IT is not an uncommon occurrence to meet with inflammation of the tissues at one or other side of the anal orifice. If this is not checked it may go on to the formation of pus which finds an outlet either into the bowel, or externally through the skin. In either case the tendency is to the formation of a fistula, that is an ulcerating tract leading from the original abscess to the surface, which continues to secrete a purulent fluid indefinitely.
Fistula has often been cured by homoeopathic means, but it is much more easily dealt with if it can be taken in the abscess stage. The medicine that has the widest range in these cases is Silica. One curious observation I have made in regard to the action of Silica in these cases, which I do not remember to have seen mentioned by any one else. When an abscess forms at one side of the anus and Silica is given, very frequently the abscess will abort and a new abscess will appear on the other side, generally smaller than the first, and then both will rapidly get well.
CASE XVII. FISTULA Mrs.D.F., 38 had consulted me occasionally for several years on account of constipation for which she had previously taken. Liquorice powder twice a week), piles, and other troubles, which had been entirely relieved by Sepia and other medicines. I had not seen her for four months, when she came to me on October 22, 1892. Ten days before, she had had a swelling on the right side of the anus, with very great pain at times, of a pricking shooting character, and bleeding. The lump had gone on to the formation of an abscess and had discharged, and the discharge still continued. If the discharge ceased for a time, the patient felt ill and low-spirited. There was a pile on the right side, and on the same side a hard nodule, in the centre of which was the opening of a fistula.
Rx Silica 3, gr. ii. four times a day. Nov. 14. Has been much better. Had a new swelling on the other side, but was better after it. This appeared on November 8, and quite disappeared without discharging. Has had a good deal of discharge at times from the opening sometimes mattery, sometimes blood. Has a sensation as if something were lodged in the bowel.
Rx Sepia 30.
This kept her right till the following March.
March 11, 1893. Has had influenza and bronchitis, and the cough had caused the fistula to open up again. She was suffering from a scaly eruption on the face, acidity, indigestion, and pain about the abdomen from left to right after eating and constipation.
Sarsaparilla was now given in a high potency.
March 25. Bowels acting better; fistula much better; rash on face not so well; pains in hypogastrium and under left shoulder blade.
She now received a course of medicines, Alumen 30, Sulphur 30, and Psoricum 30, given in succession in that order, with very great relief, in which the first named medicine seemed to have the principal share.
In June there was some return, and the same course proved effective. On October II, she again had some difficulty in passing a motion, with bleeding, and a sensation that the passage was closing up. A local practitioner had strongly urged her to have an operation.
Rx Sepia 30. and Nat. mur. 30, on alternate weeks.
There has been no return of the old trouble, as I have ascertained from the patient, who called upon me years afterwards about some thing else.
With regard to the rash on the face, I may mention that the patient discovered she always had it after drinking Indian tea. China tea did not produce the same effect.
Fistula and Constipation.
The Constitutional nature of fistula is so self-evident that it is not a little surprising that surgery should be restored to in such a light hearted way, as is generally the case. It is perfectly well known, even in the allopathic world, that ” successful” operation for fistula is frequently followed by some affection of the lungs. Fistula is frequently the expression of the consumptive state, and acts as a constitutional outlet. If this is treated by remedies directed to the constitution, the trouble can frequently be cured, and if it cannot, it is far better for the patient’s future that it should be left uncured. It would be a somewhat different matter if surgery were regarded as the assistant of medicine, and if, both before and after the surgeon had done his part, the patient were submitted to a course of treatment directed to remedying the constitutional dyscrasia, of which the fistula is an outcome. But this is not the case. As soon as all visible disease action is got rid of, the surgeon is satisfied, and as allopathic medicine knows nothing of constitutional cure, the patient is left with the idea that all has been done for him that art and science can compass. How far this is from being the fact the following cases, which show the relation between fistula and the consumptive state, will clearly illustrate.
CASE XVIII. FISTULA AND PILES.
Mr. E.C. 27 an engineer, consulted me on July 11, 1902, about a fistula which he had had for three years. He had been constipated all his life, and suffered from piles as well as fistula. He was tall and well developed, and except that his hands were cold and moist, he might be taken for a strong, healthy young man. But it is well for the physician not to trust too much to appearances. Enquiry elicited these facts of his family history. His father had died of Bright’s Disease, and his father’s father of phthisis. The patient’s only brother had died of phthisis at the age of 16. His mother is living and in fair health, but her mother, still living, has epithelioma, and her father, who drank, died of an affection of the liver. It is evident that in this case the fistula was no mere local affair. The consumptive strain was particularly strong.
