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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.


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.

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.


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

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