Christ as Divine Surgeon and Suffering Patient: Understanding Christological and Medical Illustrations in Sloane MS 1977

Erik Zou

The concept of the body held great importance in medieval religious culture. The first and most important of all bodies was the one belonging to God when the Word became flesh. In the tradition of the imago dei, all human bodies point first toward Adam and Eve, and then to the Creator Himself. In the New Testament, the mystical body of Christ further symbolizes the Eucharist itself, which by extension encapsulates the entire Catholic Church.¹ 

In similar fashion, medical illustration historically has centered around the topic of the human body. These images of the human body, however, did not explicitly encourage religious or moral messages. Rather, religious and moral themes could be superimposed onto the scientific information already displayed in the images. There did not exist an absolute mapping from the illustrated human body in medicine to the religious practices of the time. For example, images of skeletons could symbolize memento mori, and the standard male and female bodies could be seen as those of Adam and Eve. In broader medieval culture, the topic of the body was viewed as a bounded system or a construction like society.² Reading and understanding the human body, in fact, consisted of multiple methods and frameworks beyond religious contexts, including viewing it as a textual grid or even as a microcosm of the macrocosm itself. For example, when the cosmos emerged as the most all-encompassing body in later medieval culture, the human body linked anatomy to celestial entities — planets in inner circles ruled internal organs while surgeons leveraged these diagrams and linkages practically to execute operations successfully. The medieval human body could thus be viewed and represented through many facets; these views materialized as illustrations.

Yet medical practitioners themselves historically questioned the status and authority of medical images of the human body. Aristotelian and Galenic ideals emphasized the importance of first-hand visual experience when it came to matters of anatomy — images could not be trusted as truthful substitutes for direct sensory impressions. On the other hand, fourteenth-century physician Guido da Vigevano defended images in his teachings and practice, claiming that images could still enhance knowledge of anatomy. The reader, he claimed, would have a clearer understanding of organs through the viewing of surgical images. Overall, the argument against the use of medical images in practice centered on the claim that flat images could not capture three-dimensional objects and spaces. Nevertheless, some scholars like Charles Etienne argued that images served better than verbal descriptions. Thus, the overall usefulness in medical practice continued to be widely disputed, as they remained an integral but also a controversial component of medical practice and culture.³  

Sloane MS 1977, a medical anthology manuscript in the British Library created around 1300, follows the visual language found in other medieval medical documents by depicting numerous medical images addressing surgical procedures like cranial operations. The longest text in this anthology is a French translation of the Lombard surgeon Roger Frugard of Salerno’s Chirurgia, written in the late twelfth century. Surprisingly, these forty-six folios of manuscript dedicated to surgery deviate from their expected illustrations through the inclusion of forty-eight images portraying Christ’s life cycle. As a result, Sloane MS 1977 exists as an exceptional, but also curious, pairing of medieval and medical imagery and narration. How can we understand this manuscript’s unique juxtaposition of medicinal practice and the life of Jesus Christ? Though connections from folio to folio between the life of Christ and the surgeon’s teachings do not materialize when looking closely at folios or specific scenes, the leitmotifs of these two registers portray the complementary nature of Christ as patient and doctor. In this paper, I aim to detail these parallel roles of Christ in Sloane MS 1977 and briefly explore their implications in broader medieval culture. 

In Sloane MS 1977, each of the pages from f.2r to f.9v follows the same broad organizational structure: a three-by-three grid of vertically oriented rectangles creates a framed rectangular space centered on the page. Each of the nine sub-rectangles or cells, divided and surrounded by architectural columns or bars, depicts an individual image or scene. The images on each folio are painted with an alternating scheme of red and blue, with both the outside architectural frames alternating adjacently and the individual cells alternating in a checkerboard pattern. This checkerboard organization of images is particularly reminiscent of the thirteenth-century French manuscript tradition. Found in Gothic manuscript illumination, the pattern was a decorative element often used to create visually intricate designs. Possible symbolic functions include representing opposing forces and states, such as the spiritual and material worlds.⁴ Ornate pointed arches painted in orange and gold, coupled with alternating gold and patterned blue backgrounds, establish the architecture of stained-glass windows. These windows frame each rectangle on the upper register to invite the viewer into a fictitious space of religious contemplation. And indeed, the scenes portrayed within the windows reveal Christ’s life. Yet the life of Christ is not the only narrative unraveling on the page; illustrations of surgical operations lie in the two rows beneath.

