Treatises of fistula in ano : haemorrhoids, and clysters / by John Arderne

Fistula in ano.

[Sloane 6, leaf 141, back]

[1.] Of the plogeapps of fistula in ano, and of þe manere of þe leche, and of instrumentis necessary for þe fistule.

apps[I, I]ohn Arderne fro the first pestilenceapps that was in the ȝere of oure lord 1349 duellid in Newerk in Notyngham-shire vnto the ȝere of oure lord 1370, and ther I helid many men of fistula in ano. Of whiche the first was Sire Adam Euerynghamapps of laxton-in-the-clay byside Tukkesford; whiche Sire Adam, forsoth, was in Gascone with sir Henry, that tyme named Erle of derbyapps and aftir was made duke of lancastre, a noble and worthi lord. The forsaid sir Adam, forsoth, suffrand fistulamapps in ano, made for to aske counsel at aƚƚ the lecheȝ and cirurgienȝ that he myȝt fynde in Gascone,apps at Burdeux, at Briggerac, Tolows, and Neyrbon, and Peyters, and many other places. And all forsoke hym for vncurable; whiche y-se and y-herde, þe forseid Adam hastied for to torne hom to his contre. And when he come home, he did of al his knyȝtly clothinges and cladde mornyng clothes, in purpose of abydyng dissoluyng, or lesyng, of his body beyng niȝ to hym. At last I, forseid Ioℏn Arderne, y-souȝt and couenant y-made, come to hym and did my cure to hym and, oure lord beyng appsmene, [Domino mediate.] I helid hym perfitely within half a ȝere; and aftirward, hole and sounde, he ledde a glad lif by 30 ȝere and more, ffor whiche cure I gatte myche honour and louyng þurȝ al ynglond. And the forseid duke of lancastre and many othir gentileȝ wondred ther-of. Aftirward I cured hugon derlyng of ffowick of Balne by Snayþe.apps Aftirward I

cured Ioℏn Schefeld of Briȝtwell a-side Tekyll.apps Aftirward I cured sir Reynald Grey,apps lord of Wilton in Waleȝ and lord of Schirlond biside Chesterfelde, whiche asked counsel at the most famose leches of yngland, and none availed hym. Aftirward I cured sir Henry Blakborne,appsclerk, Tresorer of the lord Prince of Waleȝ. Aftirward I cured Adam Oumfray of Shelforde byside Notyngham, and sir Ioℏn, preste of the same toune; and Ioℏn of holle of Shirlande; and Sir Thomas hamelden, parsone of langare in the Vale of Beuare. appsAftirward I curid frere Thomas Gunny,apps custode of the frere Mynours of ȝorke. Aftirward, in the ȝere of oure lord 1370, I come to. london, and ther I cured Ioℏn Colyn,apps Mair of Northampton̛, that asked counsel at many lecheȝ. Aftirward I helid or cured Hew Denny, ffisshmanger of london̛, in Briggestrete; and William Polle, and Raufe Double; and oon that was called Thomas Broune, that had 15 holes by whiche went out wynde with egestious odour; that is to sey, 8 holeȝ of the to[ne] party of the ersse, and 7 on the tothir side; Of whiche some holeȝ was distant fro the towell by the space of the handbrede of a man, so that bothe his buttokis was so vlcerat and putrefied with-in that the quitour and filthe went out ich day als mych as an egg-shel miȝt take. Afterward [leaf 142] I cured 4 frereȝ prechours, that is to sey ffrere Ioℏn Writell, ffrere Ioℏn haket, ffrere Petre Browne, ffrere Thomas Apperley, and a ȝong man called Thomas Voke. Of whiche forseid som had only on hol y-distaunte fro the towelapps by oon ynche, or by two, or by thre. And other[s] had 4 or 5 holeȝ procedyng to the codde of the testicleȝ; And many other maners of whiche the tellyng war ful hard. All thise forseid cured I afore the makyng of this boke. Oure lord Ihesu y-blessid God knoweth that I lye not, and therfore no man dout of this, þof-al old famous men and ful clere in studie haue confessed tham that thei fande nat the wey of curacion̛ in this case. ffor god, that is deler or rewarder of wisdom, hath hid many thingis fro wise men and sliȝe whiche he vouchesaf aftirward for to shewe to symple men. Therfore al men þat ar to come aftirwardapps witte thai that old maistreȝ war noȝt

bisie ne pertinaceȝ in sekyng and serchyng of this forseid cure. But for thai miȝt noȝt take the hardnes of it at the first frount, thei kest it vtterly byhinde þair bak. Of whiche, forsoþ, som demed it holy for to be incurable; oþer applied doutful opinions. Therfore for-als-miche in hard thingis it spedith to studiers for to perseuere and abide, and for to turne subtily thair wittes. appsffor it is opned not to þam that ar passand but to tham þat ar perseuerand. [non transeuntibus sed perseverantibus pulsantibus aperitur.] Therfore to the honour of god almyȝti that hath opned witte to me that I shuld fynde tresour hidde in the felde of studiers that long tyme and [with] pantyng breest I haue swette and trauailed ful bisily and pertinacely appsin diuanudiis. ["diu avidius" says the best Latin text.] As my faculte sufficeþ without fair spekyng of endityng, I haue brouȝt for to shew it openly to tham that cometh aftur, our lord beyng me[ne] and this boke. Noȝt that I shewe myself more worthi of louyng of suche a gifte than other, but that I greue not god, and for the dragme that he hath giffen to me that I be not constreyned for treson. Therfore I pray that the grace of the holy gost be to this werke, that he vouch-saf for to spede it; that tho thingis whiche in wrokyng trewly I am ofte tymes experte, I may plenerly explane tham in this litel boke. appsAnd this I sey that I know noȝt in al my tyme, ne hard not in al my tyme, of any man, nouþer in yngland ne in partieȝ biȝond þe see, that kouthe cure fistula in ano; outake a frere minour that was with the prince of Waleȝ in gascon & gyan, whiche rosed & bosted hym that he had cured the forseid sekenes.apps And at london he deceyued many men; and when he miȝt noȝt cure som man, he made suggestion to tham that no man miȝt cure tham, and that affermed he with sweryng that ȝif the fistule war dried, that the pacient at the next shuld noȝt eschape dethe; whiche, forsoþe, y-lefte & forsake of hym I cured perfitely. appsAnd to remoue false opinions of ignorant men, for witnes I putte experience. Auicen, forsoþ, seiþ, 'experience ouercomeþ reson'; and galienappsin pantegni seiþ, 'No man [leaf 142 back] ow for to trust in reson al-oon but ȝit it be proued of experience.' And he seith in anoþer place, 'Experience without reson is feble, & so is reson withoute experience fest vnto hym.' Neþerlesse

I afferme noȝt that I miȝt hele al ffistulae in ano. ffor som ben vncurable as it shal be seid [more fully] ["Plenius" says the Latin text.] within when I shal trete of tham.apps ffirst it bihoueth hym that wil profite in this crafte that he sette god afore euermore in all his werkis, and euermore calle mekely with hert and mouth his help; and som tyme visite of his wynnyngis poure men aftir his myȝt, that thai by thair prayers may gete hym grace of the holy goste. And that he be noȝt y-founden temerarie or bosteful in his seyingis or in his dedes; and abstene he hym fro moche speche, and most among grete men; and answere he sleiȝly to thingis y-asked, that he be noȝt y-take in his wordes. fforsoth ȝif his werkes be oft tyme knowen for to discorde fro his wordes and his byhestis, he shal be halden more vnworthi, and he shal blemmyssh his oone gode fame. Wherfore seiþ a versifiour, 'vincat opus verbum, minuit iactantia famam'; 'lat werke ouercome thi worde, for boste lesseneþ gode lose.' Also be a leche noȝt mich laughyng ne mich playing. And als moche as he may withoute harme fle he þe felawshippe of knafes and of vnu[n]este persones. And be he euermore occupied in thingis that biholdith to his crafte; outhir rede he, or studie he, or write or pray he; for the excercyse of bokes worshippeþ a leche. ffor whyapps; he shal boþ byholden and he shal be more wise. And aboue al þise it profiteth to hym that he be founden euermore sobre; ffor dronkenneȝ destroyeth al vertu and bringith it to not, as seith a wise man, 'Ebrietas frangit quicquid sapiencia tangit': 'Dronkenes breketh what-so wisdom toucheth.' Be he content in strange places of metes and drinkes þer y-founden, vsyng mesure in al thingis. ffor the wise man seith, 'Sicut ad omne quod est mensuram ponere prodest, Sic sine mensura deperit omne quod est': 'As it profiteth to putte mesure to al thing that is, So without mesure perissheþ all þing þat is.' Skorne he no man. ffor of that it is seid, 'Deridens alios non inderisus abibit': 'He that skorneþ other men shal not go away vnskorned.' ȝif ther be made speche to hym of any leche, nouther sette he hym at nouȝt ne preise hym to mich or commende hym, but thus may he curteysly answere; 'I haue

noȝt vrey knowleche of hym, ["non habeo de eo veram notitiam" says the Latin version.] but I lerned noȝt ne I haue not herd of hym but gode and honeste.' And of this shal honour and thankyngis of eche party encresse and multiplie to hym; aftur this, honour is in the honorant & noȝt in the honored. Considere he noȝt ouer openly the lady or the douȝters or oþer fair wymmen in gret mennes [in domibus magnatum.] [houses] ne profre tham noȝt to kisse, ne touche not priuely ne apertely thair pappes,apps ne thair handes, ne thair share, [aut pubem.] that he renne noȝt into the indignacion of the lord ne of noon of his. In as moche as he may, greue he no seruant, but [leaf 143] gete he thair loue and thair gode wille. Abstene he hym fro harlotrie als wele in wordes as in dedes in euery place, for ȝif he vse hym to harlotery in priue places som tyme in opene place ther may falle to hym vnworship of yuel vsage; aftir þat it is seyde, 'Pede super colles pedes vbi pedere nolles.' 'ffart vpon hilleȝ and thou shalt fart whar thou wolde noȝt agayn thi willeȝ.' And it is seid in anoþer place, 'Shrewed speche [colloquia mala.] corrumpith gode maners.' When seke men, forsoth, or any of tham bysyde comeþ to the leche to aske help or counsel of hym, be he noȝt to tham ouer felle ne ouer homely, but mene in beryng aftir the askyngis of the personeȝ [nimis severus nec nimis familiaris sed in gestu mediocris secundum exigentiam personarum.] ; to som reuerently, to som comonly. ffor after wise men, Ouer moche homelynes bredeþ dispisyng. Also it spedeþ þat he haue semyng excusacions that he may not incline to þair askyngis, without harmyng or without indignacion of som gret man or frende, or for necessarie occupacion. Or feyne he hym hurt, or for to be seke, or som other couenable cause by whiche he may likely be excused. Therfor, ȝif he will fauoure to any mannes askyng, make he couenant for his trauaile, and take it byforehandeȝ. But avise þe leche hym-self wele that he giffe no certayn answer in any cause, but he se first þe sikenes and the maner of it; and whan he haþ seen and assaied it, þof-al hym seme that the seke may be heled, neþerlesse he shal make pronosticacion to þe pacient þe perileȝ to come ȝif the cure be differred. And ȝif he se þe pacient persewe bisily the cure, [et si viderit patientem attentius curam prosequi.] þan after that þe state of þe pacient askeþ aske he boldly more or lesse; but euer be he warre of scarse askyngis, ffor

ouer scarse askyngis setteþ at not both þe markette and the thing. Therfore for the cure of fistula in ano, when it is curable, aske he competently, of a worthi man and a gret appsan hundred marke or fourty pounde,apps wiþ robeȝ and feeȝ [cum robis et feodis.] of an hundred shillyng terme of lyfe by ȝereapps. Of lesse men fourty pounde, or fourty marke aske he without feeȝ; And take he noȝt lesse þan an hundred shillyngis. ffor neuer in all my lyf toke I lesse than an hundred shillyng for cure of that sekenes. Neþerlesse do another man as hym þink better and more spedefulle. And ȝif the pacientes or thair frendeȝ or seruauntȝ aske by how moche tyme he hopeth to hele it, euermore lat the leche byhete þe double þat he supposeth to spede by half; that is ȝif the leche hope to hele þe pacient by twenty wekes—that is the comon course of curyng—adde he so many ouer. ffor it is better that the terme be lengthed þan the cure. ffor prolongacion of the cure giffeþ cause of dispairyng to the pacienteȝ when triste to the leche is moste hope of helthe. And ȝif the pacient considere or wondre or aske why that he putte hym so long a tyme of curyng, siþe þat he heled hym by the half, answere he that it was for that the pacient was strong-herted, and suffrid wele sharp þingis, and that he was of gode complexion and hadde able flesshe to hele; & feyne he othir causes pleseable to the pacient, ffor pacienteȝ of syche wordeȝ are proude and delited. Also dispose a leche [leaf 143, back] hym that in clothes and othir apparalyngis be he honeste, noȝt likkenyng hymself in apparalyng or berying to mynistralleȝ, but in clothing and beryng shew he the maner of clerkes. ffor why; it semeth any discrete man y-cladde with clerkis clothing for to occupie gentil menneȝ bordeȝ.

¶ Haue the leche also clene handes and wele shapen naileȝ & clensed fro all blaknes and filthe. And be he curtaise at lordeȝ bordeȝ, and displese he noȝt in wordes or dedes to the gestes syttyng by; here he many þingis but speke he but fewe.

¶ For a wise man seith, 'It semeth more to vse the eres than þe tunge'; And in an-oþer place, 'ȝif thou had bene stille thou had bene holden a philosophre.' And whan he shal speke, be the wordeȝ short, and, als mich as he may, faire and resonable

and withoute sweryng.

¶ Be war that ther be neuer founden double worde [dupliciter sermo.] in his mouthe, ffor ȝif he be founden trew in his wordes ffewe or noon shal doute in his dedeȝ. Lere also a ȝong leche gode prouerbeȝ pertenyng to his crafte in counfortyng of pacienteȝ.

¶ Or ȝif pacientes pleyne that ther medicynes bene bitter or sharp or sich other, than shal the leche sey to the pacient thus; "It is redde in the last lesson of matyns of the natiuitè of oure lord that oure lorde Ihesus criste come into this world for the helthe of mannes kynd to the maner of a gode leche and wise. And when he cometh to the seke man he sheweth hym medicynes, som liȝt and som hard; and he seiþ to the seke man, 'ȝif þou wilt be made hole þise and þise shal thou tak.'

¶ Also in another place in an omely vpon the gospel of the soneȝ of Zebedee, wher þer moder askid seying, 'lord, sey þat my two sones sitte in thy kyngdome, þe tone on þi riȝt hand and the toþer on the left.' And Ihesus answeryng seide, 'ȝe wote neuer what ȝe aske'; þan seid he to the soneȝ of Zebedee, 'May ȝe drink þe chalice þat I am to drink?' Þai seid to him, 'We may'; as ȝif he seid to þam, 'ȝif ȝoure soule or mynd couaite þat deliteþ, drinke þe first þat soroweþ or akeþ.' And so by bitter drinkis of confeccion it is come to the ioyes of helþe." [Si mens vestra appetat quod demulcat, prius bibite quod dolet et sic per amarum poculum confectionis pervenitur ad gaudia salutis.] Ouer that hym ow to comforte þe pacient in monysshyng hym that in anguissheȝ he be of gret hert. ffor gret hert makeþ a man hardy and strong to suffre sharp þingis and greuous: And it is a gret vertue and an happy, ffor Boeciusapps seiþ, De disciplina scolarium, 'He is noȝt worþi of þe poynt of swetnes that kan noȝt be lymed with greuyng of bitternes. ffor why; a strong medicyne answerith to a strong sekenes.' And þeron seiþ a wise man, 'Be no cure sene heuy or greuous to the to whiche foloweþ ane heleful effecte.'

¶ And in anoþer place it is seid, 'happy or blessid be þat day þat ordeyneþ mery ȝeres.' And anoþer seith, 'he may neuer be in reste of body þat is oute of reste of soule; I wil suffre lesse þingis þat I suffre noȝt more greuous.' It semeþ a gret herted man for to suffre sharp þingis; appshe, forsoþ, þat is wayke of hert is noȝt in way of curacion, ffor [leaf 144] why; for soþe in al

my lyf I haue sene but fewe laborante in þis vice heled in any sikenes: þerfore it is to be-war to wise men þat þei entremette noȝt with sich. ffor whi; Þe wise man seiþ, 'All þinges ar hard to a waik hert man, for þai trow euermore yuelleȝ to be nyȝe to þam; þei drede euermore, þai suffre no þingis, þai are euermore vnstable and vnwise; þerfore a versifiour seiþ of tham, 'QuominusQuamvis.nil pacior paciendi me tenet horror': þat is þof-al I suffre no-þing, vgglynes of suffryng holdeth me.

