Galen remarks that diseases of the anus are difficult to cure, because the part is possessed of great sensibility, and is exposed to be irritated by the alvine discharges, which contain bile, ichor, and the like. Styptic substances, which do not produce much irritation, are most proper for them, such in particular are many of the metals. He gives a long list of applications recommended by Andromachus, Asclepiades, and others, the principal ingredients of which are ceruse, litharge, alum, rose-oil, and the like. For procidentia ani he recommends various astringent applications containing galls, sumach, roses, pomegranate rind, burnt lead, litharge, &c.
Aëtius gives a long account of these complaints, but we must be content with a brief summary of it. He treats procidentia ani in the first place with astringent applications, containing galls, hypocistis, austere wine, and the like; but when these things do not succeed, he directs us to burn the verge of the anus with the actual cautery. Hemorrhoids he advises us to extirpate with the knife; but when the patient will not submit to this operation, he directs us to burn them with caustics, such as arsenic, quicklime, and the like. He recommends various combinations of these medicines for condyloma, acrochordon, and thymus.
Octavius Horatianus may be consulted with advantage; but as his general plan of treatment is not very different from that of Celsus, we shall not give an abstract of it.
For rhagadia Marcellus recommends a composition of litharge and rose-oil. He gives an interesting description of the process of curing hemorrhoids by an application containing arsenic, chalcitis, misy, and the like. This remedy is strongly recommended by the Pseudo-Dioscorides. He says that a mixture of equal parts of arsenic and sandarach will make them drop off in half an hour. (Eupor. i, 214.)
The Arabians treat these diseases upon the same principles. Avicenna describes three kinds of hemorrhoids. The first kind are like warts; the next are of a bloody nature; and the third are intermediate between these. He treats them, like the others, either by a surgical operation, or by powerful caustics, containing arsenic, quicklime, and the like. When hemorrhoids are gross, and do not yield to ordinary treatment, Haly Abbas directs us to apply septics, such as arsenic, quicklime, &c.; and when they become black, to dress them with ceruse ointment, or a mixture of rose-oil and the whites of eggs. Procidentia ani he treats, like Celsus, with astringents, such as galls, hypocistis, recrementum ferri, &c. For fissures he recommends emollient ointments containing ceruse, basilicon, wax, &c. Alsaharavius also approves of septic applications containing arsenic, &c. When the piles are old and callous, however, he prefers the surgical operation. He also prudently recommends gentle purgatives. Rhases directs, in cases of procidentia ani, when the anus is swelled, and the gut cannot be got readily replaced, the patient to be put into a warm bath and emollient applications used; afterwards astringents are to be substituted, and a bandage applied. He recommends us to extirpate hemorrhoids with the knife, the cautery, or caustic medicines; but advises bleeding in the first place. He says that when dressed with sandarach they speedily drop off. In prolapsus, when the anus is swelled, he directs us to bathe the parts with a decoction of mallows, &c., then to smear them with mucilaginous substances; to replace the gut, and secure it with a bandage.
The primary sauce mentioned in this Section of our author is thus explained by Lister: “Liquamen optimum. Istud garum a Paulo Ægineta vocabatur πρωτειον, seu primarium, quod nobilissimum illud esset.” (Ap. Apicium, vii, 6.) It was called garum nigrum and garum sociorum by the Romans. (Galen, Med. sec. loc. iii.) It is thus described by Martial:
In the ‘Geoponics’ it is called garum hæmation. (xii.)
SECT. LX.—ON AFFECTIONS OF THE UTERUS; AND, FIRST, OF THE MENSTRUAL DISCHARGE.
With most women the menstrual discharge begins about the fourteenth year of their age; a few have it earlier, in their thirteenth or twelfth; and not a few are later than their fourteenth in having it. There is no limited time for the continuance of it, many having it only for two or three days, most women for five days, some for seven, and a very few have it for twelve days. The menses cease about the fiftieth year of age, a few have them till sixty, and with some they begin to disappear about thirty-five, particularly with such as are fat. When, therefore, the evacuation is delayed, it will be proper to have recourse to baths and potions before the expected period, such as the frequent draughts from sesame, or the headed leek boiled together with pepper and rue. But they must be drunk in Cretan sweet wine. Having drunk a cotylé of it, let the woman excite the flow of the menses by walking; and let her eat calamary, cuttle-fish, and polypus, and other things of the same kind, for they are particularly adapted for raising a tumult in the blood.
