Since the First Edition of this small work on the medicinal cure of fistula went to press, a considerable number of cases of fistula of various kinds have passed under my professional care, so that I can now rise my voice with a little greater authority, and maintain more strongly than ever that the treatment of the fistular disease by operation and locally healing measures is irrational and harmful. True it is that some cases of fistula are very difficult to cure, particularly where the number of fistula in one individual is very great. I once counted eighteen in one person-and these cases that have existed for many years and in which the lining of the fistula has become dense and hard, and constantly accustomed to secrete almost like the lining membrane of a cyst. Still even here a cure-a perfect cure-can be effected if the physician will take the trouble and the sufferers will have the patience.
It frequently happens that the fistula is only one of the ailments of a given patient, and not always the most important either. This must be well considered. It might not unreasonably be asked of me, ” what, then, is the fistular disease if the fistula proper be not the malady?” Well, I find that a considerable number of constitutional taints run out through fistulas, and I hope, with time, to give direct information on this important subject, but at present I must be content to narrate a few cases of cure, from which my readers will be able to draw certain conclusions themselves.
Perhaps by the time a third edition comes round I may be able to give a classification of fistulas according to their pathologic qualities, deduced partly from their genealogies and partly from the known actions of the remedies that have proved curative of them. Certainly there are liver-fistulas. i.e. fistulas of hepatic origin, and here the liver must be cured or the fistulas cannot be. Certainly there are lung-fistulas, i.e., fistulas of pulmonary origin. Here the lungs must be first cured, or the sequel brings constitutional retribution; here we must be especially aware of operations, for if this kind of fistula be forcibly closed, phthisis comes anon.
Certainly there are spleen fistulas, or fistulas of splenic fistula. But this part of my subject is new, and needs much thinking about before going further, so I will simply proceed to the narration of a few instructive cases of cure of fistula by medicines.
CASE OF HEREDITARY FISTULA.
The gentleman whose case is first narrated in this book sent me a friend of his suffering from fistula, as does also this latter’s father. This friend came to me on November 2, 1891, telling me that he had a Perineal abscess, which at date is again gathering. He early seeks advice became of his father’s chronic condition. Patient has, besides, a chronic winter cough, very hard; otherwise he is in excellent condition,- a trifle stout, perhaps. There are no indurated glands anywhere to be found, but he gets a little acne here and there. He suffers a good deal of pain during defecation.
In December 1892 the fistula had quite disappeared and has not since returned, though I think it very probable that he may have a few more flickerings here and there yet, though of course he may not.
The chief remedies were Bacill, Thuja, Sabina, Levico, Hydrastis, Hepar, Acidum nitricum. There were numerous gatherings of pus before the cure was accomplished.
CASE OF FISTULA CURED BY Urtica Urens.
According to my views almost every fistula has a cause more or less remote from the fistula proper; we might almost compare the fistula to the crater of a volcano.
Where a given organ seems to be the starting point of the cause of a fistula, an appropriate remedy of that organ will at times aid much in its cure. I will now relate a case which appears to have been cured by one organ-remedy alone, viz., by the notable spleen-remedy Urtica urens. The discovery that Urtica urens has a specific influence on the spleen, I claim as my own.
An unmarried gentleman came to consult me for fistula just before Christmas 1890.
Originally there appears to have been a fall, and then an abscess. Patient was operated upon for his fistula in 1886, and again in 1887, but without avail. He was in fairly good health all the time, and though he still had his fistula when he came to me, not withstanding the two operations, he did not come because he was ill, but because he was desirous of getting married. He complained only of one thing, viz., he was always very chilly.
I examined him with very great care, and apart from the fistula itself I could find nothing wrong with the him except that he had a very greatly hypertrophied spleen.
About two ounces of Urtica ur. 0, spread over a number of weeks, seemingly cured him, for he reported himself as cured in the early summer of 1891. I July of that year he went up the river, and reported some swelling of the old fistular region. Urtica was repeated, and, I believe cured him : I am not quite sure but he had previously reported himself cured, then he reported the swelling, and a few weeks later he got married. I think he must be cured, because he passes my door about twice a month to see a mutual friend of us both, and this mutual friend is in the habit of referring to this cure of fistula by medicines. Still I have not examined him, and thus of not vouch for its being a complete cure. I regard it as a fistula of splenic origin, and hence the fistula would heal as soon as the spleen was cured.
