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John of Arderne and anal fistula
An exceptional English surgeon was John of Arderne (b. 1307) who was educated at Montpellier and practised in France as a military surgeon under John of Gaunt (1340-1399) during the early years of the Hundred Years War (began 1337). He lived at Newark, Nottinghamshire between 1349-1370 before moving to London where he was admitted to the Fellowship of Surgeons. He devised an operation for anal fistula, an opening between the rectum or anus and the buttock, often caused by an abscess. It was said to be a common complication of chronic constipation and long hours in the saddle. Arderne's treatise on fistula was published in 1376. Using a set of 5 instruments and ligatures, he cut through the fistula after protecting the opposite wall of the rectum with a metal shield. Arderne's operation is still performed for this condition.
Itinerant practitioners and barber-surgeons
In Europe, from the 10th century, there were an increasing number of travelling specialists such as bone-setters, tooth-pullers, cataract couchers and hernia repairers. These were generally not medically qualified but prepared to undertake high risk procedures shunned by licensed practitioners. Not all of these were charlatans but there is no doubt that the ability to leave town fast was occasionally an advantage. From the Renaissance to the 18th century, surgery and medicine were practised in most of western Europe by separate groups of practitioners. However, surgery was rarely included in the university curriculum outside Italy. From the 12th century, physicians were licensed by universities. Surgeons were regulated by trade guilds and their closest occupational links were with barbers. Guilds of barber-surgeons were established in Europe from the 13th century.
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