Commentary. The following is a list of the ancient authors on midwifery: Hippocrates (de Nat. Mulieb.; de Morbis Mulier.; de Steril.); Galen (de Med. sec. loc. ix, et alibi); Aretæus (Morb. Chron. ii, 11); Oribasius (Med. Collect, iv; Synops. ix); Ruffus Ephesius (i); Actuarius (Meth. Med. iv); Aëtius (xvi); Soranus (de Arte Obitat.); Nonnus (103); Celsus (iv); Octavius Horatianus (iii); Pseudo-Dioscorides (Euporist. ii, 80); Moschion (de Morb. Mulier.; Isagoge Anatomica, xxix); Meletius (de Nat. Hom. 24, seq.); Marcellus (de Medicam. xxxiii); Eros (apud Gynæcia); Pliny (H. N. xxviii, xxx); Avicenna (iii, 21); Serapion (v); Avenzoar (ii, 5); Averrhoes (Collig. iv, 60); Albucasis (Chirurg. ii); Haly Abbas (Theor. ix, 39; Pract. viii); Alsaharavius (Pract. xxv); Rhases (ad Mansor. ix; Contin. xxii.)
The ideas entertained by the ancients respecting the nature of the menstrual discharge may be best learned from Aristotle (de Generat. Animal, i, 19.) Our limits will not permit us to do justice to his theory of conception. It may be proper to state, however, that he holds the menses to proceed from a sanguineous superfluity (περίττωμα) in the system. This theory found a strenuous advocate in his great commentator Averrhoes (Collig. iii, 29); and Button’s views on this subject are very little different. Hippocrates, in like manner, taught that the male semen is a superfluity collected from all parts of the body, and fancied that if any part of the parent was maimed, the semen was defective, and gave rise to a similar defect in the child engendered. (De Aere et Aquis, 52.) Pythagoras called it the froth of the blood and the superfluity of the aliment. (Plutarch de Placitis Philos. v, 3.)
Dutens gives a learned account of the ancient theories on the generation of animals. Suffice it to say, that Empedocles, Hippocrates, Aristotle, and most of the philosophers taught that all animals derive their origin from ova; but that Democritus and a few others maintained that they are produced from spermatic animalcules. (Origine des Découvr.)
It appears to have been the popular belief in ancient times that the moon exercises a certain influence on the womb; and hence Homer refers the sudden deaths of women to Diana. See Eustathius (ad Iliad, xx, 59.)
We may allude in this place to the ancient belief in superfœtation. See Hippocrates (de Superfœt.) Asclepius, a commentator on this work, relates a singular case from his own personal knowledge. (T. ii, 470, ed. Dietz.) Aristotle relates several curious cases of superfœtation. (H. A. vii, 6.)
SECT. LXI.—ON RETENTION OF THE MENSES.
The menstrual evacuation is sometimes retained owing to a weakness of the whole body, and sometimes owing to a particular affection of the uterus itself, from local coldness, or a blow, or a congenital intemperament, or from some sustained injury, for the most part from abortions, or from a primary affection of some of the more important organs, such as the liver, belly, and chest, or from some such part labouring under a chronic affection. When suppressed, it becomes the cause of many and protracted complaints. If, therefore, the discharge be suppressed or delayed, owing to a primary affection of any of the internal parts, we must first direct our particular attention to the cure of the part originally affected, and afterwards think of the uterus. The symptoms of these we have already mentioned. When none of them therefore is present, it is clear that the uterus is the original seat of the complaint; and when neither the age, habit, nor any other thing prevents, we must have recourse to venesection, yet not before the regular period of menstruation, but ten days after it is past. The quantity to be taken must not be more than two pounds and a half, nor less than one; and whether we bleed or not, we must purge with the hiera of colocynth, giving it to the amount of two drachms, in six heminæ of honied water. But when fever is present, it is not expedient to purge with hiera, but it will be advisable to open a vein during the first days of the fever. After the purging, we must give recruiting things for a few days, and afterwards recommend exercise by walking, friction of the lower extremities, and the bath. The most proper food will be that which is of easy digestion and humid, such as all sweet pot-herbs, and fishes taken from among rocks, the more tender parts of