POST-MALARIAL FISTULA IN THE BACK.
The following case of fistula is unique in my experience, and not far from being absolutely unique in the anals of fistulae.
In the fall of the year 1890 a gentlemen brought his wife to me; they were just returned from India, In June 1890 the lady had a fall in Bombay, whereupon she miscarried and before she could recover she developed malarial fever. Then abscess formed in the womb and also in the back, about the region corresponding to the part lying between the left-hand end of the pancreas and the lower part of the spleen. On inspection I found a freely discharging fistula, with much inflammation around it, occupying the first described region of the back. The spleen was very much enlarged. Patient is a large woman, 30 odd years of age, very bloodless and washed-out looking, and very ill in herself. As I find the Urtica ur. has a strong affinity for the spleen, I thought I would just bring that organ back to the normal therewith (Which I have very often done before). I gave her twenty drops of the Urtica tincture daily. This was on September 12, 1890.
October 6.- A very great change for the better has taken place in the patient; the spleen has gone down, the circumsfistular inflammation has greatly diminished, and patient looks and feels much better. The medicine to be continued in a smaller dose.
October 20.- Patient continues to improve. The fistula has closed; a little throat cough, seemingly from a cold.
Rx Phosphorus 3 and Chelidonium 0.
November 19.- The fistula has healed up; patient has had her second period since the miscarriage, and there was very much uterine pain at the time. There has been a slight attack of malarial fever with night sweats.
Helianthus annuus 0, six drops in water night and morning.
December 10.- Menses normal; a lump – flat – of the size of a baby’s open hand, has come in the left breast.
Regarding this as from the uterus, I gave Bursa pastoris 1x, six drops night and morning.
January 7, 1891.- Breast normal; some pain in the liver; much less pain at the last period; a bit of cough.
Rx. Carduus marioe 0, five drops night and morning.
February 6. One bad bout of fever, and since then very well. The fistula remains perfectly healed. I heard from the husband a good while subsequently, telling me there had been no relapse.
FISTULA PROCTALGIA-GRAVE DEPRESSION OF SPIRITS.
A city merchant, about 50 years of age, came to me in the month of March 1890, in very great distress of mind on account of his fistula, or rather, on account of the fact that three different surgeons-one an eminent specialist for diseases of the rectum-had declared and operation imperative. The idea of being operated upon had almost unhinged his mind, and he was seemingly neglecting an important business; he could talk of nothing but his fistula and the impending operation.
The fistula was very small, very painful, and had made his life miserable for about three months. During the past six weeks he has lost 16 pounds in weight. The proctalgia he described as “terrible, day and night ” At first Hydrastis can took the pain away, and it returned; Var. C. I thought indicated, but it did no good. Hydrastis was again resorted to, but it did not help, and patient literally ran about wildly from the pain, often standing with legs apart with much bearing down.
On April 23, my note runs thus :- “No amelioration. The tongue is gouty; he compares the pain to that caused by nettles. His sufferings are awful.”
Rx. Tc Urtica ur. 1x, ten drops in water every four hours.
May 9.- These drops cured the burning pain in three days.
Rx. Phytolaccinum 3x,.
June 4.- No return of the pain at all. Patient has regained much of his lost weight, and is now as hilarious as he was previously depressed. At the seat there is nothing observable save a flap of flesh at the side of the anal month.
Rx. Sodium silicate 0.
July 2.- Not happy at the seat; mentally apprehensive; a close inspection shows, hidden behind the before-named flap of flesh, a small wart with a bleeding fissure athwart it.
Rx. Sambucus 0.
Patient was discharged quiet cured and in fine physical and mental condition just fourteen months from the beginning of his treatment. During the remaining part of his treatment. During the remaining part of his treatment he received from me Chelidonium majus 0, Urtica ur. in several differing strengths. Hecla 30, Kali iod. 30, Calcarea carb. C. C., and finally Silicea C.
In this case I did use one local application, viz, powdered Thuja applied direct to the bleeding comb-like processes behind the fleshy flap, and of this flap its shrivelled remains are still in situ.
FISTULA-VERRUCOUS GROWTH AND HAEMORRHOIDS.
Early in the year 1890 a gentleman verging on 70 years of age came from the country to consult me for anal trouble characterized by a sticky, gummy discharge. An examination of the part disclosed a wart-like growth of the size of a walnut, and also a pile.
