‘BETTER OFF DEAD THAN DISFIGURED’? THE CHALLENGES OF FACIAL INJURY IN THE PRE-MODERN PAST

ABSTRACT This paper argues that facial disfigurement has been neglected in the historiography of medieval Europe, and suggests some reasons for this oversight before examining the evidence from legal and narrative texts. One reason for this may be the lack of first-person accounts of being disfigured, preventing historians from accessing the experience of being disfigured. By situating the medieval examples within a wider frame of modern responses to disfigurement, it becomes apparent that whilst medical advances have assisted in restoring the damaged face, social responses to facial difference remain largely negative.

facial injuries, uncomfortable at best to look at and often portrayed in highly emotive terms by the authors reporting them. Part of the shock in the reports is generated by the circumstances of the acquisition: unlike congenital conditions, or visible birthmarks, or difference in skin colour, a disfigurement acquired through violence or accident is a sudden, often traumatic life change. The real trauma inherent in acquired facial disfigurement arises from its suddenness, the switch from one face to another, rather than a gradual transition. I have not, therefore, foregrounded diseases as causes of acquired disfigurement in this discussion. Leprosy, for example, for all that its more severe, lepromatous form could destroy the facial features, is not a subject for enquiry here, not least because it has formed the subject of numerous, recent studies and continues to attract attention as new archaeological discoveries expand and revise our knowledge of this disease and responses to it in the early and central Middle Ages. 2 The process of adaptation, I suggest, is entirely different.
The fact that the medieval examples lived centuries ago might be thought to provide something of an insulating barrier between 'us' and 'them', but it should not. Facial disfigurement challenges basic, encoded human responses, which value symmetry and wholeness, and accounts of violence done to the face signal that something extreme is going on. Whilst the medical technologies to repair the damaged and diseased face have become ever more sophisticated, societal attitudes towards people with acquired disfigurements have remained largely static. Why should this issue concern historians? Primarily because people living with disfigurement, as modern campaigners for facial equality prefer to describe it, just like other minority groups, have been overlooked by history. Like E. P. Thompson's 'poor stockinger', or Sheila Rowbotham's 'hidden' women, or Anne Borsay's 'excluded' people with disabilities, people with disfigurements have been left out of historical narratives because their faces, quite literally, do not fit. 3 They might even work quite hard to remain out of sight. This paper, and an associated monograph, aim to restore a historical voice to this invisible group -they are invisible because no one had thought to look for them, but if you start looking, there they are. 4 Their experiences deserve our attention.
The 'triumphing over adversity' model is still a popular approach when engaging with disfigured faces in modern media: in the Anglophone world, we have only to think of the autobiographical accounts of Falklands veteran Simon Weston, or Changing Faces charity founder James Partridge, or the depressing number of female victims of facial attack by their partners (Katie Piper, Carmen Tarleton and Tina Nash), to see that the individual story can be used as a vehicle to raise awareness, understanding and, often, hard cash for the multiplicity of charities that support victims of congenital or acquired facial disfigurement. 5 Such accounts often start with a low point similar to Louis Kahn's: Tina Nash, whose violent partner gouged out her eyes, recalls that 'I asked my family to finish me off because I didn't want to be here any more.' 6 Part of the road to recovery and rehabilitation in these stories revolves around the repeated and often long-term surgical interventions to try to repair or, in Carmen's case, actually replace, the damaged face. Tina will soon be getting matching glass eyes, not because she will be able to see her restored face, but because those around her, particularly her children, will. Afghan woman Aisha Mohammadzai, just one of many women abused and disfigured by violent family members in that part of the world, made highly politicised headlines when a photograph of her mutilated face, missing its nose, was featured on the cover of Time magazine in 2010, and she was swiftly flown to the USA, where she now lives, for treatment. 