¶ Also it spedeth þat a leche kunne talke of gode taleȝ and of honest that may make þe pacientes to laugh, as wele of the biblee as of other tragedieȝ; & any othir þingis of which it is noȝt to charge whileȝ þat þey make or induce a liȝt hert to þe pacient or þe sike man.

¶ Discouer neuer the leche vnwarly the counselleȝ of his pacienteȝ, als wele of men as of wymmen, ne [MS. þe.] sette noȝt oon to anoþer at noȝt, þof-al he haue cause, þat he be noȝt gilty of counsell; ffor ȝif a man se þe hele wele anoþer mannes counsel he wil trist better in þe. Many þinges, forsoþe, bene to be kepte of a leche, wiþoute þese þat ar seid afore, þat may noȝt be noted here for ouer moche occupying. But it is noȝt to dout þat if þe forseid be wele kepte þat-ne þai shal giffe a gracious going to þe vser to þe hiȝte of worship and of wynnyng [quia ea exercenti ad culmen honoris et lucis aditum præbeant generosum.] ; for Caton seiþ, 'Virtutem primam puta esse compescere linguam': The first vertu trow you to be to refreyne þe tong. Aftur al þise it houeth that he knowe þe names of þe instrumentisapps þat perteneth to þe cure of þe fistule, withoute whiche a leche may noȝt wele spede hym. Of whiche þe first is called 'Sequere me'apps—'follow me'—whose shap is shewed wher þe instrumenteȝ ar paynted [fig. 1]. And it is called 'Sequere me' for it is þe first instrument pertenyng to þat werk; for a lech ow for to serche þer-with þe way of þe fistule whider it goþ, wheþer by þe middeȝ of longaon or noȝt. And it ow to be made on þe same maner as wymmen vseþ in þair heuedeȝ, [in capitibus.] and of þe same metal; and it ow to be smal þat it may liȝtly be plied & replied. And be þe heuedeȝ [capita.] als little as þai may wele be, elleȝ þai miȝt noȝt wele entere þe mouþ of þe fistule for þe streitnes of it.

ffor why; oft tymeȝ ffistule in ano hath riȝt smale holeȝ, so þat som tyme þai shew noȝt but þat þer appereth bolnyng in þe mouþes of þam. Afterward is þer anoþer instrument, þat is called 'Acus rostrata,'apps a snowted nedle, for it hath þe tone heued like a snowte, and in þe toþer an yȝe like a nedel by whiche þredes ow to be drawen agayn by middeȝ of þe fistule, as it shal be seid within in his place. And it ow to be of siluer, as it is paynted; and it ow to be no gretter ne lenger in þe snowte þan as it is paynted, but it ow to be longer atte þe left, þat it contene in al 8 ynches in lenghþe. [ad minusocto pollices contineat.]

¶ Þe þrid instrument is called 'tendiculum,'apps and it ow to be made of boxe or of anoþir competent tree, nouþer lenger ne gretter þan his shap is paynted. And it ow to haue an hole þurgh in þe side, as it is peynted, In whiche hole be þer putte [leaf 144, back] [The words from here to the end of this page are reproduced in facsimile in Plate III.] in a wrayst, ["unum vertile Anglicé 'a wrayste' imponatur."] by middeȝ of whiche wraiste in þe ouer ende shal be a litel hole þurgh whiche shal be putte þe two endeȝ of grete þrede four folde, goyng atte firste by þe towel [per anum.] and þe hole of þe fistule; whiche þrede is called ffrenum cesaris,apps and the whiche also goyng atuyx þe wraiste, in wraistyng þe skynne atuyx þe tewel & þe fistule be faste constreyned aboue þe snowte of þe nedel, vnto þat kittyng be done. 'Siringa'apps is an holow instrument by þe middeȝ, and it ow to be made of the shappe as it is peynted here, nouþer gretter ne lenger, but euen after þe shappe as it is peynted here; ne haue it noȝt but oon hole in þe neþer ende or smaller ende, as it is peynted here [see p. 10, Plates II and III].

[figure]

PLATE II.—The instruments used by John Arderne in the cure of fistula.

(1) The probe—sequere me; (2) The snouted needle—acus rostrata; (3) The dilaton—tendiculum; (4) The strong thread—Frænum Cæsaris; (5) The peg—vertile—fitting into the hole in the wide part of the tendiculum; (6) The syringe in general use with lateral openings; (6a) Arderne's modification of the syringe with a terminal opening only. [From Sloane MS. 2002, leaf 24.]

[figure]

[PLATE III.]

Sloane MS. 6, leaf 144, back.

[leaf 145]

[2.] Of þe apostemeȝapps in þe lure causyng þe fistule, and þe cure of tham.

2. [T]hof-al þe principal entent was for to trete de fistula in ano, Neþerles it spedeþ first for to touche somwhat of aposteme bredyng þer-in or niȝe, [vel exterius prope anum.] siþe oft tyme apostemeȝ bredyng þer bene cause of fistule or of cancre. ffor, after auctours, Aposteme y-bred in any place of þe body, if it be not y-helid by þre or four moneþes, it is turned into a fistule or a cancre.apps Therfore when ther falleth ane aposteme in þe lure or niȝe1 þou shalt knowe it by þese signes; þat is by bolnyng, akyng, brynnyng, ȝekyng & prikkyng. [per tumorem et dolorem, ardorem atque pruritum et puncturam.] And the pacient for akyng and anguissh may nouþer sitte ne ligge ne slepe. Whiche apperyng, ffirst it is to labour to þe slakyng or esyng of the akyng and brennyng and of oþer accidenteȝ without repercussione. ffor in þe lure ow noȝt to be repercussion, siþe it is ane emunctory, and in emunctorieȝ ow it noȝt to be done; þese bene emunctorieȝapps:—þe armeholes, þe þeholes, þe chawelleȝ, ["axillæ inguina et fauces," says the Latin text.] apps &c. And witte þou after Gilbertyneapps þat ane aposteme beyng within þe lure is cured with þe infusion of oile rosetapps in which is ceruse distempred, or led brent, or litarge, or all þise if þai be hadde, or with þe ȝolk of an ey. And he be euermore warre of paynyng of egestion. And ȝif his wombeapps be costyue [et si venter constipetur.] be it softned þat þe hardnes of þe ordure bryng noȝt in anguissh in egestion doyng. And be it softned with ane emplastre of malueȝapps & swynes grese; Or with water of decoccioun of malueȝ and branne, with oile or butter fressh, or suche other, and be it ȝette in by a clisterye. Therfore take oyle roset and medle it with þe ȝolke of a rawe ey in euen porcion. Aftir putte it in a little bleddere, þan take a Nastar of tree [tunc accipe unum instrumentum ligneum, concavum per medium, quod Nastare ligneum vocatur.] apps and putte it in þe bladder and bynde it aboute wiþ a strong þrede, and enoynt þe for ende wele with oyle roset, and softly putte it in þe lure and presse þat is in þe bleddre with þi fyngres in-to þe lure. Þis, forsoþe, swageþ and softeneþ þe brynnyng, þe prikkyng, smertyng & akyng, and comforteþ þe membre in boþe cause, [in omnibus membris corporis.] þat is

boþe in hote and colde. ffor, after auctores,apps Oile roset coldeþ ane hote membre and hoteþ ane colde membre [oleum ros. membrum supercalescens infrigidat et super infrigidatum calefecit.] ; and it doþ many oþer profites þere and in al þe membres of þe body. And þerfore a gode leche puruey ["provideat."] hym þat he want neuer oyle roset, siþe þer procedeþ of it many helpyngis to mannes body; for why; after Galien to euery akyng hote oile roset is mytigatif. Vpon þe aposteme, forsoþe, vtward be putte a gode emplastre and riȝt maturatif of diaquilonapps resolute with oile roset, or oile of lilieȝ, or of camamill, or dialtred, [dialthæa.] or comon oyle, þat is oyle of olyue, or swyne grese, or gandres, [anatis.] or maulerdes, [mallardes.] or hennes grese. ffor whi; diaquilon þus y-ordeyned and put-to matureþ colde materieȝ & resolueþ & mollifieþ hard materies. Also be þer made suche a vntment þat is riȝt mitigatiue. Recipe: tame comon malueȝ ["Malvas domesticas communes."] M. i or M. ij,apps& brisse þam in a morter, and put þam in a quart of oyle of olyueȝ and lat þam putrifie þerin 7 dayes or 9. After boile þam long at þe fire vnto þe oile be wele grene; after cole it and [leaf 145, back] kepe it: þis oyntment is ryȝt mitigatiue of akyng of apostemeȝ, and mollifieȝ þan if it be put vpon [tham] hote with lana succida.appsapps Lana succida is wolle þat groweth atuix þe leggeȝ of ane ewe about þe vdder, ful of swet, [sudore imbuta.] noȝt y-wasshe, and it opneþ strongly and consumeth; oyle, forsoþe, of propirte holdeþ opne and draweth and swageþ akyng. If, forsoþ, þou haue noȝt lanam succidam þan dippe a lyn clout in þe forseid oyntement and putte it hotte vppon and bynde it warly þat it fal not away. Also ane emplastre of þe forseid malueȝ is a ful gode maturatif and mitigatif of akyng in apostemeȝ of þe lure and of wymmenȝ pappeȝ, and to al oþer apostemeȝ þat nedeþ maturacion. And it is made þus. Recipe: malueȝ tame M. i. or ij; seþe þam in watir to þai wax softe, þan put þam out of þe watre and presse oute þe watre of þam, and aftir hakke þam small wiþ a sharp knyf on a clene borde; þan frye þam in a panne ouer þe fire with comon oyle or butter or swynes grese, Or, if þe pacient be riche or noble, with som of þe forseid oileȝ. And aftir vpon clene stuppes be it put on þe aposteme. And witte þou here þat if þou may haue wormedapps it profiteþ mich in curyng if it be

soden & made wiþ þe forseid malueȝ, for þat emplastre is best mitigatiue of akyng of pappes, & bryngeþ in quytour and conforteþ þe place, and makeþ þe mater for to vapour by þe poreȝ. And for certeyn it availeþ in al apostemeȝ in euery place of þe body, and also in many brissureȝ. With þis emplastre in cures of pappes I haue y-gette many worshippeȝ and benefetes, for certaynly it is soueraynly mitigatyue. But witte þou after all auctours—and I haue proued it for certayn experience— þat ane aposteme bredyng nere þe lure owe not to abide to it breste by itself, but þe leche owe bisily for to fele wiþ his fynger þe place of the aposteme, and wher-so is founden any softenes, þer, þe pacient noȝt wittyng, warly, be it boldely opned wiþ a ful sharp lancette, þat þe quitour and þe corrupte blode may gone oute. Or elleȝ, forsoþe þe gutte or þarme þat is called longaon, þat deserueþ to þe lure, shal be bristen wiþ-in þe lure, and presed byfore þat þe aposteme be bristen withoute-forþe. Whiche case byfallyng, if it al-oonly brest within it is of hard cure, and þan shal þer be ragadieȝapps or frousingeȝ, fforsoþ if it briste boþe within and with-out, þan may it neuer be cured but by a ful experte cirurgien in his crafte. ffor than may it þe firste day be called a fistule; siþe a fistule is noȝt elleȝ þan ane vlcus vndesiccable,appsand for it is vndesiccable, þerfore by consequens it is vncurable, siþe no wonde ne vlcus may be heled but if it may be dried. Som tyme it bifalleth som men for to haue ane hole apperyng outward al-oonly, persyng þurȝ þe longaon within þe lure by þe space of ane ynche or of tuo, and bisyde þat anoþer hole with-out, noȝt persyng þe longaon with-in-forþ. And I haue sene som haue 7 or 9 holeȝ on þe tone party of þe buttokkis, and 6 or 5 on þe toþer party, of whiche noon of þam, outake oon, persed longaon. And I haue sene som haue 2 or 3 holeȝ on þe buttokke, and 2 or 3 descendyng [leaf 146] doun into þe codde of þe testiculeȝ. And I haue sene som haue oon hole or many in þe tone buttok, and oon or tuo on þe party of þe ȝerde persyng als wele longaon as þe ȝerde. And in þis case, as by my demyng, sich pacientes bene vncurable, and þat for fistulyng of þe

ȝerde. And þat may be knowen, for som-tyme þe sperme goþ oute by þe hole of þe ȝerde infistulate, and som-tyme vryne or bothe. Neþerlesse I cured a preste, at lincolne in þe house of Maistre Giffray Scrope,apps þat had aposteme in his ȝerde, of whiche als wele vryne as quitour come doune into his codde, and sometyme blode went oute by þe hole of þe ȝerde, and his testicules war bolned out of mesure. Therfore, first, I putte on his testieuleȝ oon oyntement ruptorye, and I made an hole by whiche went out bothe vryne and quitour; þis i-do, þer shewed ane bolnyng vnderneþe in þe ȝerde riȝt be þe lure, whiche I opned wiþ a ruptorie; whiche y-opned, þer went out boþe quitour and vryne. Whom y-cured perfitely, oure lord beyng mene [Domino mediante.] ; but for certeyne his lure & longaon war vnhurte. And witte þou þat þis cure was ful hard. Þerfore in suche þingis be a leche avised and discrete. Also a leche owe to be circumspecte in his askyngis, þat he enquere bisily of þe pacient if he fele ony tyme ventositeȝ or egestionȝ go out by þe holes of þe fistule. appsAlso enquere he of þe pacient ȝif he fele any heuynes or greuousnes in his heued; Or if it appere to hym þat þe house some-tyme is turned vp-so-doune [ut si appareat ei quod domus subvertatur.] as it shuld falle, and þe pacient may noȝt for drede of fallyng enclyne to þe erthe; And if þe pacient fele akyng and heuynes or greuousnes in his lendeȝ ["et si sentiat gravitatem in lumbis."] and feblenes in his stomake. Also sey he to þe pacient þus: 'I wote þat þe kynde of þe fistule is soche þat somtyme it is opned by itself and putteþ out quitour, somtyme þikke and somtyme þynne, somtyme watery and somtyme blody. And somtyme it is closed be itself, & so by a moneþ or more þer renneþ no-þing out; and eft-soneȝ it bigynneþ to ake or þat it caste out quitour. And aftirward it is opned by itself, and renneþ as it is seid afore, and aftirward it is sperred.' [et postea clauditur.] ffor suche pronosticacions sheweþ and tokneth to þe pacient þat þe leche is experte in þe knowyng of þe fistule, and so þe pacient wil better trist vnto hym. And witte þou, aftir Bernard of Gordon,apps þat þe synoweȝ closyng and openyng þe lure haþe festnyng with þe stomake and wiþ þe ventriculeȝ of þe brayne, And for this cause suche

pacienteȝ ar som tyme vexed in þe heued [in capite.] and in þe stomak. When þe leche, forsoþe, haþ talked þus to þe pacient, as it is seid, and þe pacient aske & persew for to be cured of hym, aske þan first þe siȝt of þe sekenes; Whiche y-sene, be þe leche war þat he put noȝt his fynger in þe lure of þe pacient, ne shewe no pryue instrumenteȝ wher-of þe pacient myȝt wonder or be aferd;apps or if perauenture þe pacient haue wilyly broȝt in with hym any leche for to aspye, as I haue oft tyme sene. But considere þe leche bisily þe maner of þe fistule, & perceyue if it be curable. Ȝit [Nihilominus.] a leche ow for [leaf 146, back] to feyne perileȝ and hardenes of curyng, and for to make pronosticacions wilely þat þe sikenes askeþ long tyme of curyng, for þat þat þe medicyneȝ y-putte to may not abyde long for purgyng of þe wombe, and for moche moystenes goyng out of þe lure, and for many oþir lettyngis, as for þe lure is to streyte, or þe buttokkes be to grete or hard, or for þe pacient is waike of herte or vnobedient for to persew his cure or for to kepe his diete, and for many oþer þat hym ow for to feyne on his owne heued þat he supposeth be necessarye. [quæ debet capite proprio figere quæ sibi constiterit fore necessaria.] And þise pronosticated, if þe pacient stond stedfastly þat he be cured, or aske if he may be cured, þan sey þe leche þus: 'I dout noȝt, oure lord beyng mene, [Domino mediante.] and þi gode pacience folowyng, ȝif þou wilt competently make satisfaccion to me, as sich a cure—noȝt litle to be commended—askeþ, þat ne þingis y-kept þat ow to be kepte, and y-lefte þat ow to be lefte, as it is seyde, I shal mow bryng þis cure to a loueable ende and heleful.' And þan acorde þay of couenant, of whiche couenaunt—al excusacione y-put abak—take he þe half byfore handeȝ [Quo peracto medium pretii præ manibus capiat omni excusatione propositâ.] ; And þan assigne a day to þe pacient when he will bygynne. In þe mene tyme, forsoþe, ordeyne þe leche redy his medicynes and his instrumentis; þat is to sey þat he haue first two spongieȝ or þre at þe lest, & a rasour or a ful sharp launcet, and oþer instrumentis named afore, as Sequere me, Acum rostratam, Tendiculum; And silke þredes, and lyn cloutes, and girdelleȝ, and oþer þat ar seid afore and to be seid here-after. Haue he also redy a medicyne restrictyue of blode, and warme or leuke watre, and all

oþir necesarieȝ, þat no-þing wante þat the leche may nede in his wirchyng. And ouer al this it is best & most sikir þat he kutte noȝt in þe lure ne do no violence ne greuousnes to it in þe tyme þat þe moneapps is in Scorpion, or Libra, or sagittarius, for þan of astronomyeȝ is forbede þer kuttyng. ffor as wille souerayne astronomieȝ and astrologiens, þat is to sey Ptholomeus, [Ptolomæus,] Pictagoras, [Pythagoras.] Rasis, and Haly, &c. A cyrurgien ow noȝt for to kutte or brenne in any membre of a mannes body, ne do fleobotomye whiles þe mone is in a signe gouernyng or tokenyng þat membre. [

The Latin texts contain a chapter headed

Nota de cognitione signorum Lunæ.