I could not find any fistula. A month later I found the mouth of the fistula leading into a funnel-shaped discharging cavity.
He remained under treatment the best part of a year, during which time the fistula healed and patient greatly improved in health. Bacillinum C. Hydrastis can.0, Phytolaccin 3x, Sodium silicatum 0, Sambucus 0, were the chief remedies. The growth was much smaller when patient discharged himself, and was wishful to continue the treatment longer, but he was comfortable in himself, the anal region being dry since the fistula healed up. His digestion so very much improved that he “would not be bothered with any more physicking.”
CASE OF FISTULA IN A LADY.
A married lady, 33 years of age, was brought to me by her husband in the spring of 1891 to be treated for fistula-in-ano, that had been a source of annoyance and trouble for a little over two years, seemingly starting from the retention of a dead foetus at the period, which was then thought to have been three weeks dead.
At a previous confinement there had been considerable laceration of the perineum, the sequel of which had to be remedied by the electro-cautery, and thus a somewhat imperfect closing of the sphincter ani has come about, and loose stools being the rule, the poor lady had a sad time of it. A fistula alone is a humiliating possession, but when faecal incontinence is added, the condition becomes fearful. The fistula was situated at the back, and was in the habit of closing for a few days, and then it would burst and discharge. Besides the fistula and an inadequate sphincter muscles, there were piles; that, however, did not cause very much inconvenience.
Patient was put upon Thuja occidentalis 30 in infrequent doses for one month.
The cause was seen from month of month, and required some pretty careful differential drug diagnosis before it was permanently cured, patient discharged quiet well in the month of July 1892. The chief remedies used were Bacill. M. and CC. given altogether during four separate months, Helianthus annuus 0, Bursa pastoris 0, Kali iodicum. 3 trit.,. and 30, and Bovista 3 trit, have come into pay in between as indicated.
In this case I was guided to the use of the remedies from the state of the cervical glands and the circumscribed flush of the cheeks, and by the patient’s various symptoms.
CASE OF PREFISTULAR CELLULITIS DISPERSED.
Sometimes one is fortunate enough to get cases of prefistular gathering soon enough to prevent both abscess and fistula. Thus a middle-aged merchant from the Midlands came under my care in the fall of 1891, with a “lump at the seat” that was giving rise to inconvenience and anxiety to the patient, partly because he was quite familiar with fistula in his own family. He was well in three months; during the first half of the time he was taking Arnica montana, 1, twenty drops a day in water. This took away much of the swelling and nearly al the hardening, and then I gave Chelidonium majus on organopathic lines.
That we here prevented both abscess and fistula hardly admits if any doubt.
CASE OF RECTAL ABSCESSES AND FISTULA.
In the month of January 1892 a London professional man came under my care.
Two months previously he had had a very large abscess of the rectum, which had been freely incised but would not heal, and a fistular state remained, with much discharge : or, rather, I should say that there remained a hole in the flesh fully two inches long, discharging matter profusely. And notwithstanding the profuse discharge from this gash, there was another large gathering on the other side of the anus, which the surgeon was on, the point of operating on.
Patient’s father and one of his sisters had died of phthisis. I began the treatment with Ignatia amara 1, alternated with Hydrastis canadensis 0, because of patient;s low nervous anorexial condition. This was continued for a fortnight, much to his comfort and feeling of well-being, when early in February gout broke out in his right foot. This was met with Aconite 6 and Bryonia 0. With the outbreak of the gout the activity at the seat lessened,, and the gash in the flesh began to heal from the bottom. I had applied nothing to the wound, but rather encouraged its activity.
The treatment was continued-patient all the while attending to his professional duties-with some ups and downs, till May 25, 1893, when patient was discharged cured, and in capital health and spirits.
Many remedies were needed and used, and of these the chief were : Bacill, CC. and C.; Bryonia alb. 0; bellis perennis 0; Chelidonium majus 0; Chionanthus virginicus 0; Nat. mur.; 6 trit.; Levico (strong); Thuja 30, and Lycopodium 6. To give the reasons for giving the various medicines would occupy more space than I can here afford, but there were there leading ideas underlying them viz. :-
1. The hereditary phthisic taint.
2. The enlarged unhealthy liver.
3. The gout; and then we had to meet-
a. The debility.
b. The anaemia.
c. The anorexia.
d. The neurasthenia, the last-named being a potent factor in the sum; at any rate, neurasthenia cannot be operated away.