7 The increasing sophistication of maxillofacial surgery, including the production of incredibly lifelike prostheses to replace facial elements destroyed by accident or disease, is seen as a major advance in twentiethand twenty-first-century medicine. 8  series of stunning before-, during-and after-surgery portraits of some of his patients to assist them in coming to terms with their new faces, and to help the broader public to understand the human stories underlying the pictures. 9 Interest in historical accounts of disfigurement, too, has increased in recent years. In the wake of centenary commemorations for the First World War, those who survived the war but with terrible facial and other injuries have been the focus of both major academic projects and broader, public-facing media. 10 The BBC has a site called 'How do you fix a face that's been blown off by shrapnel?', 11 and colleagues at Exeter University have been engaged in a project with the Institut Faire Faces in France to explore the cultural significance of facial injury and broader meanings of the face in early twentieth-century Europe. 12 What links all of these accounts and investigations, however, is the fact that we hear something of the voices of those who experienced and still experience living with disfigurement. What happens if the focus of enquiry shifts to 915 or 1015 rather than 1915 or 2015? What changes, I think, is the fact that religious observance and models of patient forbearance assisted in explaining and living with medieval disfigurement, whilst modern secular society blames the perpetrator or tries hard to fix the damage with technological wizardry. But the ongoing use of deliberate disfigurement as a sign of moral lack or the abuse of power has a visible and persistent continuity across centuries.
Drawing upon a wide range of medieval source material from Western Europe and Byzantium, including narratives from chronicles and (to a lesser extent) hagiography, letters, legal codes, archaeological remains and iconography, it is possible to explore how acquired facial disfigurement was documented, represented, analysed and commented upon by authors, and ask whether it was possible to gain access to the experience of the disfigured person themselves. It is fair to say that the sheer prevalence of facial injury in the material was a surprise, but the absence of voices of the disfigured themselves was not: the voices of disadvantaged groups rarely make it into the medieval record (except, sometimes, through ventriloquy). In the period under review, from c. 600 to c. 1200, just two accounts are of first-person experience of facial difference, one at the less serious end of the spectrum (broken nose and increasing swelling in the jaw), and the other more catastrophic (on the receiving end of a deliberate blinding). Thietmar, bishop of Merseberg, describes his own face in the first example, whilst the second account is embedded within a hagiographic account of the mission of St Bruno to the Rus, where Wipert, one of the accompanying priests and the only survivor when the saint and his party are murdered, is deliberately blinded. 13 The spectrum of disfigurement is itself important, for if some of the facial injuries it covers might literally seem 'superficial' -the word itself is telling here -their meaning for medieval writers was anything but. Within the category of disfigurement, therefore, can be included anything from temporary facial scratches (from thorns and fingernails, the former used to identify a cattle-thief in Anglo-Saxon England) 14 and shaving of hair or eyebrows or beard, to scalping, deliberate facial burning, branding, blinding, severe head wounds and cutting off of noses, ears, lips and tongues, most of which would have led to permanent impairment. The lack of 'patient perspective', as it might be termed in modern medical parlance, may go some way to explaining why disfigurement has been such a neglected topic in medieval studies. Another reason lies in the very specificity of facial injury: the mass disfigurement and rehabilitation of cohorts in modern warfare enables group studies, but most experience of disfigurement is at an individual level, resisting generalisation. That is not to say that group disfigurement did not exist in the Middle Ages: Genoese archers defending Milan in 1245, or the actions of Ezzelino da Romano after his capture of Friuli in 1259, when he is reported to have mutilated and disfigured nearly the whole population of that city. 15 Even if some of these reports invite mistrust of their credibility, they are deployed strategically to criticise each of the perpetrators in turn.
