John of Arderne: the Father of English Surgery

Four manuscripts of medical texts by John of Arderne (fl. 1307-1370) are currently on display in the Special Collections foyer on level 12 of the library. This display was devised by Sara Oberg Stradal, a PhD History of Art student who is currently working on a thesis on the medical body in medieval art and thought. Here she takes a closer look at Aderne and his work.Those of a squeamish disposition – look away now!

Surgical instruments

Surgical instruments for use in fistula-in-ano (MS Hunter 251)

John of Arderne is often described as the Father of English surgery. However, not much is actually known about him, other than that he wrote a number of medical texts and practised as a surgeon in Newark, Nottinghamshire and London. Although in his texts he refers to himself as a master surgeon, he is not mentioned as such in the contemporary records. He is traditionally said to have travelled on the continent in the retinue of John of Gaunt (the son of Edward III) during the Hundred Years’ War, but there is no evidence to support this. What is clear, however, is that he was greatly renowned for his treatment of fistula-in-ano (anal fistula), an ailment for which there had previously been no effective remedy.

Treatment of fistula-in-ano

The treatment of fistula-in-ano (MS Hunter 339)

In 1370 he wrote his most famous work, the Practica Chirurgiae (Practice of Surgery), where he details the regimen for treatment of this condition and in which he boasts that he had a survival rate of fifty percent, which was astonishing for this period. It has often been assumed that fistula-in-ano was a condition more common among knights, and while spending hours on horseback with heavy armour would not have helped, it was not the sole cause of the ailment. Nancy G. Siraisi has pointed out that likely causes also included cancer of the bowel, trauma from previous surgeries and constipation, and it would therefore not have been an ailment specific to the knightly classes.[1]

John of Arderne combined two pre-existing ancient techniques, and he treated patients by cutting the fistula open; it was a process that could take several days. He designed new tools for this purpose and prescribed ointments and oils to treat the wound after surgery; this differed from other more corrosive treatments, which had previously been the norm. Practica Chirurgiae contains instructions for his treatment, but also other information which we today would not associate with medical practice. It describes how the surgeon should dress (like a “clerke” and not like a “mynistralle”), how he should speak (“be the wordeȝ short, and, als mich as he may, faire and resonable and withoute sweryng”) and that he should have comforting or moral stories and sayings on hand for his patients when they don’t like the taste of the medicine or become disheartened with the healing process (“Also it spedeth þat a leche kunne talke of goe taleȝ and of honest that may make þe pacients to laugh, as wele of the biblee as of other tragedieȝ; & any othir þinins of which it is noȝt to charge whileȝ þat þey make or induce a liȝt hert to þe pacient or þe sike man.”).[2]

Marginal illustrations

Marginal illustrations – including the “bubo” (MS Hunter 112)

More than 50 medieval manuscripts containing his texts remain today and 36 of them include a full image scheme with some 250 illustrations. These images are among the more interesting features of the books. They show procedures, herbs and tools, as well as symbolic representations of abstract concepts, such as pain. Among the marginal illustrations are also plays on words in the text, for example, the figure illustrating a cancerous growth is an owl because the Latin terms are homonymous, bubo meaning both boil and owl. This illustration would have helped the contemporary viewer navigate the text.  The picture series was probably dictated by Arderne himself and remained largely unchanged over decades of copying of his works from manuscript to manuscript and even remained the same when the texts were translated from Latin into English. While including illustrations made these manuscripts very costly to produce,  they were nevertheless added as they were crucial to the understanding the text.

Arderne created his text for many different reasons: to advertise and explain his treatment, but also to promote his own social status and that of his fellow surgeons. Other (master) surgeons were the primary intended audience of these texts and it is therefore important to understand their placement within the contemporary society. In England during the later Middle Ages there was a medical hierarchy which placed university educated doctors higher than surgeons and barber surgeons who had been trained and licensed through guilds. The two occupations were often described as relating to each other as geometry to carpentry. Physicians who adjusted the humoral balance within the body and whose approach was more theoretical practised the equivalent of geometry, while surgeons, who bled, cut and dealt with wounds and cancers, were like carpenters.

John of Arderne was very clear on his position in this hierarchy and he often refers to the inferior skills of barber surgeons. He tells his readers that they should be careful not to show a barber his procedure as the barber would usurp the treatment for the detriment of both patient and surgeon. On the frontispiece in MS Hunter 112, Arderne, a surgeon, is shown wearing the long robes of a university educated physician when surgeons and barber-surgeons would normally have worn shorter robes ending above the knee. These manuscripts are filled with ingenious ways in which Arderne and his profession is aligned with academic doctors, thus elevating the status of the author and his profession.

