Sylphium as injection and charpie impregnated therewith, locally applied; internally, sulphur 30. and 200, each remedy given successively for eight consecutive days, resulted in a cure in a few month. To this I would say; why the Sylphium? it probably did no radical good, and yet serve to vitiate one’s therapeutic conclusions. However, it is pleasing to note that hack the poor sufferers about.
The more one’s mind dwells upon the subject of fistula the less justifiable, nay how utterly unsound does its surgical treatment appear; I used to have some valued friends among the surgeons, but I have long since offended them all with my outspokenness in regard to the comparatively humble handworker’s sphere to which I would relegate what they are pleased to call the “science of surgery”.
I lost all my allopathic friends when I threw in my lot with the peculiar therapeutic people called homoeopaths, and have learned to do without them in my strong consciousness of right. Now I am beginning to do without my chirurgical friend just because I can do without them and so they cease to love me as of yore. Well, well, the pretty elastic ligature if my friend for fistula-in-ano is no more a cure for the fistular disease than is a catheter for the urethra, which we commonly call stricture.
Berberis vulgaris, a remedy very like Hydrastis canadensis, has also cured fistula. Dr. Schuessler, of Oldenburg, before he hatched his new duodecimal therapeusis, once wrote – Ich habe Mastdarmfistel mehrere Mal durch Berberis geheilt,” but I suppose the tissue remedies have rendered Berberis obsolete, if not inoperative, at least at Oldenburg.
I find a note on a fly-leaf of a book in my own handwriting, to the effect the Dr. Adams cured fistula with Berberis 30.
Even old-school-surgeons are compelled to admit the amenability of fistula to medicinal and general treatment, thought they make the admission rather shame facedly, and as if yielding to vulgar prejudice.
Thus the Messrs Allingham in “Diagnosis and Treatment of Diseases of the Rectum” (a sound practical work from the merely mechanical standpoint). mention the subject of “cases cured by Treatment”with a contempt that I hardly think they can really feel. To speak of those who object to having their flesh cut about for fistula as “wonderfully cowardly’ is arrant nonsense. People with fistula are not well, else they would not have fistula, and own idea is that having one’s cut for fistula is not a sign of courage, and still less of intelligence.
And I say this not with standing the dicta of all the great surgeons, special and general surgeons, special and general, including my very distinguished friend Prof. Tod Helmuth, of New York. I tell them all even where it is unavoidable it is no cure Of course, here and there a complete fistula with an opening allows for the passage of feculent matter at frequent internal;in such a case naturally, the operation becomes unavoidable, but how often how often is that the case?Not at all often.
Allingham says (P.19):- When the fistula is complete wind may through it and also faces if the bowels are relaxed; as a rule, however, this symptom does not occur, in consequence of the smallness of the internal aperture, its situation, or its valvular form. It follows that, though the passage of wind is a certain indication of a complete fistula, the absence of this symptom should not induce the belief that there is no internal opening.”
Myself I think the reason why there is not usually any faecal discharge though a complete fistula, lies in the fact that the defecatory act twists and bends the fistula canal. and so occludes it more less completely for the time being. Prof. Tod Helmuth (“system of surgery “p.779) thus treat of fistula from the standpoint of the physician;-
” When the inflammation is erysipelatous and spread rapidly, bell or Rhus may be prescribed. Silica is a very important medicines, not only in the commencement of the affection, but also when the fistula is fully established. In the former case, if the abscess has not discharged, and the cellular membrane is found in a sloughy state, a free, incision should be made to permit the escape of the purulent secretion. If healthy action does not display itself, Ars and China must be prescribed.”
” Merc, Sulph, Silica, Hepar or Calc Carb must be exhibited if incarnation proceed imperfectly, If the constitution of the patient is impaired before operation is thought of, appropriate medicines must be administered to eradicate any disease that may be present. In cases where the fistula has not been subjected to homoeopathic treatment from the commencement, Merc or Silica may be given Hepar may be required after Merc when the fistula is extensive; and Phosph, after Silic where is complication with disease of the lungs. When the digestives apparatus is impaired, Calc, Nux vomica, Merc, and silic will prove valuable medicines.”
Caust is very important in cases of long-standing, and in alteration with Silica.I have known a fistula-in-ano to be healed for a time.
“DR. Eggert of Indianapolis, and Dr. Grasmuck of Kansas both report cases of fistula cured by internal medication, the latter gentleman using AEsculus cerate in connection with Nux vomica and sulphur. My friend, Dr.Scriven, of Dublin also related to me a successfully treated case.”
