Commentary. Hippocrates describes minutely the apolinose, or the cure with the ligature, in his work ‘De Fistulis.’ We must mention, however, that Kühn and Sprengel do not admit this among the genuine treatises of Hippocrates, although they allow that it is ancient. Littré also, though with some hesitation, has rejected it from his list of the genuine works of Hippocrates. And yet, considering that it was received as such by Galen and Erotian, it seems bold in any modern critic to refuse its claims.
Celsus likewise describes distinctly the method of applying the ligature. The process, he says, is slow but free from pain. It may be expedited by smearing the thread with some escharotic ointment. The same thing, he adds, may be accomplished by means of a scalpel guided upon a specillum (sound). When many sinuses open by one mouth, he directs us to cut open a straight fistula with a scalpel, and then the others being thereby exposed are to be tied with a thread. The diet is to be of a diluent nature, with a liberal allowance of water for drink. (vii, 4.)
Aëtius gives, from Leonides, a full account of fistulæ in ano, as we have explained in another place. He recommends us to introduce a specillum, and having cut open the fistula upon it, to pare away the callous parts of it. (xiv, 11.)
Actuarius approves of the same practice as the others. He cautions against making large incisions lest the sphincter ani be wounded. (Meth. Med. iv, 6.)
Albucasis delivers nearly the same rules of treatment as our author. According to circumstances he approves of the knife, the cautery, or the apolinose. (Chir. ii, 80.)
Haly Abbas describes only the operation by the incision. He also states that if the sphincter ani be wounded, it will occasion irretention of the fæces. (Pr. ix, 60.) See also Rhases (Ad Mansor. ix, 80; Cont. xxviii); and Avicenna (iii, 18, 1, 18.) Avicenna prefers twisted hairs or bristles of a hog, as they will not putrefy.
Upon the whole no other of the ancient authorities has treated so efficiently of fistulæ in ano as Paulus.
See an excellent account of the operation in Sprengel’s ‘History of Medicine.’ John de Vigo trusted to septics, such as arsenic and the ægyptiacum. Ambrose Paré approved of the apolinose and incision. Severinus was an advocate for the cautery. Foubert and Camper likewise practised the apolinose—the one with a leaden thread, the other with a silk one. Guido de Cauliaco and Rogerius approve of the ligature. Brunus and Theodoricus prefer the actual cautery, but describe the others. The surgeons of this country have now generally rejected the methods with the ligature and the cautery.
The following account of the ancient specillum by the learned Harduin will serve to illustrate our author’s description of the operation. We overlooked it in the commentary on [the fifteenth section]. “Quid sit specillum Varro explicat (Lib. 5 de Lingua Lat.) Quo oculos inunguimus quibus specimus (hoc est, aspicimus), specillum est. Græcis μηλὴ dicitur. Aëtius Serm. 8, 14, cum specillo instrumento, quod melam Græci appellant. Instrumentum parvum ac teres, quo utuntur ad vulnerum aut fistularum viam aut profunditatem pernoscendam. Une sonde de chirurgien.” (Ad Plin. H. N. vii, 54.) If the κοπάριον, however, was the same as the μηλὴ or the specillum, it was evidently used for cutting with as well as for cutting upon.