'The disfigured' as a group, however, do not appear in medieval sources alongside 'the poor' and 'the weak' or 'lepers' or 'widows and orphans' among the vulnerable groups in our texts (nor, come to that, do 'the impaired or disabled', presumably classed as 'weak' instead). Indeed, it is even difficult to find any commonly used term in the medieval Latin and Greek sources for 'disfigurement' at all, either as a process -becoming disfigured, inflicting disfigurement -or a condition -being disfigured. Writers certainly focus on the ways in which the face was injured, and/or describe the scar/s left by the wounds, but they do so using verbs for wounding, cutting, branding and burning. Search for 'disfigured' people electronically in online resources for medieval Europe, then, and you will not find them. (Modern translators, by contrast, often employ 'disfigured' to translate some of these verbs.) A further impediment might lie in the ways in which history has fragmented into so many sub-disciplines: ironically, the post-modern 'democratisation' of the subject, opening out into many hitherto neglected areas of human experience, has led to an increased specialisation that itself leaves gaps. This has meant that the history of disfigurement has fallen into a space between histories of medicine and studies of premodern disability. For most medieval victims of disfigurement, there was apparently little hope of medical intervention, meaning that medical historians have tended to ignore the medieval evidence for surgical procedures on the face, and focused largely on practical texts emerging in the early modern period, such as those of Heinrich von Pfolspeundt and his German contemporaries from the fifteenth century, or of Ambroise Paré and Gasparre Tagliacozzi in the sixteenth. 16 Studies of disability in the medieval period, on the other hand, focus on sensory or motor impairments, which are much better documented and have formed the basis of a number of recent, rich surveys. 17 For disfigurement to appear in the latter, however, it needs to be accompanied by a physical impairment, otherwise it is at best tangential and at worst irrelevant to the concerns both of medieval authors and modern commentators. The social disability inherent in a damaged face is hardly considered.
Surely, though, the history of a damaged face has featured in work on the medieval body, whether whole or fragmented, whose physical and metaphorical meanings have been dissected for nearly half a century by cultural historians and literary scholars alike? 18 In fact this turns out not to be the case: much work on the body has focused on the female body, medical theories including one-and two-sex models, 19 or reproductive health, 20 or the fleshly implications of women's affective piety and selfmortification, 21 or, as we have seen already, the impaired body. The diversity of the field, with no central argument, was commented upon as early as 1995 by Caroline Walker Bynum, and Sarah Coakley in 1997 suggested that 'It is as if we are clear about an agreed cultural obsessionthe "body" -but far from assured about its referent.' 22 Disembodied heads have recently been the subject of study, and the fascination of genitalia (and their lack) continues to loom large in such analysis, but the major vehicle of interpersonal communication, the face, has been curiously omitted. 23 This despite the fact, as Ruth Mazo Karras has pointed out, that female beauty has long been blamed for the inappropriate behaviours of men. 24 And whilst anger has featured as the subject of study within the burgeoning field of the medieval emotional landscape, it has not generated much consideration of how connected facial mutilation is with outbursts of extreme rage in the sources. 25 Disfigurement itself, however, is a gendered phenomenon in the medieval evidence. Deliberate disfigurement is, at its core, a power play, a show of dominance over the victim, whether authorised through judicial channels, or totally illicit and intended to challenge that authority. Male on female acts not only reinforce a hierarchy of physical strength, but also demonstrate masculinity (whether articulated as hardness or familial discipline) to other men. Deliberate acts of disfigurement dominate in medieval accounts, in early law codes, in narratives and in archaeological reports: accidental facial injury is in fact relatively rare in the material explored, although two possible examples will be discussed a little later in this paper. Those who disfigured deliberately, with just a handful of exceptions, were men, but those whom they disfigured were almost all other men, at least in the records (domestic violence against women, however, was and remains a largely hidden or ignored phenomenon). 26 It is striking that male aggression towards women, where it is documented at all, is thought to have gone too far if it reaches the woman's head or face, signalling a lack of self-control on the part of the husband. 27 And whilst some forms of disfigurement, mainly those on the severe end of the spectrum, might be fatal, they were not intended to be. Byzantine authors report that political and judicial blindings were often carried out by the executioner, but he had to be good at his job and in this case keep his victims alive. (A particularly lengthy, possibly eye-witness, account in Michael Psellos, for example, has the executioner tie one of his victims down to prevent him moving at the point of impact, and being told by  another, in an act of bravado, that if he moves the executioner should nail him down. 28 ) Disfiguring injuries and blindings were designed to disable, to humiliate, to cause pain and suffering, and above all to demonstrate the power of the person injuring. 29 Whether that was intended to bring approval -the just punishment of recidivist criminals in Cnut's laws for England, for example -or showed the perpetrator up as the worst kind of tyrant -Cnut in his younger days can take a bow here too, as the mutilator of Anglo-Saxon hostages -was beside the point. 30 Both sides of the coin demonstrated dominance, however it was written up.