Si quis scire et invenire voluerit in quo signo cœli fuerit Luna omni die, primo sciat signum in quo Luna soli conjungatur et diem conjunctionis per kalendarium. Quo invento tunc scias quod ab illa hora diei vel noctis in qua fuerit conjunctio usque ad talem horam diei sequentis completur, prima dies Lune. Postea computa quot sunt dies ab imprimatione prædicta usque ad diem de quo queris in kalenderio. Tunc videndum est in tabula precidente ubi invenitur numerus ille. Quo invento, queratur in superiori capite tabulæ sub quo signo Luna fuerit pr'ma sub quo recte descendens transeas donec directe perveneas ad signum correspondens Linealiter numero ætatis Lunæ predictæ, et in illo signo existit Luna eodem die. Et nota quod in ista computatione dies naturalis ad meridiem diei incipit secundum Astronomos. Qui, igitur, de tempore certificari voluerit tabulam sequentem de 12 signis discat et agnoscat; sic, incipit Aries, Taurus, Cancer, Virgo, &c. [[The Table given on pages 18, 19 follows here in Latin Text.]]

Sicunt volunt Astrologi summi videlicet Ptolomæus, Pythagoras, Rhasis, Haly, &c., non debet cirugus incidere vel urere in aliquo membro corporis humani nec facere phlebotomiam dum Luna fuerit in signo regnante illud membrum. Nam secundum est quod 12 signa zodiaci regunt 12 partes humani corporis prout patet in imagine predicta, ubi aries quod est signum igneum temperate siccum caput regit cum suis contentis. Luna vero in ariete existente cave ab incisione in capite et facie et [ne] incidas venam capitalem. Luna vero in tauro existente, cave ab incisione colli vel gutturis, nec incidas venam in his locis. Luna existente in geminis cave ab incisione spatularum brachiorum et manuum nec aperias venam in his locis. Luna existente in cancro cave ab incisione in mammis vel pectore aut stomacho, et a læsione pulmonis, nec incidas arteriam seu venam ad ipsam directionem. Luna existentein leone cave a læsione laterum, costarum et ne incidas in dorso neque per apertionem neque per ventosam. Luna existente in virgine cave in ventre aut in locis interioribus occultis, nec minuas matricem mulierum deservientem. Luna existente in libra cave ne umbilico aut in natibus et hanc [in ano] nec in renibus, nec venam renibus servientem aperias, nec ventosam apponas. Luna existente in scorpione cave testiculorum, virgæ virilis, colli vesicæ, nec aperias venam testiculorum deservientem nec ventosam apponas. Luna in sagittario existente cave ab incisione femorum nec incidas maculas vcl superfluitates quascunque in corpore humano existentes. Luna existente in Capricorno cave in genibus et a læsione venarum et nervorum in his locis. Luna existente in aquario cave ne incidis in tibiis aut in nervis earum a genibus usque ad inferiora cavillarum. Luna vero existente in pisce cave in pedibus, nec venam aperias in eorum extremitatibus. [Supplied from Rawlinson, C 355, in the Bodleian Library.]

A note on the recognition of the Signs of the Moon.

If any one wishes to know and to discover in which sign of the heaven the moon is on any day, he must first discover in the almanac the sign in which the Moon is in conjunction with the Sun and the day of the conjunction. When this is found you know the first day of the moon because it is from that hour of the day or night when the conjunction occurs to the same hour of the next day. Then calculate by the almanac the number of days from the new moon thus obtained to the day you want. Look next in the previous table where the number is found, and when it is found look in the upper line of the table for the sign in which the moon is. Coming straight down from this you cross until you come directly to the sign corresponding lineally with the number of the age of the moon, and this gives the sign of the moon on that day. And note that in this calculation the natural day begins at midday according to the Astronomers. If any one wishes therefore to be sure of the time let him learn and understand the following table of the 12 signs. It begins thus—Aries, Taurus, Cancer, Virgo, &c. [[The Table given on pages 18, 19 follows here in Latin Text.]]

The highest Astrologers, viz.: Ptolomy, Pythagoras, Rhasis, Haly, &c., aver that a surgeon ought not to cut or to cauterise any member of the human body nor to breathe a vein so long as the moon is in the house ruling that member. For the 12 signs of the Zodiac rule the twelve parts of the human body, as is clear from the aforementioned drawing, where Aries, which is a fiery sign moderately dry, governs the head with its contents. But when the moon is in Aries beware of operating upon the head or face and do not open one of the head veins. When the moon is in Taurus refrain from operating upon the neck or throat and do not bleed from a vein in these parts. When the moon is in Gemini beware of operating on the shoulders, arms or hands, and do not

[figure]

[Table for finding the Moon's house.]

open a vein in these parts. When the moon is in Cancer refrain from operating upon the breasts or chest or stomach and from injuring the lungs, neither open an artery or a vein in their neighbourhood. When the moon is in Leo take care not to injure the flanks or the ribs, and do not operate upon the back either by cutting or by cupping. When the moon is in Virgo take care not to operate upon the belly or the internal parts, and do not bleed from the veins supplying the womb in women. When the moon is in Libra refrain from operating upon the navel or upon the buttocks or upon the kidneys, and do not open the vein supplying the kidneys, nor apply a cup. When the moon is in Scorpio refrain from operating upon the testicles, the penis and the neck of the bladder; do not open the testicular vein and do not apply a cup. When the moon is in Sagittarius do not operate upon the thighs, do not remove spots or superfluous parts occurring in any part of the human body. When the moon is in Capricornus refrain from the knees and from injuring the veins and nerves in these parts. When the moon is in Aquarius do not operate upon the legs or upon their nerves from the knees to the bottom of the calves. When the moon is in Pisces do not operate upon the feet and do not open the vein in their extremities.

]

[3.] Of diffinicion of a fistule, and places þat it is bred in, and when it is curable or noȝt.

[N]ow it is to procede to þe curyng of þe fistule. And aftir auctours of cirurgie, a fistule is a depe aposteme, hauyng oonly oon hole somtyme, and ofte-tymes two or þre, and oftymes mo, and bredyng in eche membre of þe body of aposteme or of a wounde yuel y-cured, giffyng out quitour of diuerse colour and of diuerse substaunce; þat is to sey now white and þinne, now watrye, now as wasshyng of flesshe þat is rawe, now clotty; somtyme myche stynkyng, somtyme litle. And somtyme þe holes ar closed be þam-self, and aftir a fourteniȝt or a moneþ, akyng goyng afore in þe place, þai ar eft-sones opned. And when siche maner fistules is bredde in þe armes or in the brest, or in þe costes, or in þe þies, or in þe knees, or in þe legges, or in þe fete, or in þe hende, or in þe ioyntours [ [Sloane MS. 277, leaf 66, col. 1] of [The MS. Sloane 6 is defective here. The missing folios are supplied from another English version, Sloane 277, made early in the fifteenth century.] þise, þat it corrumpeþ oft-tyme þe boneȝ and þai ycorrupte ar oft tymeȝ put out by þe holeȝ of þe fistule.

¶ Bot fistuleȝ of

iunctureȝ noȝt comyng of outward cause ar called þe fistulatfestred gout.apps And sich fistuleȝ almost bene all vncurable, and namely in Wymmen. In ȝong [ȝong written above, olde deleted.] men forsoþ or waxen men, I hafe seene few euer be cured, out-tak þat I haue sene tuyse or þrise som waxen men by long processe of tyme, þurȝ benefice of nature, be cured of þe fistula in þe leggeȝ and in þe fete; þat is to sey in þe seuent ȝere or fourtent or two and tuenty fro þe tyme þat þe fistule come to þam. And þat miȝt be for, after Ypocras,apps alle sekeneȝ ouþer is termyned after þe mouyng of þe mone or of þe son.

¶ If it be after þe mouyng of þe mone. so it is termined in þe fourtened day, which is endyng of acuteȝ sekeneȝ and bygynnyng of croniceȝ.

If it be after þe mouyng of þe son þan þe first schal be in þe seuent moneþ or seuent ȝere and so ascendyng vpward by seuen, &c.

[leaf 66, col. 2] ¶ And witte þou þat al ȝong men hauyng sich forseid fistuleȝ, if þai be in febreȝ and lene of body, ful seldom abideþ þe fourtened ȝere. To which for-soþ noieth most vse of milk and of fruyte and lichery.

¶ If þe fistule for-soþ be in a fleschy place of þe body al-only, it is possible to be cured and þer-for fistula in ano or bredyng niȝe may wele be cured. Whileȝ neþerlesse it be noȝt ouer olde or depe, [dummodo tamen nota fuerit nimis inveterata vel profundior.] þat may be knowen by þe hardnes of þe place and discoloryng of þe skynne and mich goyng out of þe egestionȝ, and feblyneȝ of þe pacient, and if it haue perced þe waieȝ of þe vryne.

apps¶ Þerfor wake ȝe þat couaitise blynde noȝt þe siȝt of ȝour eiȝen, [vigilate ergo ne cupiditas oculorum aciem exteret.] þat it may noȝt deme atuix curable and vncurable.

[4.] Of a maner of wirchyng in fistula in ano and þe curying þer-of.

When for-soþ thou knoweȝ þat he þat haþ fistule in þe lure, or niȝ biside, is strong and þe place of þe sekeneȝ wele colored and þat the pacient is gode herted and abydyng, it is noȝt to drede þat-ne þe lech schal spede wele in þe cure of it if he be experte.

¶ Which perceyued, when þe pacient and þe lech ar

acorded in al þings, þan be þe pacient ledde to a place made redy Where þe lech schal do þe mynysteryng of cure. And all men amoued away out-take one or tuo, þat þe lech will haue with hym to his helping, ouþer of his owne men or of oþer; þan sey þe lech þus to þe pacient, reward [habito respectu ad personam patientis; "sciat generositas vestra et celsitudo necnon vestra magnanimitas."] yhadde to þe person of þe pacient.

¶ 'Witte ȝour gentilnes and ȝour hiȝnes, and also ȝour godehertynes, þat þe gracious perfeccion [leaf 67] of þis cure ow not only to be recced as now to þe possibilite of my gode bisynes, bot also to ȝour gode and abydyng pacience.

¶ And for-alsmich be it noȝt hidde to ȝow þat if ȝe be vnobedient and vnpacient to my commandyngs, lustyngappsþe tyme of wirchyng, ȝe may falle in-to a ful gret perile or tary longer þe effecte of þe cure. Therfor beþ-war, For he þat is warned afore is noȝt bygiled. Paynful things passeþ sone when at the next foloweþ glorious helthe.' [Cito transiebunt penosa, cùm in proximo salus succedit gloriosa.]

apps¶ Þise things yseid, be þe pacient putte vp-on a bedde bifore a liȝt Wyndow, and be he putte after þe maner of þe sekenes þat is if þe holeȝ of þe fistule be in þe lefte side lye he on þe lefte side. And if þai be in the riȝt side vp-on þe riȝt side, or if þai be to-ward rigebone [versus caudam spinæ dorsi, i. e. "rigbon" ejusdem.] apps lie he þan wide opne boþe his leggeȝ or þe tone raised vp after þat it semeth more spedeful and be þai hungen vp with a corde or with a towell festned aboue to a balk or a beme.

¶ Þe felaw of þe lech sitte at þe bakke of þe pacient, aboue on þe bedde þat þe pacient lieþ in, and hold fast with his handeȝ þe ouer buttoke in raisyng it vpward þat þe lech may haue gode siȝt in his wyrchyng.

¶ Þan at first putte the leche þe schewyng [digitum manus sinistræ ... qui index dicitur.] fynger of his left hande enoynted with oile, or som oyntment, in-to þe lure of þe pacient. Which ydo with þe tother hand putte he þe heued of þe instrument þat is called sequere me in-to þe hole of þe fistule *þat is next to þe lure, if þer be many holeȝ, and assay [leaf 67, col. 2] bisily on þe fynger beyng in þe lure if he fele with it the instrument or fynger with-out any þing atuix. Which if byfall witte he with-out dout þat þe longaon is persed.

¶ And þan witte he for certayn þat it byhoueþ noȝt to cure þe pacient with no cure bot cuttyng with yren, or fretyng with a threde strengely yfestned.

apps¶ If þat hole for-soþe be noȝt distant fro þe lure bot by a nynch al-one, þan schal kuttyng be þe moste kynde and sonest cure; þat if it be so, þan tak þe lech Acum rostratam and putte he þe end hauyng þe eiȝ thurȝ þe hole next to þe lure þe lefte fynger yputte, as it is seid, in-to þe lure. And when he feleþ þe nedle wiþ his fynger, labor he warly þat he may bring out with his fynger þe heued of þe instrument þurȝ þe lure appliyng and wryþing.

¶ Whiche ydo, be þer taken a fourfold þrede of silk white or of strong lyne or tuyne and it is called ffrenum Cesaris. And be it put in þe eiȝ of þe nedle And with þat þrede anoþer single threde and at oneȝ and to-gidre be þe nedle drawen þurȝ þe lure and þe hole of þe fistule. Afterward þe single þrede be fest by itself noȝt constreynyng, bot þat it go noȝt out þe lech noȝt willyng, þar-if parauentur frenum cesaris be kutte or brusten þan schal þer anoþer frenum cesaris mow be broȝt in with þe forseid þrede with-out any anguisch.

¶ Therfor be þe lech witty in þis wirchyng þat he may do, and kon do, tuo things þan he fyndeþ in wrytyngs, [leaf 67, back, col. 1] appsFor al þings þat ow to be done about sich werk may noȝt be expressed in lettreȝ, and þerfor it byhoueþ a crafty [lech] to be wise and slyȝe wele ymagynyng subtile þings, þat in þose þings þat perteneþ to þe perfitenes of þis werk and aboue þo þings þat he has lerned in þis boke he may availe hym þurȝ benefice of his ovne witte; For Boeciusapps seith

¶ De disciplina scolarium, He is of moste wreched witte þat euer more vseþ þings yfounden and noȝt things to be founden. [Sic igitur medicus ingeniosus in hac operatione ut plura quam in scriptis inveniat agere sciat: quia omnia quæ circa tale opus fleri debent non possunt litteris exprimi. Et ideo oportet artificem esse providentem, subtilia bene imaginantem, ut in his quæ ad hujus operis perfectionem pertinent super ea quæ in hoc libello didicerit ingenii beneflcio valeat prævalere. Dicit enim Boëcius "de disciplina scholarium," "Miserrimi est ingenii qui tantum utitur inventis et inveniendis."]

¶ Þerfor þe frene and þe þrede ydrawen, as it is seid, þan may þou chese wheþer þou will kutte it or fret it with þe þred.