The patient had a good appetite, but he has an aversion to milk. The tongue was dirty at the back. There was a venous zigzag across the epigastrium, indicating portal congestion. The spleen and liver were both large. There was also some varicocele.
He had had measles and scarlatina in childhood, and a year before I saw him had had jaundice. He had been vaccinated several times, the last time some six months before he came to me, and this time it ” didn’t take.” The fistula made its first appearance in 1899.
The local condition I found as follows: Internal piles which some times protrude. An indurated area on the left side of the anus which occasionally breaks and discharges. In addition to this there was the habitual constipation.
The vaccinal element, being the last taint introduced, was the first to be dealt with, and I prescribed a course of Thuja 30. Under this he was kept till Sept. 18. Bowels regular. Fistula getting larger.
In the left cruse of the penis is thickening lengthwise, feeling almost like an encysted tumour. A little itching; no tenderness. Rx Silica 30.
Nov. 3. Slowly healing.
Rx Tubercul. k. 100 once in about ten days.
Dec. 10 Fistula seems growing larger. More in evidence; discharge more readily, but not much at a time.
Rx Silicea 100. Dec. 30. Fistula better; he only feels it when piles protrude and are painful. Then the fistula is painful and discharges. There was a soft swelling towards left of anus. Rx Repeat Silicea Ointment of Ranulus ficO to be applied at bedtime.
Mar. 20, 1903. Fistula less noticeable. Piles tend to protrude after stool.
Rx Sulph. 30, one powder at bedtime.
April. 4. Fistula scarcely visible.
Piles rather prominent.
Rx Ranulus fic. M.T. gtt ii. in powder, once in ten days. Lotion of Ranunculus fic. M.T.
June 30. Has been pretty well till middle of month, when he had a chill and sore throat. I found the right tonsil rather big and the throat rather granular looking. Fistula felt like a bit of gristle to left of anus.
Rx Silicea 100. July 27. Very costive. Piles and fistula very persistent. Fistula not so prominent, but longer and more sinuous.
Rx Bac. test. 30 at bed time, three doses in the month. Aesculus hip. 30 the other nights.
This prescription was repeated on October and November. In January 1904 he had a cold and cough, and the piles were trouble some; but the fistula was much better, the thickening was disappearing. Bacil. test. 30, Causticum 30, Sulphur 30, and Malandrinum 30 were now given in succession.
Sept. 16, 1904 Fistula a little troublesome.
Rx Conium 30. Nov. 4, 1904. Feels the fistula after cycling. Bowels rather costive.
Rx Sulph. 30. Nov. 25, 1904. Piles no trouble. Bowels regular.
Rx Bac. test. 100. Jan. 27, 1905. Fistula almost well. Piles come down at times.
Rx Thuja 30, three doses in the month; other nights Aesculus hip.
30. March 31, 1905. Fistula cured. This patient remained at his work through the whole of the treatment. He was not incapacitated a day for the whole of the time; is constitutionally a different man from what he was at the beginning. In this case surgery would almost inevitably have directed the constitutional expression of his ailment to the lungs.
This patient had been for some time under the care of the late Dr. Burnett before I took him in hand, and I many mention here the case of another of Dr. Burnett’s patients, whom I have seen, Captain C. This patient came to me for a patch of gouty eczema near the anus, and the history was somewhat interesting. Some years before, fistula had developed, and his local medical man (an allopath) sent him to a well-known surgeon, who advised operation without delay. Arrangements were about to be made when the Captain was advised to consult Dr. Burnett, who said he could cure him without operation, and in no very great time he made good his word. Some years after this, the said patch of eczema appeared, and Dr. Burnett being no longer at hand, Captain C. again consulted his old adviser. “Ah,” said he, jumping to a conclusion, “just what I said the fistula has come back again. You will have to be operated on after all.” And once more he was sent to the surgeon who had advised operation in the first instance. This time, the surgeon, who was not so hasty as the family doctor, was compelled to own that the fistula was absolutely and completely cured. “There is nothing for me to operate on,” said he.
CASE XIX. FISTULA IN PATIENT OF CONSUMPTIVE HISTORY.