Social class also mattered to reports of disfigurement: it hardly ever seems to occur across class boundaries (except in a few isolated cases of oppression in saints' lives), but is carried out within the peer group to which both the perpetrator and victim belong. When servants became involved in the disputes of their lords, they attacked each other. 31 Attacking someone else's servants or subjects, however, was a powerful mutilationby-proxy of the lord or king himself, and in the words of sociologist Erving Goffman, a 'face-threatening act'. 32 (Not that a 'face-threatening act' needed to target the physical face of course, but the latter presented a very obvious and visible target.) Medieval honour culture -injuries between equals, and the focus of much historical enquiry -existed alongside and has not been sufficiently distinguished from medieval 'face' culture, where the injuries, physical or verbal, were inflicted between people of different social status. 33 This is what gives Cnut's actions such resonance as a challenge to Aethelred's 'face' as king in 1014. It is also why an attack by pirates on the Saxon coast in 994, in which Thietmar of Merseberg nearly ended up being given as a hostage, remained a focal point of discussion nearly a century after it happened, since it included the maiming of noble hostages who 'lived a long time after, a reproach to the Empire and a pitiful spectacle for all the people', according to Adam of Bremen. 34 Neither king nor emperor was able to prevent the atrocities, and were themselves written up as weakened as a result.
The writing-up process, though, introduces a problem of its own. Generations of scholars of early medieval laws, for example, have pointed out that these were directly affected by the process of conversion to Christianity across Europe, and shaped by clerical ideas of ideal kingship. Nearly all of the narrative sources, too, emanate from the pens of male, clerical writers, and all but one or two of the texts are produced within a Christian frame of reference. And it shows. Medieval violence, in particular violence against the face, is often presented with biblical exempla in mind, most drawn from the Old Testament. The mutilation of clerics' or rulers' faces or heads called to mind the Levitical ban on men with deformities serving as priests (particularly in Byzantium, where political depositions might include cutting off noses and lips, blinding or simply tonsuring and exile); 35 the judicial mutilation of adulteresses, pimps and the incestuous with nose-cutting reflected the fate of the prostitute Oholibah in Ezekiel; 36 and any ruler who went beyond the boundaries of acceptable use of mutilation as judicial punishment was likely to be compared, explicitly or not, with the 'tyrant' Herod (Ezzelino's atrocity against the Friulians, mentioned earlier, included attacking innocent babies, for example). The model of Malchus's mutilation by Peter in the Garden of Gethsemane was almost certainly in writers' minds when they described and discussed the loss of ears. 37 Absent from this panoply of biblical figures is any reference to the mark of Cain the murderer, but since the Bible is totally opaque on what that 'mark' may have been, this is unsurprising. The influence of the idea of a mark, though, may be seen in the practice of literally marking a criminal if he or she was not to be put to death, mirroring God's intention as set out in the Bible. 38 The net effect of this biblical framework, it seems, is to close down discussion of any incidence of facial disfigurement that could not easily be related to biblical models, Old or New Testament. Many accounts, after all, were written up with an explicitly moral lesson about self-restraint and its lack, or the power of God through the saints, or the control of sexuality. A failure to grant mercy, for example, underpins the story of King Henry I of England's order to blind two knights (against the advice of his companions) and a minstrel, Luke of La Barre, as reported by Orderic Vitalis. Luke, in fact, prefers to kill himself rather than be blinded ('better off dead' again?), and Orderic's mournful comment on his death makes it clear that Henry had got it very wrong here. 39 Strikingly, the few women being disfigured in the sample are presented (and punished) as whores, whether their punishment is for sexual crimes or not. For example, in his sixth-century History of the Franks, Gregory of Tours reports the treason of the royal nursemaid, Septimina, but is as much concerned, possibly even more concerned, with the fact that her accomplice was her lover, Droctulf, to whom she had gone 'like a whore' after killing her husband. She is punished with burning to the face ('cauteriis accensis in faciae vulnerata') unlike Droctulf's loss of his ears. 40 And almost without exception, the individuals (and some groups) whose disfigurement is reported are either socially prominent, such as Charles the Bald's son Young Charles, who was grievously injured in the face during a bout of swordplay with his peers, and/or have a specific story that brings them to prominence and justifies their case being reported, such as that of the priest Walchelin, again in Orderic.
