In the basement of the British Museum sits a small ivory plaque from 14th-century France. The piece is tiny, only 5 by 8 centimeters, small enough to fit neatly into the palm of the hand. It would probably have originally been used as a writing tablet. Paired with another small plaque of identical size, the two halves would have hinged together in the manner of a miniature book, its sculpted surface acting as a cover while recessed spaces in its back were filled with a thin coating of wax. Short notes or calculations could be inscribed into this hardened layer with a sharp stylus by its owner to record their thoughts or figure sums, before the piece was then run over a candle to melt and reset the wax page, clearing it of writing in a single swoop like a medieval Etch-a-Sketch.
The carved image on its decorated front was more permanent. It depicts a gathered collection of men and women tightly framed within three architectural niches. These courtly figures—some standing, one seated, another two on the floor—are playing a game known in the Middle Ages as Haute Coquille, “Hot Cockles,” or sometimes La Main Chaude, “The Hot Hand,” a jaunty name that masks a rather more sexualized pastime. To play, someone is blindfolded and then spanked. In the British Museum ivory it is a young man who finds himself kneeling at the center of the action, his head placed inside the folds of a seated woman’s skirt so he cannot see.
Despite the small size of the piece his outline is delicately rendered, ghostly beneath the cloth, and we get a sense of the game’s erotic potential in the silhouette of his hand, creeping up the woman’s left thigh. The act of spanking itself is prefigured in the raised right arms of the two women behind, their exaggerated hands poised to strike him in a pair of flat, slapping swings. The game finished with the blindfolded figure guessing the identity of his or her slapper by the sting of their spank alone. If they were correct, they would be rewarded with a kiss, as shown at the ivory’s upper-right, where a victorious couple quietly smooch among the arches.
Hands are conspicuous in this piece. They touch, slap, pat, hitch, point, grope, caress, spank. The more we look, the more of them we see. The woman whose skirt the man is under rests her left hand on his head, her right at the same time pointing with a strangely elongated finger upward to the assembled crowd. The pair of spankers hitch up their skirts with grabbing motions. The bearded figure in the lower left, who presumably is up—or should that be under—next seems to be using his hands to part the crowd, edging his way between the women with flattened palms.
Even the woman at the far left of the composition, a figure so peripheral as to not be granted a whole body within the bounds of the plaque, is still given a large flapping hand, tucked centrally inside the ivory’s frame. Placed in the palm of the hand, as this writing tablet often was, these details would have resonated: the ivory conveys not just the tactile extremities of the body but the sense of touch itself in action.
Medieval concepts of touch are difficult to get to grips with, full of inherent problems and contradictions. When compared with the more mystical, ethereal sensations of vision and sound, which travelled via diaphanous rays and vibrating air, or even the more tangible senses of taste and smell, touch was found right at the bottom of the sensory pile, the very basest of the five senses in the Middle Ages.
Perhaps this was because it is a confusingly simultaneous sense, neither totally active nor totally receptive: in reaching out to touch something, that thing is inevitably touching you at the same time. What is happening there? Are you touching or being touched? Or both? This haptic inelegance seemed clearly ignoble in comparison to the illusive magic of sweetening song, the soft waft of a heavenly scent or the subtle gradations of vision.
On the other hand, however, the undeniable sensual immediacy that comes with touch meant that at times it could also be presented as one of the more vital of medieval sensations. Like scent, taste, sound and sight, touch was thought to function through the animating spiritus flowing through the medieval body, transferring sensory information from the surface of the skin back to the brain for cognition. But unlike these other senses, touch was sturdy, hard-headed and definitive. It could give direct and tangible presence to the world around you. The fact that touch is, of course, impossible at a distance—compared with hearing far-off sounds or seeing images on the horizon—suggested a certain thrilling proximity. It could even be viewed as the most crucial sense of all.
Scholars continued to acknowledge the claim made by philosophers like Aristotle that touch was the one sense absolutely necessary for life. That is to say, an organism might exist without its other senses—might be deaf, blind, anosmic or ageusic—but without any sense of touch a being must be thought of as fundamentally lifeless, must be dead. In this way touch was used as a fundamental measure of vitality and was thought of as a diagnostic tenet in its own right in the Middle Ages.
Manipulating the patient’s body to different degrees could ascertain their levels of pain, while tapping them at particular points was advised while listening for certain echoes or sounds, something still done by doctors today to gauge the health of the chest. Hands were described by medical authorities as the body’s workmen, and employing them to test the firmness of a particular body part—its swelling, texture or moisture—was all of interest in understanding the nature of a patient’s particular condition. Sickness could be keenly sensed through a doctor’s fingers.
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A problem emerged from the importance placed on this curative touch in the medieval medical encounter. What if a medic needed to carry out their work not with their hands but with tools? What if they needed to cut, to suture, to stitch? If touch was prized for its directness in diagnosis, was it not a problem to attend to the patient at such a state of tactile remove?