A young married lady, wife of a country clergyman, dark, petite, of consumptive type, first consulted me in October 1896, for troubles incident to pregnancy. This was her history: For a long time she had suffered from post-nasal catarrh. Six years before I saw her she had piles and fissure, which were both operated on several times. Now post-nasal catarrh, piles, and fissure do not occur unless there is some constitutional dyscrasia behind them, and the business of the physician is to find out what that dyscrasia is, and remedy it if possible. On enquiring about the family, I ascertained that one uncle and one aunt had fistula. The uncle was operated on, and subsequently died of phthisis. The aunt refused to be operated on, and after several years the fistula healed, and she became quite well. When I saw the patient first, there was no rectal trouble, but she was constipated, her natural habit being one of relaxation. In April, 1897, the child, a healthy boy, was born. The following August an abscess formed near the anus, and this subsequently opened externally, a fistula resulting; or rather two fistulae, one opening being near the anus and one near the coccyx. At this time she was under the care of the country doctor who attended her in her confinement, and he strongly advised operation. She was nursing her child all the time. The operation was declined, and Mrs C. again came under my care. Silicea 3 was prescribed in iii-gr. doses, and a Calendula lotion. The patient’s general condition improved very much, and in April 1898 the coccygeal opening had closed, but the other remained open. Bacill. 100, Maland. 30, and Acidum fluoricum were now given in succession.
The patient had a busy and somewhat arduous life, and the demands on her energies were greater than the supply, so that with her delicate constitution the strength was rather reduced.
Mar. 15, 1899. Soon gets run down in body and spirits. A little blood comes from one opening. Often much irritation just before the monthly period. Ulcers inside bottom lip close to the gums. These generally appear at the period. She used to have them constantly, but has been free from them for a long time previously to the last few months.
Rx Teuc. Scorod. O, ten drops three times a day.
May 1. Feeling better. Discomfort when the bowels act. Full feeling on the wound side afterwards.
Rx Teuc. Mar. ver. O, ten drops ter die.
June 21. Better. No inconvenience from the wound.
In November of this year there was rather an anxious period, as chest symptoms developed.
Dec. 20, 1899. Hard cough, with pain on left side of chest on coughing. Three times little spots of blood appeared, and once thick blood in the expectoration.
Rx Phosphorus 3 every two hours.
Dec. 24. Ever since the cold, has had full feeling in the left chest as if there was something to be coughed up. Often taste of blood in the mouth. Got up a little old-looking blood this morning. I saw the patient on this occasion, and found the chest resonant. A little increased vocal resonance at right apex. No distinct dulness. A little pain in left apex. Cough was worse when lying on right side.
Continue. In a few days there was great improvement in all symptoms, and by the end of the mouth all fear of chest complications was at an end. A second pregnancy now followed, the child being born Dec. 1900.
The patient required a good deal of treatment subsequently to this, among the remedies given were Therid. 30, Elaps 12, Bellis 3x, Stephylococcin 200. The result of it all is that the fistula gives no trouble, and the husband writes:- “Mrs C.’s health generally seems to have wonderfully improved, thanks to scientific medicine.”
CASE XX. RECTAL AND SCROTAL FISTULA AND ASTHMA.
This case, that of a city gentleman, Mr T., aged 48, illustrates in a no less marked degree the relation between fistula in a no and lung disease. In this case the fistula is associated with asthma, and when from any cause the discharge from the fistula is arrested the asthma is much worse.
Mr T.’s mother died of consumption when he was an infant. Twenty years before I saw him he had rheumatism, which began as writer’s cramp in the right thumb. By the use of soda baths the pain was driven from the thumb to knees and ankles, and finally to right great toe. Eight years before he had stricture of the urethra, which was operated upon, and the result of the operation was that a fistula formed, discharging in the centre of the scrotum, beneath. In addition, there is a rectal fistula discharging near the anus. Appetite not good. Bowels act regularly. Liver and spleen both enlarged. The lungs were somewhat emphysematous. The asthma was always worse on Sundays, and was sometimes better in cold weather. Breathing was worse when lying down, and in the morning. His face had the dusky look of persons whose blood is not well oxygenated. The appetite was not good. Had pains round the abdomen after meals. He had been vaccinated in infancy only.
Rx Tuberc. k. 30, three doses to go over the month. Urt. ur. O, gtt. v. in a wineglass of hot water every two hours when required for an asthmatic attack.