fowls, milk, honied cakes, thin white wine not very old; flesh and pulse, except ptisan, are improper. When the accustomed period is at hand, give of sea-fishes the cartilaginous, and the mollusca, as they are called, and the testacea, and headed leeks (porrum capitatum), boiled with rue and pepper; and let the woman drink the decoction of them, and apply ligatures to the lower extremities for three or four days. When the expected period is at hand, the ligatures are to be removed, and she is to take beforehand fragrant draughts of myrrh, to the amount of an obolus, or the size of a bean; or of castor with must, or with honied water; or the decoction of mugwort; or of sage after the bath in must, and in that of wormwood. The wine of wormwood should be drunk as a propoma during the whole time of treatment. When the period has gone past, and no discharge, or at least none of any consequence has taken place, we must open a vein at the ankle, and abstract blood; but after the seventh or eighth day we must purge with hiera; and after the fourth day a calefacient plaster (dropax) is to be applied to the lower part of the belly, loins, and thighs. Having drunk water for three days, let a cataplasm, made of equal portions of mustard and soaked bread, be applied until the equinox, after which let the patient bathe. Next month, let dried figs instead of bread be mixed with the decoction of fenugreek, of mallows, of pennyroyal, of rue, and of mugwort. And let oil of lilies (susinum) or of marjoram be injected into the vagina; and let the pessary called Enneapharmacus, or the Olibanius be introduced. A pessary consists of carded wool, rounded to the shape of the finger, and impregnated with the medicines. This mode of treatment is generally sufficient for restoring the menstrual evacuation; but if stronger medicines are required, they are as follows: Illyrian iris drunk with wine and cyperus, the root of wakerobin, cassia, the schenanth, valerian, a decoction of the root of elicampane, myrrh to the size of a Grecian bean drunk with must in half a hemina of honied water, and two heminæ of the decoction of dittany, and ammoniac, and sagapene. To persons whose stomachs are less easily deranged, a small quantity of opopanax, made into a little ball, and steeped in boiled honey, may be given. Moreover, certain common seeds are calculated to promote the menstrual evacuation, but in an inferior degree, such as fennel, cumin, parsley, Cretan carrot, hartwort, bishop’s weed, sison, chick-peas, juniper-berries, and all the diuretics. But the following things are to be applied per vaginam: Myrrh triturated with the decoction of wormwood, or of lupines; or triturated with the juice of rue; bdellium, in like manner; storax, the gum of the wild olive, and that of the juice of rue, in like manner; or the long birthwort made into the form of a collyrium; and so also the root of the great centaury, or of hellebore, or of the juice of scammony, and the medullary part of the wild gourd by itself, and mugwort formed with rue and galbanum, applied in the form of a fumigation. These things are calculated also to expel the fœtus.
Commentary. One may find in Hippocrates a long list of medicines possessed of real or imaginary virtues as emmenagogues; such as cantharides, myrrh, peony, cumin, elaterium, squills, the fruit of juniper, seseli, thyme, St. John’s wort, rue, castor, elicampane, nettle, sage, &c. Of these some were given by the mouth, and others applied upon pessaries. He also recommends fumigations with aromatics. The pessaries were supposed to be likewise capable of producing abortion; but Hippocrates, in his Oath, forbids to give them to pregnant women. It appears from Juvenal that fœticide was a very common practice in his time (see Sat. vi); and various methods of performing it are described by Avicenna (iii, 21, 2), which we forbear to explain, lest our pages should be instrumental in increasing the frequency of this disgusting crime. It would seem that the ancient Lydians practised some Malthusian process to prevent conception. See Athen. (Deip. xii, 11, with the notes of Casaubon and Schweigh.) Aristotle says that, with this intention, some anointed the os uteri with oil of juniper, or with ceruse and frankincense mixed with oil. (H. A. vi, 3.) Aëtius makes mention of a mixture of alum, galbanum, with wine, &c. being used for this purpose. (xvi.)
