate. The hands could be read, seriously or otherwise, to determine one’s future. The hands of a king (especially right after coronation) were thought to have healing properties of scrofula (a type of tuberculosis), and audiences were granted to people with the disease for the healing touch of the king. The back of a hand-held wax tablet featured hands in a game of Hot Cockles (sometimes, Hot Hands), where a man was spanked by a woman, and if he correctly guessed who it was he got to kiss her. In the carving, the man, kneeling, buries his face in a woman’s skirt to be spanked, and his hands ... may be wandering.

The stomach, thought to be round, digested the food, but also produced the humors. Thus changing the humors could be accomplished through ingesting medicines, and there were books illustrating herbs and their use (as well as warnings, such as for the mandrake, which was thought to scream loud enough to deafen a person if removed, so the illustration shows it being removed by a dog on a chain). Different classes of people were thought to have different balances of humors, so the balanced diet of the nobles was different from that of the peasants or the elderly. Nobles, with high heat maintaining their noble status would want warming foods like spices, meat, and red wine. There are about fifty surviving medieval cookbooks ranging from fancy feasts to a cookbook for a wealthy Parisian household. The recipes usually do not contain quantities, being more of a pointer to a set of cooking techniques already known, although some give measurements of utensils, like the height of a pan in body quantities like “half a finger tall”.

Spiritually, fasting was seen a beneficial for focusing on spiritual things. For women, who had less control over their lives, fasting was something they could take control over. Sometimes entrails were buried in monasteries, and the monks or nuns would pray for the people, as was the case at Maubuisson Abbey, where the effigies have the person holding their entrails indicating that the entrails are buried there. Several French royalty requested their entrails buried there. The nuns were proud of this, seeing that it made their abbey important to the crown. In 1652, while renovating the church, a wall was disturbed, disinterring the 300 year old entrails of Robert II of Artois, which were found by witness as “fresh, vermilion, and full-blooded”, with a sweet perfume; neither of these dissipated during the ten week exhibition of them.

The anal area was subject to painful and deadly abscesses from riding horses for long periods of time, especially in a wet saddle. These were difficult to treat, and often fatal. In the 1640s, Englishman John Arderne, wrote treatises on how to successfully treat them, with illustrations (from below) of how to sew up different kinds of anal fistulae. More humorously, jesters were kept that could fart on command, and there was even a French play titled “The Farce of the Fart”, where a woman farts so loudly that her husband takes her to court, where the judge and lawyer are lampooned, with the result a ruling that the husband has to live with her.

Babies were thought to be the result of the male sperm (thought to be from the testicles) and the female sperm from the ovaries, combining, and coagulating in the heat and compression of the womb to form a child. The liver formed first to create blood, and then after 40 days for male, 80 days for a female (females being cooler and forming slower), God imbued it with a soul. The milk from the breast that nourished the baby after birth was thought to be from the same blood that nourished the baby in the womb. Sculptures known as Shrine Madonnas, which had Mary nursing Jesus, but when opened had Jesus enthroned and seven scenes of salvation, also illustrated the medieval assumption that the uterus was divided into seven cells. A foetus formed in three of these would be a boy, six would be a girl, and all seven would be hermaphroditic. The color of menstrual blood was useful for diagnostic. Menstrual blood was thought of as part of the woman’s curse for disobedience, and would make bronze turn black, kill crops, and make animals insane. (Also, burying the hairs a menstruating women would result in a serpent, come spring.) The uterus was thought to need regular purging from menstruation or sex, otherwise it would give off deadly odors or rise within the body and suffocate the woman (solutions for the latter involved inhaling smoke of certain burned things to drive it down, or by enticing it down with sweet-smelling things placed below).

Pregnancy was dangerous, and had a reasonably high chance of dying, so successful births were celebrated. After 1300 in Italy, trays with gifts on them would be brought to women (at least ones with rich friends). They show scenes of the woman sitting up in bed (resting for four to six weeks after birth), with a nurse tending to the baby, and big houses. Women from noble families generally had marriages arranged for the good of the families, and could be married very young (Louis VIII, the dauphin, and Blanche of Castille married when they were both twelve). Refusing these marriages led to several women martyrs; (Wilgefortis [from virgo fortis, “strong virgin”] did not want to marry and prayed that she would become ugly. After this happened, her father had her killed.) In England and the Flemish cities women generally married around 20, sometimes even at 30 or 40, and for “shared comfort, not ... the speedy bearing of children” (245). A widow might have considerable financial freedom, although the Church forbade divorce. Jewish women could divorce without their husband’s agreement and remarry as they wished. Muslim women had to be fully covered outside and were confined to certain areas of the house, but on the other hand, they enjoyed female-only spaces which European women did not have. (A manuscript has an illustration of the women in the balcony of a mosque chatting with each other, while the men are all serious below.) Penalties for sexual crimes against women was based on the harm to the man she belonged to. If single, the man might be required to support her financially. If married, it could be a large fine up to hanging. The psychological and physical condition of the woman was not considered. In stories, sexual aggression was often on the part of the woman, the womb being seen as an empty void wanting to be filled.