Oct. 30, 1902. Very much better. Eats more than he used to do. After the first powder had asthma all day, but with the exception of a little “stuffiness” in the morning he was well till a few days back. Bowels act much better; stools black. Fistula discharges, but gives no trouble.
On these remedies he continued to make steady progress for some months. The asthma which was his chief trouble, as it crippled him for the time being and rendered him unable to come to his business from his residence in the suburbs, kept in abeyance. In March, during the stormy period, his breathing was very bad. There was a good deal of wheezing in the chest, which was worse when he lay on the left side.
Rx Thuja 30, three doses in the month. Urt. ur. O when required, as before.
Sept. 28, 1903. Good progress was made up to this date, the asthma seldom troubling him, and the fistula being quite manageable. The report on this date was: Not very well. For two days in the week asthma has been bad, making it impossible to lie down at night, the only comfortable position being standing, holding on to the bed-post. The drops (Urtica) cause him to sweat all over, especially about the genitals. Fistula not discharging much. Bowels not confined.
Rx Tuberculinum k. 30, once in ten days; Lobel. acet. O, gtt. iii, in wineglass of water every two hours when required for asthma.
Nov. 10, 1903. Twice had to take the drops, but the attacks were not so severe. He was able to lie down. The Lobel. did not relieve as promptly as the Urtica, but the effect was more lasting.
Dec. 17, 1903. Scrotal fistula appears to be healing. Not so much itching as formerly.
Jan. 27, 1904. Anal fistula appears to be healed.
April 15, 1904. Had an attack of vomiting four days ago, and the next day severe pains under right breast, right arm, and below right scapula. Breathing caused pain, and he couldn’t lie down any way. A local doctor who was called in said this was “severe congestion, but no pneumonia and no pleurisy.” The discharge form the scrotal opening had ceased. The scrotum seemed filling with matter. The skin was inflamed and irritated, becoming sore when rubbed, and matter was exuded through it. He had found that when the first opening had closed, matter found its way along the urethra.
Rx Nat. Sulph. 30, every four hours. Calendula lotion to be applied.
April 19, 1904. Better. Repeat night and morning. July 11, 1904. No asthma. Right leg swelled last week. (I found it slightly oedematous).
Things went on well after this under Nat. Sul. 30, Bac. test. 30, and Thuja 30.
May 10, 1905. Patient wrote to me:- “The fistula seems to have closed up in part. Nothing comes through this way, but there is much swelling in the fork. Unable to walk.”
Rx Silicea 30, every four hours. Calendula lotion. May 17, 1905. Very much better. Opening occurred in the night. Breathing much better.
Repeat night and morning.
Since this time the patient has had no real trouble. The anal fistula ceased discharging, and the scrotal one, which still acts as the constitutional outlet, is easily managed, and the patient’s general health is vastly better than it used to be.
CASE XXI. SCROTAL FISTULAE FROM TUBERCULOUS TESTICLES.
Before leaving this subject I should like to relate briefly a case of fistulae of a different kind.
Mr. D., a Greek gentleman, 35, came to me on June 13, 1904, with fistulous openings on each side of the scrotum, communicating with swollen and tender testes. The history of the case was that he had recently been under an eminent surgeon, who had opened the abscesses and had recommended the removal of the testicles as they were, undoubtedly, tuberculous. This measures the patient objected to, and hence his visit to me.
He was a very delicate patient. His father had died of dropsy and his mother was melancholic. One sister had died of anaemia. As a child the patient had had depression, and there was a curious history of depression in the family. His mother had three sisters, and two of them suffered from melancholia. The patient had had influenza fifteen years before. Had malaria in Sidonia, the attacks coming on every eight days. Since a child he had had eczema at the back of the knees, on elbows, and on perinaeum. The swelling of the left testicle had come on suddenly, as a sequel to influenza. The patient had never had any venereal disease, though he had suffered from nocturnal emissions. The surgeon who operated on him gave as one inducement to the patient to submit to castration that “in any case he would never pass semen again.”
I told him homoeopathy would give him a far better chance than surgery, and he put himself under my care.
Rx. Tuberc. test. 100, three doses to go over a fortnight. June 28. Testicles very much better; less swollen; discharge ceased; no pain.
Repeat. From this point improvement was steady and pronounced. On July 15 he reported: “Fistula from left testis healed. Right fistula nearly healed.” In August nocturnal emissions recurred, thus falsifying the surgeon’s prognosis.