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FIstula's in the Fundament are bred of the same causes as other kinds of * 1.1 Fistula's are; to wit, of a wound or abscesse not well cured, or of a haemor∣rhoide which is suppurated. Such as are occult, may be knowne by drop∣ping * 1.2 downe of the sanious and purulent humor by the Fundament and
the paine of the adjacent parts. But such as are manifest by the helpe of your probe you may finde whither they goe and how farre they reach. For this purpose the Chirurgion shall put his finger into the Fundament of the patient, and then put a Leaden probe into the orifice of the Fistula, which if it come to the finger without interposition of any medium, it is a signe it penetrats into the capacity of the Gut. Besides also then there flowes not onely by the fundament but also by the orifice which the maligne humor hath opened by its acrimony, much matter, somewhiles sanious, and oft times also breeding Wormes. Fistula's may be judged cuniculous, and running into many turnings and windings, if the probe doe not enter farre in, and yet not withstanding more matter flowes therehence than reason requires should proceede from so small an Vlcer.
You may in the o••ifices of all Fistula's, perceive a certaine callous wart, which the common Chirurgions tearme a Hens arse. Many symptomes accompany Fistula's * 1.3 which are in the Fundament, as a Tenesmus, strangury & falling downe of the Funda∣ment. If the Fustula must be cured by manuall operation, let the patient lye so up∣on his backe, that lifting up his legges, his thighs may presse his belly, then let the Chirurgion, having his naile pared, put his finger besmeared with some oyntment * 1.4 into the patients Fundament; then let him thrust in at the orifice of the Fistula a thick Leaden needle drawing after it a thread consisting of thread and horse haires woven together, and then with his finger taking hold thereof and somewhat crooking it, draw it forth at the Fundament, together with the end of the thread. Then let him knit the two ends of the thread with a draw or loose knot, that so hee may straiten them at his pleasure. But before you bind them you shall draw the thread some-what roughly towards you as though you meant to saw the flesh therein conteined, that you may by this meanes cut the Fistula without any feare of an Haemorrhagye, or flux of blood.
It sometimes happens that such Fistula's penetrate not into the Gut; so that the finger by interposition of some callous body cannot meete with the needle or probe. Then it is convenient to put in a hollow iron or silver probe so through the cavi∣ty thereof to thrust a sharp pointed needle, and that by pricking and cutting may de∣stroy the callous; which thing you cannot performe with the formerly described lea∣den probe, which hath a blunt point, unlesse with great paine.
A. Shewes the Needle.
B. The hollow probe.
C. The needle with the probe.
D. The Leaden needle drawing a thread after it.
The Callus being waisted, the Fistula shall be bound as wee formerly mentioned That which is superficiary needs no binding, onely it must be cut with a croked scal∣prum, and the Callus being consumed, the rest of the cure must bee performed after
the manner of other Vlcers. But you must note, that if any parcell of the Callous body remaine untoucht by the medicine or instrument, the Fistula reviving againe will cause a relapse.
The causes.
Signes.
Symptomes.
The art of binding and cu••ing a Fi∣stula of the Fundament.