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John Ardern

In English-speaking countries of course we are interested in what was

done by Englishmen at this time. Fortunately we have the record of one

great English surgeon of the period worthy to be placed beside even the

writers already mentioned. This is John Ardern, whose name is probably a

modification of the more familiar Arden, whose career well deserves

attention. I have given a sketch of his work in The Popes and

.[22] He was educated at Montpellier, and practised surgery for

a time in France. About the middle of the century however, according to

Pagel, he went back to his native land and settled for some twenty years

at Newark, in Nottinghamshire, and then for nearly thirty years longer,

until about the end of the century, was in London. He is the chief

representative of English surgery during the Middle Ages. His

Practica, as yet unprinted, contains, according to Pagel, a short

sketch of internal medicine, but is mainly devoted to surgery. Contrary

to the usual impression with regard to works in medicine and surgery at

this time, the book abounds in references to case histories which Ardern

had gathered, partly from his own and partly from others' experience.

The therapeutic measures that he suggests are usually very simple, in

the majority of cases quite rational, though, of course, there are many

superstitions among them; but Ardern always furnished a number of

suggestions from which to choose. He must have been an expert operator,

and had excellent success in the treatment of diseases of the rectum. He

seems to have been the first operator who made careful statistics of his

cases, and was quite as proud as any modern surgeon of the large

numbers that he had operated on, which he gives very exactly. He was the

inventor of a new clyster apparatus.

Fortunately we possess here in America, in the Surgeon General's Library

at Washington, a very interesting manuscript containing Ardern's

surgical writings, though it has not yet been published. Even a little

study of this and of the notes on it prepared by an English bibliophile

before its purchase by the Surgeon General's Library, serves to show how

valuable the work is in the history of surgery. There are illustrations

scarcely less interesting than the text. Some of these illustrations

were inserted by the original writer or copyist, and some of them later.

In general, however, they show a rather high development of the

mechanics of surgery at that time. Some of the pages have spaces for

illustrations left unfilled, so that evidently the copyist did not

complete his work. The titles of certain of the chapters are

interesting, as illustrating the fact that our medical and surgical

problems were stated clearly in the olden time, and thinking physicians,

even six centuries ago, met them quite rationally. There is, for

instance, a chapter headed Against Colic and the Iliac Passion,

immediately followed by the subheading, Method of Administering

Clysters. The iliac passion, passio iliaca of the old Latin, is

usually taken to signify some obstruction of the intestines causing

severe pain, vomiting, and eventually fecal vomiting. A good many

different forms of severe painful conditions, especially all those

complicated by peritonitis, were included under the term, and the modern

student of surgery is likely to wonder whether these old observers had

not noted that the right iliac region was particularly prone to be the

source of fatal conditions. There is a chapter entitled Against Pain in

the Loins and the Kidneys, followed by the chapter subheading, Against

Stone in the Kidneys. There is a chapter with the title, Against

Ulceration of the Bladder or the Kidneys. Another one, with the title

Against Burning of the Urine and Excoriation of the Lower Part of the

Yard. Gonorrhea is frankly treated under the name Shawdepisse,

evidently an English alliteration of the corresponding French word. As

to the instrumentation of such conditions and for probing in general,

Ardern suggests the use of a lead probe, because it may readily be made

to bend any way and not injure the tissues.