Certain things in the recent era can feel akin to the Middle Ages … or at least what we think of the Middle Ages. The truth is a lot of what pop-culture presents of the period doesn't match the actual history. This week at Cracked, we're doing a Middle Ages deep-dive – the good, the bad, and the ugly.

Life as a medieval knight would’ve been a lot less glamorous than going on daring adventures. Armor was cumbersome, and any injury could become fatal thanks to horrifyingly bad medical knowledge. The odds of making it to your 50th birthday wouldn’t be great to begin with, and one trademark of knighthood could lead to an embarrassing and painful demise. This is the story of anal fistulas and the disturbingly painful surgery developed for them.

There are few images more archetypically heroic than a knight on horseback. Dressed in the finest of armor, the knight would spend full days riding through Europe… and his butt would be absolutely aching because of it. The heaviness of the knight’s armor combined with the wet and otherwise unpleasant riding conditions created perfect conditions for anal fistulas to develop

The name “anal fistula” sounds equal parts disgusting and painful, and that is exactly what an anal fistula is like. This condition involves infected tunnels from around to inside the anus, and it often comes as a result of abscesses. For medieval knights, abscesses would develop from long horseback rides, and they often worsened to become fistulas. As with most other conditions in the Middle Ages, a lack of quality medical treatment could mean that this embarrassing infection could be fatal. 

Treatments did exist to combat anal fistulas, but these were notoriously deadly. Thankfully, one 14th-century surgeon developed a surgery to combat the anal enemy of knights everywhere. 

John of Arderne is believed to have been born in either 1307 or 1308, with his experience as a surgeon probably beginning during the Hundred Years’ War. Arderne published his Practica Chirurgiae with an illustrated guide to treating “fistula-in-ano,” and the surgery sounds like a method of torture. A surgeon would use a series of probes and knives made specifically for this surgery. They would run the tools through the fistula and out of the anus. This cut and drained the fistula, and Arderne proudly proclaimed that he had a 50% survival rate. This sounds laughable by modern standards, but it was depressingly impressive at the time. 

Public Domain/Wiki Commons

The collection of surgical tools (AKA torture devices) used in an anal fistula procedure

Arderne’s guide to the surgery also includes several success stories. This means that in addition to having to suffer from an anal fistula, some poor knights get to live on in history through accounts of their butt surgeries. 

Top Image: PxHere

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