GENERAL REFLECTIONS ON FISTULA.
Fistula is practically just a convenient term for a certain morbid state found at a given part, and it cannot be regarded as a disease sui generis, though it is itself a generic term which potentially includes quiet a number of diseases of a more or less formidable nature.
Fistula is a condition that is sequential to another condition, viz, to a gathering or abscess of some kind, and when we speak of a fistula-say a fistula-in-ano we mean that at the indicated part there is a variously shaped, often a pipe-shaped, mattering portion of eroded or other wise denuded tissue. Now it is commonly taught that this discharging pipe-like abscess is in itself the disease, and that its cure consists in cutting it open, cleaning it, and making it heal, and there the thing is supposed to end.
But is it so?
I know a lady who in 1868 was abroad, and suffering from fistula, and the local family doctor ordered her home to London to be operated on for her fistula, he having previously tried divers local applications in vain. She came home to London, was operated on, and cured-that is to say, the fistula with a good deal of trouble was got to heal up. After that the os uteri became gravely ulcerated, and patient spent nearly two years for the most part lying on her back, and underwent an almost endless number of local manipulations and operations. At length the ulceration in the region of the os were made to heal. Then came leucorrhoea without ulceration, and of a most distressing kind; a very dapper gynaecologist occupied several years in stemming this discharging tide, and when the unfortunate lady had been fairly rid of the leucorrhoea by the injections so long and so strong. she found herself cured surgically and completely of-Ist. fistula-in-ano; 2ndly, of ulcerations of the os uteri; and 3rdly, and lastly, of this severe leucorrhoea. And then? health? not at all, but a hard tumour in the region of bowel and womb, which has rendered her state simply awful; for, apart from the ultimate significance of the tumour per se, the exit of the bowel being almost obliterated, the going to stool can be only characterized as awful, so distressing, so tedious, and so painful is it.
Now, what is the meaning of this all? Just this : the lady was ill in herself, and her organism tried to rid itself of some of (at least) the product of her ill-being; to this end it constructed a fistula in an out-of-the way district of the economy, through which it might drain off matter inimical to itself : the surgeons, in forcibly healing the fistula practically stopped the outlet pipe. Then the same process was repeated in regard to the said ulceration, and again with the surface outlet, which we call leucorrhoea; and, finally, finding all direct outlets effectually blocked by the doctors, Nature was fairly compelled to deposit within the organism the before- mentioned inimical matter in the form of a tumour, and that at the next nearest available point to the seat of the fistula, ulcers, and leucorrhoea respectively. Controvert his, ye men of the knife, it ye can.
FISTULA AND LEUCORRHOEA.
We have just seen that when the fistula was closed forcibly, leucorrhoea took its place.
Now one comes across notable examples of cases supposedly of leucorrhoea which turn out of be chronic fistula, the diapers and linen being taken as evidence of the said leucorrhoea. I myself treated a case of very severe fistula for a considerable time. mistaking it for leucorrhoea, no examination having been made. It is not always easy to tell when and whether it is our duty to make a proper examination of the anal and crural regions in ladies. Fortunately it is quiet possible to treat the one, and yet cure the other. This may sound very oddly to the uninitiated, but it is really a high compliment to the method of treatment, in as much as it shows that, in all probability, the patient was being treated, and not the name merely of her disease, for she was also cured. I went by the symptoms and state of the patient, and principally by the tongue, by the tint of the skin, and by the nature of the discharge, and, though I was needlessly long about it, still the lady made a perfect recovery, and remains well to this day. The amount of the discharge was at one time very great. The principal remedies used were Thuja occidentalis. Hydrastis, Sepia, Chelidonium, Hepar, Silicea, Psorinum, Sabina, and Aqua silicata.
A brother of this lady is being wrecked by fistula, for notwithstanding several operations and the very best hygiene, the surgeons say “the fistula will not heal”; the poor conceited ignoramus himself thinks homoeopathy “very well for women and children” (in which he is right), but no use in fistula!
Here I would like to ask the fistula cutters how it is that (the fistula being, as they contend, of local origin and nature), I ask, how is it that when they fail to force the healing-up process, they then say that the fistula will not heal! Leucorrhoea is a constitutional disorder; so is fistula; and they are not infrequently of absolutely identical nature and significance, though, of course, they just as often differ so much that they have nothing in common but their ill fate of constituting the happy hunting ground of specialists ” of the world worldly, of the earth earthy”.