The People's Common Sense Medical Adviser in Plain English / or, Medicine Simplified, 54th ed., One Million, Six Hundred / and Fifty Thousand

by Ray Vaughn Pierce

ANAL FISTULA. (FISTULA IN ANO.)

This disease is more dangerous than piles, though, after once formed, not so painful. It sometimes commences with intense itching about the anus, accompanied with a little discharge; or the first symptom may be a painful abscess, like a boil, which finally breaks. The soreness then in a measure subsides, leaving a fistulous opening, with a continuous discharge of matter. This unnatural opening, with its constant drain upon the system, sooner or later is certain to ruin the health or develop consumption or other maladies, and destroy life.

Fistula in Ano may exist in three conditions: First, complete fistula—when the opening is continuous from the cavity of the rectum or bowel to the surface of the skin, so that liquids, gases, etc., escape; secondly, internal incomplete fistula, when the opening extends from the inside of the rectum into the tissues surrounding it, but not through the skin. A few cases of this kind exist, while the sufferers are unconscious of the nature of the difficulty, supposing it to be piles or some trouble—they know not what. Thirdly, external, incomplete fistula, when the opening extends through the skin into the tissues around the rectum, but does not enter the bowel.

Other complications, such as pendulous tits or projections, from one-fourth to one and a half inches in length, are attendant upon fistula. Two or more openings may appear in the skin, all communicating with the same sinus, or opening into the rectum. Sometimes only a small external opening is seen, while a large abscess exists internally. In any case, the discharge is not only reducing to the system, but it is disgusting and offensive.

Causes The causes are a constitutional predisposition, constipation, piles, or the presence of foreign bodies in the rectum, causing an abscess or ulcer. Some authors have contended that fistula always originates from an ulcer in the rectum, which gradually makes its way through the cellular tissue to the surface. Others contend that the cause of this disease consists in an abscess, which burrows in the tissues and makes its exit into the rectum, or through the skin, or both. No doubt it may originate in both ways. It can readily be seen that when an internal opening is once established, the foeces which enter into it must sooner or later work their way to the surface, burrowing through those parts which offer the least resistance, until a place of exit is reached.

Diagnosis. The disease may be suspected, if there has been an abscess in the parts involved, or if the patient has been subject to pain in the rectum, and the parts are tender, tumid, or indurated. When the fistula opens externally, the linen will be moistened and soiled with pus, or a bloody fluid, and when the tract is large, the foeces may pass through it. A careful exploration with a probe, passed into the external opening while the finger is in the rectum, generally reveals the direction of the tract; but, sometimes, in consequence of the tortuous course of the canal, the probe cannot he made to follow it. When the fistula is incomplete, and opens internally, the probe is passed into the rectum and directed outwards, when it may be felt externally. In such cases, a tumor, caused by the contents of the fistula, may generally be seen protruding near the anus, and the pain will be considerably increased during defecation, by the foeces passing into it and disturbing its walls. The examination should be made with the greatest possible care, for it is attended with more or less pain.

Treatment. When constitutional derangement exists, it must be rectified, or any treatment will be liable to result in failure. The comfort of the patient may be greatly promoted by attention to the bowels, keeping their contents in a soluble condition, and the liver active, so as to prevent congestion of the rectum and adjacent structures. This can best be done by careful attention to hygiene, and the use of "Golden Medical Discovery" and "Pellets," in sufficient quantities to produce the above named effects.

A radical cure, however, cannot be accomplished except by surgical means, for which we have the knife, ligature, caustic, stimulating injections, etc., which may be varied to suit the emergency, but which should never be employed except by a competent surgeon. Constitutional conditions materially influence the cure, no matter what procedure is adopted; the greater the constitutional derangement and the poorer the general health, the longer is the cure delayed. The great secret of our success in treating this disease consists in applying appropriate constitutional treatment at the same time.

The use of the knife is becoming obsolete, and has, to a great extent, given way to other measures which are equally successful. Indeed, other means will succeed in cases in which the knife fails or is for any reason inapplicable. One great objection to the knife is not only the dread which patients entertain of it, but the great liability of its use to result in paralysis of the sphincters of the anus, the consequence of which is loss of control over the bowels; and another is that it sometimes entirely fails to result in cure. By the means which we employ, these objections are entirely overcome, and, while the general system is being renovated, the fistula is healed, without any complications.

Fistula is much more common than has generally been supposed. It is apt to be associated with pulmonary diseases. Heretofore, it has been supposed that to heal the fistula, during the progress of the lung affection, would result in fatal consequences, and the patient has been left to suffer and die under the combined influence, of the two diseases. Observation, based upon an extensive experience in the management of such diseases, has proved that supposition to be fallacious in every respect, and we would urge all persons afflicted with fistula to have the affliction cured, no matter what complications may exist. The fact underlying this erroneous opinion is, that when grave constitutional troubles have co-existed the use of the knife has resulted in failure, and the fistula has refused to heal.