¶ Iff thou will kutte it þan schalt þou take acum rostratam and] [MS. Sloane 6, leaf 147, continues.] [leaf 147] putte it þurȝ þe middeȝ of þe lengþe of þe instrument þat is called tendiculum, bygynnyng at þe gretter ende. After take boþe þe endes of freni cesaris, drawen þurȝ þe middes of þe lure and of þe hole of þe fistule, and þurȝ þe middis of þe hole of þe instrument þat is called vertile—a wraiste—. Be þai drawen þurȝ, and be þai faste y-knettid in proporcionyng þe lengþe of þe

freni cesaris as it bihoueth, þat is after þe distance of þe hole of þe tendiculi to þe hole of þe fistule; þan take þe tendicule and putte þe snowte of þe nedle in þe hole of þe fistule in-puttyng it strongly. Aftirward take þe wraiste wiþ freno cesaris,descriptionOpen page and put it in þe hole of þe tendicule, þat is þe side of it; whiche y-putte in, putte þi fynger in þe lure, and wiþ þe toþer hand þrist faste þe tendicule with þe snowt toward þy fynger. And when þou seeȝ tyme, be þe wraist turned aboute þat frenum cesaris hold fast þe tendicule þat it go noȝt out. And so labour þe leche vnto þat he bringe out þe poynt of þe snowte by þe middes of þe lure; and þat he streyne fast þe flesshe festned in þe frene wiþ þe wraiste and þe frene. Whiche y-do, take þe instrument þat is called coclear— a spone—Of whiche þe holow heued be putte in þe lure agayn þe poynt of þe snowte, so þat þe poynt of þe snowte stand in þe hole þat is in þe spone, noȝt þurȝ persed, & be þat halden of þe felaw of þe leche; þis, forsoþe, shal defende þe lure þat it be noȝt hurt, þruȝ uncouenable mouyng and sodayn styrryng of þe pacient, wiþ þe poynt of þe rasour or of þe launcette.apps As soon aftirward—þe pacient comforted—putte þe leche þe poynt of þe rasour in þe holwnes of þe snowte þat is in þe spone, and, als sone as he may, boldly kutte þe flesshe festened in þe frene aboue þe snowte euen be þe middes; and it y-kutte by þe middes, þe snowte wiþ þe frene shal lepe out by it-self. If, forsoþe, þer be many holes þat ow to be kutted, be it done as it is seid. Or if it be nede, differre it to anoþir tyme;apps ffor in som case þe toþer holes beyng outward may be heled wiþoute kuttyng or byndyng of þrede. appsOf whiche it shal be seid aftirward, þan it is to labour to þe staunchyng of blode. ffirst put a spounge wette in a litel warme watre and wele wrongen in þe place of the kuttyng, and hold it þer fast to receyue þe blode, and lat it abide þer a gode while; þerfore when þou trowest þe sponge to be wele ful of blode, remoue it, and if it be nede putte agayn anoþer sponge, or þe same ordeyned in þe forseid maner. And when þou hast doon þus, be þe pacient raised vp warly, and make hym

to sitte fast in a redy place vpon þe forseid sponge; and dout not þat ne it shal be wele staunchid. Aftirward when þou demeȝ dew tyme, be þe pacient put in a dewe place and þe sponge remoued; and wheþir þe blode be staunchid, or noȝt, putte in þe kuttyng puluer of boli, sanguis dracon̛, aloes epaticus, puluer of hennes feþereȝ y-brent, or of an old lyn cloþe y-brynt, asshen of heres of hares y-brent, [leaf 147, back] Iuyse or puluer of walwort,apps &c., Of whiche it shal be seid aftirward in þair place. But witte þou þat it is noȝt required þat al þise at ooneȝ and to-gidre be putte to, but I putte þam here þat a leche, som wantyng or noȝt y-had of þe forseid þingis, may competently spede wiþ þe toþer his nedeȝ or occupacion. ffor why; eueriche of þise medicynes symply by hymself or medled wiþ þe white of an ey stauncheþ wele blode þer and in oþir places. But witte þou þat to worþi men and noble it semeþ to putte to more noble medicynes and more dere. And witte þou þat þe iuse of walwort or puluer of þe same, if it be had redy, is namely in euery medicyne þat is restrictiue of blode. How, forsoþe, þe poudre of walwort ow to be made, or þe iuse of it to be kepte, it shall be seid aftirward. Þe medicyne restrictiue, forsoþe, y-put to wiþ clene stupes and smal, or wiþ coton wele y-tesed, or wiþ heres of hares noȝt y-brent, and with lynnen cloutis put aboue, be it warly bounden; þat is to sey be he girded on þe bare naked wele streit wiþ a lynnen girdel. Afterward haue he a list of wolnen cloþe, and be it bounden byhynd at þe bak of þe pacient to þe lynnen girdel, and lat it descende atuix his buttokes vpon þe cloutes couerying þe lure, and be it festned fast to þe girdel vpon þe womb, and lat it abide so stille to þe tyme come þat it be eft-sones remoued. If þe holes, forsoþe, be in þe buttok somdele remoued fro þe lure, þan most it oþerwise be bounden. And þat þus, haue þe pacient a wolnen girdel or a lynnen, wiþ þe whiche he be girded in þe flankeȝ, to þe whiche girdel be hongen a lynnen cloute hauyng in brede seuen or 8 ynches, and in lengþe als many or mo; þerfore be þe pacient girded þat þe side of þe clout next to þe lure lye riȝt atuix

þe buttokkes upon þe lure; and oþir cloutes y-putte atuix, þan be bounden two listis hyngyng about þe þie of þe pacient. And if boþe þe buttokkes bene hurt, ordeyne he anoþer girdel to þe toþer, and be it ordeyned as it is seid afore, and on þe same wise. ffor knowe the leche þat competent byndyng shal giffe noȝt litte help in curyng. But if medicyneȝ, forsoþ, may cleue to vnto dew tyme, þe cure shal longer be taried. fforsoþe when þou seest, in þe secound day or þe þrid, þe blode wele staunched, þan take þe ȝolke of a raw ey, and wiþ oile roset or of camomille, or wiþ sanguis veneris,apps or, þise defailyng, distempre it wiþ comon̛ oile, and put it in a littel bleddre, and wiþ anastar of treedescriptionOpen page ich day but oones be it ȝetted into þe lure, so þat þe wounde be filled þerof. And aftirward put aboue lynnen stupeȝ kutted smal wiþ shereȝ, and aboue þe stupes a lynnen cloute. And þan be it bounden as it perteneþ, and lat it so lye vnto þe morne. And þis cure ow to be kepte by 8 or 9 dayes; whiche, forsoþe, y-fulfilled, þanne owe þe leche to putte in þe kuttyng of my poudre þat I, Ioℏn Arderne, made, whiche I called 'puluer sine pari,'apps an[d] on frenssh, 'poudre saunȝ pere.' I wist neuer, forsoþe, ne knew poudre like to it, Of whiche it shal be seid aftirward in his place. [The MS. Sloane 6 is again defective, and the missing folios are again supplied from Sloane MS. 277.] [Sloane MS. 277, leaf 68, col. 1] Aboue þe poudre, forsoþ, put coton or stupeȝ and bynd it.

¶ And so by tuo hole natural daies be it noȝt moued, bot if voydyng of þe wombe make it [nisi ventris evacuatio cogerit.] ; bot warne þe lech þe pacient that he dispose hym so þat he remoue noȝt þe medycyne in any maner in als-mich as he may abstene. Elleȝ þe fruyte and þe vertue with þe effecte of the medycyne schal be annulled. If þe pacient for-soþ may noȝt abstene hym fro þe pryue [leaf 68, back, col. 2] In þe mornyng be it clensed with hote watre and a sponge and be it dryed and eft soneȝ be putte in of þe forseid poudre, And be it ordeyned as on þe day afore. And ȝitte be he comaunded for to abstene as afore, þat if he do noȝt eft-soneȝ þe þrid tyme be it ordeyned with þe same poudre as afore, And ȝitte he be amonysched to abstine.

¶ Afterward wheþer he abstene or not, þe place wele yclensed and dried, be þe lure enoynted with

þe fynger dipped in vnguento viridi hard molten in ane ostree schell att þe fyre. And on ich aside about the wounde and within the lure and where-so-euer he seeþ þe skynne flayne.

¶ For why; þis enoyntment doþe away alle smertyng and fleyng. [Nam hujusmodi unguentum omnino pruritum "smertyng" delet et excoriationem,] And þis enoyntment is called Salus populi,apps þe making of which shal be schewed afterward.

¶ Which enoynted, be þer ȝetted in as byfore with a nastare of tree of þe ȝolke of an ey and oile. And as it is seid in þe place afore, be it reparaled in al þings, renewyng eueryday oneȝ first with þe forseid oyntment molten in a schell. And be þer ȝette in with a nastare of tree oile with an ey.

¶ And þis wirchyng be continued by 9 daies at the lest.

¶ About the twenty day, forsoth, or 24 or 26, eft-soneȝ if þou see nede, þan it is gode þat þou putte bisily within þe lure of poudre sine pari, and fille þe place of þe fistule within and without and as it is seid be it redied. [et ut dictum est præparetur.]

¶ When forsoþ þe wonde is remoued. eft-soneȝ as it is seid afore be it wasched and dried and be it anoynted about with Salus populi And after be caste in by a nastare oyle and þe ȝolk of ane ey And, if þe pacient may abstene hym fro þe pryue, be it noȝt remoued by two daies. [leaf 69, col. 1] Elleȝ forsoþ when it is nede be it remoued. And considere þe lech bisily þe wounde ymundified if it be wele tretable and with-out hardnes and bolnyngapps and yuel colour: and som what for to cesse þe superflue moistnes which þe wonde sent out first. þan witte þe lech þat at þe next he may putte to cicatrizatiues as bene þise, Puluer of alum ȝucarin combust,apps 'bole armenic,' sanguis draconis, Aloe, mirra, sarcocolla,apps meele of barly and of beeneȝ, puluer of galleȝ and psidie [pulvis gallarum quercuum.] apps and puluer tanny, gummy arabic, terra sigillata,apps &c.

¶ Suppose noȝt þe lech þat it byhoueþ him to haue in one receyte al thise forseid togidre for þai ar sette here togidre. Bot it is to vnderstand þat þai ar named here togidre þat a lech know al to be of þe same vertu in regeneracion of flesch an[d] cicatrizacione and þat þai bene al stiptik. And to þise may be added ceruseapps and litarge of gold and of siluer.

¶ Iff þe lech want any of þem take of þe toþer þat he may fynde, For nouþer it byhoueþ here ne in none oþer place, þat

al þings named þat haþ þe same vertue be putte in every confection; bot tuo, or thre, sufficeþ als mich as alle.

¶ Tak þer-for þe lech of þise forseid, tuo, or thre, or foure and medle þam with þe ȝolk of a raw ey, a litle oile of lynsede putte to, if it be hadde, or of sanguis veneris or of melle rosat', and with soft stupeȝ of lyne kutte smal or with coton. be it putt warly in the wounde, For whi; it clenseth þe wounde and heleþ and dryeþ it wele [leaf 69, col. 2] for certayne.

¶ Or þou may put to common vnguentum album þat apotecharieȝ makeþ,apps þis neþerlesse yknowen afore [hoc tamen prænoto.] þat þou ow to medle þer-with poudre of bole armenic' and sanguis dragonis, if þou haue it, and oile roset with watre of rose in which be resolued gumme arabic, and bþ it wele ymedled togidre and þerof be putte euery day in þe wounde and about þe wounde with coton. And for certayn it heleth wele noȝt only þer bot in euery place of þe body. And þis oyntment wold I neuer want and I calle it vnguentum arabicum of gumme arabic̘ þat entreþ þerin and þan schal it be of rede colour.

¶ And witte þou þat with þis oyntment without any oþer medicine, outtake salus populi þou may finaly hele þe wounde of þe fistule, if þer be in it no ded flesch, no cauehole, or bolnyng, or hardneȝ, or blones, or rednes, or any oþer instans þat may be-falle. [livor aut rubor aut aliquod aliud instans quod contingere poterit/]

¶ Þat if þer be-falle any of þise accidenteȝ why þe wounde may noȝt perfitely be souded be þer put in of puluis sine pari and it schal bryng in þe desired effecte.

¶ And þis schal be to þe þe tokne of perfite curyng when þou seeȝ þe linne clouteȝ putte to with þe medicyneȝ to be drye when þou remoueȝ þam. And in-als-mych as þai ar more drye in-so-mych þai ar þe better.

¶ And þis sufficeþ of þe kuttyng of þe fistule and of the curyng of it. by þo þings þat thurȝ þe bisines of a gode lech and a witty may make þe forseid werk more. [Et hæc de incisione fistulæ et ejus iunctione sufficiunt præter ea quæ per industriam boni et ingeniosi medici prædictum opus valeant ampliari.]

[leaf 69, back, col. 1]

[5.] Of a-noþer maner wirchyng in þe same fistule and þe cure wiþ diuerse exempleȝ.

If it by falle forsoþ þat þe fistule be depe and haue grete distance atuix þe hole of þe fistule and þe lure.

Or if þe pacient be ferdful for to suffer kuttyng. Or for oþer notable causeȝ being þer, þan may þe lech with kuttyng of þe þrede ydrawen thurȝ þe middeȝ of þe hole of þe fistule and þe lure kutte þe flesch, and þat availeþ even to kuttyng with iren, outtake þat it askeþ a longer tyme of curyng. For why; þof-al it be bounden riȝt streitly at þe first tyme ȝitte vnneþe schal þe fretyng be complete in som men by a moneþ or thre wekeȝ.

¶ Sich cure þerfor ysewed and þe festnyng ydo on dewe maner, [Prosecuta ergo tali cura et innexione debito modo facta/] þat is after þat þe pacient may resonably suffre, puruey þe leche if þe pacient be delicate or feble, or waike of hert, þat þe þrede by which þe fistule is knytte, be so bonden þat if it be nede þat it may be loused without kuttyng, þat is with a lache knotte or slyppyng knotte. [Cum nodo currente Anglice "large knot" vel "slippyng knot."]

¶ Which ydo, lye þe pacient on a bedde; or stande he or go he by þre oureȝ or 5, or 6, vnto þat þe payne ycaused of þe byndyng cese somwhat. And wheþer þe akyng cese at þe forseid tyme or noȝt, putte þe pacient on a bedde and with a naister of tree putte into þe lure of þe ȝolk of a raw ey, medled with oile of rose leuke, [et cum nastare ligneo infundatur in anum de vitello ovi crudo cum oleo ros. mistum.] and be þe lure wele enoyntid [Sloane 6, leaf 148, continues.] [Sloane [MS] 6, leaf 148] of þe same withouteforþe. And so wiþoute puttyng atuix of any-þing late it aloon by a niȝt; At morne, forsoþe, bifore þat þe pacient go to priuè, be ȝettid into þe lure by a nastre som oyle, what-so pleseþ to þe, þat þe pacient may so moche more liȝt ese hym. Witte þou þat þus ow þou to chaufe þe ȝolk of an ey with oyle. Take þe nastare wiþ þe forseid medicyne putte in þe bledder, and þe bledder putte in some vessell wiþ hote water, þat þe medicyne may be chauffed by þe hete of þe watre; ffor why; hote þing eseþ better þe akyng. Þan afore þe pacient go to þe priuè, take þe leche þe forseid þrede in þe lure, and be þe vtter knotte loused, and aftir be þe þrede more strongly constreyned if it may wiþout anguissh of þe pacient. Elleȝ, forsoþe, be it bounden wiþ tuo knottis or þre vnlouseable, and be þe heuedeȝ of þe þredeȝ kutte away so nere þe knotte þat þai may noȝt be perceyued of þe pacient or of oþer men. And witte þou þat þe leche

shuld haue euermore þrede of white silke, small and strong; if he haue noȝt, forsoþe, þan take he strong þrede of lyne or of tuyne. And in no maner after his miȝt shewe he noȝt his wirkyng, nouþer in kuttyng ne wiþ þrede byndyng, þat his werke be perceyued of strange men, þat his cure be noȝt litle sette by, or þat any oþer witty man perceyuyng his werk mow vsurpe it to hymself; for þus did I, þerfore wake ȝe, for he þat is warned aforne is noȝt bigiled. It byhoueþ a leche vse many cauteleȝ, þat he adourne [ut facultatem suam decoret.] his faculte, whiche I may noȝt note to þe laste. It seemeþ, forsoþe, vnworþi for to vse wele þingis y-giffe þat kan noȝt gette hym mo þingis. Þerfore when þe pacient has clensed his wombe, be he putte vpon a bedde, and be his lure wele clensed and wyped wiþ hote watre and wiþ a sponge. Aftirward be it enoynted wiþ þi fynger atuix þe buttokeȝ and on ich aside about þe lure wiþ Salus populi hette in an ostree shell. Aftirward be þer ȝetted in by a nastare þe ȝolk of an ey as aboue wiþ oile. Aftirward be þer putte aboue siche ane Emplastre: Recipe—þe Iuyse of smalacheapps or merch, wormode, Molayne,apps walworte, Sparge, waybrede, Mugworte, auance, petite consoude,apps wodbynd. Of alle þise herbes, if þou may haue þam, take euen porcion, outtake of wodebynde, of whiche, if it may be hadde, be taken þe triple or quadriple. If al, forsoþe, may not be hadde, take þe toþer þat þou may haue, and namely þe þre first named wiþ wodebynd if þou may haue it. The confeccion̛ is þus:—Take þe Iuse of þe herbes, and be it medled wiþ als mich of wele clarified hony, al-wise mouyng on an esy fire, and boile tham so long vnto þat þe watrynes of þe Iuyse be somewhat þikned; whiche, y-take of þe fire and keled, kepe it in a gode potte. [ab igne deposita et infrigerata, reservatur.] It may laste al one ȝere or tuo; þerfore when þou wilt vse þerof, take of it als mich as it is nede, and putte þerto als miche of whites of eiren, wele y-bette and scomed, [prius ad ignem despunati.] and moue þam togider. Aftir be þer put to þam of subtile mele of whete als moche as sufficeþ, and medle þam wele to-gidre; þan putte [leaf 148, back] to a litle oyle of olyue, or of fressℏ buttre scomed at þe fire, wiþ als miche virgine wax