Folio f.2r (fig. 1) identifies the beginning of the life cycle of Christ, presenting scenes of the Annunciation, Visitation, and Nativity on the upper register of the rectangle. In the top left scene, the angel Gabriel, easily identified through orange halo and wings, unravels the Word of God to tell the Virgin Mary that she would be the mother of the savior Christ. The iconography of this scene is in line with preceding manuscript traditions. While the pointed arches framing the scene differ from the use of round arches found in other manuscript depictions of the Annunciation, such as the thirteenth-century Psalter of Ham of Fecamp, the image still follows standard readings of a theatrical revealing of the beginning of Christ’s life. Furthermore, Mary can be seen reading the Book of Isaiah’s prophecy decreeing that the Virgin will conceive of the savior. This visual motif, present in the Psalter of Ham of Fecamp and the Aix-en-Provence, Bibliothèque municipal, MS 15 (fig. 2), became an important symbol in visualizing Mary’s role in the Annunciation. The subsequent scene on the top register of folio f.2r portrays a pregnant Mary, recognizable through her red, white, and green garb, rejoicing with a pregnant Elizabeth. The vegetal motifs allude to prosperity and fertility, echoing the two women’s blessed pregnancies. The last scene in the top row of the folio finally shows the birth of Christ, as Mary can be seen resting while a baby Jesus is identified through his halo. 

In contrast, the six images below are formatted relatively plainly with respect to their backgrounds and lack of architectural elements. In all these medical scenes, a surgeon stands on the left, while a patient adopts different positions: standing, kneeling, or sitting cross-legged. The surgeon, clothed in a long sleeveless outer robe and coif, wields numerous tools while operating on a patient in a cranial surgery. The setting of a treatment facility is lightly suggested through the shelves in the middle-left cell on the page. The emphasis on tools is part and parcel of medieval medical illustration: as an example, the bottom left image on the next page, f.2v (fig. 3), depicts the medication of a fractured cranium. Following procedures found in texts of the time, the surgeon here applies a healing ointment, called apostolicon chirurgicon, to the patient’s healing cranial wound.⁵ Other medical images found in the bottom two registers of the remaining folios depict manual operations like the setting of fractures, treatment of tumors, and other forms of wound surgery. Through an examination of the initial images found on the first couple of illustrated folios in the manuscript, it becomes clear that the numerous scenes belonging to two separate classes of images — the religious and the medicinal — exemplify their respective visual and historical traditions. As demonstrated by those found on folio f.2r and f.2v, the religious scenes locate themselves in traditions of other French medieval manuscripts and speak to this manuscript’s quality, while the medical illustrations accurately detail surgical operations practiced in the time.

With the nature and quality of illustrations in the manuscript established, the next question entails understanding why these two traditions of the Christ cycle and surgical operations were placed together. A natural reading of the relationship between these two narratives declares that they are somehow paired folio by folio and even scene by scene, given the grid-like structure of the images. This view would neatly provide commentary on the relationship between Christ and medicine. Two prominent examples of such a literal and tightly connected dynamic between Christ’s life and surgical operations can be found in folios f.5r and f.7r (fig. 4). On the top right scene in folio f.5r, familiar ornate pointed arches reveal Judas’ suicide in front of a shimmering golden background. A tall tree to the right of the scene, with two groupings of leaves paired with the arches, buckles under the weight of Judas’ body. The rope wraps from the top of the tree and around his neck as he grabs on with his left hand. The wrinkling of the eyebrows and protruding tongue depict Judas’ demise as his feet hang above the ground. Looking directly under this scene, the reader finds a patient visiting a doctor with a dislocated neck, illustrating a clear tie between the adjacent cells. Another example can be found on the top right image of folio f.7r, where Christ is pictured crucified on the upper register of scenes. Christ, pinned to the cross with blood spurting from the nails in his body, is stabbed with a spear by a soldier below. In the surgical images below, namely the middle one, the patient can be seen requesting the removal of missile weapons from his torso. 