Then Dr. Helmuth decided against the adequacy of remedies, and says surgical means must be resorted to as general rule. On this point I very much question his power to speak with authority. for the very reason that he is such a splendid surgeon. I well remember, some nine or ten years.Prof Helmuth honouring me with a visit here, and showing me the then little- know elastic ligature of Dittel, and so infection was his enthusiasm for the thing that I really thought for a time medicines were nowhere, But some experience and mature reflection teach me that fistula cannot be really cured by any mechanical mean whatsoever Still certain cases do need surgical aid and then I cordially join Prof. Helmuth in his praise of the elastic ligature of Dittel. I say medicines first, and afterwards surgery if, unhappily, be There is a good practical work by Prof. J.S.Gilchrist (surgical Diseases and their Homoeopathic Therapeutics, Chicago, 1880 third edition), from which I call the following practice cases, placed under the heard of the remedies used;-
” Aloes.- A case is reported cured by Dr. Boyd (Medorrhinum Invest, vol. vi. p. 122), complicated with piles, in which the fistula was found cured when the piles had disappeared.”
” Berberis vulgaris.- This remedy I have already referred to as curative of as certain kind of fistula, Dr. Adams (N.Y.State Socy. Train,1868, p. 378) gives a case cured with the following symptoms :- Great soreness and pain thought the entire back, from the sacrum to the shoulder, greatly increased from exercise. The fistula would close up, and inflammation and suppuration follow. Acrid leucorrhoeal discharge very prostrating.
” Lachesis.- A case was cured in which, with other symptoms of the remedy, there was a full feeling of the rectum, and a sensation of little beating ‘(Eggert, Medorrhinum Invest.,’ vol, vi p, 143
” Thuja- Eggert also report a case cured (with Thuja occidentalis), in which the condylomatous condition was present.
” Arsenic.- Dr. Mera (N.Y.Tran,’1871, p. 617) cured with Arsenicum a case of fistula of ten years’ standing in which the symptoms were great despondency, chill running up and down the back, relief from heat, large purple swelling in the right gluteal region.”
Causticum.- Gilchrist himself report case of one year’s standing in an old man, very corpulent the discharge being acrid, and accompanied with intense pruritus ani. The cure was speedy and radical.
Eggert’s Thuja case is rather better report by Hoyle (Clinical Therapeutics,” vol ii), or rather Hoyle mention two cases of fistula of the anus as having been cured by Eggert thus:-
CASE 406-Two case of blind external fistula with the symptoms- at the verge of the anus cauli-flower excrescence of the size of a quarter of a dollar and offensive. Thuja 200, two doses, cured in ten weeks. Thus put, we understand the case better.
Eggert’s lachesis case also requires a little more elucidation than Gilchrist vouchsafes, viz, that the case was one of a lady at the climacteric. Put into the ordinary language of every-day clinical work, Thuja case was prescribed for on Hahnemann’s recommendation as an anti-sycotic; the Lachesis, because of the Climacteric symptoms.
Both successful cases, and both treated according to the doctrines of Hahnemann in the Coethen phase of homoeopathy. The Aloes case was cured. The known effect of Aloes in haemorrhoids lead to its being prescribed. That is quite intelligible.
The indication in the Berberis case was evidently the yellow leucorrhoeal discharge.In fact, primarily, from the time -old signatura rerum naturalium. And the like may be said of Thuja in sycosis.
Schuessler’s use of berberis in fistula I have already mentioned.
Silicea In Ruckert’s “Klinische Erfahrungen” I find Silicea was a favourite remedy with Hahnemann himself for fistula* takes a very high rank.
1. A boy. two year and a half old, was to have been operated on for fistula, but two doses of Silica cured it within three weeks- Altmuller.
2. A tender- skinned, fair-haired young man in whom scabies had been twice got rid of with ointment, and who had been twice rid gonorrhoea by injection, got an abscess in the perineum near the anus, that had been opened surgically, but this would not heal up.
The consequence was a fistula of the anus, accompanied with debility. emaciation, cough, and fever. Large doses of China were given him in vain. His general condition was much ameliorated by sulphur, and in about a week there was a tickling sensation at the aperture of the fistula, with an increased discharged of pure Sulphur was repeated every sixth day. Afterwards three doses of Silica, whereupon the fistula was completely cured within three weeks from the time of its being first administered.
Here again we have the causal treatment in the first place- antipsoric for psora.
