New reflections on the instruments represented in the manuscripts of John Arderne's treatise "De Fistula in Ano".

The author believes that there has been insufficient explanation of the use of the instruments described by the medieval English Surgeon John Arderne, to treat fistula in ano. Examining the existing manuscripts which describe the instruments and the operations, brings to light some problems of interpretation, particularly in relation to the tendiculum. The primary text is unknown and we have to use various texts in Latin and Old English from the 14th and 15th Centuries. It is important to understand the way in which John Arderne used illustrations of instruments in his work. The text and drawings were carefully combined and the instruments drawn to scale. In Latin this is described as "sicut depingit" and in 15th century old English "as it is peynted (or paynted)". This is rare in medieval manuscripts, but gives us more insight into both the instruments and the way that they were used. The paper examines the instruments and the techniques that John Arderne described and compares different interpretations that have appeared over the years. In particular Sloane Ms 3844 is felt to be the most accurate and helpful, and extracts from this are looked at in some detail to give a clearer picture of the treatment of fistula in ano described by John Arderne.