While these two examples closely link the medicine and religion portrayed in adjacent cells, there are plenty of counterexamples in the manuscript where the images of Christ have no specific connection to the medical illustrations nearby. The lack of scenes showing Christ’s healing miracles, which are central to his life, further discourages this attempt to map scenes consistently from these two narratives together due to the definite connection between healing and medicine. Miracles pertaining to bodily healing and sickness would provide an explicit and robust link for this view to remain fully grounded. 

Rather than arguing for literal connections between Christ’s life and surgical treatments, the coexistence of these images suggests more practical reasons relating to status and splendor. The formatting and treatment of images from each cycle impart a hierarchical dimension to the relationship between these two popular narratives. With images from Christ’s life consistently occupying the upper register of the folios, the reader is constantly reminded of a clear separation between the religious and medical scenes. Additionally, the Christ cycle scenes are clearly illustrated with a different level of care. These images throughout the manuscript feature highly decorative backgrounds, ornate architectural forms, and a prolific use of gold. While the Chirurgia visualized numerous important surgical techniques, its practical use may still have been limited. As discussed by Helen Elizabeth Valls, the lack of explanation surrounding techniques like suturing spoke to its nature as a document tailored toward individuals with a fundamental understanding of human anatomy and surgery. It was neither meant as an introduction to surgery nor an encyclopedia of surgical procedures.⁶ The rendering of Christological images therefore confers a certain luxurious status on this manuscript and could have simply elevated the value of the Chirurgia. By incorporating such a fundamental component of religious doctrine and honoring it with careful illustration and decoration, the Chirurgia and, by extension, Sloane MS 1977, could have been viewed more favorably. This value could have also been used to promote the teachings of Roger Frugard and the legitimacy of the health and surgery profession. In this sense, the combination of religious and medical imagery in this manuscript could have served clever practical purposes not necessarily related to the relationship between the cycles themselves.

This intersection of healing and suffering demonstrates that Christ represents both characters in surgery: the surgeon and the patient.

While the above interpretation of the combination of medical and Christological images certainly poses likely practical reasons behind the manuscript’s unique illustrations, it fails to address what arguments the images make at a more conceptual level. Rather than view the juxtaposition of scenes at a microscopic level through individual scenes and folios, a reading of the overall relationship between the Christ cycle and surgery cycle proves more fruitful.⁷ More generally, these narrative cycles intersect and overlap in interpretation and significance. The scenes involving surgery and medical procedures necessarily concern topics of healing and suffering. Additionally, these scenes clearly delineate surgeon and patient. While scenarios and illnesses may vary throughout the images, these two characters remain central and easily recognizable through visual cues in clothing and the portrayal of their bodies. Although the manuscript scenes of Christ’s life contain moments of his suffering and do not explicitly address instances of healing, referring to the whole narrative of Christ’s life reveals that he is both a sufferer and a miraculous healer. This intersection of healing and suffering demonstrates that Christ represents both characters in surgery: the surgeon and the patient. While the images in the Sloane manuscript themselves may not explicitly point toward or illustrate Christ as surgeon and patient, the juxtaposition of Christological and surgical scenes in the grids on all sixteen folios generates a significant contextual backdrop to see Christ in these parallel roles. 

