In Symptomatic Subjects, Orlemanski investigates the use of “terms of physik” in literary writing in the fourteenth and fifteenth century, a time which saw an enormous proliferation of medical material. The later Middle Ages, she argues, is a time of “etiological imagination”(the way people think about medicine and causation)– a greater interest in causal chains (why does what happens, happen?) and also greater exchange between scholarly and non scholarly discourse (in new genres like the encyclopedia, the plague tract, the gynecology treatise, etc.). Her central claim is that “when we attend to the language of physik, both in the intricacy of its conceptual system and in its promiscuous uptake, we discover previously unremarked experiments in combining causation and selfhood in the texts of late medieval England. These experiments transpire, I will show, in the space of a stubborn phenomenological gap between one’s materiality and one’s experience, or between having and being a body” (3). “Symptomatic subjects”, including Arcite in the Knight’s Tale and Thomas Hoccleve in the Series, are characters who are compelled to understand and explain their bodily condition. Such narratives, including romance, regimes, and autobiographies, “speak back” to physik, reinventing it by mapping the self and its causes.

The first four chapters are more strictly medical, though they pay close attention to related genres like the fabliau, the exemplum, and the self-help tract or mirror. Chapter 1 discusses the Wound Man as an example of the rise of medical textuality in the fourteenth century, where readers were encouraged to imagine their own bodies and see them as the materialization of causes (11). If every illness or condition has a cause, the etiological imagination becomes key for understanding why symptoms originate and questioning whether (in Galenic terms) the complexion determines the person, or vice versa. As a dissolving body between “him” and “it”, pulled back together by the idea of the self while being a compendium of other peoples’ injuries, the wound man is an example of medieval medicine’s transition between particulars and generalities, and also represents the embodiment of causes in an individual.

This is where we get an explanation of the “symptom”, a “somatic disturbance that, in its departure from expectations of bodily appearance or function, provokes interpretation” (16). As an involuntary but not necessarily medical bodily sign, they require practitioners to infer causes from effects and also to look at the “discursive environment” the body is in and make a choice between systems that explain what is happening. The sign (in Augustinian terms) is either a natural sign (smoke comes from fire), or a conventional sign (a wish to be understood, for example language). In this arrangement, a symptom “means” a disease because it is caused by one; the symptom is a signifier, and the problem is the signified.

Chapter 2 examines physik’s expression in four areas: cause, sign, authority, and book.

1. Cause: Galen (humoral), Aristotelian (four causes, philosophical), and Joannitian (the “naturals”) are the three main discourses of cause in the medieval period.
2. Authority: The rise of physik means physicians become the ones who interpret the body, rather than the patient; however, access to medicine was still multi-step and took individuals through a lengthy route to treatment.
3. Sign: Signification of an illness needs both a sign(a change in the humors, temperature, etc.) and an apprehending mind (the physician); when it is interpreted, the living body becomes a signifier. (As with Daniel on melancholy, the sign must be seen to exist; however, I’m unsure whether the patient seeing the sign is enough here, if the patient does not.)
4. Book: Medical texts increasingly appear alongside literary works, and their layout informs and embodies medieval ideas about the “relationship between literature and healing” (70).

Chapters 3 and 4 cover this relationship in medical language in fabliau (jargon) and exempla. Chapters 5 and 6 cover literary narratives, including the specific medical language of Arcite’s death scene and leprosy in Cresseid. The last two chapters cover the autobiographical writing of Thomas Hoccleve and Margery Kempe, arguing for the importance of sociality in construction of illness and wellness and reading Margery’s tears as a symptom that both repels and draws people into itself, offering the possibility for spiritual transformation to a near-infinite audience.

As with Rawcliffe’s overview of late medieval medicine, Orlemanski notes the permeability of medieval bodies by sight, smell, and thought, connecting this as susceptibility to causes. Like Daniel, she also draws attention to Galenic (humoral/theoretical) and Aristotelian (experiential) factors, though they clearly have different resonances at this time and she notes Avicenna’s attempts to fuse them. She argues that physik (the intellectualization and popularization of medicine) becomes the dominant medical ideology in the fourteenth century, relying less on (Galenic) self-determination of the body and more on patients’ bodies as particular expressions of general ideas or problems, which the physician can interpret. I was also especially interested in her assertion that the proliferation of medical texts produced a kind of “too-muchness”: “The potential for both ‘information’ and for ‘noise’ grows with the expansion of the lexicon” (85), a claim which reminds me of Daniel’s claim about Burton and his encyclopedic listing. Can the medical ouevre of the late Middle Ages be seen as performing a similar melancholizing or overwhelming function as the Anatomy does?

Ultimately I found Orlemanski’s central tie between literary texts and medical texts compelling. Both are concerned with determining causes, and both show symptomatic bodies that a) signify something about themselves and b) exceed and are exceeded by their symptoms. No one can completely describe, communicate, or (in certain cases) even recall their condition, but symptoms spur performance of the self. The process of finding a chain of cause and effect in order to construct oneself saw medieval writers experimenting with how to understand a person’s material condition, and how to influence it. I also think it’s fascinating that she approaches physik from an understanding of its weakness: if physik is not a dominating ideology but one among many, it becomes more available for medieval writers to use and set against other discourses in a narrative as ways to talk about or explain embodiment. The “gap between somatic materiality and felt experience– between having and being a body” (279)– means dwelling between generalized and individual suffering, an exercise that can stretch into the present.