As has already been emphasised, stories of disfigurement tend to be stories of individuals, and two particular cases, Charles and Walchelin, bring out the contrasting approaches of medieval authors when recounting such tales. Charles's injury is carefully described in the was struck in the head with a sword by a youth named Albuin. The blow penetrated almost as far as the brain, reaching from his left temple to his right cheekbone and jaw. 41 There is always the lurking suspicion, with any accidental injury to a royal figure, that this was no accident, but the annalist leaves it as 'the work of the devil' and allows the reader to make up his or her own mind. The major injury Charles received is described in detail, and indeed the diagonal sword-slash to the face is a relatively common injury visible in osteoarchaeological remains -Albuin was clearly right-handed. 42 But there was no hint in the source that his assailant intended to injure Charles, no reference in the annals to compensation by, or punishment of, Albuin being demanded. (If this had been Iceland, as William Miller has illustrated, things might have been rather different. 43 ) Charles apparently suffered epileptic fits thereafter, and it is doubtful whether he escaped other impairments given the severity of the injury, but he did remain as sub-king of Aquitaine (albeit a largely inactive one) for the remaining two years of his life. Because Charles was so prominent, however, we have more than one account of the injury: Ado of Vienne (d. 870) reports that Charles was 'molestatus et dehonestatus' by the incident and his injury. 44 Later, Regino of Prum (d. 915) tells a rather different story of the incident, saying that Charles provoked Albuin's attack 'out of the levity of youth' and that his assailant struck him on the head with his sword, leaving him half-dead with a 'vultu deformatus'. 45 For Regino, therefore, writing at a safe chronological distance, the disfigurement was Charles's own fault, a condition that his irresponsible behaviour had brought upon himself. That is, the story of an accident could be written up and recast as a moral example of the folly of young men swinging swords at each other, almost asking to be injured. The more the moral frame intrudes, the more negatively Charles's disfigured face is viewed. He is, after all, a king, and so there is clearly some disquiet being expressed about his continuing fitness to be king. Here, the power of his family maintained him, but it could not silence the critics.
Was there any way to 'change face' then? Could victims of disfigurement manage others' responses to them, and be seen as the person behind the injury? Open to clerical commentators, of course, was the contrast between fleshly and spiritual health, and certainly Thietmar laments his sinful soul more than his misshapen face. As has been alluded to earlier, these writers might have recourse to religious explanations and comfort. The scars on the surface of the skin mattered little when integrity of the soul was what counted. Wipert, blinded on his mission with Bruno, in fact emphasises that his subsequent life as a blind, wandering beggar was spiritually beneficial to him and to those who gave him alms.