The Sloane MS implicitly portrays Christ as a surgeon or doctor. As noted by Valls, the preface of the Chirurgia states: 

Cil souverains mires volt a soi retenir la cure de la partie pardurable, c’est de l’ame, et nos deguerpi et nos laissa la cure de la chetiveté terrienne, c’est du cors, a curer, sicomme sont des plaies et des autres enfermetés.⁸

Here, God is viewed as a physician who cares for the soul while man cares for the body. While the preface clearly separates the spiritual from the material, there remains a parallel drawn between Christ and the surgeon in their roles as healers. Christ himself also does not strictly adhere to this boundary. As God in human flesh, Christ is shown to have performed many miracles directly curing people’s physical illnesses in addition to spiritual cures. For example, when a leper approached Jesus and pleaded to be made clean, Jesus cleansed him of his leprosy with the touch of a hand and the words “Be clean!”⁹ This tactile nature of Christ’s healing can be compared to that of a surgeon, who works primarily on exterior wounds with handheld tools. 

Still, Christ is no human doctor, as he succeeds in curing conditions like blindness from birth that would be incurable by medical methods of the past and even methods today. The surgeon in the Sloane manuscript performs medical feats requiring a great deal of skill. Within this framework, the hierarchical grid of the manuscript images is explained as physical representations of this separation between divine healing and human healing, while their alignment and placement together in the first place point toward Christ as a divine surgeon. 

The issues raised by the Sloane MS regarding the relationship between physical and spiritual healing enter a comprehensive discourse around the concept of Christus medicus: Christ the Divine Physician. Preachers and medical practitioners called upon this model in their works and imagery to invoke Christ’s mission of preaching and healing. The Christian tradition espousing this model saw spiritual care of the soul as a process interconnected with the body in terms of health, illness, sin, and absolution. One of the main voices concerned with the rhetoric of Christus medicus, Augustine, constructed a logic-based approach to the health of the body that extended to spiritual health. He believed that the body and soul functioned together not only for the individual but also for collectives of individuals like the Church. He also maintained that the Church functioned like a body — it could be in perfect health and function as intended, or break down under the corruption of sin.¹⁰ Augustine’s views connecting the Church and individual illness and suffering reveal the complexity surrounding the dynamics between physical and spiritual illness as well as the extension from a single body to a community such as the Church. The relationship latent within the illustrations of the Sloane MS connects the narratives of Christ’s life and surgery in Chirurgia to the much broader topic of Christus medicus. The Sloane manuscript exemplifies this whole cleansing of the individual that Jesus can perform. In the tradition of Christus medicus, the reader learns about healing patients from a variety of bodily wounds on the bottom rows while simultaneously tending to their spiritual health by reading about the life of Christ. 

As suggested by the topos of Christus medicus, one also cannot ignore the commitment to pedagogy in Christ’s life when comparing Christ to healer. Christ not only performed divine miracles to heal others but also took on the role of teacher in many forms. This emphasis on teaching calls upon literature regarding scholastic medicine. As a discipline, medicine places much importance on medical education. In Sermones medicinales of the fifteenth century, Niccolo Falcucci explained the pedagogical responsibility of physicians: the exemplar physician became a doctus and expertus together, gaining both theoretical and doctrinal competence.¹¹ In medicine and especially surgery, the ability to know and do are clearly integrated closely and valued. The medical illustrations in the Sloane MS detail various procedures but remain limited in their educational scope as discussed earlier, as they were not meant to introduce the reader to surgery and were instead intended for more practiced surgeons. However, the images themselves reveal that the surgeon takes on an instructional role while the patient learns. In nearly all medical scenes, the surgeon engages in animated conversation with the patient as seen from various hand gestures. Although typical images of masters or teachers involve the master carrying text of some sort, the receptivity of learning displayed by the patient is expressed through his or her hand gestures. For example, the middle section of folio f.7v (fig. 5) shows the surgeon pointing his finger or gesturing with an open palm, while the patient raises an unoccupied hand while looking directly at the surgeon, sometimes even turning their head. Despite the poor physical condition of the patient, this communication remains apparent in the images, conveying the importance of teaching in these medical scenes. These themes in medical education overlap significantly with the broader educational views on the importance of moral traits like docility, filial affection, and respect for the teacher. 