Although Galen has treated very fully of this disease in different parts of his works, and has explained satisfactorily the nature of emmenagogues, we shall pass him by on the present occasion, in order to afford us more room for doing justice to the views of Aëtius, whose account of amenorrhœa we consider decidedly the best we ever met with. Aëtius says that barren and pregnant women, singers, and dancers do not menstruate, the menstrual superfluity in the latter being consumed by too much exercise. It is undoubtedly true, as he remarks, that those who take strong exercise have less discharge than women who lead an indolent life. Sometimes, too, he says, a fat or lean state of the body will occasion suppression of the menses, because fat persons have too little blood in their veins, it being consumed in forming the fat; and hence too they seldom conceive, or, if they do, their offspring is puny. In those, too, who are much emaciated, the necessary sanguineous superfluity is wanting. The menses may likewise be suppressed from disease, such as loss of blood, profuse perspirations, vomiting, purging, or cutaneous eruptions. Callosities, cicatrices, and other diseases of the uterus will likewise occasion suppression. His treatment is judiciously varied according to the cause of the complaint. Suppression, he says, brings on heaviness, torpor, pain of the loins, of the hindhead, of the root of the eyes, &c. When suppression arises from a hot temperament, it is to be treated with cooling and diluent food, such as ptisan, milk, lettuces, domestic kids and lambs, tender fishes and fowls, grapes, cucumbers, and a white watery wine. Baths of common water are to be used. When connected with a cold temperament, the patient is of a pale leaden colour, and her urine watery. She is to live upon food of a heating nature, with a generous fragrant wine, or the wine made with salt water, and must take active exercise. The suitable medicines are those of a calefacient nature, such as thyme, calamint, cassia, spikenard, or savin, taken in a white old wine. He also recommends myrrh, assafœtida, opopanax, castor, sage, rue, cumin, and the like, all of which are to be taken immediately after the bath; and when these do not succeed, he directs us to purge or give an emetic. Pessaries too may be used, but the more acrid substances, such as elaterium, cantharides, and white hellebore, must be rejected, as they are apt to occasion irritation and inflammation. Of his long list of prescriptions for pessaries, we shall merely notice the one consisting of turpentine, myrrh, honey, and saffron. When occasioned by fatness, the principal reliance is to be put upon an attenuant diet, but suitable fomentations and potions must not be neglected. Guarded purging with drastic cathartics, such as scammony or spurge, has often a good effect. Strong pessaries are likewise proper. When the suppression is connected with plethora, the patient experiences pains about the loins and lower part of the belly at the accustomed period, and a marked fulness of the veins is perceptible. It is to be cured by copious bleeding either from the arm or foot, by quietude, and the use of common fomentations. Restriction as to the bath and food must be enjoined. When connected with emaciation, the constitution is to be recruited by suitable exercise and regimen, not neglecting pessaries and potions. When occasioned by vitiated humours, such as bile or phlegm, the body is to be purged with the proper medicines, and the parts fomented. Fragrant articles are to be mixed with the food. The pessaries are to be made of elaterium, sow-bread, or the like, if bile prevails; but of anemone, pepper, or colocynth, if phlegm. When a bleeding at the nose is the cause of suppression, it is to be cured by sweating, vomiting, or other evacuations. But in this case, and when the suppression arises from barrenness or excessive labour, no marked inconvenience is felt, only conception cannot take place. When occasioned by an indolent course of life the proper remedies are suitable labour, exercise, gestation, a thin white wine, and living on attenuant and humid food. When the complaint is not connected with any of the causes or states above described, it is to be presumed that it is occasioned by some organic disease, which must be treated accordingly.
The same subject is well treated of by Avicenna, but we cannot afford room for even an outline of his account. Like our author, he approves of tight ligatures around the thighs, bleeding from the saphena; and among his emmenagogues we remark savin, musk, castor, and myrrh. All these occur also in Scrapion’s list. Haly Abbas recommends baths medicated with various stimulant articles, such as fennel, rue, chamomile, parsley, &c. He mentions pessaries and suppositories, or tents prepared with attenuant and stimulant medicines, such as myrrh, wild marjoram, rue, savin, hellebore, colocynth, wormwood, bulks gall, &c. He also speaks of fumigations with the vapours of aromatics, such as castor, olibanum, lignum aloes, &c. He approves of bleeding from the saphena, and of applying cupping-instruments to the thighs, especially when there is any determination to the nose. When connected with corpulence, he enjoins strong exercise, attenuant food, restricted diet, and purgatives. Alsaharavius treats fully of this complaint upon nearly the same plan as Aëtius. He says the stronger emmenagogues are wild mint, juniper, black hellebore, mastich, myrrh, colocynth, gentian, &c. To relieve the pains which sometimes precede menstruation, he recommends the tepid bath, moderate exercise, and attenuant food. Rhases recommends bleeding at the ankle, savin, purging with hiera, black hellebore, &c.; pessaries of the same, the hot bath, and stimulant friction.
