ON FISTULAE
by Hippocrates
translated by Francis
Adams
ON FISTULAE
Fistulae are produced by contusions and tubercles,
and they are also
occasioned
by rowing, on horseback, when blood accumulates in the
nates
near the anus. For, having become putrid, it spreads to the soft
parts
(the breech being of a humid nature, and the flesh in which it
spreads
being soft), until the tubercle break and corrupt below at the
anus.
When this happens, a fistula is formed, having an ichorous
discharge,
and faeces pass by it, with flatus and much and
abomination.
It is produced, then, by contusions when any of the parts
about
the anus are bruised by a blow, or a fall, or a wound, or by
riding,
or rowing, or any such cause. For blood is collected, and
it,
becoming corrupted, suppurates; and the from the the same
accidents
happen, as have been described in the case of tubercles.
2. In the first place, then, when you see any
such tubercle
formed,
you must cut it open while still unripe, before it suppurate
and
burst into the rectum. But if a fistula be already formed when you
undertake
the case, take a stalk of fresh garlic, and having laid
the
man on his back, and separated his thighs on both sides, push down
the
stalk as far as it will go, and thereby measure the depth of the
fistula.
Then, having bruised the root of seseli to a very fine
powder,
and poured in some water, let it macerate for four days,
and,
mixing the water with honey, let the patient drink it, fasting,
to
the amount of three cyathi, and at the same time purge away the
ascarides.
Those who are left without treatment die.
3. In the next place, having moistened the
strip of cotton cloth,
with
the juice of the great tithymallus, and sprinkling on it the flos
aeris,
roasted and triturated, and having made it into a tent equal in
length
to the fistula, and having passed a thread through the ends
of
the tent again through the stalk, and having placed the patient
in
a reclining position, and having examined the ulcerated parts of
the
rectum with a speculum, pass the stalk by it, and when it
reaches
the rectum, take hold of it and draw it out until the tent
be
pushed through, and be brought on a level above and below. When
it
(the tent?) has been pushed inward, introduce a ball of horn into
the
rectum (the rectum having been previously smeared with Cimolian
chalk),
and leave it there, and when the patient wants to go to stool,
let
it be taken out and again replaced, and let this practice be
continued
for five days. On the sixth day let it be removed, and
drawing
the tent out of the flesh, and afterwards pounding alum and
filling
the ball (pessary) and introducing it into the rectum, leave
it
until the alum melts. Anoint the rectum with myrrh until the
parts
appear to be united.
4. Another method of cure:-Taking a very slender
thread of raw lint,
and
uniting it into five folds of the length of a span, and wrapping
them
round with a horse hair; then having made a director
(specillum)
of tin, with an eye at its extremity, and having passed
through
it the end of raw lint wrapped round as above described,
introduce
the director into the fistula, and, at the same time,
introduce
the index finger of the left hand per anum; and when the
director
touches the finger, bring it out with the finger, bending the
extremity
of the director and the end of the threads in it, and the
director
is to be withdrawn, but the ends of the threads are to be
knotted
twice or thrice, and the rest of the raw threads is to be
twisted
around and fastened into a knot. Then the patient is to be
told
that he may go and attend to his matters. The rest of the
treatment:-Whenever
any part of the thread gets loose owing to the
fistula
becoming putrid, it is to be tightened and twisted every
day;
and should the raw thread rot before the fistula is eaten
through,
you must attach another piece of raw thread to the hair, pass
it
through, and tie it, for it was for this purpose that the hair
was
rolled round the raw lint, as it is not liable to rot. When the
fistula
has sloughed through, a soft sponge is to be cut into very
slender
pieces and applied, and then the flowers of copper, roasted,
are
to be frequently applied with a director; and the sponge smeared
with
honey is to be introduced with the index finger of the left hand,
and
pushed forward; and another bit of added, it is to be bound on
in
the same manner as in the operation for hemorrhoids. Next day,
having
loosed the bandages, the fistula is to be washed with hot
water,
and cleansed, as far as possible, with the finger of the left
hand
by means of the sponge, and again the flos aeris is to be
applied.
This is to be done for seven days, for generally the coat
of
the fistula takes that time to fistula takes that time to slouch
through.
The same mode of bandaging is to be persevered in afterwards,
until
the cure be completed. For in this way, the fistula being
forcibly
expanded by the sponge will not fill up and heal unequally,
but
it will all become whole together. During the treatment, the
part
should be bathed with plenty of warm water, and the patient
kept
on a spare diet.
5. When the fistula does not get eaten through,
having first
examined
it with a sound, cut down as far as it passes, and sprinkle
with
the flos aeris, and let it remain for five days. Then pour warm
water
upon it, and above lay flour mixed with water, and bind on it
the
leaves of beet. When the flos aeris comes away, and the
fistulous
sore becomes clean, cure it as before described. But if
the
fistula be in a part which does not admit of this treatment, and
if
it be deep, syringe it with the flowers of copper, and myrrh, and
natron,
diluted with urine, and introduce a piece of lead into the
orifice
of the fistula so that it may not close. Syringe the fistula
by
means of a quill attached to a bladder, so that the injection may
distend
the fistula. But it does not heal unless it be cut open.
6. If the anus gets inflamed, and there is
pain, fever, a frequent
desire
of going to stool without passing anything, and the anus
appears
to protrude, owing to the inflammation, and if at times
strangury
come on, this disease is formed, when phlegm, collected from
the
whole body, is determined to the rectum. Warm things are
beneficial
in this case; for these, when applied, can attenuate and
dissolve
the phlegm, and dilute the acrid and salt particles, so
that
the heat subsides, and the irritation in the rectum is removed.
