Stephenson:Neal:Quicksilver:654:a frightful purplish swelling (Al Ju)

From the Quicksilver Metaweb.

This event is based in fact. In 1686, Louis XIV developed an perianal fistula. This is a tract connecting the inside of the anal canal with the skin surrounding the anus. It can come from inflammatory conditions like Crohn's Disease, but also from chronic infections or abscesses in the area. In particular, Louis XIV's fistula was said to come from a perirectal abscess. These present with pain, itching, and discharge, and can be VERY unpleasant.

The standard surgery is a fistulotomy, in which the fistula is cut through and laid open, replacing the closed tract with an open wound that can heal over properly. These surgeries are pretty routine nowadays. The fistula can recur, but the number one complication is fecal incontinence, the risk of which depends on the location and size of the fistula.

Some other treatments have been tried. For example, a loose stitch can be passed through the fistula canal and tied. This is known as a Seton Stitch. Due to pressure and friction, the stitch slowly cuts across the tract, working its way towards the surface skin. Due to the slow nature of this process, the fistula and the area cut by the stitch scar over so that at no point is there a gaping wound. This treatment has been used since ancient times, but can be quite painful and incontinence can be a problem. Sometimes Seton stitches are placed a few weeks prior to surgery. Also, fibrin glue has been used to close down these fistulas instead of cutting them open.

When Louis XIV was diagnosed with the fistula, he asked his chief surgeon, Claude-Francois Felix de Tassy, to operate. As related in Quicksilver, he practiced on hundreds of people beforehand. The technique used is pretty similar to that used today. The operation was a complete success. Louis XIV granted him a title, an estate, and 300,000 francs.

As a result, surgery gained great prestige in France. Prior to this event, surgeons were not held in high acclaim. They were considered manual technicians, unlike physicians, who worked with their minds. In the original Hippocratic Oath, physicians had to swear that they would "not cut for the stone."- i.e they would not lower themselves to performing surgery. Afterwards, surgeons commanded more respect.