togidre dissolued at þe fire by it self; þan first putte aboue þe iuse to þe fire wiþ hony and white of eyren, and moue þam all wayse wiþ a sklyse [cum spatulâ.] þat þai cleue not to þe panne. When forsoþe it is wele hote but not wele y-soþen, be þe wax molten wiþ oile or buttre, as it is seyde aboue; whiche y-molten and þe forseid þingis beyng hote—þat is to seye þe hony, þe iuse, and þe white of eyren—be þai ȝetted togidre, and so euermore mouyng strongly wiþ a spatour, seþe þam on a softe fyre vnto þey be made oon body: whiche y-do, sette it of þe fire, and it beyng hote, putte to of terebentyne als moche as sufficeþ and moue it strongly wiþ a spature vnto þat þe terebentyne be dronken in. And if it be nede for to chaufe it more for þe terebentyne, loke þat it suffre noȝt mych hete, for in seþing loseþ terebentyne his myȝtes. Þise y-do, be it yputte in a box and y-kepte to vse. Take of þis and wiþ a spatour or with þi þombe strech it vpon clene lyn stupeȝ and softe, and put it vpon þe lure, and aboue put a lyn cloute and bynde it, as it is seyde, in þe cure of cuttyng. Þis emplastre, forsoþe, is called 'diaflosmus,'apps for molayne þat is called flosmus. And not oonly it availeþ in þis forseid cure but also in cuttyng of þe fistule; ffor why; it heleþ wele alle woundes, þof-al þai be horrible, & also bolnyngis in woundeȝ and in brissures; and it seseþ wele þe akyngis of woundes and of brusours. And it eseþ wele þe akyngis and þe bolnyngis of ioyntures; þis, forsoþe, haue I ful ofte proued. I sey, forsoþe, þat þis emplastre i-had, it is noȝt nede in þe forseid caseȝ to renne to oþer medicynes. And witte þou þat þer is a naturel vertu in walwort þat moste wele restreyneþ blode of woundes, and akyng and bolnyng of woundes and of al membreȝ it doþ best away. Witte þou þat þat confeccion aboue þat receyueþ Smalache, wormode, moleyne, sparge, &c, wiþ clarified hony soþen togidre at þe fire and kept by itself in a vessell is called 'Tapsimel.' When, forsoþe, þer is added þerto white of eiren and oyle, wiþ wax and whete floure and terebentyne, and ar soþen togidre, þan it is called 'diaflosmus.' And þus ow þam to be proporcioned:—Recipe. tapsimel,

white of eiren—aua ounce iiij; whete floure ounce iij; oyle, wax— ana ounce iij; terbentyne ounce ij. And witte þou þat if in þe tyme of þe makyng of Tapsimel may be founden a litel pety morel [solanum parvum possit haberi.] whiche bereþ white flours and blak grapes or berieȝ, it shuld for certayn make riȝt noble þe emplastre diaflosmus. And petite morel is called in fflaundres 'Naghtstach.' [Naghtsarth.] apps And witte þou þat þe iuse of it doþe best awey þe pustules in childres [childreȝ Sloane MS. 277. lf. 70, back.] mouþes.

If, forsoþe, þer be many holes persed to-gidre, þan owe þe leche als sone as he may for anguissℏ of þe pacient, after þe reperacion of þe first wounde, as it is seid afore, for to knytte wiþ a þrede, as it is seyde afore, þe toþer holes strongly. Or, if he may, þat is better þat þey be kutte al fro oon hole to an-oþer, acu rostrata, þe snowted nedle y-putte in þe hole, or som lynne tent, kutte þam to þe grounde wiþ a rasour or wiþ a launcete. Whiche holes, [leaf 149] forsoþe, y-brouȝt into oon, be þe wounde als soon y-filled of puluer sine pari; Aboue the poudre, forsoþe, I putte stupes kutte small, or coton̛, or carpe of lynnen cloþe. Aftir putte aboue þe forseid emplastre diaflosmus, and be it bounden as it is seid, and ich day ooneȝ reparailed. I sawe a man of Northamptoun [Vidi et alium hominem sc. Iohan: Colyn de Northampton.] þat had þre holes in þe lefte buttok, and þre in þe testicleȝ codde, and al persed fro oon to anoþer by þe middeȝ of longaon; whom I cured wiþ cuttyng of al þe holes at oon tyme, of longaon as wele as of oþer. Of þe kuttyng, forsoþe, of longaon, blode went strongly out, for þe fistule was riȝt depe; wherefore þe pacient swowned; perfore I putte to a sponge wette in cold watir and receyued þe blode. Aftirward I put in þe kuttyng of longaon restrictyues of blode, of whiche it is seid aboue, and a gode sponge y-wette in cold watre. I made þe pacient for to sitte in a chayer, and als soon þe blod was cesed. And aftir refetyng of mete and drink, he went into his bedde and sleped wele all þe niȝt, wiþoute goyng out of blode. In þe morne, forsoþe, he had hym wele; þe seconde day, forsoþe, after þe kuttyng I filled all þe woundes of puluer sine pari, and as it is seid afore in all þingis, with oile and an ey and salus populi and diaflosmus I helid hym finaly wiþ

in 14 wekes. Whiche, forsoþe, [Qui vero, ut dixit, viginti medicorum curam subegit.] as he seid, he vnderȝede þe cure of meny leches, And suffred it ten ȝere. And witte þou þat I saw neuer man vnder my hand suffre swounyng, outake hym þis; he was forsoþe corpulent and waike of hert, but neþerlesse aboute þe fourty day after þe kuttyng he rode. I heled anoþer man þat had a fistule in þe same maner in all þingis, outake þat longaon was noȝt persed; whom I cured wiþ kuttyng in þe same maner as it is seid of þe first. I haue sene som men hauyng oon hole aloon niȝ þe lure þat persed noȝt þe longaon, whom I heled wiþ puluer sine pari finaly; but for þe mouþe of þe vlcere was ouer streit, first I put aboue of vnguento ruptorioapps of calce viue & sape for to large þe mouþe of the fistule; of whiche it shal be treted afterward among oþir confeccions. I haue sene som men haue tuo holes byside þe lure, of whiche oon persed þe longaon and þe toþer persed in no place, but it was oonly symple by itself in þe flesshe, hauyng no passyng to þe tother hole. Of whiche was such a cure:—The hole nerre þe lure was cured wiþ kuttyng or byndyng; þe toþer, forsoþe, wiþ poudre sine pare y-put in and diaflosmo, and oon emplastre þat is called Neyrbone put aboue, whos confeccion̛ shal be shewed aftirwarde. I saw also, and, oure lord beyng mene, I heled perfitely a man þat had ffistula in ano on þe riȝt side and on þe lefte side; whiche, forsoþe, had on þe lefte buttok 8 holeȝ, and þre in þe riȝt buttok; and wiþin was longaon persed toward þe riȝt side oonly. But neþerlesse all þe holes of aiþer party of þe lure answered togidre in þe grounde þat was proued þus. I toke a siryng of siluer and a bleddre y-bounden aboute ful of sanguis veneris, and þe siryng y-putte in þurȝ oon hole and þe bleddre compressed wiþ þe fyngers, þe oile inȝetted [leaf 149, back] went out by al þe holes togidre on boþe sides, and neþerlesse þe hole of longaon answered noȝt but to oon hole oonly, and þat in þe riȝt buttok; þe soþefastnes of whiche þing was proued wiþ þe instrument þat is callid sequere me, and wiþ acu rostrata, wiþ ful gret hardnes and bisynes; þe cure of whiche was suche: ffirst euery day in þe lefte buttok þurȝ oon of þe holes I ȝetted in sanguis

veneris wiþ þe forseid siring and bledder; whiche y-do, I putte in tuo tentes or þre, or lard of pork or swyne in þe larger holes; after þat þe depnes of þe fistules asked, þe heuedes, forsoþe, of þe tentesapps war tokned with þredes drawen þurȝ þe middes wiþ a nedell, þat þe tentes shuld noȝt be drowned in þe grounde of þe fistules when þe tentes war put in. And I putte aboue þe emplastre þat is called Neyrbon strecchid vpon lynne cloutes, and dewly y-bounden aboute þe lendes wiþ a girdill and cloutes y-shapen as it is seid afore. I lefte it in pece vnto þe morne. At morne, forsoþe, þe emplastre remoued, þer appered aboue ȝe emplastre ful putrid quitour in superflue quantite. Eftsones in þe secounde day I reparailed it in al þingis as in þe first day, and it bifell as in þe firste day; and so it continued almost by a moneþ. When þe quitour, þerfore, bigynne to lessen somwhat, and the bolnyng somwhat to cese, and þe colour and þe substaunce of þe skynne for to turne to his ovne naturel habitude, þan at þe first turned I to þe principale cure of þe fistule with persyng of longaon, whiche I cured finaly wiþ byndyng of a þrede in þe hole of longaon. Þe toþer holeȝ, forsoþe, beyng bisyde it I cured wiþ cuttyng and with puluer sine pare. Euermore continuyng þe cure wiþ þe siryng in þe lefte side, and wiþ tentes als long as þay wolde entre in, and þe emplastre Neyrbon y-putte aboue, and salus populi and vnguento arabico, vnto a loueable ende wiþ goddes help aboute half a ȝere I cured hym, and lefte hym in pece. Also þer bene som men þat haþ fistules noȝt apperyng outward, but þay putte out miche putred & watrye humour, and som-tyme clere blode, and somtyme blode y-medled wiþ quitour. And þai disese myche þe pacientes and febleþ þam. And oft-tymes suche maner sikenes bene toward þe rigbone of þe bak niȝ þe lure, þat þay may be feled wiþ a fynger. But wheþer þay may be feled or noȝt be þer done suche a cure wiþ whiche I haue cured many men. Be þe pacient putte vpon a bedde wyde opne agaynes a wyndowe, liȝt shynyng, and þe legges y-raised vp and wiþ a towel y-hungen or wiþ a corde ordeyned to þis werk; whiche y-do, be þe lure y-opned wiþ

tonges so y-shape þat when þe vtward endes bene streyned togidre þe inner endes be opned & agaynward. Or if þe leche kanne ymagyne more couenable instrumentis to þe forseid werk to be done, for so moche loued be god þat streyngþes mannes witte in godes. Þe lure, forsoþe, y-opened, and þe sikenes bisily y-sene, be þe hole of þe sikenes y-filled wiþ puluer sine pare, and coton y-putte aboue; be þe tonges warly drawen out þat þai spill noȝt þe poudre, or þat þei hurt noȝt þe pacient. Whiche y-drawen out, and þe legges laten doun, late þe pacient long reste or þat he go, þat þe poudre be [leaf 150] noȝt letted for to go; and abide it so stille vnto þat þe pacient clense his wombe; and if þe pacient may abstene hymself fro þe pryuè by two dayes, it war full necessary to hym. When þe pacient, forsoþe, ow to be reparaled,appsþan be þe lure wasshen and dried; whiche y-wasshen, be þer ȝette in of a ȝolk of an ey wiþ sanguis veneris to esyng of þe ake þat comeþ of puluer sine pare, and to þe clensyng of þe vlcer of flessh mortified by þe forseid poudre. And þis cure continue þe leche by fife dayes or mo, þat is to sey of þe ȝolk and of sanguis veneris, vnto þat he se þe pacient wele alegedde [bene alleviatur.] of þe first akyng. Whiche y-do, þan owe þe leche in þe best maner þat he may for to opne þe lure and bisily biholde wiþin, and considere if þe sikenes be mortified; whiche is knowen if þat þe vlcer seme depper þan it was sene afore þe puttyng in of þe poudre, and also by oþer tokenes þat a gode leche fyndeþ more experte of long exercise. In þis þerfore to be yknowen be noȝt þe leche slowe; for why; þer shal folow noȝt litle louyng þerof. Þerfore if it be noȝt mortified be it eftsones filled of puluer sine pare, and be it sewed [et prosequatur.] in all þingis as it is seid afore, wiþ þe ȝolk of an ey, & wiþ sanguis veneris, vnto þat he se efte-sones þe pacient wele alegged, as it is seid afore. When, forsoþe, he troweþ þat it is mortified, þan it is to turne agayne to anoþer cure, þat is to sey þat he take þe ȝolke of an ey to whiche be added þe half parte of tapsimell, and als miche as sufficeþ of poudre of alumme ȝucaryne y-brent. And be it so made þat it may be ȝetted in by a Nastar of tree; and

þis cure be continued al-oonly by þre or foure dayes: þe fourþe, forsoþe, or þe fifthe day aftir þis medicyne done to, be þe vlcer reparaled wiþ þe ȝolk of an ey and sanguis veneris þre or foure dayes continued. And so owe þe leche for to chaunge his hande fro oon medycyne to anoþer, vnto þat he se þe superflue moisteneȝ firste goyng out for to cesse; þat is tokne of cure or helþ beyng niȝe. Þan, forsoþe, may he with vnguento arabico and salus populi finaly spede þe forseid cure aboute four & tuenty wekes, or more or lesse, aftir þat þe pacient be obedient and bisy; ffor why; gret spede of werk standeth in þe paciens and bisynes of þe pacient. [Nam magna operis expeditio in patientiâ et sedulitate patientis consistit.] And it is to witte þat in all vlcerieȝ beyng wiþin þe lure, or moiste ragadiis puttyng out quitour or blode, þis I sey þat þe vlcereȝ be noȝt bubones,descriptionOpen page i. e. owles, of whiche it shal be seid aftirward, for þai be al vncurable [Nota de ulceribus infra anum existentibus. Et notandum quod in omnibus ulceribus infra anum existentibus, vel rhagadiis humidis saniem emittentibus vel sanguinem, hoc dico, quod ulcera non sunt bubones, de quibus inferius suo loco dicetur; Bubones namque sunt omnes incurabiles.] : þat if a leche may noȝt wiþoute grete anguissℏ, als wele of hymself as of þe pacient, opne þe lure of þe pacient wiþ tonges, as it is seide afore, þan owe þe leche oonly putte in of tapsimell and puluer sine pare medled togidre in suche þiknes þat it may be ȝetted in by a nastare of tree. For why; þis medicyne mortifieþ wele and clenseþ putred flessh in an vlcere. But witte þou þat euermore aftir þe ȝettyng in of tapsimel wiþ þe forseid poudre, þou ow in þe nexte reparalyng for to ȝette in wiþ a nastare of tre of þe ȝolk of an ey wiþ sanguis veneris or oyle rosette, or wiþ comon̛ oile if þe forsaid wante. And þis cure be continued wiþoute leffyng [leaf 150, back] by þre or foure dayes. It spedeþ noȝt, forsoþe, þat medicynes bryngyng in akyng be to moche vsed or haunted, as is tapsimel wiþ puluer sine pare. Neþerlesse tapsimel wiþout puluer sine pare, wiþ þe ȝolk of an ey and wiþ poudre of bole armonic ful smal y-broke and medled wiþ oile of lynsed togidre, oyle of rose added to, or of violettis, or of sanguis veneris if it be had redy, And ȝetted in wiþ Nastare of tre, heleþ wele vlceres, ragadyes, and excoriacions or fleyngis wiþin

þe lure; þis supposed after þe sleyng of flessh putred, [Hoc superposito post mortificationem putridæ carnis.] wiþ enoyntyng of salus populi, þat availeth beste for certeyn in euery cause wiþin þe lure and wiþoute.

[6.] Of bubo with-in þe lure, and the impossibilitie or mych hardnes of þe cure of it.

