The workes of that famous chirurgion Ambrose Parey translated out of Latin and compared with the French. by Tho: Johnson. Whereunto are added three tractates our of Adrianus Spigelius of the veines, arteries, & nerves, with large figures. Also a table of the bookes and chapters.

CHAP. XXIII. Of the Fistulaes in the Fundament.

FIstulaes in the Fundament are bred of the same causes as other kindes of Fistulaes are; to wit, of a wound or abscess not well cured, or of a haemorrhoid which is suppurated. Such as are occult, may be known by dropping down of the sanious and purulent humor by the Fundament, and the pain of the adjacent parts. But such as are manifest, by the help of your probe you may finde whither they goe, and how far they reach. For this purpose the Chirurgeon 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 sign it pene∣trates into the capacity of the Gut. Besides also, then there flowes not only by the Fundament, but also by the orifice which the malign humor hath opened by its acrimony, much matter, some∣whiles sanious, and oft-times also breeding Worms. Fistulaes may be judged cuniculous, and run∣ning into many turnings and windings, if the probe do not enter far in, and yet notwithstanding more matter flowes therehence then reason requires should proceed from so small an Ulcer. You may in the orifices of all Fistulaes, perceive a certain callous wart, which the common Chirurge∣ons tearm a Hens arse. Many symptomes accompany Fistulaes which are in the Fundament, as a Tenesmus, strangury and falling down of the Fundament. If the Fistula must be cured by manual operation, let the Patient lye so upon his back, that lifting up his legs, his thighs may press his belly; then let the Chirurgeon, having his nail pared, put his finger besmeared with some oint∣ment into the Patients Fundament; then let him thrust in at the orifice of the Fistula, a thick Lea∣den Needle, drawing after it a thread consisting of thread and horse-hairs woven together, and then with his finger taking hold thereof, and somewhat crooking it, draw it forth at the Funda∣ment, 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 he may straiten them at his pleasure. But before you binde them, you shall draw the thread somewhat roughly towards you, as though you meant to saw the flesh therein contained, that you may by this means cut the Fistula without any fear of an Haemorrhage, or flux of blood. It sometimes happens, that such Fistulaes penetrate not into the Gut; so that the finger by interposition of some callous body, cannot meet with the needle or probe. Then it is convenient to put in a hollow Iron or Silver Probe, so through the cavity thereof to thrust a sharp pointed needle, and that by pricking and cutting may destroy the Callus; which thing you cannot perform with the formerly described Leaden Probe, which hath a blunt point, unless with great pain.

[illustration]

The description of a hollow silver Probe, to be used with a needle, as also a Leaden Probe.

• A. Shews the Needle.
• B. The hollow Probe.
• C. The Nee∣dle with the Probe.
• D. The lea∣den Needle drawing a thread af∣ter it.

The Callus being wasted, the Fistula shall be bound as we formerly mentioned. That which is superficiary needs no binding, only it must be cut with a crooked scalprum, and the Callus being consumed, the rest of the cure must be performed after the manner of other Ulcers. But you must note, that if any parcel of the Callous body remain untoucht by the medicin or Instrument, the Fistula reviving again, will cause a relapse.

Notes

• The causes.
• Signs.
• Symptomes.
• The art of binding and cutting a Fistu∣la of the Fun∣dament.