One goal of medical education states that the goal of the master is to reproduce himself in the pupil. Just as the doctor teaches the pupil to master medicine, Christ fulfills this role with his disciples. In Luke 10:9, he sends seventy-two disciples to enter a town to heal the sick and say: “The kingdom of God is at hand for you,”¹² thereby establishing his role as mentor and teacher. The disciples fulfill their role as discipuli in the medical sense, ingesting Christ’s teachings and then assuming the role of doctors as they cure physical sickness and spread the gospel.

The coexistence of the Christ cycle and surgical operations does not solely point toward Christ as surgeon, it also evokes Christ himself as patient. Although the surgeon is a key figure throughout the illustrated folios, the patient is the other constant character present in the medical procedures. Typically, in medieval surgery scenes, “patients are shown either held or tied down; and the accompanying texts sometimes recommended that the patient ‘be held in chains’.”¹³ In contrast, the patients in the Sloane MS can be seen enduring seemingly agonizing illnesses and treatments without being held down or restrained in any way. Rather, the patient freely stands, kneels, or sits while showing the surgeon their cause for treatment with an expression devoid of pain. This notable deviation in the medical illustrations of Chirurgia connects the patient to Christ. Christ is seen without an expression of pain or suffering amidst scenes of flagellation (f. 6r, fig. 6) and crucifixion (f.7r). While the wounds covering his body and blood gushing out illustrate the severity of the physical torment he is subjected to, his emotional state seems unaffected. In this way, Christ and the patient converge in these images.

As a patient, Christ provides a model for how to endure suffering and pain. Not only is Christ unwavering and stoic in reactions to pain, but he also willingly experiences pain by taking on human flesh for the sake of humanity’s salvation. Christ’s suffering becomes integral to the culture of pain and suffering. One manifestation of this phenomenon is the emergence of devotional image-types like the Man of Sorrows, which shows Christ’s bodily suffering.¹⁴ The Man of Sorrows depicts Christ in a state of suffering and sorrow from his life, which includes Christ wearing a crown of thorns, with wounds on his hands and feet, or with his head bowed. In the Book of Hours’ Man of Sorrows (fig. 7), Christ points toward his wound as blood runs down his side, acutely emphasizing his bodily experience of suffering.

This iconography resonates with viewers as a reminder of Christ’s sacrifice and love. Another crucial component of this culture of suffering is the stigmata, a replication of the sacred wounds of Christ on a believer. These wounds emulate the suffering of Christ for the salvation of humanity as an imitatio Christi. Scholarship has historically identified examples of stigmatization, with some prominent examples including Saint Francis. Saint Francis was the emblematic saint of late medieval Christianity who attributed spiritual significance to his experience of illness: 

The experience of suffering from illness – an experience Saint Francis really knew – was not seen by him as divine punishment for personal sins (he refers nowhere to such supporting Old Testament quotes), but rather as a spiritual exercise for participating in the suffering of Christ.¹⁵

This concept of imitatio Christi emerges as an important motif in the culture of pain even in later medieval art and beyond, as exemplified in Piero della Francesca’s The Flagellation (fig. 8).¹⁶ This painting depicts the flagellation of Christ in the background while a trio of figures of quattrocento Italy remain removed from the situation. Two of the historical figures are powerful Renaissance men recently struck by the loss of their sons. An angelic son brings the two together. These men parallel the flagellation due to shared loss and pain: Jesus’ expressionless face as he accepts God’s will provides a model for the two in handling grief. Christ’s endurance of suffering as suggested in the Sloane MS continues this rich tradition. Because Christ’s suffering resulted in the ultimate healing for humanity, the pain of Christ as patient is inextricably also tied with healing. Patients must bear suffering to be healed through salvation in a similar manner to how Christ suffered in a human body to save mankind itself.¹⁷ This healing aspect of Christ’s suffering as a patient transforms this experience into more than just the reciprocal of Christ as surgeon: the roles of patient and surgeon are not solely delineated as healed and healer respectively. 