6. apps[B]ubo is ane aposteme bredyng wiþin þe lure in þe longaon wiþ grete hardnes but litle akyng. Þis I sey byfore his vlceracion þat is noþing elles þan a hidde cankere, þat may noȝt in þe bigynnyng of it be knowen by þe siȝt of þe eiȝe, for it is hid al wiþin þe lure; And þerfore it is callid bubo, for as bubo, i.e. an owle, is a best dwellyng in hideles [Bubo est animal latebras colens.] so þis sikenes lurkeþ wiþin þe lure in þe bikynnyng, but after processe of tyme it vlcerate, & fretyng þe lure goþe out. And ofte-tyme it fretiþ and wasteth all þe circumference of it, so þat þe feces of egestiones goþ out continuely vnto þe deth, þat it may neuer be cured wiþ mannes cure but if it plese god, þat made man of noȝt, for to help wiþ his vnspekeable vertu. Whiche, forsoþe, is knowen þus: Putte þe leche his fynger into þe lure of þe pacient, and if he fynde wiþin þe lure ane hard þing as a stone, somtyme on þe to party al-oonly, som tyme of boþe, so þat it lette þe pacient for to haue egestion, it is bubo for certayn. Signes, forsoþe, of his vlceracion bene þise: þe pacient may noȝt abstene hym fro þe pryuè for akyng & prikkyng, and þat twyse or þrise wiþin ane houre ["et aliquando sæpius," adds the Latin text.] ; and þer goþe quitour out þer-of as it war medled wiþ watrye blode and stynkyng. To þat also wele vnkunyng leches,apps as þe pacient, [Tam medici ignari, quam patientis.] troweþ þat þey haue þe dissenterie, þat is þe blody fluxe, when trewly it is noȝt. Dissenterye is euermore wiþ flux of þe wombe, but bubo goþ out hard egestions, and som tyme þey may noȝt go out for streytnes of þe bubon̛ but þai ar constreyned wiþin þe lure streitly, so þat þai may be feled wiþ þe fynger and y-drawe out. And in þis cas availeþ þe myche clisteries lenitiues of watre of decoccion̛ of whete brenne [lenitiva ex aquá decoct. furfuris tritici.] wiþ oyle or butter, or wiþ

symple decoccion of branne wiþoute medlyng of any oþer þing. Neþerlesse vnkunyng leches ministreþ vnto suche restrictiues medicynes of dissenterie, of bole, and sang dracon̛, mastik, coriandre, sumac, mirtilles, harde ȝolkis of eyren, gret wyne, and suche oþer þat availeþ to restreynyng of flux of þe wombe, as þou shalt mowe fynde in 'lilio [in lilio medicinæ capitulo.] medicyne,' capito "de fluxu ventris." And how moche more þat þai giffe restrictiues, so moche more þai noye to þe forseid in constipand, i.[e.] costyuenes, and in hardenand þe squilullam [squibala.] ; þat I haue oftymes bene experte of,apps And I haue lerned it in experience in whiche I was not bigiled: ffor why; constrictiues y-lefte als wele in diete as in þe forseid medicynes I esed mich wiþ vse [leaf 151] of clisterieȝ of branne symple or of malueȝ and branne wiþoute oyle or butter or any fatnes; ffor why; al fatte þingis and oile þingis norissheþ þe cancre and fediþ it. And it is to witte þat þise bene þe accidentes of þam þat haþ bubon̛ in þe lure: þai may ete and drynk and go, and somwhat sitte and somwhat slepe; þai be menely hungry and þrifty in mete vnto þe ende; þai may noȝt abstene þam fro þe priuè. And ofte tymeȝ comeþ perisshyng to þam aboute autumpne or heruest; and it neiȝyng nere, þay bigynne for to haue febres as it war a softe febre; and þai lose as it war þair appetite; þai bigynne for to loþe ale and þai couaite wyne; þai ete ych day lesse and lesse; þai slepe vnesely; þai ar made heuy als wele in mynde as in body; and þe fallyng doune neiȝhyng nere, þai are made feble, and þai halde continuely þair bedde, and þay couayte watre aboue all þingis. Þise þerfore y-sene, deþe is in þe ȝatis. [His ergo visis, mors est in januis.] Neþerlesse þai may speke & raise þamself vp and moue almost to þe breþing out of þe spirit. Þerfore wake ȝe þat ȝe putte noȝt ȝoure hand to þis but in giffyng clisteries, as it is seid afore; whiche alegeþe mych þe forseid pacientes, as I haue be experte, and makeþ euermore pronosticacion to þam or to þair frendes als wele of deþ as of vncurablenes. Sich pronosticacion, forsoþe, shal worshipe þe bisynes of þe leche: þerfore flieþ auarice and abstene ȝow fro false byhestis. Witte þou þat þe fyngerapps y-putte

into þe lure of hym þat has þe dissenterye, he shal fele noþing in þe longaon but to þe maner of oþer hole menne. But in þe lure of þam þat haþ þe bubon̛ shal be feled a bolnyng riȝt hard, as if þer war an ey of ane henne or of a gose. But neþerlesse þe putrede, i.[e.] rotenneȝ, and þe blode þat goþe out of boþe bene mych liche; þat is þe quitour is citryne or ȝellow and blodescriptionOpen page or wanne medled wiþ watry blode wiþ gret stynk, and it goþe out to þe quantite of o sponeful or of tuo wiþout medlyng of egestionȝ, and som-tyme wiþ egestion. But in dissenterie he shal fele fretyng about þe nauyle and þe flankes; in bubon, forsoþe, noȝt so; but akyng, stirryng, and prikkyng, and tenasmon; þat is, appetite of egestion. I se oon of Northampton-shire whos lure was frete on euery party, so þat he miȝt wiþholde noþing of þe feces of egestions but þe grettest; ffor why; his lure was euermore stopped with a grete towell of lynne cloþe; but neþerlesse þe þinner egestions went out continuely, so þat his cloþes about his buttokes war euermore moyste; and þe towel y-drawen out, in þe stede of þe lure was a rounde hole by whiche an ey of a dukke miȝt liȝtly be putte in, and I myȝt se ferre into his wombe. Whiche died afterward of þe forseid infirmite; ffor why; he was vncurable, for þe mouþe of þe lure wiþ þe lacertes and þe synowes speryng and opnyng þe lure was vtterly gnawen away. [quod orificium luræ cum lacertis et nervis Luram claudentibus et aperientibus omnino corrodebantur.] And forþy [idcirco.] in suche like be it done avisily þat couaitise bryng noȝt forþe blame to þe leche.apps I saw neuer ne I hard noȝt any man þat miȝt be cured of þe bubon̛, but I haue knowen many þat defaileþ of þe forseid sikenes. Also I haue sene som hauyng a ful gret brennyng aboute þe lure wiþout, and vntholeful smertyng [pruriginem intolerabilem.] wiþ ronklyng of þe skynne aboute þe lure closed to þe [leaf 151, back] maner of a purse, wherfore þe pacientes miȝt noȝt wele sitte, ne ligge, ne stonde euen, ne fynde reste in no place, but euermore monyng and stirryng þamself as it war wode men. And superflue watrenes swette out fro þe place þat was wonte for to file many lynnen cloþes putte atwix. To whiche sikenes availeþ mich colde þingis in power but hote in dede y-putte to, as bene aysel, [acetum.] apps vinegre, hote by itself or wiþ

Iuyse of rubarbe, or plantayne, or virga pastoris,apps or of oþer cold þingis in power. But for þat ofte-tymes suche herbes may noȝt be had redy, þan it is to flye to oþer remedyes; þat is to sey, Take þe raw ȝolk of an ey and medle it wele wiþ þe poudre of bole armenic broken ful smal, or ceruse, or boþe, and anoynt it aboue þe sore wiþ a penne or feþer or wiþ a spatule; þis, forsoþe, seseþ þe brennyng and þe akyng, and be þis oft tymes done agaynȝ. Also in euery remouyng it availeþ mich þat þe yuel or sore be wele fomented or soked wiþ vinegre and watre y-medled togidre and chaufed; ffor why; þis gretly euaporeth noyful hete. And aftir þe fomentyng, þe place wele y-dried, be it reparaled as it is seid afore, wiþ þe ȝolk of an ey and bole. When þe customable watrynes, forsoþe, is sene to cese, and þe pacient feleþ as it war vnsufferable ychyng, þan be þer putte to euery day oones ane oyntement made of blakke sope and poudre of bole and sulphur and frankensence ymedled to-gidre. And þis oyntment shal drie, and shal make skales to rise fro þe sore; whiche y-sene, be þe lure anoyntedapps als wele wiþin as wiþout wiþ vnguentum album sharped wiþ bole and wiþ quik-siluer, and þis shal cese þe hete and it shal cicatriȝe þe fleeng. [et hoc calorem sedabit et escoriationem cicatrisabit.] And if it bene anoynted wiþ salus populi, it profiteþ mych. At þe last, forsoþe, agaynȝ þe disesyng ychyng be it anoynted wiþ tapsimel, In whiche be puluereȝ of alume ȝucarine brent, of attrament,apps and of vitriol; þis, forsoþe, doþe heste away ychyng for certayn, als wele wiþin þe lure as wiþoute. Or if þou haue noȝt redy þe forseid tapsimell, be þe same done wiþ scomed hony, and þe ferseid pulueres medled þer-to. Or þer may be made a medicyne to þe maner of þe forseid tapsimel of þe Iuyse of celidoneapps and scomed hony, to þe whiche þe forseid puluereȝ ymedled, I haue proued þat it doþe heste awey ychyng. [Pruritus] Also þe Iuyse of celidone y-medled wiþ vinegre and warmed at þe fire, and wiþ a fether anoynted up þe foreseid sore, þat is to sey in þe bigynnyng of þe sikenes, it quenchiþ wele þe wickid hete and keped fro recidinacion, [bene calorem noxium extinguit et a recidinatione preservit.] þat is fallyng agayne. And it quenchiþ wele herisipƚam, þat is wilde fir

or few sawage ["feu sauvage."] apps in euery place of þe body. And þe same doþ leuke vinegre [Acetum tepidum.] put aboue by itself; Or vnguentum album sharped wiþ quicsiluer. Also oile of citonior: cureþ þe herisiple and wickid vlcereȝ. [Ulcus perniciosa.] Also þe Iuyse of celidone, imbibed in a sponge or in lynne cloþes, and y-putte leuke to þe front and to þe temples, it ceseþ þe akyng of þe heued. And þis I proued oftymes in þe second pestilence.apps Þer come a man fro Burdeux in Gascon vnto Newerk, þat had ane horrible sore, þat is to sey peces or gobettis of rede flesshe and rawe in parties hyngyng dovne to þe lengþe of ane ynch. And þai occupied boþe his buttokes on aiþer party of þe lure to þe *brede of þre fyngers; and þer went out þer-of [leaf 152] riȝt mich watrinesse and some-tyme blode wiþ gret hete and stynk, so þat his buttokkes war cauteriȝid; and þei grew to þe liknes of þe womb of a fissh þat is seid creuyse or lopster when he spermeþ or frieþ. And þose superfluites partyngly grew in þe hole skynne; and when þei war mortified euen to þe rotes, þer appered holes fro whens þai went out. I mortified, forsoþe, þe superfluities wiþ a poudre þat is called Puluer greke, þe confeccion of þe whiche shal shewe aftir. And for þat þe mich watrynes goyng out in þe bigynnyng ouercome þe forseid poudre, þerfore I putte aboue, aftir þe puttyng of þe poudre greke, of þe moste subtile mele of barly abundandly, þat is called alfita, aboue þe poudre greke; and so I quenchid þe forseid superfluites wiþin þre or four puttyng to, so þat þai bigan to dry and to welk and fall away. Puluer grek, forsoþe, is riȝt desiccatiue and wele cleuyng [bene adhærens.] to; and noȝt oonly it restreyneth wele watry moistenes but also blode, and it mortifieþ þe curable cancer and þe blody fike [ficum sanguineum.] in euery place. A man had vpon his buttok a blody fykapps puttyng out blode and somtyme quitour, and it was like to a Mulbery; to þe whiche I putte aboue puluer grek by oon niȝt, and in þe mornyng I pulled out riȝt liȝtly wiþ my fyngers þe fike half mortified; þe whiche y-drawe out, blak blode went out after. After a litel goyng of þe blode, forsoþe, I putte to puluer grek, and þe blode was restreyned. Aboue þe

poudre, forsoþe, coton y-put atuyx, I putte aboue þe emplastre Nerbon vpon a lyn cloute, to kepe þe poudre þat it shulde noȝt falle away. And þus, þis forseid cure continued, he was hole wiþin a shorte tyme.

Notes

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  1/1. Ploge seems to be a variant of the more common form plage and is equivalent to 'Plague,' but it is not given in this form in the New English Dictionary.
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  1/4. An account of John Arderne is given in the Forewords. He calls himself Johannes Arderne Sirurgicus in 1372 and Magister Joh. de Arderne after 1376. I have adopted the simpler form.
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  1/4. The first pestilence was the Black Death, which entered England at Weymouth about the middle of August 1348, and ravaged the kingdom in 1349. It was pandemic, and yet, in spite of the tremendous mortality which attended its progress, it does not seem to have attracted much attention from the medical men who lived through it. Arderne only uses it in this passage as a means of determining the time when he began to practise in Nottinghamshire, yet he must have seen it in its full fury. Details of the Black Death will be found in Creighton's "History of Epidemics in England," vol. i, and in Father Gasquet's "The Great Pestilence now commonly known as the Black Death." The second pestilence, called the Great Plague, occurred in 1361, and killed amongst others Henry, Earl of Derby and Duke of Lancaster (cf. 1/10). The third pestilence in 1369 killed his daughter Blanche, wife of John of Gaunt.
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  1/8. Sir Adam Everyngham. The Everynghams had long been established at Tuxford. An Adam de Everyngham went bail for several deerstealers, 36 Hen. III (1251), and Thoroton, in the "Antiquities of Nottinghamshire" (ed. 1677, p. 380, col. 2), states that John de Lexington died 41 Hen. III (1256), seized of the manor of Tuxford and hamlet of Warsop, and of the land in Lexington held of Adam de Everyngham. The Records of the Borough of Nottingham (1155-1399, vol. i, p. 389) note on April 27th, 1330, a grant from Richard, son of Richard de Lameleye dwelling in Lampadidnawe in Wales … to William de Mekisburg of Nottingham of a messuage in Gedeling and all the land formerly held of Sir Adam de Everyngham in Gedelin, Carleton and Stoke Bardolf. The Sir Adam de Everyngham treated by John Arderne died 8th Feb., 2 Ric. II (1378-9), and he was probably operated upon not later than 1358. This treatise on the fistula was written in 1376 (see Forewords, p. xi), so that this passage must have been a later addition to the original manuscript. The armorial bearings of the Everyngham family are Argent, a fess azure, a label of three points gules. Thoroton (ed. 1797, vol. 3, p. 207) gives a pedigree of the family of Everyngham.
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  1/10. Sir Henry, that tyme named Erle of Derby. He was Henry Plantagenet (1299?-1361), son of Henry, Earl of Lancaster, and his Countess Maud. Sir Henry was cousin to Edward III who created him Earl of Derby in 1337, Earl of Lincoln in 1349, and Duke of Lancaster in 1351, being the second person in England to be made a Duke. Sir Henry was one of the original Knights of the Garter, and was looked upon throughout Europe as the very mirror of chivalry, when chivalry was at its height. Readers of Froissart will recall many of his exploits often in company with that other great Captain, Sir Walter de Manny. Sir Henry sailed for Antwerp with King Edward III in July 1338, and in 1339, after the great sea fight at Sluys, he was left in prison in Flanders as security for the King's debts. It may have been at this time that Arderne was practising at Antwerp, if there is any truth in the tradition (see Forewords, p. xii). In 1343 Sir Henry, then Earl of Derby, was sent to Avignon to Pope Clement VI and Alfonzo XI of Castile. Whilst in Spain he and his fellow ambassador, the Earl of Salisbury, did good service against the Moors at the siege of Algeĉiras when cannon are said to have been used for the first time. Arderne treated a Spanish nobleman at Algeĉiras (Forewords, p. xi).
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  1/13. The irregular endings of the technical terms which is noticeable here and in other parts of the MS. (cf. 24/5) is due to the scribe copying them as they stand in the Latin text where the case varies with the construction of the sentence in which it occurs.
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  1/14. Arderne's knowledge of the Gascony campaign is curiously minute and makes it possible that he had actually taken part in it or that he knew the country intimately. Writing more than thirty years after the event he gives the towns in the order in which they were visited by one of the three divisions into which the Duke of Lancaster, formerly the Earl of Derby, had divided his forces, rather than in the correct geographical order. The army landed at Bordeaux and captured Bergerac on 24th August, 1345. The town was granted to Lancaster as a reward for his services but reverted to the crown upon his death. It came afterwards into the hands of Edward "the Black Prince," and was given by him to John of Gaunt in 1370. The arms of the town "Deux pattes de griffon sur un champ d'or" may still be seen emblazoned in the Great Crowcher Book of the Duchy of Lancaster, says Mr. Armitage-Smith in his "John of Gaunt" (p. 199).

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    Toulouse. Sir Adam doubtless reached here with the force acting on the Lot and Garonne rivers after the battle of Auberoche on 24th October, 1345, when 300 lances and 600 archers defeated a force estimated at 10,000 strong under the Count of Lille-Jourdain.

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    Narbonne had some special association for John Arderne, since he named one of his best-beloved ointments Ungt. Noirbon, adding as a pun that though it was black (Noir) it was good (bon).