The same message seems to emerge from an extended account in Orderic Vitalis of the visions of a priest named Walchelin. Extending over several pages in the modern edition, the heart of the story has Walchelin recounting a vision he had had fifteen years earlier, in which he had seen the walking dead, and been attacked and dragged along the ground by an evil knight with burning hands. Fifteen years later, he recounted his tale to Orderic, who believed his informant on the basis that 'I saw the scar on his face caused by the touch of the terrible knight.' 46 The story is a striking one, and Orderic's belief in its authenticity rests upon the only material proof remaining, Walchelin's still-scarred face. By recording the priest's tale in writing, Orderic adds another layer of authority and in effect tells us: 'This is Walchelin, just wait till you hear how he got those burns on his face.' The tale of the terrible knight, fifteen years ago in a vision, is a compelling story. By re-telling it, Walchelin gains social capital and validation -'My vision was so real it has left scars'deflecting enquiry as to the mundane reason for his facial difference, which in all probability was a childhood accident with boiling water or a fire.
Children -and accidents -are in fact totally under-represented in the written material explored, and this partly reflects a reality that in most law codes accidents were not actionable, and children rarely appear as a separate group. The Damweiniau or 'Eventualities', an appendix of case law added to the legal codes of Wales, for example, explicitly said that 'there is no damage done by a person's fire to another person's flesh, without the person's act associated with it, for which compensation is paid'. That is, the fire had to be deliberately wielded or applied for the transactions of the royal historical society injury to become actionable. 47 But such evidence of accidents is quite rare.
Moving on to consider children and congenital impairment, it seems that this was an acquired disfigurement for the parents. A child born with a birthmark might arouse some attention; a cleft lip or palate (even assuming that the surgical treatment outlined in the Anglo-Saxon leechbooks was ever attempted) could present more challenging problems. 48 Pace Ariès and his detractors, the focus here is not whether parents felt an emotional bond towards impaired children, but in evidence from archaeology showing if a child had a congenital impairment and died young, it was either treated entirely neutrally in the burial rite, undifferentiated from able-bodied children, or might be made special with bespoke items. 49 Not having reached social adulthood was a protection of sorts. But what if he or she grew up? A thirteenth-century account in the chronicle of Salimbene features a monk named Aldevrandus, described as having a deformed head in the shape of a helmet, and copious hair on his forehead (excessive hairiness was almost always written up negatively, whether in historical or fictional works). When his turn came to start off the responses (antiphon) and, presumably, with all eyes upon him, the other monks would laugh, causing him to be upset and blush. 50 Salimbene, of course, turns this harassment into an edifying tale of Aldevrandus's Christ-like humility in the face of his persecutors, but it is worth speculating how he had come to be in a monastic community at all. Perhaps he was a child oblate, offered to the church perhaps to protect him from wider attention, but condemned to a life of pain from his so-called brothers.
If the stories of Wipert and Walchelin are perhaps medieval examples of triumph over adversity, Aldevrandus's gives us pause before we become too optimistic about the status of people with disfigurements in medieval society. We have to remember that Walchelin -or indeed Orderic -felt the need to construct a more exciting story to explain his appearance (which, we should note, is never fully described). Why? Modern psychological studies about facial difference have included a consideration of its capacity to elicit a disgust response, which Miller has also investigated from a historical perspective. According to him, medieval people felt no shame at pointing, staring and being repelled by scenes of violence, or cruelty, or the mutilation of others and its aftermath; this, he says, is what distinguishes medieval people from us 'moderns', who would be too ashamed or embarrassed to behave in the same way. 51 Certainly, there are accounts of political enemies or criminals being publicly paraded and publicly mutilated, suggesting that the so-called 'medieval theatre of cruelty' was not simply the product of medieval dramatists. 52 But whilst there are explicit examples of difference in appearance being ridiculed, the disgust that Miller posits is notably absent from the language of the sources.
