The Father of English Surgery

John of Arderne (1307 - 1392) was an innovative English surgeon who devised a number of cures and procedures and is considered the first English surgeon.

He grew up in Newark-on-Trent, which in his lifetime was a fairly large town. It is believed he attended the University of Montpellier; if so, then he may have been exposed to the Practica Chirurgia of Roger Frugard. He was in London in 1370, and was active in the Hundred Years' War in the regiment of Henry Grosmont, Duke of Lancaster, and John of Gaunt (King Edward III's son and Henry's son-in-law). (Incidentally, this would put him in the orbit of a young Geoffrey Chaucer.) He remained an employee of Gaunt.

War creates injuries, and this is where surgeons are most needed and are given opportunities to come up with new ideas for treating people. Long stretches bouncing on horseback can be damaging and lead to an issue now called a pilonidal cyst, but described by Arderne as a fistula in ano ("fistula in anus"). A fistula is a connection between two parts of the body that don't normally connect. You can learn more about this and Arderne's painful-but-successful treatment in this post.

But perhaps not so painful. Arderne knew of the soporific and nerve-deadening effects of opium, and prescribed it so that the patient "shal sleep so that he shal feel no cutting." To the opium he would add hemlock and henbane. He would apply this topically via an enema, and also use it on arrow wounds to deaden the pain while they were extracted.

His innovations were not just in what he was able to do for patients, but also in the profession itself. He believed, for instance, that wealthy patients should be charged what the market would bear, but poor patients should be treated for free. He also suggested ways to con duct oneself as a surgeon, and what to wear. The frontispiece for one of his manuscripts (shown above) shows him dressed in the robes of a university doctor, elevating the status above that of the more mundane "barber surgeon" who (because they possessed razors) were used to quickly treat war-related amputations, blood-letting, and (of course) hair-cutting. Because of the messiness involved, barber surgeons wore short robes. Arderne advised against this, urging his followers to distinguish themselves from the less-educated barbers.

More than 50 medieval manuscripts exist today with his texts, most with multiple illustrations as well. I'll share more of his guide for successful surgeons tomorrow.

Grosmont's Observations

The 1st Duke of Lancaster, Henry Grosmont, the wealthiest and most popular peer of the realm, wrote a book about his sins and the way to heal or atone for them using the metaphor of sin as sickness. This book, Le Livre de Seyntz Medicines or "The Book of Holy Medicines" also includes many autobiographical notes, as well as comments and observations that give us insight into the beliefs and culture of mid-14th century England.

Regarding the medical metaphors: we don't know that Grosmont himself had a large library, but his writing suggests a well-read man who could draw on other sources for his knowledge and ideas. Also, he would have had access to Leicester Abbey's library near his home, which at the time held at least 80 books on medicine. He also—as many nobles would— had a personal physician from Bologna from whom he would have learned much. (Bologna was known for training physicians, such as Jacob Mantino and Guy de Chauliac.)

His own physician probably gave him the information mentioned here that theriac is a good poison for driving out other poisons; however, if the patient is too far gone because of poison, theriac will only make things worse. He also offers the cure for delirium by slicing open a live young rooster and placing the cockerel on the patient's head.

During Grosmont's lifetime, Pope Urban V (whose personal physician was Guy de Chauliac) founded the medical University of Montpelier. One of its features was the collection of the bodies of executed criminals for dissection and research. Grosmont wishes his own soul could be opened up in this way to examine and understand his sin.

Some less medical or religious comments are about things like salmon. They understood that salmon are born in freshwater streams then head out to the ocean only to return to their streams to spawn. He expresses that a salmon born in a stream is not truly a salmon because it has not gone through its life cycle of stream-ocean-stream. He also tells us that goat's milk is ideally drunk in Spring, because the goat has only dined on new fresh plants at that time. Grosmont also offers a recipe for chicken soup, and how to know if a pomegranate is fresh.

In 1360, Grosmont was chief negotiator of the Treaty of Brétigny, ending a phase of the Hundred Years War. When he returned to England from the continent late in that year, he fell ill. Although only about 50 years old, he died on 23 March 1361. There was a resurgence of the Bubonic Plague that year, but it was not being noted until May, so we cannot attribute his death to it. He also wrote up a will 10 days before his death, so whatever prompted him to do so took longer to kill him than the Plague would. He was buried in the Church of the Annunciation of Our Lady of the Newarke ("New Work") in Leicester, which Grosmont had founded in 1354.

I am thinking that paragraph three above mentions something that would be unfamiliar to most readers. Tomorrow I'll explain theriac. See you then.