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    Poitiers was stormed on 4th October, 1346, with a tremendous slaughter of men, women and children. So much rich booty was taken that raiment was held of no account unless it was cloth of gold or silver, or plumes. The campaign ended here, and the Duke of Lancaster returned to London 13th June, 1347.
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  1/23. Mene is here used in the sense of "an instrument or agency," and is equivalent to "deo favente." It is as favourite a phrase with Arderne as "I dressed him, God cured him," used to be with Ambroise Paré.
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  1/29. Balne by Snaith. Balne is 5 1/4 miles from Snaith, a small town in the West Riding of Yorkshire. There was a priory at Snaith belonging to the Warwick family.
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  2/1. John Schefeld of Briȝtwell a-side Tekyll. This John was probably a member of the knightly family of Sheffield of Nottingham. The manor of Tickhill was granted to John of Gaunt in 1372 with other rewards for surrendering the Earldom and Honour of Richmond, which was immediately bestowed upon John de Montford to secure his allegiance then wavering between England and France.
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  2/2. Sir Reginald Grey de Wilton, also known as Grey de Shirlond or De Grey. He was the fourth Lord de Grey and was aged 30 in 1342. He died in 1370, and held the manor of Shirland, co. Derby. His grandfather John, Lord de Grey, was Justice of North Wales and Vice-Justice of Chester 1296-97. Sir Reginald Grey's son, the fifth Lord de Grey, served in Gascony in 1366. The peerage became extinct in 1614 when the fifteenth Lord de Grey died in the Tower after having been found guilty of high treason in connection with the Bye or Priest's Plot. The Calendar of Close Rolls (Ed. III, 1354-1360, No. 1358) gives the names of Sir Reynold de Grey and John Arderne as witnesses to an enrolment of release by Roger de Puttenham, knight of the manor of Wylye, co. Warwick.
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  2/5. Sir Henry Blakborne. A Sir Henry de Blakeburn, son of William, son of Paulinus de Eleston of the County of Lancaster, obtained "a general pardon for his good service in the war of France … on condition that he did not withdraw from the King's service so long as he shall stay this time on this side the sea without his special licence." The pardon is granted by K and the testimony of Adam de Swynburn, under-constable of the Army. It is dated "By Calais, September 4th, 1346." There also exists a ratification of the estate of a Henry de Blakeburn as prebendary of Preston, in the church of St. Mary, Salisbury. It bears the date September 22nd, 1351. On May 7th, 1379, "Henry de Blakeburn was presented to the church of Reddcleve-on-Soar by John de Wynewyk, and has since resigned it." ("Cal. of Patent Rolls," Ed. III, viii, 496; ix, 137; and Rich. II (1377-1381), p. 363.)
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  2/10. The transcriber has left out a line here. The text runs, "Afterward I halid Sir Iohn Masty parsone of Stopporte in Chestre-shire."
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  2/11. Gunnas or Gunnays was a York family in the fourteenth century. Thomas Gunnays was a scrivener in 1363-4; John Gunnays a Tannator in 1389-90, and there was also John, a Marchaunt. ("Register of York Freemen," The Surtees Soc., vol. i, 1896.)
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  2/13. The scribe has made a mistake in the name. John le Colier was Mayor of Northampton in 1326-7, and again in 1339-40. He seems to have been a most regular attendant at the meetings of the Town Council, because his name appears as a witness to thirty-three documents between the years 1315 and 1340. ("Records of the Borough of Nottingham," vol. i, 1155-1399.) A William Colyar was Mayor of Northampton 1368-9.
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  2/29. Towel. Arderne's translator uses somewhat unusual terms for the parts with which he is dealing. The towel is always the Anus. It is, I suppose, a form of "tewel," a pipe or funnell, and the word has survived in the North of England as a "tuyer" in connection with the blast furnaces. Longanon or Longaon is the ordinary mediæval word for the rectum or lowest segment of the large intestine. The Lure is sometimes the ischiorectal fossa, and sometimes the anus or rectum. The "Promptorium Parvulorum" gives "Mouth of a botel," "Lura," or Leather bagge, adds the Bibliotheca Eliotæ, ed. 1559. The New English Dictionary, s.v. Lure, 2 Her(aldic), says, "A conventional representation of a hawk's 'lure,' consisting of two birds' wings with the points directed downwards and joined above by a ring attached to a cord." Either of these similes suits the anatomy of the ischio-rectal fossa, but it is clearly the simpler one that was in Arderne's mind, as he did not know enough anatomy to visualise the ischio-rectal fossa in accordance with the hawk's lure. Cf. 11/10.
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  2/40. The opinions of Arderne's immediate contemporaries and predecessors on the subject of Fistula in ano are given in the Forewords (p. xvi).
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  3/8. The translation quite misses the beauty of this passage, which should read, "It is not opened to them that knock as they pass by, but to those who stand and knock."
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  3/13. In diuanudiis. These words have proved a crux from the earliest times. Some scribes have merely copied the words here printed, others have omitted them entirely. John Arderne clearly wrote a very bad hand, but Miss E. M. Thompson has made the following transcription of Sloane MS. No. 29301 (leaf 22, back, col. 80), which was presumedly a fair copy produced under Arderne's immediate supervision—"Nota de honore dei. Ad honorem ergo dei omnipotentis qui aperuit mihi sensum ut thesaurum in agro studenter absconditum quod longo tempore pectoreque anelo diligencius ac pertinacius diu auidius insuadaverim invenire prout mea suppetat facultas absque scernatis facunditate posteris, domino mediante istoque libello, explicite duxi exarandus. Non ut meipsum laude dignum ex tanto munere ceteris efferam sed, ut ne domχinum irretem et pro dragma quam mihi tradidit affatu urgeor delatoris." The badly written words "diu avidius" in this passage were soon corrupted into "in diuanudiis," the "in" being an interpolation. "In diuanudiis" easily became "De Dinamidiis," the name of a spurious work ascribed to Galen, and thus Arderne acquired an undeserved reputation as a Grecian.
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  3/23. The transcriber has omitted the line, "þat is leful forsoþ to sey that is knowen & for to witness that is seene."
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  3/27. This was the Black Prince's campaign in 1355. It lasted eight weeks, and was of a freebooting character.
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  3/34. Yet John Arderne thought it wise to obtain the Minorite's secret. "Il ne révèle son secret (en 1370) que parce qu'il est vieux et qu'il a tiré des très-beaux bénéfices," says Daremberg (Hist. des. Sci. méd. i, 301, note).
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  3/36. It is unnecessary to show the debt of the medical profession in the middle ages to Galen, who was born at Pergamos about A.D. 131. Arderne probably quotes Galen through a Latin translation of an Arabic version. He knows him as the author of the Megatechni or De methodo medendi—Θεραπευτιχῆζ μεθόδου—and of the Microtechni, or simply the Techni or Tegni which was the ars medica or τέΧνη ἰατριχὴ. The Pantechni or Pantegni used here by Arderne was not one of Galen's writings. It was written in Arabic by Isaac the Jew (d. 932 A.D.), and was translated into Latin by Constantinus Africanus (fl. 1036 A.D.), who issued it as his own. Cf. 55/3. Prof. Ed. Nicaise ("La Grande Chirurgie de Guy de Chauliac," Paris, 1890, p. 52) says that in 1309 the Faculty of Medicine at Montpellier demanded that each bachelor who wished to become a Master must have studied the following books of Galen, "De complexionibus; de malicia complexionis diverse; De simplici medicina; De crisi et criticis diebus; De Ingenio sanitatis." He had also to explain two books which had been lectured upon and one which had not been commented upon, of the Techni and Prognostics, or of the Aphorisms of Hippocrates, or of his Regimen, or the Isagoge of Johannitius, the Febres of Isaac, or the Antidotary of Rhazes. See Dr. Payne on Medical Books in use at Montpellier, Rashdall's "Universities of Europe," Vol. 2, part ii, page 780. The fact that Arderne knew and quotes all these writers lends some support to the theory that he was educated at Montpellier.
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  4/2. These passages on the Manner or Behaviour of a Leech form the true joy of those who travail amongst the old Masters of Medicine and surgery. They are full of conceits, and give a picture of contemporary manners and customs which it is impossible to obtain in any other way. The parallel passages from Salicet, Mondeville and Lanfrank are given in the Forewords (xix-xxvi), and show that there was a common source for these paragraphs on medical ethics of which the chief was "De adventu medici" of Archimattheus, a master at Salerno.
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  4/24. The expression "for why" is employed by the translator as the English equivalent for the Latin word "Nam." It does not imply a question therefore, but is used as we should now say "because."
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  5/8. The greeting of ladies by thrusting the hands into their bosom had a long vogue in England, and it would be interesting to know whether the fashion of wearing low-necked dresses was a cause or an effect of the custom. By the end of the seventeenth century it was only used by near relatives, and Mr. Samuel Pepys records that he availed himself of the privilege.
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  6/4. Speaking of the cure of scabies by the inunction of a mercurial ointment (MS. Ashmol. 1434, leaf 131; cf. 79/1), Arderne says, "I have tried it many times and have made a good deal of money from it, and I got twenty shillings for a single application. And take notice that the inunction must be repeated for forty days, or for a month at least. ("Quod centies probavi et exinde multa lucra adquisivi pro certo et haec xxs. pro uno liserio. Et nota quod tale lisorium per xl dies vel mensem ad minus debet portari.")
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  6/4. The fees charged by Arderne are very large, if it be remembered that money had at least seventeen times and perhaps twenty times its present value. I have given some account of the fees of our ancestors in Janus (May-June 1909, pp. 287-293), and to the facts there contained I may add an observation obtained by Prof. Ed. Nicaise for his edition of Guy de Chauliac's Surgery (op. cit. p. lxii). "A lady was attended in 1348 by three doctors, two Jews and a Christian, and she paid a fee of half a florin to each. The livre tournois at this time was equivalent to one florin and 16 sols of pontifical money—the cash then current at Avignon—and corresponded to 27 francs 34 centimes of modern French money. The general practitioner therefore received 8 francs 17 centimes for each visit, which is equivalent to three visits for a guinea."
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  6/5. The custom of paying for an operation by an annuity as well as by a fee lingered in England until late in the seventeenth century, for Richard Wiseman (1622?-1676), speaking of a patient, says, "This person retired into the country afterwards and returned to London at the end of two years, and acknowledged to me his cure by settling thirty pounds a year upon me during his life and paid me sixty pounds for the two years passed." Readers of French history, too, will recollect that Louis XIV paid Dr. Franĉois Felix the sum of one hundred and fifty pounds and settled a farm upon him in 1686 for curing him of a fistula.
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  7/29. "The Senator Boetius," says Gibbon, "is the last of the Romans whom Cato or Tully could have acknowledged for their countryman." ("Roman Empire," ed. 1862, v, 27.) He was born at Rome about 475 A.D. and was consul in 510. He was a minister of Theodoric, King of the Ostrogoths, who displaced the Emperor Odoacer. Boethius was afterwards imprisoned at Pavia and was put to death in 525 A.D. He was subsequently canonised as St. Severinus. He wrote the "De consolatione Philosophiæ" (Chaucer's translation of which was published in the Early English Text Soc.'s Extra Series, No. V, 1868), as well as some valuable treatises on Music and Geometry. The "de disciplina scholarium" mentioned in the text is falsely ascribed to Boetius. It is quoted again 23/27.
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  7/39. Arderne repeatedly draws attention to the effect of the mind on the body, and makes it appear that what we now call neurasthenia was not unknown in his experience. Cf. 6/23, 8/3, 60/16, 64/32.
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  8/27. The operation of fistula recommended by Arderne is described in the Forewords (p. xvii) to this volume. Arderne purposely gives fancy names to the instruments and to the remedies he uses as part of a fixed design to keep his methods secret. This secrecy was a common feature of the medical profession until quite recently—indeed it still lingers in parts where medical men dispense "our ointment" or "our linctus." Arderne especially feared the competition of other leeches, cf. 15/9 and 30/3, of the Barbers, cf. 71/16, and of the laity, cf. 103/3, for when he used the charm against tic, tetanus and delirium tremens, he not only disguised the words in Greek characters but he made nonsense of them, "ne a laicis perspicietur."
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  8/29. The sequere me was a flexible probe, and was named appropriately enough because it was the guide to be followed.
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  9/4. The acus rostrata, or "snowted needle," was a grooved director along which the scalpel was passed. The snowted or curved end fitted into a hole in the cochlearia or shield which was introduced later in the operation to protect the opposite side of the rectum at the moment the fistula was divided. This snouted needle was made of silver.
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  9/12. The tendiculum, or dilator, made of boxwood, was used chiefly to keep the ligature taut whilst the fistula was being divided. For this purpose it was provided with a hole into which fitted (9/16) the wrayste or "vertile," much in the same way that the peg fits into a violin. The ends of the ligature were passed round the wrayste, which was then twisted until the frænum cæsaris was tight enough.
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  9/20. The frœnum Cœsaris, or ligature, constricted the rectal side of the fistula. It seems to be merely a vestigium of an obsolete operation for the cure of fistula. Albucasis used it as an écraseur, and Arderne had sufficient reverence for authority not to discard it. But the operation he describes is one of simple division. The tendiculum, the wrayste and the frænum Cæsaris, therefore, are useless because as soon as the division was complete, they all fell out of the wound. Cf. 24/26. They steadied the parts whilst the incision was made, but they complicated the operation by giving the surgeon two instruments to hold in his left hand (the acus rostrata and the tendiculum) whilst he held the scalpel in his right hand. The cochlearia must always have been held by the assistant—the fellow of the leech—as Arderne calls him,—the surgeon's mate—as the Elizabethans knew him.
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  9/24. The siringa is probably only a clyster-pipe. Two forms are given, the one with side-openings, as was then used, the other an improved form recommended by Arderne as the result of his own experience (cf. 74/38) in which there is only a single terminal orifice.
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  11/1. Aposteme is an early form of the word which afterwards became Imposthume. It means a suppurating inflammation or an abscess.
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  11/6. Arderne's pathology of fistula is excellent and is clearly the result of observation. He has seen and treated cases of ischio-rectal abscess, and has observed how such abscesses have become chronic and ended in a fistula.
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  11/18. The axillary glands were the emunctories of the heart: the inguinal glands of the liver: the cervical glands of the brain.
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  11/19. Chawelleȝ is quite an unusual word, and except for the Latin version it would be incomprehensible. The Latin gives the English gloss "fauces." It seems, therefore, to be a form derived from the same source as "Chawylbone" which the Promptorium Parvulorum renders Mandibula.
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  11/20. Gilbertyn is Gilbert the Englishman, known to all readers of Chaucer because he is named in the Prologue (1. 429) with Bernard and Gatesden. Gilbertus Anglicus flourished about 1210, and is said to be the first practical English writer on medicine though Master Richard preceded him. Dr. Payne in his Fitzpatrick lectures in 1904 says that Theodoric took his description of leprosy from Gilbertyn, a description evidently at first hand and in many respects very accurate. Gilbert wrote a compendium or Laurea of medicine, printed at Lyons 1510 (cf. 55/10), and a Commentary upon the verses of Gilles de Corbeil "De Urinis" (cf. 59/32). A commentary in English upon these same verses and attributed to John Arderne exists in manuscript in the Hunterian Library at Glasgow (No. 328).
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  11/21. Ol. roset. Oil of roses entered largely into the mediæval pharmacopœia as a soothing application. The ceruse here ordered to be mingled with it is carbonate of lead, and the litharge is protoxide of lead. The lotion thus had the soothing and astringent properties which is still attributed to lead lotion or Goulard extract.
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  11/24. Wombe. Arderne speaks consistently of the belly as the womb both in men and women; when he speaks specifically of the womb in women he employs the term Marice. Cf. pp. 80/39, 85/4 and 86/26.
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  11/27. Arderne, like his contemporaries, recognises two forms of Mallow. The Althæa rosea—which he calls "tame" mallow (cf. 12/15), because it was grown in the garden, and Malva silvestris—the wild mallow.
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  11/32. A Nastar of tree. Arderne fortunately gives the English equivalent for Nastar in the manuscript No. 112 (T. 5, 14), fol. 77, contained in the Hunterian Library, Glasgow, and says, "Nastare species est clysteris sive enematis 'a glister pipe.'" A Nastar of tree, therefore, is a wooden enema nozzle. The wood may be either boxwood, hazel or willow. His description of the bladder and its method of preparation is given later on; cf. 75/1 et seqq.
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  12/1. After auctores. The author is probably Serapion the younger who wrote a large work on pharmacology, which was translated from Arabic into Latin under the title "Liber de medicamentis simplicibus" or "De temperamentis simplicium." He lived about the end of the eleventh century. For Serapion the elder see 55/29, p. 124.
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  12/9. Diaquilon. Three forms of diachylon plaster were used. One called Rhazes' plaster; a second Mesue's, and the third diachylon commune. Arderne here recommends Mesue's diachylon which contained mucilage of Althæa and oil of camomile amongst many other ingredients.
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  12/15. M. The symbol M. is used for Manipulus in dispensing drugs— a handful—and the handful was either large or small. The small handful or pinch was denoted by the letter P. for Pugillus, and it was usually estimated at about the eighth part of the Manipulus.
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  12/21. Lana succida is sufficiently described in the text. It seems to have been a crude method of obtaining what is now called lanolin. An undressed fleece is still used in folk-medicine.
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  12/21. The persistence of these simple remedies is shown by Miss Edith Durham's interesting account of Higher Albania (Lond. 1909, p. 93). She says, speaking of a comminuted fracture of the leg treated by an old Franciscan at Vukli:—"He then plugged and dressed the wound with a salve of his own making—the ingredients are extract of pine resin, the green bark of elder twigs, white beeswax and olive oil. The pine resin would provide a strong antiseptic. The property of the elder bark I do not know.… In gunshot wounds he was very expert. For 'first aid' his prescription was: Take the white of an egg and a lot of salt, pour on to the wound as soon as possible and bandage. This only temporary till the patient could be properly treated with rakia (the local alcoholic drink) and pine salve as above. The wound was to be plugged with sheep's wool, cleaned and soaked in the salve. The dressing to be changed at night and morning and at midday also if the weather be very hot. Should the wound show signs of becoming foul, wash again with rakia as often as necessary. This treatment he had inherited from his grandfather who had it from his. The exact proportions and way of making salve he begged to be excused from telling me as they were a family secret." Every word of this passage would have been approved by Arderne. He would have recognised his Unguentum sambuci (cf. 30/21), the egg medled (cf. 28/4) with salt would have been nothing new to him, the cleaning of the sheep's wool he might have considered an improvement upon his own lana succida (cf. 12/20), as he had an open mind (cf. 35/4), and he would have endorsed thoroughly the old priest's disinclination to give away the secret of a preparation (cf. 15/8).
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  12/40. Wormed, i. e. warmed.
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  13/20. Ragadieȝ was the name given to fissures formed round the anus and vulva. It is used here to denote chronic ulceration. Frousingeȝ seems to be a mere repetition of ragadieȝ, as it does not occur in the Latin texts.
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  13/24. An ulcus undesiccable is an ulcer which continues to form pus in spite of treatment. Mediæval surgeons were very skilful in frightening themselves with names.
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  14/4. There were two Geoffrey Scropes living in the latter half of the fourteenth century. (i) Sir Geoffrey Scrope, knighted before Paris, 1360. He was the eldest son of Sir Henry le Scrope of Masham, Co. York, the first Lord Scrope, who was Governor of Guisnes and Calais in 1360. This Geoffrey Scrope was slain at Piskre, Lithuania, in 1362 (cf. 67/34). (ii) Sir Geoffrey le Scrope, son of Stephen, second Lord Scrope, who was living in 1409, but had died sine prole before 1418. The brother of this Geoffrey le Scrope was Stephen le Scrope, Archdeacon of Richmond in Yorkshire, who died September 5, 1418.
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  14/20. It is clear from this and the following lines that Arderne had seen and noted cases of uræmia following upon long-continued urethral fistulæ. The headache, giddiness, dull pain in the loins and vomiting which occur during the later stages of renal disease are all duly noted.
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  14/38. Bernard de Gordon was teaching at Montpellier in 1285, and was living in 1318. He wrote the "Lilium medicinæ," but Arderne here shows that he was absolutely ignorant of Anatomy.
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  15/8. This is another good instance of the secrecy which characterised the practice of surgery at this period. It was still a trade to be taught, and it was many years before it became a profession to be learned. (Cf. 8/25 and 71/15.)
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  16/4. It would have been impossible for Arderne to have escaped the belief in Astrology which was a feature of his time. He gives the usual table, common to all his contemporaries, for finding the house of the moon on any given day, and he thought that the planets had an influence upon the twelve parts of the body which correspond to the signs of the zodiac.
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  21/2. Arderne's account of fistulate or festred gout makes its probable that he is describing the condition which is now known as chronic inflammation of the bone due to infective micro-organisms. Sophocles described Philoctetes as suffering from a similar condition. Cf. 46/25.
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  21/9. Ypocras, i. e. Hippocrates, lived during the golden age in Greece (460-377 B.C.), and was contemporary with Socrates. His writings were known through Galen's commentaries upon the Prognostics, Aphorisms, and on Regimen in Acute Diseases, which had been translated into Latin before the fourteenth century.
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  21/27. The meaning of this passage may be thus rendered, "Take heed lest thou art so blinded by the desire for money as to operate upon a case thou knowest to be incurable."
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  22/12. Lusting is here equivalent to grudging.
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  22/17. The details of the operation are admirably given, and it is quite possible to follow each step, a very rare thing in the case of mediæval writers on surgery, but Arderne was a master of this part of his subject. Cf. Forewords, p. xvii.
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  22/22. The rig bone is the vertebral column. Cf. 34/34, 62/8, 70/24.
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  23/1. Arderne shows his ability by recommending a cutting operation. It proves that he was not afraid of the bleeding which daunted his contemporaries and many of his successors. Cf. 24/32.
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  23/21. Both John Arderne and Henri de Mondeville were never tired of repeating that surgery was an art to be learnt by practice. It was too much the custom of the time to rely upon authority and to think that everything could be learnt from books.
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  7/29. "The Senator Boetius," says Gibbon, "is the last of the Romans whom Cato or Tully could have acknowledged for their countryman." ("Roman Empire," ed. 1862, v, 27.) He was born at Rome about 475 A.D. and was consul in 510. He was a minister of Theodoric, King of the Ostrogoths, who displaced the Emperor Odoacer. Boethius was afterwards imprisoned at Pavia and was put to death in 525 A.D. He was subsequently canonised as St. Severinus. He wrote the "De consolatione Philosophiæ" (Chaucer's translation of which was published in the Early English Text Soc.'s Extra Series, No. V, 1868), as well as some valuable treatises on Music and Geometry. The "de disciplina scholarium" mentioned in the text is falsely ascribed to Boetius. It is quoted again 23/27.
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  24/21. Arderne gives a choice of two cutting instruments, a razor and a lancet. Dr. Stewart Milne ("Surgical Instruments in Greek and Roman Times," Oxford, 1907, p. 31) describes a form of razor in which "a scalpel blade is mounted on a ring and the fore-finger is passed through the ring." Such a razor would have suited Arderne's purpose admirably, but he used some form of scalpel. "Lanceola," says Dr. Freind ("The History of Physic," part 2, p. 177), "in its proper genuine signification is no older than Julius Capitolinus, how long it has been applied to signify a surgical instrument I cannot tell; however, it may be traced as high at least as the time of William of Bretagne, who lived in 1220 and wrote the history of Philip August, whose chaplain he was." He gives some account of the lanceola, and distinguishes it very plainly from the Phlebotomus, both which instruments we see were made use of in that age. "Lanceola dicitur subtile ferrum acutum, cum quo minutores aliqui pungendo venam aperiunt in minutione. Aliqui cum Phlebotomo venam percutiunt." (Lanceola is a name given to a delicate pointed instrument with which some bleeders open a vein by puncturing it in bleeding. Others breathe a vein with a phlebotome.) (Cf. 61/23.)
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  24/29. Arderne here shows that he knows the last thing a surgeon learns—the knowledge when to stop in operating.
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  24/32. Surgeons had no satisfactory instruments for stopping bleeding until pressure forceps were invented by Sir Spencer Wells about 1884. Many devices were tried and had their day, but hæmorrhage remained the bugbear of every operating surgeon, and the fear of its occurrence limited the scope of his work. Arderne here recommends the excellent, simple and cleanly method of sponge pressure to arrest the immediate hæmorrhage, and afterwards uses a styptic powder. Arderne gained a great reputation for his prescriptions (cf. Forewords p. xxxi), and it is evident that he was a good physician as well as a practical surgeon; cf. pp. 97 and 98. The styptics here recommended were all in common use. Boli is Bolus armeniacus, a yellow earth containing oxide of iron. Sanguis draconis was the resin obtained from the fruit of the Calamus draco. Aloes epaticus: the mediæval materia medica recognised socotrin aloes and hepatic aloes which was an inferior quality.
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  25/9. Walwort is either the Sambucus or the Pellitory. Arderne probably means the Elder, of which it was said "this tree has not one part but is used in Pharmacy." The juice is still used in the form of Elder wine.
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  26/11. Directions for making sanguis veneris and oil of camomile are given on pp. 89 and 94.
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  26/21. The preparation of Pulv. sine pari is given on p. 86.
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  27/6. The preparation of Salus populi is given on p. 90. It is characteristic of the time that fancy names are purposely given to all these preparations lest their composition should become known to the barbers or to other leeches.
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  27/25. Bolnyng is equivalent to swelling or swollen.
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  27/28. Alum ȝucarin. combust. is described on p. 81. Three kinds of alum were recognised: alum glass, alum plume, and alum zuccarin. Alum glass was the crude alum crystals; alum plume was the natural aluminium sulphate; alum zuccarin. was the re-crystallised form; but alum zuccarin. was also used as a synonym for sugar candy. The crude alum was sometimes called Alumen roche from the town of Roche in Syria, and as this was often written Alumen Rō it came to be called Alum of Rome.
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  27/30. Sarcocolla is the resin of the Penæa sarcocolla and mucronata. It was thought to make the flesh adhere together, hence its name.
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  27/31. Psidie is pomegranate bark.
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  27/32. Terra sigillata, or Lemnos earth, was imported from Egypt in large pastiles stamped with the Sultan's seal, hence its name. It had astringent properties.
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  27/38. Ceruse is carbonate of lead. Lithargyrum or Litharge is the protoxide of lead which forms as a pellicle on the surface of melted lead; lithargyrate of silver and gold are formed similarly when these metals are melted.
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  28/10. Arderne clearly indicates the calling of an apothecary as distinct from the barbers, surgeons and physicians of the time. As a surgeon he gathered his own simples and made his own preparations, rather to keep their composition a secret than because he was obliged to do so, for the apothecaries would have made them up for him equally well.
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  30/21. "Smalach," says Dr. R. C. A. Prior ("On the Popular Names of British Plants," Lond. 1879, p. 217), "or Smallage, is a former name of the celery, meaning the small ache or parsley compared with the great parsley, olus atrum. Ach, Fr. ache, is derived from the Latin apium by the change of pi to ch, as in sapiam to sache."