GRAVE CASE OF RECTO – VAGINAL FISTULA.
A childless lady, many years married, 42 years of age, came to consult me for rectovaginal fistula early in the year 1890. Both of her parents died about 80 years of age,- in fact her mother lived to be 82; and all her brothers and sisters still alive and well, and patient herself being of very fine build.
I was quiet astonished to hear the following narration of her health-history and present state :- Formerly had a fearful cough, remaining as a sequel of a pneumonia, the cough, being so bad that some thought it from a form of asthma. Formerly very thin then stout (Large, not obese), i.e. polysarcous, and now losing flesh. It noteworthy that when she began to get perineal abscesses her cough entirely disappeared.
In childhood she bad had measles, whooping-cough, and scarlatina in the proper way,- since then a carbuncle on her tight arm. Menses copious; she is weary and tired; tongue gouty, with no “strawberry” pips (a very important point); considerable leucorrhoea; she is very chilly. Not with standing the history of pneumonia, and not with standing the very bad cough that disappeared as soon as the pre-fistular abscesses began to appear, I still could not regard the fistula as in any sense indicative of a phthisic taint, but I came to the conclusion that it was a case of genuine vaccinosic mainfestations; the chilliness, the leucorrhoea, the polysarcia, the pithy tongue, the sterility all, in my judgement, pointing at any rate to the hydrogenoid constitution of Grauvogl.
The fistula was sequential to abscesses at the spot, and patient stated that it had gathered twelve times.
Patient had been operated on by a distinguished surgeon three months previously but without success, and a further and very much more serious operation was in prospect, and hence the lady’s visit to me. Now it happened that this lady’s house was, and is, the rendezvous of quite a number of medical men all sincerely attached to this lady’s husband. “Nearly all our friends happen to be medical men.” said she, and my husband has discussed the question of the possibility of my fistula being cured with medicines, and they all declare it to be absolutely impossible, an my husband is so sure that it is impossible that he has refused to come with me.”
Still, in an aside, she gave me to understand that he privately hoped she would come, on the off-chance of a cure, and so avoid the alarmingly radical operation in contemplation.
It is to be remembered that an operation for fistula depends a good deal on the kind of person to be operated upon as well as its position.
In this case the position was most awkward, and the quantity of tissue through which the incisions would have to be made very considerable.
in the left groin glands are indurated and enlarged; moreover, they become tender just before each gathering, and remain so till is has burst and discharged.
In as much as many medical men had declared this case absolutely unamenable to medicinal treatment, and two of them watched the progress of the case, in as much as one operation had already failed (it was performed in a well-known hospital, it being considered too considerable to be conveniently done at home), and in as much as my diagnosis will be unacceptable to almost all medical men, even to many of my best friends and colleagues, I am going to enter into very full details of the case, to motive my diagnosis and the line of treatment such diagnosis compelled.
If any one of my readers takes an interest in the question of the constitutional effects of the poison of vaccination, I refer such a one to my little treatise on th subject, entitled ” Vaccinosis and its Cure by Thuja.”
In this case patient had been vaccinated four times. From this fact, and for the reasons already given (symptoms negative and positive). I considered I had to do with a genuine and severe case of vaccinosis.
I began the treatment of January 10, 1890, with the matrix tincture of Hydrastis Canadensis, giving eight drops in water three times a day.
February 3.- The leucorrhoea is not so bad; the place is angry, but the swelling is less. Patient feels better. ” I am picking up.” Feels very cold always, and she is also cold to the touch. Sleeps lightly, and gets the fidgets in her legs.
Rx. Thuja occidentalis 30, infrequently.
February 17.- Markedly better; no trouble with the gathering whatever; no discharge from the fistula worth while; no menses for six weeks; still feels very chilly; parts no longer swelling! no tenderness of inguinal glands; much better of the tiredness and weariness.
No medicine, to allow the remedial action already set up to continue undisturbedly.
March 7 – No pain, and no gathering; one scanty menstruation; she is always cold; the enlargement of the inguinal glands has disappeared; not so tied or weary.
Rx. Vaccininum C., very infrequently.
March 26,- No gathering; not so cold; leucorrhoea better; has a cold, with a little cough; is gaining flesh.
Rx. Ceanothus Americanus, ten drops in water night and morning.