The Book of Holy Medicine

Unlike his contemporaries, Henry Grosmont was very forthcoming about his feelings about religion by writing an autobiographical treatise called Le Livre de Seyntz Medicines, "The Book of Holy Medicines" or "The Book of Holy Doctors."

Written in his early forties, in 1354, he employs the metaphor of his body as a castle and the Seven Deadly Sins as enemies entering through breaches in his defenses, making him ill. To combat this, he needs the services of a doctor in the person of Jesus Christ, who is accompanied by a nurse, the Virgin Mary.

Grosmont is willing in this work to lay bare all of his spiritual failings. As a younger man, he laments that he wishes he had "as much covetousness for the kingdom of heaven as I had for £100 of land" and that his body caused him to sin, as when his feet would bring him wine instead of being willing to go on a holy pilgrimage.

It is an unusual work in that it was written by a layman instead of a cleric or a mystic like, for example, Julian of Norwich or Margery Kempe. Whether it was written by Grosmont himself or he used a "ghost writer" or simply dictated it cannot be known for certain, but that he claimed it as his work is shown by a postscript (seen above, with the name marked in red):

Cest livre estoit comencee et parfaite en l'an de grace Nostre Seignur Jesu Crist MCCCLIIII. Et le fist un fole cheitif peccheour qe l'en appelle ERTSACNAL ED CUD IRNEH, a qi Dieux ses malfaitz pardoynt. Amen.

This book was begun and perfected in the year of grace of Our Lord Jesu Crist MCCCLIIII. And the fist is a foolish sinful sinner who calls him ERTSACNAL ED CUD IRNEH, to whom Gods forgive his misdeeds. Amen.

He humbly hides his name by writing backwards "Henri Duc de Lancastre" as the "fist," the hand that wrote it.

An argument against Grosmont merely hiring a writer to make himself look more pious is that his actions in life also demonstrated piety. He used his vast wealth to support churches and colleges and many clerics. Also, remember that Crusading was a religious act, not just about war. During a battle of the Hundred Years War, when the citizens of Bergerac begged for mercy, Grosmont is said to have replied "who prays for mercy shall have mercy."

Besides being a spiritual work, Le Livre de Seyntz Medicines also grants us a look into what the culture of 14th century England believed about the world. I'll talk more about that tomorrow, and Grosmont's end.

Henry Grosmont

Henry of Grosmont was a second cousin of King Edward III through their shared ancestry as great-grandsons of Henry III. Henry was the son of Henry, the 3rd Earl of Lancaster, and Maud Chaworth. Although one of seven children, he was the only male, and so inherited much more than he would have if he had brothers.

He was born about 1310 at Grosmont Castle in Wales. He referred to himself in his memoirs as tall, slim, and good-looking. During his youth his father—the wealthiest peer in England—was hostile to the excesses of Edward II; his youth must have been full of radical national events. His family's relationship to the Crown improved once Edward III was enthroned. In fact, Henry's father—although old and nearly blind—was chosen to ceremoniously knight Edward at the Coronation.

Henry was knighted the same year and, because of his father's increasing infirmity, represented his father in parliament and at the King's Council. He took over the management of his father's estates, including Bolingbroke Castle and the Savoy in London.

Henry and Edward III were only two years apart in age, which probably helped their personal relationship. Henry distinguished himself with Edward and on Edward's behalf in a dozen battles of the Hundred Years War, the Second War of Scottish Independence, as well as the "Northern Crusades" in the Baltics.

In 1345, Edward decided to attack France. As part of this campaign, Henry arrived at Bordeaux in August with 500 men-at-arms and 1500 archers (500 of the archers were mounted), as well as support troops. He was very successful at surprising the enemy with swift attacks: they were accustomed to the English setting up long, drawn-out sieges. While there, Henry's father died, making young Henry the Earl of Lancaster and the wealthiest peer of the realm. He also inherited the Barony of Halton (which would also pass to his son-in-law John of Gaunt, and then John's son Henry Bolingbroke, who would become King Henry IV).

In 1347, the king elevated Henry to the rare title of duke, in this case Duke of Lancaster. With the title he was granted palatinate powers, a condition available in England, Ireland, and Wales that allowed the person holding it to operate almost independently from the Crown.  This was an enormous amount of power for the king to "give away," but since Henry had no male heir, this seemed to be a gift to Henry that would not go further than his lifetime.

Edward also made Henry a founding member of the new Order of the Garter. 

Much of his life can be determined from his own writing. Tomorrow I'd like to talk about something he wrote: Le Livre de Seyntz Medicines, "The Book of Holy Medicine."