The Sloane MS 1977 juxtaposes images depicting Christ’s life with images of surgical procedures. Though these illustrations follow visual traditions found in the corpus of thirteenth-century manuscript illumination, the pairing of the two cycles is puzzling. Though it is difficult to consistently match moments from the life of Christ to medical operations, one explanation for the combination of these two image groups involves arguments of practicality and luxury. Including well-known and gold-adorned Christological images likely increased the status of the medical manuscript. But this explanation does not seem satisfactory. Abstracting away from connections between specific medical and religious scenes reveals a significant connection between the two parallel cycles. The overlapping of these two cycles at the nexus of physical and spiritual healing and suffering culminates in Christ as surgeon and patient. The concept of Christ in these two roles is contained in the manuscript images, thrusting the Sloane MS into existing discourse regarding the intersection of medieval medicine and religion. 

In this interpretation of the images, the versatile scenes of the Sloane MS gain further instructional value. As a resource for surgeons, the images of Christ’s life serve as more than a symbol of luxury and status: the surgeon must look toward the example set by the divine physician Christ. He has the indispensable duty of healing the patient of physical illnesses and must fulfill his role as teacher for other students of medicine. But Christ as patient is also an exemplar for the surgeon in the endurance of suffering for sacrifice and salvation. The Sloane MS curates a unique experience contemplating pain, suffering, and healing both spiritually and materially. Each folio perhaps serves as a reminder that physical health and spiritual devotion come aligned as a pair.

1. Michael Camille, “The image and the self: unwriting late medieval bodies” in Framing Medieval Bodies, ed. Sarah Kay and Miri Rubin, United Kingdom: Manchester University Press, 1996, 74. ↩︎
2. Ibid., 64. ↩︎
3. Isabelle Pantin, “Analogy and Difference.” In Observing the World through Images, (Leiden, The Netherlands: Brill, 2014) doi: https://doi.org/10.1163/9789004263857_003. ↩︎
4. Alison Stones, Gothic Manuscripts 1260-1320 / Alison Stones. Survey of Manuscripts Illuminated in France. 2013. ↩︎
5. Loren Carey MacKinney, Medical Illustrations in Medieval Manuscripts. London, 1965, 68. ↩︎
6. Helen Elizabeth Valls, “Studies on Roger Frugardi’s “Chirurgia”.” Order No. NN11647, University of Toronto (Canada), 1996. http://search.proquest.com.ezp-prod1.hul.harvard.edu/dissertations-theses/studies-on-roger-frugardis-chirurgia/docview/304327375/se-2, 15. ↩︎
7. Karl Whittington, “Picturing Christ as Surgeon and Patient in British Library MS Sloane 1977.” Mediaevalia 35 (2014), 86. doi:10.1353/mdi.2014.0009. ↩︎
8. Sloane MS 1977, “A medical anthology including Roger Frugardi’s Chirurgia.” F.10r. ↩︎
9. Matthew 8:1–4; Mark 1:40–45; Luke 5:12–16. ↩︎
10. Patrick Outhwaite,”Christus Medicus and Religious Controversy in Late-Medieval Europe: Dissidence, Authority, and Regulation.” McGill University (Canada), 2021. http://search.proquest.com.ezp-prod1.hul.harvard.edu/dissertations-theses/christus-medicus-religious-controversy-late/docview/2734699026/se-2, 3. ↩︎
11. Chiara Crisciani, “Teachers and learners in scholastic medicine: some images and metaphors.” (1997 – 1999). In History of Universities vol. 15 (1997/99), 75. ↩︎
12. Luke 10:9. ↩︎
13. MacKinney, Medical Illustrations, 63. ↩︎
14. Camille, “The image and the self,” 74. ↩︎
15. Gábor Klaniczay, “Illness, self-inflicted body pain and supernatural stigmata: three ways of identification with the suffering body of Christ.” 2015. In Infirmity in Antiquity and the Middle Ages, 126. ↩︎
16. David B. Morris, The Culture of Pain. United States: University of California Press, 1991, 272. ↩︎
17. Valls, “Studies,” 136. ↩︎