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CHAP. XXI. Of Fistula's.
A Fistula is a sinuous, white, narrow, callous and not seldome unpercei∣vable Vlcer. It tooke its denomination from the similitude of a reeden * 1.1 (Fistula) that is, a pipe, like whose hollownes it is. A Fistula is bred in sundry parts of the body, and commonly followes upon Abscesses or Vlcers not well cured.
A Callous is a certaine fleshy substance, white, solid, or dense and hard, dry and * 1.2 without paine, generated by heaping up of dryed excrementitious phlegme, or else adult melancholy, encompassing the circuite of the Vlcer, and substituting its selfe in∣to the place of laudible flesh. The Sinus or cavity of a Fistula is sometimes dry, and * 1.3 otherwhile drops with continuall moisture: sometimes the dropping of the matter sodainly ceases, and the orifice thereof is shut up, that so it may deceive both the Chirurgion and the Patient with a false shew of an absolute cure; for within a while after it will open againe and run as formerly it did. Some Fistula's are bred by the corruption of a bone, others of a nerve, others of membranes, and others of other parts of the body. Some run straight in, others and that the greater part, have tur∣nings and windings; some have one, others have more orifices and windings; some are at the Ioynts, others penetrate into some capaoity of the body, as into the chest, belly, guts, womb bladder; some are easily, others difficultly cured, and some wholly uncurable. There are divers signes of Fistula's according to the varie∣ty * 1.4 of the parts they possesse; for if that which you touch with the end of your probe make resistance, and resound, then you may know that it is come to the bone; and then if the end of the probe slip up and downe as on a smooth and polite superficies, it is a signe that the bone is yet sound; but if it stop and stay in any place as in a rough way, then know that the bone is eaten, rough and perished; sometimes the bone lies bare, and then you neede not use the probe. Besides also it is a signe that * 1.5 the bone is affected, if there be a purulent efflux of an unctuous or oily matter, not much unlike that marrow wherewith the bone is nourished. For every excrement shewes the condition of the nourishment of the part whence it is sent; in a Fistula which penetrates to a Nerve, the patient is troubled with a pricking paine, especially when you come to search it with a probe, especially if the matter which flowes downe be more acrid. Oft times if it be cold, the member is stupified the motion * 1.6 being weakned; besides also the matter which flowes from thence is more sub∣tle, and somewhat like unto that which flowes from the bones, yet not oily nor fat, but sanious and viscous resembling the condition of the alimentary humor of the Nerves. The same usually appeares and happens in Fistula's which penetrate to the Tendons and those membranes which involve the muscles. If the Fistula bee within the flesh, the matter flowing thence is more thicke and plentifull, smooth, white and equall. If it descend into the Veines or Arteries, the same happen as in those of the Nerves; but that there is no such great paine in searching with your probe, nor no offence or impediment in the use of any member: yet if the matter of the Fistulous Vlcer be so acrid, as that it corrode the vessells, blood will flow forth; and that more thicke if it be from a veine, but more subtle and with some murmuring if from an Artery. Old Fistula's and such as have run for many yeares, if suddainly * 1.7 shut up, cause death, especially in an ancient and weake body.