FISTULA IN AN INFANT
On June 3, 1879, a country gentleman brought his little six-year old son to me for fistula-in-ano. At its birth the nurse discovered a lump at the seat. A little time afterwards, this gathered and burst like a boil, and had continued ever to gather and burst at intervals. The right eye had no lashes; he had severe ophthalmia tarsi of the same eye – also ever since he was born.
An examination of the anal region showed a fistula external and external and incomplete, and numerous scars where other had healed.
The right nostril was also chronically inflamed, If he gets a thorn or splinter in his flesh, it festers as does equally the tiniest scratch or prick. A connection between eye and fistula is noticed, for when the eye is very bad the anus gets better, and conversely.
Rx Tc. Phosphorus 30 three drops in water night and morning.
July 24- The eye lashes are beginning to grow.
Rx Tc. Kali carb 30.
October 20-fistula cured His nose bothers him a good deal, becoming very much inflamed. There is considered mattery discharge from the eye.
Aurum foliatum, 3 trituration, four grains dry on the tongue twice a day.
January 15, 1880 -fistula continues well; nose well eye better, lashes perceptibly growing.
Repeat the Aurum foliatum, but in the fourth centesimal trituration, four grains at bed-time only.
July 25, 1881.- fistula and nose continue well; there is quite a show of eye-lashes; still some ophthalmia tarsi, however. Around the meatus of the left ear there is some eczema.
Rx Psorin. 30 in infrequent dose, thereafter Thuja occidentialis 30 in like manner.
Discharged quite cured.
Four years later he was again brought, but this time for enlarged tonsils, which our ordinary remedies slowly (not rapidly cured, and then was reported well and I again ascertained that he was well in all respects in February 1894
It is not often that one meets with fistula in the very young. The eye, nose, and anal troubles all yielded, and the permanency there of proved by nearly fifteen years subsequent observation.
I suppose the ” proper ‘ treatment of this case would have bee-1st operation for the fistula by a specialist for the anal affection.
2ndly The eye must have been treated by an oculist, who would have his greases and washes, and the never-lacking Nitras argenti.
3rdly, The eczema must have been treated by a skin-doctor also, without any doubt, with an ointment
4thly. The nose must have specially needed the services of a rhinologist.
5thly, The enlarged tonsils would have afforded an opportunity for the exercise of the special skill of a throat specialist, who would have whipped off the tonsils by an operation never before invented.
And finally, as the good lad was nervous, and twitched once or twice a moon, no doubt his prepuce would been ablated or slit open. Quite lately a noble peer told me gleefully that he had just had his son circumcised and also had his tonsils removed and I fear his Lordship thought me rude when I replied that the Creator must have bungled a good deal, else, why these needless tonsils and superfluous prepuces?
It is satisfactory to note that some of the greater physicians to see the true effects of specialism.
Thus, I lately read an account of the Eighth Medical Congress at Wiesbaden, and in it the following report summarized from the ” Berliner klin. Wochenschrift” Nos. 18 and 19, 1889 :-
” Herr Petersen (Copenhagen) read an important paper `On the hippocratic Method of Treatment,” or, in other word, `On hippocratism.’ Although this mode of treatment seemed overdrawn in many respects, many of its principles were still deserving of recognition.
Hippocrates’ designation of fever as instrumentum felicissimum was now seen to be worthy of praise. with Hippocrates the whole man was ill, not one particular organ only; hence specialism was excluded. An extremely individual treatment was adopted. The first aim of treatment was adopted. The first aim of treatment was not scientific, but sanative, and the chief means were dietetic. The physician was a `healing artist,’ who became such only by unwearied diligence and powerful talent, especially the gift of observation. The whole cultivation was mainly clinical. The French had become more anatomical, while the English remained true to `Hippocratism’ In Germany, medicine, as directed by Trauble, Rokitansky, and Virchow, had departed from Hippocratism; but since then, under the influence of Frerichs and Leyden, seemed inclined to return to it. Modern medicine must return to the ancient path, or it would be destroyed by specialism.