  Wormode is wormwood, the Artemisia absinthium. The word is corrupted from A.S. and O.E. wermod. Wormwood was used in the Middle Ages to keep off mod or made, a maggot; the first syllable, derived from A.S. werian, to keep off, has become by similarity of sound worm.
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  30/22. Molayne is the Verbascum Thapsus, or Tapsibarbatus ebulus, the hig (hag) taper, or Bullock's lungwort.

  Walwort is the dwarf elder, the Sambucus ebulus, sometimes called Danesblood or Danewort.

  Sparge or Spurge is the Cataputia minor; Weybread is the plantain—Plantago major; Mugwort is the Artemisia vulgaris. It is said to have obtained its popular name from its use against moughte, mough or moghe, a moth or maggot. Auance is Avens or Herb Benett, i.e. Benedicta, the Geum urbanum. "Where the root is in the house the devil can do nothing and flies from it; wherefore it is blessed above all herbs," says Platearius, whose book Arderne had read. Cf. 79/10.
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  30/23. Petite Consoude was the consolida minima or the daisy—Bellis perennis. The name Consoude was given to several different plants in the Middle Ages, e.g. the Comfrey, the Bugle and the Wild Larkspur. "And for healing of wounds, so soveraigne it is, that if it bee put into the pot and sodden with pieces of flesh, it will souder and rejoine them, whereupon the Greekes imposed upon it the name of Symphytum-Consound," says Pliny in Philemon Holland's translation (Bk. 27, ch. vi, p. 275).

  Wodbynd is the Woodbine or Lonicera Periclymenum.
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  31/21. Diaflosmus is the plaster used as a local application, whilst tapsimel is the confection for internal use. Tapsimel here mentioned, and for the first time, had an extraordinary popularity and was officinal as late as 1773. Cf. Forewords, p. xxx.
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  32/7. The deadly nightshade is called in German Nachtschatten, and it is possible that Arderne may have learnt the Flemish word for it, if he was at Antwerp, as is reported traditionally. Cf. Forewords, p. xii.
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  33/13. Arderne gives a formula for his unguentum ruptorium (Sloane MS. 29301, leaf 35, col. 1), which is substantially the same as the one mentioned here. It consists of unslaked lime well mingled with black soap and made into a mass, which was afterwards bound with diachylon upon the part to be destroyed. Jamerius (cf. 55/3, Rubrica xxi) also gives a formula for a ruptory, "De unguento quod ruptorium dicitur. Unguentum forte quod ruptorium dicitur. ℞. Saponis saracenici pondus x denariorum; calcis vive pondus viii, capitelli fortissimi pondus v denariorum. Confice sic: calx prius cribellata cum sapone diu conficiatur, deinde addatur capitellum, et cum predictis commisceatur." There were two kinds of lime ointment. The older form was made by "taking of lime that hath been washed at least seven times lb.ss. Wax ounce iii; Oil of Roses lb.i. Let them all be briskly worked together in a leaden mortar, after the wax hath been by a slow fire melted in a sufficient quantity of the same oil." (Alleyne, op. cit., p. 330, col. i, No. 11.) The other ointment was the more active. ℞. Quicklime ounce vj; Auripigment ounceiss.; roots of Florentine Orris ounce i; yellow Sulphur; Nitre ana ounceiss.; a strong lixivium of Bean Stalks lb. ii.; Mix and boil all, in a new pot glazed, to a just thickness, which you may know by anointing a feathered quill therewith, if the feathers easily fall off; then add Oyl of Spike ouncess.; and make an ointment or liniment." (Salmon's "New London Dispensary," 1678, p. 768, col. 2.) Soap was of two kinds: White soft soap known as French soap, and hard grey soap called Saracenic soap. The latter is meant when the prescription demands black soap.
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  34/4. Arderne anchored his tents in much the same way as we now anchor drainage tubes in deep wounds by putting a thread through one end. He uses the word "ground" systematically for "bottom," so that where we should say the bottom of the wound he says (34/6) "in the grounde of the fistula."
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  35/15. Reparaled means the same as re-dressing a wound, that is to say, changing the dressings.
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  36/15. Arderne loved to play upon words. Cf. 37/12 and 91/32. He could not resist the pun with "bubo," which is the technical term for an abscess in the axilla or groin, and also means an owl. Guy makes the same joke (ed. Nicaise, p. 166). Buboes were the characteristic mark of the bubonic plague, and he must have seen many examples. In the later epidemics the Searchers recognised the disease by the botch which is a plague token.
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  37/6 et seqq. Arderne gives a most creditable account of cancer of the rectum, and distinguishes it clearly from dysentery.
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  37/29. Those who know how many cases of cancer of the rectum are still overlooked and are treated as cases of chronic constipation, will trow with Arderne that there are still many "wele unkunyng leeches" abroad.
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  38/11 et seqq. The treatment and the picture of the later stages of cancer of the rectum are excellent, and are evidently drawn from repeated personal experience.
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  38/40. Arderne very properly insists on a digital examination in cases of chronic ulceration of the rectum. Such an examination is still too often omitted. Both time and knowledge are then lost, to the great detriment of the patient.
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  39/8. Blo is throughout the scribe's method of spelling blue; "bloness" (cf. 52/27), therefore, is the same as bluish.
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  39/27. Arderne again warns against the dishonest habit of operating merely for the sake of the fee when no commensurate advantage is gained by the patient.
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  39/40. Aysel is an early form for eissel—vinegar.
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  40/1. Virga pastoris was used by the old writers on materia medica for several varieties of Dipsacus, and more especially for D. pilosus, silvestris and fullonum. It is the Teasel.
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  40/21. There were several varieties of white ointment. The form attributed to Rhazes contains oil of roses ounce ix; Ceruse carefully washed in rose-water and powdered ounce iii; white wax ounce ii. Avicenna's ointment contained litharge as an ingredient, with the white of eggs beaten into it.
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  40/27. Attrament is here a synonym for Vitriol (cf. 79/1). "Of atramenteȝ, i. e. of vitrioleȝ." It also means Ink (cf. 67/28).
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  40/33. Celidone is the Chelidonium majus, the juice of which was greatly esteemed as a collyrium, "because," says Gerarde (p. 911), "some hold opinion that with this herbe the dams restore sight to their young ones, when their eyes be put out." Dr. Prior (op. cit. p. 40) says that this notion, quoted by Gerarde from Dodoens and copied by him from Pliny, who had it from Aristotle, was received and repeated by every botanical writer, and is embodied in the Regimen Sanitatis Salerni—

  "Cæcatis pullis ac lumine mater hirundoPlinius ut scribit, quamvis sunt eruta reddit ."

  which was Englished—

  "Young Swallowes that are blind, and lacke their sight,The Damme (by Celendine) doth give them light,Therefore (by Plinie) wee may boldly say,Celendine for the sight is good alway."
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  41/1. Few sawage is erysipelas. Cf. 91/9, p. 133.
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  41/8. The second pestilence was the epidemic of 1361. Cf. 1/4.
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  41/33. The blody fik is explained in the treatise on hæmorrhoids to be a bleeding pile. Cf. 56/21.