To combat this, medieval surgeons began to develop a way of thinking about their tools which conceptually merged their instruments with their own bodies. In particular, authors discussed probes, scissors, knives and other tools as direct extensions of their operator’s hands. Both Greek and Latin terminology preserve something of this inextricable bond in the very etymology of the word “surgery,” inherited from the Greek, kheirourgos, or Latin, chirurgia, both combinations of the terms for “hand” and “work.”
In early medieval Old English texts direct conflations were made of medical tools with the people who wielded them, the terms for surgeon and surgical instrument often interchangeable with one another. And in later Middle English writings too the language of the medical professional was caught up in everyday bodily terminology. The ring finger was often also dubbed the leche fingir—from the Old English for doctor, læce—both because it was commonly used to mix and apply medicines and because its veins were thought to lead directly to the heart.
Henri de Mondeville, the French surgeon whose writings on skin vividly illustrated by the figure of a flayed man, even went so far as to describe the iron joints and blades of his surgical knives as being like a surgeon’s very own fingernails and digits. This linguistic idea could also work backwards, with surgeons writing that they themselves needed to be delicately formed in the manner of their exquisite surgical tools. The Italian medic Lanfranc of Milan (c.1245–1306) stressed the importance of a surgeon’s well-shaped hands with long small fingers, while his contemporary the Flemish author Jan Yperman (c.1260–1330), spoke of surgeons needing “vingheren ende lanc sterc van lichame, niet bevende,” “fingers extending long from the body and which do not tremble.”
We can begin to see what these surgeons meant when we look more closely at the complicated tools that would have been used in their surgeries. Surviving instruments from the Middle Ages are exceptionally rare, not often preserved among the precious collections of objects passed down to the modern day. Even so, elaborate images in manuscripts do exist and these give at least some sense of medieval surgical instrumentation. Perhaps the most prominent of these is an influential series of treatises by al-Zahrawi, who addressed surgery in the last volume of his 30-part book the Kitab at-Tasrif (known in English as The Method of Medicine). It preserves around 200 depictions of surgical tools, elongated forms slotted between passages of explanatory text.
Like the illustrated skeleton of the Persian physician Mansur, whose bones are presented diagrammatically rather than realistically on the page, these images of tools are not intended to convey precise shapes and dimensions to the reader. Whether in original Arabic manuscripts, Latin translations or even later printed editions, al-Zahrawi’s instruments appear for the most part rather thin, wildly coloured and with toothed blades of exaggerated size or strange, feather-like softness. Nevertheless, such luxurious images still make clear just how important these objects were to the surgeons who wrote and arranged these books: careful time and attention have been taken to convey the ornate detailing of their grips and the subtle decoration of their ends, showcasing them as expensive, professionally crafted items.
Presenting instruments like this was also an acknowledgement that the tools of their trade formed an important part of surgery’s public face. Possession of the right equipment for the job communicated both competence and expertise, just as today the set-up of a doctor’s surgery or their impressive new diagnostic technologies might seek to tell a patient that they are in the hands of a well-trained and successful professional. Good-quality tools were so important to medieval surgeons that we frequently find them mentioned as star objects in their wills. The final testament of one Antony Copage, a surgeon in late medieval London, requested that all his steel instruments be left to his servant George on the condition that “he be of the same craft.” Listed alongside Copage’s valuable books, his finest clothes and even some personal keepsakes left to his wife, his surgical kit was clearly among his most prized possessions.
Depictions of hands appear extremely frequently in the margins of all types of medieval manuscripts, medical, fictional and poetical.Tools also allowed surgical guilds to regulate the field by sanctioning certain individuals to practice. These communal institutions could grow to substantial size and renown. In late medieval York, for instance, the barber-surgeons’ guild was a pre-eminent medical force, responsible for activities as diverse as organising annual religious plays and enfranchising newly trained members. Some amateur workers seem on occasion to have slipped through the cracks: records of St. Bartholomew’s Hospital in London list a carpenter by the name of Galop being called to “practyse surgery” on a patient whose limb needed amputating with a saw, obviously not for his anatomical expertise but because he simply had something resembling the right equipment.
Nonetheless, for approved professionals, being allowed by their community to wield their tools conferred both masterful status and social standing. Indeed, the guild’s consent could be withdrawn just as momentously as it was granted. If found transgressing the rules—failing to keep up payment of dues or dropping below certain professional standards or moral benchmarks—a member might be forbidden to practice and have their tools confiscated. To strip them of their instruments was to strip them of their very hands to work with.
Surgical instruments from the Middle Ages were even sometimes thought to possess a kind of inherent agency in their own right. For strict followers of Aristotle, for whom the ability to touch marked the difference between the living and the dead, this made little sense: a scalpel or a saw formed of cold, hard metal should have no vitality to it at all. But in the hands of the medieval creative imagination these heavy, inert tools could come alive. The designs of surviving instruments are almost always organic and extremely animated.
