Italian artist Duccio di Buoninsegna painted the Madonna dei Francescani in the 1280s.Leemage / UIG via Getty / The Atlantic

By the middle of 1493, the Holy Roman Emperor Friedrich III’s left foot had turned almost completely black. His doctors had begun to worry some weeks earlier, when it first started slowly shifting from a healthy pink toward a shade of darkened blue. The late medieval compendia to which they might have turned for guidance spent little time on this final extremity of the body, only really discussing what to do in the case of surface issues such as boils, blisters, or swellings. So without further instruction, the doctors were left to think instinctively.

Some declared Friedrich was lacking humoral warmth and should be prescribed fiery medicaments to remedy the situation. Others insisted that the malady was down to the emperor’s near-constant consumption of melons, in which he apparently took excessive pleasure. Either way, something had to be done.

This post was excerpted from Hartnell’s upcoming book.

A coterie of medics converged on the Austrian city of Linz, where the emperor was attempting to recover. Friedrich’s son, the future Emperor Maximilian, sent his Portuguese physician, Matteo Lupi. The monarch’s brother-in-law, Duke Albrecht IV of Bayern-München, sent the renowned surgeon Hans Seyff to Friedrich’s bedside. And they were joined there by four more German physicians who had been summoned: Heinrich von Cologne, Heinz Pflaundorfer von Landshut, Erhard von Graz, and Friedrich von Olmutz. After mulling over the emperor, the learned group decided reluctantly that his worsening foot necessitated medieval medicine’s last resort: amputation.

What followed cannot have been pleasant. While some anesthetic would probably have been made available to Friedrich—numbing plants and opiates, hemlock, poppy or meadowsweet, applied to a sponge or burned for inhalation—pain relief in the Middle Ages was minimal and not particularly effective.

As the five physicians steadied Friedrich, Seyff and another surgeon, Larius von Passau, cut through the leg above the affected area, severing skin and soft flesh with sharp knives before sawing through what remained in order to remove the foot. They then applied powders to stanch the bleeding and bandages to keep the wound as clean as possible. Though one hopes the procedure was quick, it is hard to believe he underwent it with quite the grace shown in an image of the operation preserved in a manuscript in Vienna. There, Friedrich appears blank-faced and in a mood of drooping calm, sitting relaxed and stretched wide in Christ-like repose as the surgeons work away at the coal-black foot. The attending physicians are shown behind him daintily supporting his arms, although they were far more likely to have been pinning the struggling emperor down as the saw’s teeth worked their way through skin and muscle to the bone.

We know an unusual amount about this amputation because of an account written after the fact by the surgeon Seyff himself. Why exactly he felt compelled to put pen to paper is unclear, but the account speaks to a reverence for the feet of rulers that extended well beyond Friedrich.

Feet had long been identified as a place for elaborate displays of loyalty to the Crown, or those in power. Kneeling before rulers to kiss their shoes or toes was thought the ultimate mark of fealty and respect, and while Muslim leaders at the time tended to swear off the practice as frivolous and vulgar, European leaders were extremely keen.

Popes had reportedly required the custom ever since the eighth-century pontiff Hadrian I had insisted his feet be ritually kissed as a symbol of allegiance by the Holy Roman Emperor Charlemagne, the centuries-removed predecessor of black-footed Friedrich. Certainly by the 12th century, kissing the pope’s foot was a regular part of the coronation ritual of the emperors, who were expected to genuflect before the pontiff and embrace his feet before the pope, in turn, placed the crown on their head.

In other cultures, too, the social dance of kissing feet could be equally complex, sometimes even laced with cunning political one-upmanship. The Gesta Normannorum, an 11th-century history of the Normans, records that the Viking leader Rollo (c. 846–930) was required to kiss the foot of the Frankish king Charles the Simple after losing to him in battle. When offered the foot, however, Rollo supposedly refused to stoop. He demanded that one of his kinsmen lift the limb up to his lips, rather than the other way around, toppling Charles from his throne in the process. Rollo had adroitly, and somewhat literally, turned the symbolic politics of the situation on its head.

The foot-kissing traditions of the Byzantine emperors were even more elaborate. Many long-standing and convoluted civic procedures had been slowly accruing in the court of Constantinople since the city’s foundation as the empire’s capital, and a unique 14th-century treatise titled On Dignities and Offices records the complicated etiquette involved in bowing and limb-kissing. Some courtiers are ordered to remove their headwear when they prostrate themselves before the ruler, while others may keep their hats on. Important figures might be allowed to kiss the emperor’s right cheek or hand, while others could hope for no higher than his foot.

The Netherlandish author and clergyman Willem Jordaens, born in 1321, was one of many writers who mused imaginatively on the nature of such interactions. In a series of instructions almost as laborious and detailed as the protocols of the Byzantine court, Willem advocated mentally throwing yourself on the floor in front of Christ, in order to access a deep spirituality:

Prostrate yourself at his feet. Moisten the left foot of truth with your tears and lament … Dry this foot with your hair, that is, with sorrow and dissatisfaction over your life. Kiss it with your mouth, that is, yearn with inner desire to lead your life in accordance with the rules of truth … You must then moisten the right foot of God’s mercy with inner, loving tears, so as to receive his grace and a sweet desire to live according to the truth … Look, my poor soul, you should kiss these two feet of our Lord with humble loving desire, and you should never kiss one without the other.

The Italian artist Duccio di Buoninsegna shows just the same sort of podiatric longing in a small but intricate panel painting of the Virgin painted at some point in the 1280s, known as the Madonna dei Francescani.

In the painting, Mary is holding Christ, dressed in a robe of deepest blue and flanked on either side by angels that waft a piece of continuous-patterned fabric behind her broad throne. Small enough that you might miss them, in the painting’s lower left-hand corner is a group of Franciscan monks, prostrating themselves before the Holy Mother. The lowest is just about to bring his face to touch the Virgin’s slipper, his mouth puckering to kiss the holy foot, wide-eyed and smiling.

These accumulated medieval practices of the foot resound in Emperor Friedrich’s operation. We will never know exactly why Seyff so intently recorded details of the amputation. Perhaps it was the immense pressure of operating on an emperor in the presence of his personal doctors, as well as various lords, knights, and barons of the court who, he anxiously notes, were also keenly observing. Perhaps the surgical narrative was intended as some sort of personal insurance for Seyff against his patient’s yo-yoing condition: The operation to remove the foot went exactly as planned (success), but Friedrich still died some weeks later (failure).

Or perhaps the account was designed to immortalize Seyff ’s encounter with the most revered body in the land. The personage of an emperor, like all other medieval rulers, was thought the most impressive of any in society. Glorified during their life and immortalized after their death in tombs, monuments, poetry, and song, an emperor’s body could even be split into different pieces to be venerated in different places, just like the bodies of the saints. The blackened foot Seyff found himself holding was no ordinary appendage. It was one of the medieval world’s most pivotal parts, a vital point of contact between a sovereign and the people.


This post was excerpted from Hartnell’s recent book, Medieval Bodies.

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