Ruckert then mentions, at second hand, six cases of fistula-in and cured by Yeldham and report in the “British Journal of Homoeopathy,’but the remedies are not given.
In the ” Transactions of the homoeopathic Medical Society of the State of New York,”vol. ix 1871, Dr. Alfred K. hills makes (interalia) the following remarks, to which I partially subscribe:-
Hamamelis in fistula.- A certain physician, in prescribing for a patient remarked that it was strange he could not hit the case for rarely a patient came to him the third time without some relief. After racking his brain for a moment, he says, This case must be one of disease of the internal canal. so I will give nitrate of sliver.’ It is evident that the prescription was made upon a supposed pathological condition alone and not upon the totality of the symptoms. In one of our journals is reported a case of fistula-in-ano. It is stated that the case was treated by a physician prejudiced in favour of high potencies who failed to ascertain the pathological condition and there was no improvement under his statement. The writer says that when the case came into his hands, and examination revealed what he expected, viz, fistula. Hamamelis 1 was prescribed and shortly the cured. Now what do we gain by the statement that Hamamelis is good for fistula-in-ano? And shall we prescribe it for every such pathological condition? I cannot see that we add in the slightest degree to our knowledge of therapeutics by such generalization, and if we expect Hamamelis to cure every case of fistula-in-ano we shall be sadly disappointed.
A patient present himself to us suffering from headache, and states that it is made much worse from motion; now, when we hear this Key-note, note, we must no feel satisfied that Bryonia is the remedy from this characteristic symptom will find himself as much mistaken, many times as the man who prescribed upon one objective symptom, or the morbid anatomy and pathological show alone, regardless of the others, instead of the totality of the symptoms.
Bryonia will not cure every case of disease aggravated by motion, for other remedies have the same symptoms (Belladonna, Nux vomica, Sanguinaria), neither will Hamamelis cure every case of fistula-in-ano, for there area number of remedies possessing marked symptoms in this direction,
What Dr. Hill here says is what I am trying to say throughout this little treatise, viz., that there is fistula and fistula and what will cure one will not cure another.
The real reason, however, why ( for instance Hamamelis will not cure every case of fistula -in-ano, is not”because there are a number of remedies possessing marked symptoms in this direction,” but because the fistula state or disease is not qualitatively (aetiologically and pathological) the same in all persons having fistula.
Hamamelis will cure the hamamelis- like fistular compliant, because like cures likes, and when the fistula state of an individual is Silicea -like of course Hamamelis is no good, but silicea is the remedy, and also conversely. But Hamamelis would also not cure all cases of fistula even though we had no other remedy whatever “possessing marked symptoms in this direction,”Homoeopathicity to the case to be cured is the pharmacological desideratum here as elsewhere.
Moreover, there is another point to which I would direct attention. Dr. Hill says,- “The writer says that when the case came into his hands, an examination revealed what he expected, viz., fistula. Hamamelis 1 was prescribed, and shortly the case was cured. Now what do we gain by the statement that Hamamelis is good for fistula-in-ano? And shall we prescribe it for every such pathological condition I cannot see that we add in the slightest degree to our knowledge of therapeutics by such generalizations, and if we expect Hamamelis to cure every case of fistula-in-ano, we shall be sadly disappointed.”
Now I think we again a great deal when we know that, for instance. Hamamelis can cure fistula-in-ano. In the first place we gain the positive knowledge that at least sometimes, fistula- in-ano can be cured by medicines. We gain thus a direct proof of the truth of the general proposition as to the medicinal curability of fistula. Is that nothing? Let those suffer from fistula decided And furthermore, we gain the very important information that Hamamelis must stand in list of our medicines of fistula. This must necessarily be always our first point de depart in all drug therapeutic. What Dr. Hills should say is this;We want not only that Hamamelis will cure fistula, but we also must know what constitutes the special indications for its use, so. I enter into the point because this kind of seemingly sapient, yet really shallow criticism is often levelled against published cases of cure. We must, of course, aim at the bull’s eye of fine pharmic differentiations, but if we do not begin to shoot till we can certainly hits the bull’s-eye, we shall never hits the therapeutic bull’s-eye at all.
Your superfine critic is commonly very sterile himself. I fancy I once read in a copy-books, pour Bien parler, il faut commencer par MAL Parler.
Solanum nigrum is recommended as a local application”in most fistula.” This quality it no doubt has in common with so many of the solanaceous plants.
Aurum in Fistula.-Just ten years ago I published a small volume on the general use of this great remedy, entitled “god as a remedy in Disease etc.(pg.106,107). Pliny already speak of it (qy. in ano?).
