John of Arderne and Medieval Anal Fistulas

What can anal fistula teach us about Medieval life? A great deal, tuns out.

The first image you see here is a 15th-century illustration of one of the most important medical treatises of the Middle Ages, the “Practica of fistula in ano.” It is all about how to cure diseases of the colon and rectum, including the sadly common situation of anal fistula, wherein the anal glands become blocked, form abscesses, ooze out, and erupt as painful swellings on the skin surface. You might have to squint to make out the details in the photo, but they are there.

It used to be thought that anal fistula were mainly experienced by knights, whose heavy armor and long hours in the saddle caused their ailments. However, the poor diets and resulting chronic constipation were likely the more common cause. (Note to self: were these folks — medieval Europeans across the centuries — not drinking enough fluids? Was this a thing more experienced by the wealthy, and if so, was it because they ate too much meat and very little fiber? Do any readers here know?).

Anyways, you can see the surgical tools that John of Arderne used, and apparently he was very successful. We know this not just because he tells us about how many people he has cured, but also because a lot of the descriptions he relates in his medical text actually were correct practices. Unusually, he put a high emphasis on maintaining cleanliness, despite not knowing germ theory. But he also carefully related how to sponge the sores he lanced very quickly, which prevented hemorrhage. Although Arderne in another writing promoted the use of opium to blunt the pain of the operation, he argued that post-surgical care should not entail messing about with too many ointments — this probably prevented infection and helped John’s patients recover.

Whatever problems or distresses you may face in your life today, I hope they do not include the situation that the poor sufferers featured in John of Arderne faced.