If we go to the other end of the scale, Jacques Le Goff long ago suggested that medieval Europe teemed with the disease-ridden, impaired and mutilated, implying that a disfigured face would not have been seen as all that exceptional. 53 Not surprisingly, I disagree with this view as well, because having a different face clearly did involve stigmatisation of some kind. Why else did legislators from Ireland to Byzantium penalise apparently trivial injuries to the face and teeth, and at the same time utilise such measures to express their own authority against wrongdoers? A visibly beaten-up Lombard male in Italy, according to the laws, suffered ridicule and shame for his state; 54 Gregory of Tours recounts that a group of conspirators against King Childebert II were deprived of their ears and noses then 'let out as a subject of ridicule'; 55 in the early Irish law code Bretha Dein Checht, the shame of the public scar on the face exposed its victim to public ridicule -hence, the law states, a fine has to be paid for every public assembly the victim has to endure with facial disfigurement; 56 and Thietmar of Merseberg, even as he dismisses the importance of his 'ridiculous' face, still goes to the trouble of using that term. It is no coincidence that these are all men, and the danger to their reputations was not that people would find them repulsive or disgusting, but that they would laugh at them. Ridicule, as Irish poets knew well, was a devastating weapon, and perhaps Henry's anger at Luke of La Barre might not have been so terrible had not that poet circulated scurrilous (and presumably amusing) rhymes at the king's expense. Humour, as early medievalists have highlighted, can be highly dangerous. 57 This brief survey has sought to demonstrate that disfigurement is a constant of human history, whether congenital or acquired, but what counts as a 'normal' appearance fluctuates over time and place. Medical historians have privileged interventions, looking at ways in which faces have been fixed or 'saved', and thus have overlooked the social history of people with disfigurements, except in very prominent cases where, for example, that person became an exhibit. 58 This reinforces the objectification of those with disfigurements as passive recipients of treatment. Of course, almost all accounts of people with facial difference before the age of surgical intervention are equally objectifying -we get little sense of what it felt like to become and be disfigured, and have to rely upon the assumptions of legislators and chroniclers that it was humiliating and shameful. Clerics were able to draw lessons and, even, some comfort from their faith about their facial difference, but for most medieval elite men, the bulk of our sample of some 400 separate references to disfigurement, humility and patient acceptance was not part of the honour package.
What, though, about our own practice as historians? What assumptions do we bring to this subject matter? It is all too easy to equate the face, the surface, with the person and, if we have not personally experienced disfigurement, to think of it in entirely negative terms. Valentin Groebner's book Defaced and his preceding article, 'Losing Face, Saving Face', express this sense of loss and lack. 59 Reading modern accounts, the journey to a restored sense of selfhood comes through a combination of good surgeons, effective cosmetics, supportive families and, in most cases, access to resources. This is not so different from our medieval cases, but here the combination might omit the first, have limited access to the second and rely far more on the third and fourth, and add 'supportive community or priest' as a fifth element. In both periods, however, a good back-story matters, however horrific it might be. People with disfigurements who make it into the medieval record, however, are often already prominent, whether through their office, rank, birth or actions. Military men, bishops and clergy, courtiers and royalty are all represented. Wealthy merchants are held hostage and mutilated in order that they ransom their remaining digits or facial features, not so very different from medieval judicial systems that mutilate those who cannot pay compensation. By contrast, many of the biographies identified at the start of this paper are of people who became prominent because of their disfigurement. Does this represent the cultural shift that Miller recognised? Has surgical 'progress' heightened expectations that everyone can -even should -look more 'normal', and thus marginalised those who are judged not to? Is the atomised, individualistic nature of modern society such that individuals with impaired faces are more isolated than they might have been in medieval society? This does not assume a cosy, comforting view of medieval village or monastic communities looking after their own (a small community, after all, turned into something of a living hell for Aldevrandus), but simply access to support and acceptance if the person was well known. By contrast, as Luke Demaitre has argued, the sharp rise in urban dwellers in the thirteenth and fourteenth centuries, often strangers to each other but living in close proximity, heightened awareness of facial difference so much that we have far more records of doctors being consulted for often trivial conditions (sunburn, spots, hair loss), suggesting that first impressions -based on the human reflex of facial scrutiny -mattered more in this context. 60 By continuing to study how different communities viewed disfiguring conditions and injuries, and analysing, insofar as we can, how those with different faces responded to their change in appearance, we can perhaps make connections not only with their experiences in the past, but provide a firmer platform for arguing for social justice and equality in the present.