I may not, perhaps, be justified in designating the kind of fistula I here refer to as hepatic, but at any rate one meets with certain people with fistula that have enlarged livers as concomitants, and our common hepatics readily cure them. Chelidonium majus. Carduus Maria, Myrica cerifera and Berberis vulgaris (as the case may be ), cure the liver and at the same time the fistula. They are simple and, probably, either not constitutional at all, or only in a very slight degree, and they do not readily recur. I do not regard them as particularly important, and therefore will not dwell upon them. I have sometimes thought they may be due to living and want of exercise. There may also be a slight strumous taint at the bottom of them.
This is the common origin of fistula, and its treatment is highly important. I so rarely use local application at all in any complaints that I will pause here, and under the heading of circumanal abscess, I will say that the very best plan (where the pain and distress are very great ) is to keep the gathering constantly moistened with rags dipped in Liquor calcis, P.B changing the rags very frequently.
I shall not easily forget a gentleman I once attended for perennial abscess in which the pain were extremely severe. Troubles about the anus are, in my experience, for the most part distressing ones, even if only slight. Well, this gentleman in my judgment, was riding his organism of a tuberculous tendency by mean of this perennial abscess, i.e, the organism was brimming over at the part to save the lungs, so I was particularly anxious not to have the abscess interfered with, for I have noticed that cutting open immature abscess is no gain; they simply go on “sweating”, for double the time it would the time it would have taken to heal had the abscess been allowed to mature own way. But he really could not bear the pain; when I applied lime water rags, with the result that the pain became a mere nothing, patient forthwith had a beautiful sleep. He made a capital recovery, and fistula was prevented. The principal remedies used were Aconite, Silicea, Hepar, Calcarea Sulphurica, and China; with one or two subsequently given constitutional remedies, foremost being Kali carb 30 and Lappa major 0.
For the relief of the pain of acute gathering I have very great confidence in lime-water rags. I have often felt very thankful to this excellent practical tip that I first learned of Dr. George Wyld, of London, and if my reading memory does not deceive me, it was a favourite little clinical knack of no less a man than Theophrastus Von Hohenheim, commonly called Paracelsus, and a splendid friend in need it is I once had a case of gastritis near Hyde Park that resisted all my remedies, and began to look ugly indeed, when I applied abdominal compress, saturated with Liquor calcis P. B. and frequently changed.
Patient had a good sleep within two hour, and returned home to her friend in the country within a week.
In advocating the medicinal treatment of fistula (which I should certainly prefer to call the fistula disease), I am stepping out of the serried ranks of the profession to some extent, and am therefore by no means medically catholic or orthodox. Still there are other who have done, and do the same thing.
I mention this lest I be understood to give out that I have myself originated the cure of anal fistula by medicines. This is not so.
PHYSICIANS WHO TREAT FISTULA MEDICINALLY.
Before proceeding any further. I will quote the doings and saying of a number of physicians more or less like-minded with myself. Thus: Dr. Kidd (“laws of Therapeutics,” p.174)shows that whether we profess homoeopathy or not, we require its teachings to cure our patients He says : fistula-in-ano cured by dilute nitric acid. Mr. B, of a dark sallow complexion (note the unhealthy skin ), aged 42, applied to me for a fistula-in-ano, which had existed for nearly a year and which two of the best London surgeons agreed must be operated upon, saying it could not be cured without operation, He complained of soreness and burning pain in the lower bowel;a thin greenish discharged flowed freely from the fistula. I(Dr. Kidd) prescribed eight drops of dilute Nitric acid in a wine-glass of water there times a day, without any local treatment. This perfectly and permanently cured the fistula in two months.
The use of Nitric acid in fistula is ancient history with the homoeopaths. Hughes, “Manual of Pharmacodynamics,” third edition, well seems it up by pointing out that nitric acid manifests great power over the mucocutaneous outlets.-those part where mucous membrane is exposed to the external to the air and where skin is so shielded and moistened that it approximates to mucous membrane” Hughes, writing still of nitric acid, continues, ” It exhibits a singular power over the rectum and anus; it cured prolapsus fistula and even fissure”.
Then Dr. Kidd gives (p.175) the following;- Fistula-in-ano cured by Hydrastis canadensis.-Mr L. aged 46, a Greek merchant came to me suffering from fistula -in ano, which had existed for three months. A well-known specialist and the family medical attendant assured him that he could without operation. Unwilling to submit to this he came to me. I prescribed ten drops of the tincture of Hydrastis canadensis in water, night and morning, also a compress over the fistula of four drachms of tincture of hydrastis to four ounces of water, applied on cotton wool, night and day.
To his great delight this perfectly cured him in a month” As our author gives no data or data we cannot judge of the cases for ourselves, but they serve my purpose for quoting them, viz. to show that homoeopathy enables her follower to cure fistula medically. And Hydrastis (as well as Hydrastin) is well known in the United States as possessing power over fistula-in-ano, and it is thence that we have both the remedy and our knowledge of it.
Hughes, in his “Manual of Therapeutics,” write of the medicinal cure of fistula as follows:-Fistula-in-ano you would hardly expect to be reached by internal remedies, and I am not confident that it would be so cured without local application also. But with the Calendula and hydrastis of Materia Medica thus applied we have several cases to report.There is one by Dr. Eadon in the ‘monthly homoeopathic Review ‘for June 1865, in which Calcarea phosphorica, with injections of Calendula lotion and the stream douche, proved curative;anther by Mr. Clifton in the same journal for July, 1860 Causticum with Calendula being the remedies;and a third from America, in the ‘British Journal ‘for October, 1868, where Nux and Sulphur were given with injections of Hydrastin”.
But I am myself more than suspicious of the genuineness and the far-reachingness of the cures by local application. I do not mean that the cures reported are not genuine, but that the constitutional crisis underlying the fistular state can hardly be really cued by local remedies for I do not believe that fistula is very often local in its nature, thought it may be expressed in the anal region and nowhere else. The following from my own practice comes nearer my idea of a real cure:-
CASE OF FISTULA CURED BY MEDICINES.
A stout middle-aged merchant came to me on April 20, 1887, for fistula-in-ano. His local medical man had got the fistula to heal by local and topic measures, but the uneasiness of the anal region was even greater than before. Patient had for long been subject to boils, but had had no compliant, except measles and scarlatina in his childhood. From the fact that he a good deal of pustular acne on certain part that he had been twice vaccinated, I thought it likely that vaccinosis lay at the root the disease expressed at the anus.
The first remedy given was Thuja occidentalis 30, which was followed by a small lump at the part where the fistula had healed up: really it evidently was not. And there was another abscess just beginning. I then gave him Bellis perennis 1, five drops in water night and morning and he thereafter had Hepar sulphur 3x Silicea 6th trituration, and Kali carbonica 30, was them discharged perfectly cured. All the sclerosed circumanal tissue had becomes quite healthy, and old eczema had also disappeared.
And I would remark that the consentaneous disappearance of the eczema stamps the cure as like the disease, i.e., general and constitutional. And this is essentially important, for I much doubt whether the forcible healing up of fistula even by calendula and Hydrastis or Hydrastin, or douches, is an unmixed advantage, unless the general state be simultaneously righted. For will any one on reflection, seriously tell me that fistula is even conceivable in a truly individual? Big stout men do indeed, get fistula, but are they truly healthy? I think not.
In “L’Hahnemannisme ” for October, 1872, Dr. Leon Simon report as follows.