Kissing the feet of royalty was part of showing loyalty (although the ceremony of fealty was only completed by grasping each other’s hands). More important people might kiss parts higher up, like a hand or a cheek, while if you are more on the enemy side you might not even be allowed to kiss the feet, and be limited to a curtsy instead. Coverings for the feet were initially simple, with little difference between men and women’s styles, like a leather soled sandal in Mediterranean climates or a wooden soled shoe for working in the fields in colder climates. After cobblers developed technology to allow multiple layers of leather, styles burgeoned, including one fashion of extremely long, pointed shoes. Having no shoes was looked down on; Mamluk bakers in Cairo disgusted Ibn al-Hajj, since medieval streets were not the cleanest, and he assumed some of that got into the bread. Prisoners’ shoes were taken to slow runaways down, and walking long distances barefoot until your feet were bloody was a criminal punishment (particularly for Jews). Washing feet on Maunday Thursday was a practice of humility, and going barefoot as a monk was a practice of giving everything up (e.g. St. Francis of Assissi). Distances were measured related to the body: “feet”, “mile” (1000 paces), and “league” (the distance walkable in an hour, about 3 miles).

Speaking of distance, pilgrimages were not uncommon, but longer distance travel was difficult. Overland travel was risky, due to bandits, but sea travel was also risky (from storms sinking the boat), although faster than travel over land. The Travels of Benjamin, a Jew from Spain who reported his travels to Constantinople and then to Baghdad and Basra with vivid accounts of the scenery and events. Along he fictional Travels of John Madeville and the travels of Marco Polo, there was a demand for travelogues. Arabic geographic knowledge was also in demand for maps; several kings commission maps from Arabic sources. Some of the maps are rather accurate, while others emphasize different things that geography.

Medieval Bodies is an interesting way of connecting medieval facts. I chose it partly because the local library had limited selection, but also because it talks about medieval culture and values, instead of medieval history, and that is something that I have found difficult to find. I am finding the trend of stringing together tangential stories rather tiresome, but this book at least strings together tangential topics. You do not get the feeling that you have thorough knowledge of anything with the tangent-strings approach, but at least the format of the different body parts gives a reasonable overview. It may not be thorough, but it does highlight lots of interesting nooks and crannies. I thought C.S. Lewis had made up the “Thumpers” in Voyage of the Downtreader, but here I discovered that they were a popular medieval legend. Medieval views on the body is reasonably thorough, due to the structure, and information on the available medical knowledge is also good.

I did notice two couple glaring errors, which I found surprising. The book seems well-sourced, with a copious bibliography, so I found it surprising that on p. 17 - 18, Muslim cities were the first to build large-scale hospitals. This is incorrect in two senses: Muslim cities did not build the first large hospitals, nor were they the first to have large-scale charity. The first hospital was built starting in 369, after a plague and famine, when St. Basil the Great of Caeserea called on the wealthy of the city to fund a city outside the city, where the sick were attended to, orphans and travelers housed, even including a trade school. Basil was motivated by view that everyone is of infinite worth, being an image of God. This was imitated in the rich eastern Mediterranean, so the Muslims inherited the pre-existing idea, although they no doubt made their own valuable contributions. Secondly, on p. 240, a prayer/incantation is claimed to be addressed to someone we only know through their initial “N.” Anyone who has ever glanced at the prayers the Book of Common Prayer for various occasions (and Hartnell is English), will know that N. indicates that you substitute the name of the person. This particular “incantantion” could be something along those lines, but it also reads reasonably as a prayer. How can the reader trust interpretation of a fundamentally Christian culture when the interpreter fails on basic interpretations, at the level of A Canticle for Leibowitz, where engineering drawings remaining from a nuclear winter are venerated as spiritual diagrams?

This is an interesting book, and a fun and informative read. However, if your goal is to learn about the middle ages, even bodies, it reads a little bit more like a serious atlasobscura.com mind candy than something that will inform you. On the other hand, I think the tangential format offers lots of ideas for worldbuilding for storytelling, with enough cultural depth to inform decent worldbuilding, and offering handles for further research for thorough worldbuilding.