Eros strongly recommends repeated bleeding at the ankle, the tepid bath, purgatives, diuretics, and emmenagogues, such as savin, calamint, myrrh, &c.
SECT. LXII.—ON IMMODERATE MENSTRUATION AND UTERINE HEMORRHAGE.
Immoderate discharges in women take place, sometimes from retention of the menses which break out more copious than usual, and sometimes after parturition at the full time, when they cease spontaneously for the most part; and frequently after miscarriages, when a violent hemorrhage often takes place, and proves dangerous. In the first place, then, we must apply ligatures round the members, at the armpits and groins; give to drink oxycrate not cold; sprinkle with oxycrate; and apply to the parts a large quantity of wool squeezed out of wine and oil, or rose-oil, or oil of apples, or myrtle-oil. For food, we may give chondrus soaked in oxycrate, or rice, or alica; but prohibiting wine, we may give austere hydromel, omphacomel, or the like. The patient may take propomata of pomegranate flowers in oxycrate, or the juice of hypocistis, or of acacia, or lycium, or Samian earth, or unripe grapes dried, or rhubarb, or the ashes of cork burnt in an Italian earthen vessel; or she may eat sesame soaked in oxycrate until it become soft. The following substances introduced into the vagina stop hemorrhage: The juice of hypocistis, or of acacia, with manna, being triturated with vinegar. An admirable application is a sponge soaked in wine or liquid pitch, and applied; or the ashes of it burnt when applied with vinegar or oxycrate; and in like manner the ashes of cork burnt in an Italian earthen vessel. But astringent epithemes applied externally are beneficial; and cataplasms from dates and quinces, containing also pomegranate rind, or the tops of bramble, or acorns of the holm oak, or the leaves of lentisk, wild pomegranate flowers, acacia, hypocistis, galls, or alum; but more particularly the following: Taurocolla is macerated in oxycrate until it is dissolved, and is then spread upon a strong rag, and glued to the loins. The agglutinative plasters are also powerful remedies, such as the Harmonium, Icesium, Athena, Melinum, Indicum, and the like. Pessaries are to be used for the hemorrhage; mixing the inner part of galls powdered and rosemary with water, apply; or the flowers of the cultivated pomegranate, or the sweet pomegranate in like manner, or powdered knotgrass. The following is a compound one: Of fissile alum, of the inner part of galls, of the juice of acacia, of manna, of each, dr. iv; the yelks of four roasted eggs; these powders are rubbed with the juice of plantain, and mixed. In using it a pessary of wool is impregnated with it, dipped into rose-oil, and applied. And dry-cupping by large instruments applied frequently under the nipples acts powerfully by revulsion. The following is a composition for a hip-bath, in which a person having hemorrhage may sit: Of the heads of sharp rush, of myrtle, of roses, of the leaves of rhamnus, of bramble tops, equal parts; boil in water, which let the patient use for a hip-bath.—Another: Of the bark of sweet pomegranate-root, of myrtle, of the rind of cypress, of each, p. iij; of galls, p. j; boil in a sufficient quantity of water. Inject with an uterine syringe the decoction of plantain, or of endive, or of knotgrass, or of nightshade, or of perdicium, or of fleawort, or of hypocistis, or of acacia; and let these things also be applied with wool, or by the finger, or a speculum, or a long-shaped feather, to the mouth of the uterus. And the trochisk of Andron, when injected by an uterine syringe, with some of the decoctions formerly mentioned, or with astringent wine, is an active remedy.
Commentary. Aëtius gives a very full account of these complaints, but nearly in the same terms as our author. He condemns the practice of applying sponges soaked in cold posca, because, he says, they prove injurious to the uterus by producing too much coldness. Galen remarks that pregnant women have sometimes discharges of blood from the veins of the os uteri. We can attest the correctness of this statement.
Oribasius and Actuarius treat these complaints like our author.
