On Fistulae (1-5)

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,

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out with the finger, bending the extremity of the director and the end of the threads in it, and the director is to be withdrawn, but the ends of the threads are to be knotted twice or thrice, and the rest of the raw threads is to be twisted around and fastened into a knot.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

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.