Wherefore
it is to be treated thus: The patient is to be put into a
hip-bath
of hot water, and sixty grains of the grana gnidia are to
be
pounded and infused in a hemina of wine, with half a hemina of oil,
and
injected. This brings away phlegm and faeces. When the patient
does
not take the hip-bath, boil eggs in dark-colored fragrant wine,
and
apply to the anus, and spread to the anus, and spread something
warm
below, either a bladder filled with warm water, or linseed
toasted
and ground, and its meal stirred up and mixed equally with
dark,
fragrant wine, and oil, and this applied very warm as a
cataplasm;
or, having mixed barley and Egyptian alum pulverized,
form
into an oblong ball (suppository?) and warming it gently at the
fire,
make it into a cataplasm, foment, form it into shape with the
fingers,
and then making it quite tepid, introduce it into the anus.
The
external parts are to be anointed with cerate, and a cataplasm
of
boiled garlic, with dark wine diluted, is to be applied. But if you
remove
these things, let him take the hip-bath of hot water, and
having
mixed together the juice of srychnos, the grease of a goose,
swine's
seam, chrysocolla, resin, and white wax, and then having
melted
in the same and mixed together, anoint with these things, and
while
the inflammation lasts, use the cataplasm of boiled garlic.
And
if by these means he be freed from the pain, it is enough; but
if
not, give him the white meconium (Euphorbia peplus?), or, if not
it,
any other phlegmagogue medicine. While the inflammation lasts, the
diet
should be light.
7. The strangury comes on in this way:-The
bladder being heated from
the
rectum, phlegm is attracted by the heat, and by the phlegm
(inflammation?)
the strangury is occasioned. If, then, as is
frequently
the case, it cease with the disease, well; but, not
withstanding,
if not, give any of the medicines for strangury.
8. If procidentia ani take place, having fomented
the part with a
soft
sponge, and anointed it with a snail, bind the man's hands
together,
and suspend him for a short time, and the gut will return.
But
if it still prolapse, and will not remain up, fasten a girdle
round
his loins and attach a shawl behind, and having pushed up the
anus,
apply to it a soft sponge, moistened with hot water in which the
shavings
of lotus have been boiled; pour of this decoction upon the
anus
by squeezing the sponge, then, bringing the shawl below between
the
legs, fasten it at the navel. But if he wish to evacuate the
bowels,
let him do so upon a very narrow night-stool. Or, if the
patient
be a child, let him be placed on the feet of a woman, with his
back
reclined to her knees, and when the bowels are evacuated, let the
legs
be extended. In this way the anus will be the least disposed to
fall
out. When a watery and ichorous discharge flows from the
rectum,
wash it out with burnt lees of wine, and water from myrtle,
and
having dried maiden-hair, pound and sift it, and apply as a
cataplasm.
But if there be a discharge of blood, having washed with
the
same, and pounded chalcitis, and the shavings of cypress, or of
juniper,
or of stone-pine, or of turpentine, the in equal
proportions
the apply as a cataplasm. Anoint the external parts with
thick
cerate.
9. When the gut protrudes and will not remain
in its place,
scrape
the finest and most compact silphium (assafoetida?) into
small
pieces and apply as a cataplasm, and apply a sternutatory
medicine
to the nose and provoke sneezing, and having moistened
pomegranate
rind with hot water, and having powdered alum in white
wine,
pour it on the gut, then apply rags, bind the thighs together
for
three days, and let the patient fast, only he may drink sweet
wine.
If even thus matters do not proceed properly, having mixed
vermillion
with honey, anoint.
10. If procidentia ani be attended with a discharge
of blood, pare
off
the rind of the root of wakerobin, then pound and mix flour with
it,
and apply it warm as a cataplasm. Another: Having scraped off
the
rind of the most tender roots of the wild vine, which some call
psilothrion,
boil in a dark austere wine undiluted; then having
pounded,
apply as a tepid cataplasm; but mix also flour and stir it up
with
white wine and oil in a tepid state. Another:-Having pounded
the
seed of hemlock, pour on it a fragrant white wine, and then
apply
in a tepid state as a cataplasm.
11. But if it be inflamed, having boiled in
water the root of me
ivy,
finely powdered, and mixing the finest flour, and stirring it
up
with white wine, apply as a cataplasm, and mix up some fat with
these
things. Another:-Take the root of the mandrake, especially the
green
(fresh) root, but otherwise the dried, and having cleaned the
green
root and cut it down, boil in diluted wine, and apply as a
cataplasm;
but the dry may be pounded and applied as a cataplasm in
the
manner. Another:-Having bruised the inner part of a ripe
cucumber
to a soft state, apply as a cataplasm.
12. If there be pain without inflammation,
having roasted red
natron,
and pounded it to a fine powder, and added alum and roasted
salts,
finely triturated, mix together in equal proportions; then
having
mixed it up with the best pitch and spread upon a rag, apply,
and
bind. Another:-Having pounded the green leaves of capers, put into
a
bag and bind on the part; and when it appears to burn, take it
away
and apply it afterward; or, if you have not the leaves of capers,
pound
the rind of its roots, and having mixed it up with
dark-colored
wine, bind on the part in the same manner. This is a good
application
also for pains of the spleen. Of these poultices, those
which
are cooling, stop the discharge; those which are emollient and
heating,
discuss; and those which are attractive, dry up and
attenuate.
This disease is formed when bile and phlegm become seated
in
the parts. When the anus is inflamed, it should be anointed with
the
ointment, the ingredients of which are resin, oil, wax,
plumbago,
and suet, these being all melted and applied quite hot as
a
cataplasm.
THE END
