Tech Coloproctol DOI 10.1007/s10151-015-1338-x
CORRESPONDENCE
The origin of cure for fistula in ano: technique of Hippocrates D. Tsamis1
Received: 1 June 2015 / Accepted: 23 June 2015 Ó Springer-Verlag Italia Srl 2015
Dear Editor Fistula in ano is certainly one of the oldest pathologies in humankind. The only doctor who first analyzed the etiology and his technique in healing this troublesome condition is Hippocrates [1–4]. Hippocrates is one of the greater therapists in ancient Greece. It is believed that Hippocrates evolved medicine to distinct profession. This outstanding therapist was born in island of Cos in 460 B.C. [3, 4]. One of his texts is devoted to anus and especially in fistula. Hippocrates has the theory that fistula is produced by contusions and swellings. He thinks that rowing on horseback or falling accumulates the blood near anus. The collected blood is becoming corrupted and suppurates. It spreads, breaks and corrupts below at the anus. Then, he describes the course of the disease that an ichorous discharge or feces are passing by. Hippocrates believes in the early treatment of fistula. He notes that when a doctor sees any such swelling or inflammation formed, he must cut it open before suppuration exists. If the fistula has already been formed, Hippocrates suggests the measurement and assessment of the fistula tract by a stalk of fresh garlic. He suggests that the patient must be in supine position with his thighs separated. The next step curing fistula from Hippocrates’ point of view is the creation and placement of a plug. This is created by moisture from the juice of tithymallus strip of
& D. Tsamis [email protected] 1
Colorectal Surgical Department, St Mark’s Hospital and Academic Institute, 5J Nicoll Road, Harrow, London NW10 9AX, UK
cotton cloth. This plug is inserted in full length inside the fistula with the use of a thread and probes (Fig. 1). At the end, a horn is placed inside the rectum for 5 days. Another method of cure Hippocrates is suggesting is the placement of a seton inside the fistula tract. The seton was created taking raw lint and uniting it into fivefold of the length of a span. Then, these folds were wrapped round with a horse hair. This type of primitive seton was passed through the fistula tract. The patient is advised to come every day in order the doctor to tighten and twist the seton. When the fistula has sloughed through, a sponge smeared with honey is introduced inside the rectum and anus. Roasted flowers of copper are applied every day at the site of fistula for 7 days. Hippocrates also advices that the seton should be renewed before it rots. He notices that the horse hair is rolled round the raw lint as they are not liable to rot. The patient is advised all this time to have warm baths and keep a spare diet. Hippocrates suggests also the cut-down of the fistula tract as far as it passes, but only if it is superficial. If the fistula is deep, the seton or the plug is the reasonable solution. It is worth saying that Hippocrates resembled a modern professional surgeon. He describes an operational theater, where he notices that physical light as much as an artificial light is needed. He also describes how the room is prepared and how the surgical tools are sanitized and the patient is getting ready. Everyone can see that Hippocrates surely knew how to place the patient and examine him. The specialized instruments were not very different than the modern ones. He could tell after examination the course of the fistula and proposed the therapeutic procedure depending of the deep or superficial route. It is fantastic that he indeed proposed plugs and cutting setons to treat and cure this troublesome condition, the most available treatment options until now.
123
Tech Coloproctol Conflict of interest of interest.
The authors declare that they have no conflict
Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent
In this letter no participants were included
References
Fig. 1 Curettes and probes from classical period in ancient Greece (fifth to third century B.C.). Exhibits of the British museum Acknowledgments I have to thank Mrs. Thalassini Delistathi for the great help in translating the original documents of Hippocrates ‘‘On Fistula’’ from ancient Greek.