Portrait of Arderne

Frontispiece portrait of Arderne depicting him as a University educated physician (MS Hunter 112)

Three out of the four manuscripts currently on display in the Special Collections foyer consist entirely of works produced by John of Arderne and they all have over 250 marginal and larger illustrations. The fourth volume is a compilation of medical texts in which Arderne’s work has been included. This manuscript was produced later than the others and it only contains two illustrations; this could indicate that interest in Arderne’s treatments had waned over time.

Opening with marginal illustrations

Opening with marginal illustrations (MS Hunter 251)

These manuscripts offer modern researchers valuable insights into the practise of surgery in the medieval period. They also highlight the contemporary theological, social and ideological concerns of the surgeons who originally owned them.

If you would like to read more about John of Arderne, the practice of surgery or medieval medical manuscripts you can have a look at these books:

Arderne, John of, Treatise of Fistula in Ano and haemorrhoids clusters, edited and with a foreword by D’Arcy Power (London: Early English Text Society, Oxford University Press: 1910).

Jones, Peter Murray, “Image, Word and Medicine in the Middle Ages”, Visualizing Medieval Medicine and Natural History 1200-1500, edited by Jean A. Givens, Karen M. Reeds, Alain Touwaide. (Aldershot: Ashgate, 2006) 1-24.

Jones, Peter Murray, Medieval Medical Miniatures (London: British Library in association with the Wellcome Institute for the History of Medicine, 1984).

Jones, Peter Murray, “Sicut hic depingitur… John of Arderne and English Medical Illustration in the 14th and 15th Centuries” Die Kunst und das Studium der Natur 14 (1987): 103-126.

Rawcliffe, Carole, Medicine & Society in Later Medieval England (Stroud: Alan Sutton Publishing, 2005).

Siriasi, Nancy G., Medieval & Early Renaissance Medicine: An Introduction to Knowledge and Practice (Chicago: University of Chicago Press, 1990).

[1]    Siriasi, Nancy G., Medieval & Early Renaissance Medicine: An Introduction to Knowledge and Practice (Chicago: University of Chicago Press, 1990): p. 183.

[2]    Arderne, John of, Treatise of fistula in Ano, haemorrhoids, and clyster (London: Oxford University Press, 1910): p.6-8.

Post written by Sara Oberg Stradal.



Categories: Special Collections

Tags: , , ,

6 replies

  1. Sara, look forward to seeing your work on surgical diagrams – thanks for this on Arderne The latest on his surgical roll in Stockholm is in Early Medicine from the Body to the Stars, ed Gerald d’Andiran, a catalogue of the exhibition at the Fondation Martin Bodmer in Geneva in 2010-11, where the roll was on display.

  2. Hi Sara, there’s an article in the current issue of The Chaucer Review (Marion Turner, “Thomas Usk and John Arderne”, The Chaucer Review Vol. 47, No. 1 (2012), pp. 95-105) suggesting that Usk underwent such surgery in the 1370s. I don’t have access to the database, so have only read the first page…

  3. That is interesting, I did not know that “the Father of English Surgery” had been applied to John Hunter. John of Arderne, who lived quite a bit earlier, has also been called that by, among others, Kathleen Scott in Later Gothic Manuscripts 1390-1490 (1996).

    • Christopher Lawrence’s book review of Wendy Moore’s biography of Hunter “The Knife Man: Blood, Body-snatching and the birth of Modern Surgery” (2005) in the ‘Bulletin of the History of Medicine ‘ (Spring, 2006) is titled “The Knife Man: The Extraordinary Life and Times of John Hunter, Father of Modern Surgery”. The Royal College of Surgeons of England dedicated a plaque in St.Martin’s-in-the-Fields (where Hunter was buried until Frank Buckland had the remains removed to Westminster Abbey in 1859) which reads “John Hunter Founder of Scientific Surgery”; and as Roy Porter described Hunter in “The Greatest Benefit to Mankind: A Medical History of Humanity” (1997), “Hunter was seen to embody surgery’s claim to be the true basis of experimental physiology and, through the cultivation of anatomy, the model of medical instruction and research”. More colloquially he has simply been known as, ‘the Father of English surgery’, his birthday still celebrated annually in the Royal College: this extraordinary man was certainly the model for RL Stevenson’s Jekyll and Hyde, and a case can be made that his experiments in electrical resuscitation (now, defibrillation) on at least one corpse from Tyburn, was the inspiration for Frankenstein (1818).

  4. Comment above written in haste. Errata: John Hunter (1723-93); ‘Curator’ for ‘Curaor'; ‘whose’ for ‘whos’!

  5. The “Father of English Surgery” is a term usually applied to John Hunter (1723-1795), the brother of William Hunter (of the Glasgow Hunterian Museum, Gallery and Collection); a man still revered by the Royal College of Surgeons in London, whose Hunterian Museum was the inspiration for the Natural History Museum (founded by Richard Owen, Professor and Curaor of the Hunterian); whose work made an important contribution to pre-Darwinist evolutionary theory and whos papers and museum played a critical part in Charles Darwin’s education in evolutionary theory in the 1830s.

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