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FOr the cure; in the first place it will be expedient to search the Fistula; & that * 1.1 either with a waxe size, a probe of lead, gold or silver, to find out the depth and windings or corners thereof. But if the Fistula be hollowed with two
or more orifices, and those cuniculous, so that you cannot possibly and certainly search or finde them all out with your probe; then must you cast an injection into some one of these holes, and so observe the places where it comes forth, for so you may learne how many, and how deepe or superficiary cavities there be; then by ma∣king incisions you must lay open and cut away the callous parts. You must make in∣cisions with an incision knife or razour, or else apply actuall or potentiall caute∣ries; for nature cannot unlesse the Callous substance bee first taken away, restore or generate flesh or agglutinate the distant bodies. For hard things cannot grow together, unlesse by the interposition of glue, such as is laudible blood; but a callous body on all sides possessing the surface of the ulcerated flesh, hinders the flowing of the blood out of the capillary veines for the restoring of the lost substance and uni∣ting of the disjoyned parts. If you at any time make causticke injections into the * 1.2 Fistula, you must presently stop the orifice thereof, that so they may have time to worke the effect, for which they are intended. Which thing we may conjecture by the tumor of the part, the digesture of the flowing matter, and its lesser quantity. Then you must hasten the falling away of the Eschar, and then the Vlcer must be dres∣sed like other Vlcers. But oft times the Callous which possesses the sinuous cavity of a Fistula, overcome by the power of acrid and escharoticke medicines comes * 1.3 whole forth, and falls out like a pipe, and so leaves a pure Vlcer underneath it. Which I observed in a certaine Gentleman, when I had washed with strong Aegyp∣tiacum divers times a Fistulous Vlcer in his thigh shot through with a bullet; then presently by putting in my Balsame formerly described, he grew well in a short time. Fistula's which are neare great vessells, Nerves or principall intrailes, must not bee medled with, unlesse with great caution. When a Fistula proceeds by the fault of a * 1.4 corrupt bone, it is to be considered whether that fault in your bone be superficiary, or deeper in, or whether it is wholly rotten and perished. For if the default be superfi∣ciary it may easily be taken away with a desquammatory Treapan; but if it penetrate even to the marrow, it must be taken forth with cutting mullets, first having made way with a Terebellum. But if the bone be quite rotten and perished, it must bee wholly taken away, which may be fitly done, in the joynts of the fingers, the radius of the Cubite and Legge; but no such thing may be attempted in the socket of the Huckle bone, the head of the Thigh bone, or any of the Rack bones when they are mortified, neither in those Fistula's, which are of their owne nature uncurable; but you shall thinke you have discharged your duty and done sufficiently for the Patient, if you leave it with a prognosticke. Of this nature are Fistula's which penetrate * 1.5 even to the bowells, which come into the parts orespread with large vessells or Nerves, which happen to effeminate and tender persons, who had rather dye by much, than to suffer the paine and torment of the operation. Like caution must bee used, when by the cutting of a Fistula there is feare of greater danger, as of convulsi∣on if the disease be in a nervous part. In these and the like cases the Chirurgion shall not set upon the perfect cure of the disease, but shall thinke it better to prevent by all * 1.6 meanes possible that the disease by fresh supplies become no worse, which may bee done if he prevent the falling downe of any new defluxion into the part; if by an artificial diet hee have a care that excrementitious humors be not too plentifully ge∣nerated in the body; or so order it, that being generated they may be evacuated at certaine times, or else diverted from the more noble to the base parts. But in the meane space it shall be requisite to waist the faulty flesh, which growes up more than is fitting in the Vlcer, and to clense the sordes or filth, with medicines, which may doe it without biting or acrimony and putrefaction.
How to finde out the win∣dings and ca∣vities of Fi∣stula's.
Causticke in∣jections.
Colsu•• lib. 5.
Remedies for a Fistula pro∣ceeding from a corrupt bone.
The cure of what Fistu∣la's may be attempted, and which may not.
A palliative cure of a Fi∣stula.