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.