Case of fistula-in-ano.- Young man, twenty-one of age, bilioso- sanguine temperament. For five months fistula-in-ano, excrescences on scrotum ( eight month after primary symptoms). Cured with five grains of the perchloride of gold, all the symptoms had disappeared with the third grain (Clinique of M. Lallemand, in Legrand, p. 188)
Another – Young man of bilious temperament, twenty-six years old, of strong constitution, had chancres, fistula-in-ano, for five months.
He was cured with five grain of the of the perchloride of Gold, In that kind of anal fistula for which Kali carb is such a classical remedy,Aurum does not suggest itself to my mind, but rather in that dependent upon a specific taint, and notably after Mercurius.
Prof.E.M.Hale (Homoeopathic materia Medica of the New Remedies,” 1867 )mentions Collinsonia, hydrastis, and Sanguinaria as probable remedies in fistula of the anus.
Of Phytolacca decandra Hale says:- Dr.Paine (eclectic), after asserting that the Phytolacca will cause burning in stomach, tenderness of the bowels, heat in the rectum, tenesmus, and bloody discharge, dysentery and haemorrhoids, gives his experience in its use.’ I have treated a large number of cases of ulceration of the rectum remarkable success. A physician of note who had treated himself, and had been treated by other with all the ordinary remedies for what was called a cancerous affection of the rectum, applied to me some two years, since and Placed him upon one-half grain doses of Phytolaccin every two or three hours, together with nutritious diet…. and enema of warm water everyday.
This treatment was continued for two or three months, and resulted in a complete cure.”
Fissure, prolapsus recti, and piles have also been cured by Phyto. dec. Prof. Hale compares it to Acid and Mercurius, and probably few know more of drug action than does Hale.
CASE OF FISTULA-IN-ANO.
On May 17,1889, an unmarried city gentleman, thirty year of age, came under my observation for fistula0in-ano. Four or five years previously he had an abscess he had an abscess on the edge of the anus. It burst and healed. Fourteen months ago another one in the same spot. It burst with the aid of poulticings and healed up (?). some moisture and blood ooze therefrom ever since a small opening to an incomplete fistula.He also complained of “feverishness” and indigestion.
Rx Tc. Pyrozenium 5, five drops in water and morning.
MAY 31 -“I am much better”. How do you know? “because the sweating at my seat I had so many years has gone”.
Complains that in warm weather he is apt to get dry eczema of the hands. Since taking the Pyrozenium his skin has assumed a cleaner aspect.
Thuja 30 in infrequent dose.
June 29- Discharged thick matter and blood soon after beginning with the powders. The fistula still discharge, and there is a good deal of sclerosed tissue at its bottom and around it. Patient is dusky and drowsy.
R Nux vomica 1, five drops in water night and morning.
August 7, Perfectly well of the fistula, and of the circumjacent telar sclerosis. Just before the fistula began to heal up definitely, a small calculus -hard and sharp, size of a pea -was passed from it with much pain, or rather it pained very much, and on feeling the part he discovered the calculous formation and removed it, and brought it to me.
CASE OF POITRINARY FISTULA.
This designation of connection with connection with chest symptoms seems to me convenient, and I accordingly coin it.
A city gentleman, single, thirtyfive years of age, came to me on march 4, 1889 for fistula-in ano and chest. He informed me that he had much expectoration of phlegm all his life, but for the past two years the same had becomes bloody For a number of years, under homoeopathic treatment with benefits, he had maintained his ground and even gained a little in strength and bulk. Present weight ten stone, i found his throat studded with tubercles, his lungs very flat, vocal resonance much increased at both apices, and all down apices and all down the left side of the thorax; he is very short-winded, coughs, and expectorates almost incessantly; his skin is dingy, dusky and greasy; the glands of his neck hard, though small the phlegm is thick, yellow-green. For the past two years has been suffering from fistula. Under my treatment the old fistula dried up, but then (Ap.9.) A new one formed on the other side. Previously he had been twice cut for fistula. This needless torture I was able to spare him.
April 29 – Perineal abscess reopened, burst discharged very freely, and has now all healed.’
May 13 – fistula quite well.
August 9.- fistula continues well. Patient himself much better and stronger, and remains under treatment for his throat and chest. Patient received some nosodes- Thuja 30, Hydrastis can 0, Nux vomica 1x and Dulcamara 0.
I have myself not met with many cases of fistula in the very young, but here is no.