123
1. Vigoni M (1985) History of the treatment of anal fistulas (introduction). Acta Chir Belg 85:307–311 2. Deeba S, Aziz O, Sains PS, Darzi A (2008) Fistula-in-ano: advances in treatment. Am J Surg 196:95–99 3. Corman ML (1980) Classic articles in colon and rectal surgery. Hippocrates: on fistulae. Dis Colon Rectum 23:56–59 4. Glaser S (1969) Hippocrates and proctology. Proc R Soc Med 62:380–381
CORRESPONDENCE
The origin of cure for fistula in ano: technique of Hippocrates D. Tsamis1
Received: 1 June 2015 / Accepted: 23 June 2015 Ó Springer-Verlag Italia Srl 2015
Dear Editor Fistula in ano is certainly one of the oldest pathologies in humankind. The only doctor who first analyzed the etiology and his technique in healing this troublesome condition is Hippocrates [1–4]. Hippocrates is one of the greater therapists in ancient Greece. It is believed that Hippocrates evolved medicine to distinct profession. This outstanding therapist was born in island of Cos in 460 B.C. [3, 4]. One of his texts is devoted to anus and especially in fistula. Hippocrates has the theory that fistula is produced by contusions and swellings. He thinks that rowing on horseback or falling accumulates the blood near anus. The collected blood is becoming corrupted and suppurates. It spreads, breaks and corrupts below at the anus. Then, he describes the course of the disease that an ichorous discharge or feces are passing by. Hippocrates believes in the early treatment of fistula. He notes that when a doctor sees any such swelling or inflammation formed, he must cut it open before suppuration exists. If the fistula has already been formed, Hippocrates suggests the measurement and assessment of the fistula tract by a stalk of fresh garlic. He suggests that the patient must be in supine position with his thighs separated. The next step curing fistula from Hippocrates’ point of view is the creation and placement of a plug. This is created by moisture from the juice of tithymallus strip of
& D. Tsamis [email protected] 1
Colorectal Surgical Department, St Mark’s Hospital and Academic Institute, 5J Nicoll Road, Harrow, London NW10 9AX, UK
cotton cloth. This plug is inserted in full length inside the fistula with the use of a thread and probes (Fig. 1). At the end, a horn is placed inside the rectum for 5 days. Another method of cure Hippocrates is suggesting is the placement of a seton inside the fistula tract. The seton was created taking raw lint and uniting it into fivefold of the length of a span. Then, these folds were wrapped round with a horse hair. This type of primitive seton was passed through the fistula tract. The patient is advised to come every day in order the doctor to tighten and twist the seton. When the fistula has sloughed through, a sponge smeared with honey is introduced inside the rectum and anus. Roasted flowers of copper are applied every day at the site of fistula for 7 days. Hippocrates also advices that the seton should be renewed before it rots. He notices that the horse hair is rolled round the raw lint as they are not liable to rot. The patient is advised all this time to have warm baths and keep a spare diet. Hippocrates suggests also the cut-down of the fistula tract as far as it passes, but only if it is superficial. If the fistula is deep, the seton or the plug is the reasonable solution. It is worth saying that Hippocrates resembled a modern professional surgeon. He describes an operational theater, where he notices that physical light as much as an artificial light is needed. He also describes how the room is prepared and how the surgical tools are sanitized and the patient is getting ready. Everyone can see that Hippocrates surely knew how to place the patient and examine him. The specialized instruments were not very different than the modern ones. He could tell after examination the course of the fistula and proposed the therapeutic procedure depending of the deep or superficial route. It is fantastic that he indeed proposed plugs and cutting setons to treat and cure this troublesome condition, the most available treatment options until now.
123
Tech Coloproctol Conflict of interest of interest.
The authors declare that they have no conflict
Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent
In this letter no participants were included
References
Fig. 1 Curettes and probes from classical period in ancient Greece (fifth to third century B.C.). Exhibits of the British museum Acknowledgments I have to thank Mrs. Thalassini Delistathi for the great help in translating the original documents of Hippocrates ‘‘On Fistula’’ from ancient Greek.
123
1. Vigoni M (1985) History of the treatment of anal fistulas (introduction). Acta Chir Belg 85:307–311 2. Deeba S, Aziz O, Sains PS, Darzi A (2008) Fistula-in-ano: advances in treatment. Am J Surg 196:95–99 3. Corman ML (1980) Classic articles in colon and rectal surgery. Hippocrates: on fistulae. Dis Colon Rectum 23:56–59 4. Glaser S (1969) Hippocrates and proctology. Proc R Soc Med 62:380–381