Patterns gravitate towards foliage, with shimmering petal-shaped gilding and vine-scroll, damascened inlay. Others sport active animal features, hawk-headed handles or frilled elephantine trunks that spiral out from the main body of the design, energizing their forms. Human faces and mouths also abound, sprouting from handles and joints. Such orally fixated animation is especially fitting, given that contemporary medical treatises often rhetorically referred to surgery as a biting craft, with writers returning repeatedly to the actions of “chewing,” “munching” or “gnawing” in their texts to describe both the spread of diseases and the movement of tools as they worked through the body.
These active designs align too with descriptions of instruments in contemporary literature, a fictional realm where instruments could come to life even more evocatively. In Middle English poetry, a tool like a saw—used by a number of different professionals, butchers or foresters as well as surgeons—could not only look on from its animal ends and gnaw whatever its serrated teeth cut into but could also be made to speak.
A 15th-century manuscript from Leicestershire preserves a short poem entitled “The Debate of the Carpenter’s Tools,” in which a gaggle of animated objects from a woodworker’s bench debate the best way for their master to achieve prosperity and, more urgently, how their furious work might keep up with his rapacious habit for drink. After disputations from the axe, the brace and others, the saw eagerly joins the chorus, reprimanding the previous speaker, the compass, as an apologist for his inebriated master:
It is bote bost þat þou doyst blow
For thofe þou wyrke bothe dey and nyght
He wyll not the I sey þe ryght
He wones to nyghe þe alewyffe
It is but boast that you do blow
For though you work both day and night,
I say he will not prosper.
He lives too near the landlady.
The carpenter’s saw, just like the surgeon’s saws and knives, stood for hard toil and committed craft, embodying animated loyalty and artisanal common sense. As sentient speaking beings, touching the patient all over, they morphed into eloquent commentators on the surgical world they actively witnessed. One later German surgical saw, now in Vienna, offers a short poetic verse etched onto its bow. Punning on the double meaning of the German word spruch, translatable both as a “saw” and as a “motto,” it reminds readers of the simultaneous fear and hope such tools could inspire:
Grausam sieht mein Gestalt herein,
Mit Angst, Schwäche und großer Pein,
Wann das Werk nun ist vollendt
Mein Schmerzen sich in Freide wendt.
[Cruel looks are in my shape here lain,
With fear, weakness and great pain,
But when the work is then all ended,
My hurting into joy is rendered.]
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Depictions of hands appear extremely frequently in the margins of all types of medieval manuscripts, medical, fictional and poetical. In fact, they feature more than any other body part. These manicules, as they are now known, consist of slender palms that sprout sets of extremely elongated fingers, one of which will point to a particular section of text.
These little hands are the remnants of medieval readers, designed deliberately to draw the eye to an important phrase, the start of an especially consequential chapter or even just a place in the text to which, for reasons now forgotten, a book’s owner wished to return at some point in the future. As markers, they are often appended to personalized notes also made in the margins and might have been added by multiple people at multiple moments in the history of a manuscript, building up a layered sense of a book’s pattern of use.
These marginal hands are just one of several tantalizing palimpsests of the medieval act of reading, many of which suggest that the experience could have been a quite different one from our own. Letters and other correspondence are recurrently described in the Middle Ages as being read out loud by messengers to whoever was present, rather than being absorbed alone by their addressee. And the debate as to whether most everyday reading happened silently in a person’s head or was actually vocalized audibly as they made their way through a book is still a live one.
But more than anything, these surviving manicules affirm just how tactile an operation medieval reading could be. With readers trawling across lines of text with their fingers and thumbing back the corners of pages to turn them, some parchment books have become almost blackened through repeated handling, so much so that modern conservators’ machines, known as densitometers, can be used to measure the comparative scruffiness of pages and isolate the most dirty—and therefore likely most popular—passages of a particular text, the ones to which a certain owner turned time and time again. Not that readers went unwarned against such tough treatment of these expensive objects. Florentius de Valeranica, a 10th-century Spanish scribe, reminded his readers of the pain and difficulty of writing:
si uelis scire singulatim nuntio tibi quam grabe est scribturae pondus. oculis caliginem facit. dorsum incurbat. costas et uentrem frangit. renibus dolorem inmittit et omne corpus fastidium nutrit. ideo tu lector lente folias uersa. longe a litteris digitos tene quia sicut grando fecunditatem telluris tollit sic lector inutilis scribturam et librum euertit. nam quam suauis est nauigantibus portum extremum ita et scribtori nobissimus uersus.
[If you want to know how great the burden of writing is: it mists the eyes, it curves the back, it breaks the belly and the ribs, it fills the kidneys with pain, and the body with all kinds of suffering. Therefore, turn the pages slowly, reader, and keep your fingers well away from the pages, for just as a hailstorm ruins crops, so the sloppy reader destroys both the book and the writing. As a port is sweet to the sailor, so the final line is sweet to the writer.]
