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.