The facial disfigurement of women, whether through deliberate mutilation, accidental injury or the ravages of disease, was and still is a subject that evokes strong reactions, both positive (sympathy for the victim, attempts at rehabilitation and/or reconstruction of the damaged features, psychological counselling) and negative (shock or repulsion at the appearance of the victim, the passing of judgement or calculation of fault that led to the disfigurement, her rejection from the community). Whilst men, too, might suffer traumatic facial damage, the gendered assumption that a woman valued and was valued for her beauty (regardless of the number of onlookers permitted to see her face) was and still is a strong element in the habitus of many communities. Our evolution as human beings has led us to scrutinise the face before all other features, to determine community membership (is s/he one of us?), recognition (who is s/he?), likely reception (is s/he friendly?) and subjective value (is s/he pleasing to the eye?). Any disruption of the facial features confuses such signals, and may even send out misleading ones to the viewer (for example, if features are missing, or paralysis or disease limits facial expressions). The equation of beauty with good and ugliness with evil is a powerful idea.

Yet such categories are not set in stone. Dyan Elliot has pointed up the dangers of female beauty in the specific context of the medieval relationship between confessing women and their clerical confessors, and highlighted the increasing attention of commentators to preventing such relationships becoming carnal. Raymond of Peñafort, for example, recommended sitting opposite the penitent but not looking at her face during her confession. Moreover, the phenomenon of the frequently-confessing woman, she argues, came to be viewed not as a beneficial practice but a ‘pathological’ one. Such terminology marks out one of the ways in which gender, religion and medicine – at least medical metaphors – could intersect, and has direct resonances with the case studies featured in this chapter.