Octavius Horatianus directs us to subject the parts to the vapours of such astringent articles as pomegranate-rind, roses, and galls; or to apply to the parts a sponge soaked in posca, or wool squeezed out of some of the styptic juices. He also recommends us to produce revulsion by means of cupping-instruments applied to the breasts. He further directs us to apply to the parts epithemes of astringents, especially Theban dates boiled in wine or vinegar.
Moschion gives a very sensible account of uterine hemorrhages, for which he recommends perfect quietude and sponging with cold water and vinegar, or if that fail, with astringent decoctions, &c.
Soranus, in like manner, gives a very accurate detail of the symptoms and treatment of uterine hemorrhage.
Rhases recommends venesection (but does not point out the cases in which it is applicable); astringent trochisks containing the recrementum ferri; cupping-instruments applied to the breasts; stuffing the vagina with wool smeared in the mixture of frankincense, wild pomegranate-flowers, galls, antimony, acacia, and alum. He also recommends epithemes, and when these things do not succeed, pessaries made with escharotics. In uterine hemorrhage after delivery, he recommends cold astringent applications, and bandages to the extremities. Haly Abbas correctly remarks that uterine hemorrhage sometimes proceeds from plethora of the system, in which case he properly recommends bleeding. When connected with thinness of the blood, he recommends incrassant food. He also makes mention of the usual astringent applications consisting of galls, vinegar, and the like. Serapion and Alsaharavius lay down similar rules of practice. Avicenna, however, is the fullest of the Arabian authorities upon menorrhagia. Like Haly, he states that it sometimes proceeds from plethora, when he recommends us to produce revulsion by bleeding at the arm. When connected with debility, he prescribes astringents. When it proceeds from ulcers, he approves of a combination of agglutinative, astringent, and narcotic medicines. His general treatment during an attack is almost the same as that recommended by Paulus. He mentions acidulated water, vinegar, camphor, alum, galls, &c. Some of his prescriptions contain opium, which is an anticipation of the modern practice in such cases.
SECT. LXIII.—ON THE FEMALE FLUX.
This is a defluxion of the uterus, by which the whole body is purged. Wherefore that which is evacuated is of the same colour as the prevailing humour. It is red when from the ichorous part of the blood; white, from phlegm; pale, from bitter bile; and black from black bile; and sometimes it is watery. If the blood is discharged pure as in venesection, we must attend carefully, lest there be any erosion of the uterus. The flux is recognized by the following symptoms: The parts are moistened with fluids of various colours; the patient is pale; is not nourished; and loathes her food; and is affected with difficulty of breathing when she walks; her eyes are swelled; and the discharge sometimes is accompanied with pain, and sometimes without it; with ulceration or without it; and the ulceration is inflammatory, foul, or clean. Wherefore, when the affection is of a humid nature, we must endeavour to remedy the general system by administering such things as are desiccants, without being manifestly of a heating nature. The whole body is to be rubbed, and anointed with honey properly boiled, and we must give diuretic medicines, such as water in which asarabacca and parsley have been boiled, and evacuate the whole body by the bowels. In addition to these, purslain when eaten, and the juice of it when drunk, are beneficial. Also the flowers of the wild pomegranate, the fruit and flowers of bramble, that part of an oak which is under the membranous part of the trunk, and that which is below the peel of the acorn. Horse-tail in particular stops a red discharge, when drunk with water or wine; or hypocistis; the fruit of lentisk sodden with wine and drunk; Samian aster, Lemnian earth, the rennet of a hare, or of a kid, or of a lamb, or of a calf, or of a stag; grape-stones triturated, myrtles, dried unripe grapes, the bark of the pine, and those things recommended for uterine hemorrhage, unless the most drastic. When the flux is attended with pain, we must inject with an uterine syringe, or clyster instrument, the juice of alica, or of ptisan, or of tragus, or of rice, with some of the anodyne medicines. And during the exacerbations we must soothe; but during the remissions (for it has its periods) we must try to alter the system by different kinds of gestation, walking, vociferation, anointing, cupping, dropaces to the parts above, insolation, friction, depilatories, detergent ointments, sinapisms, emetics from radishes, a restorative regimen, baths, wine, and variety of food.
Commentary. By the term female flux, Ruffus describes the complaint now called the whites; but our author applies it to any vitiated state of the menstrual discharge.
Hippocrates has given a very good description of the symptoms which sometimes attend leucorrhœa, namely, swelling of the face, paleness of the countenance, enlargement of the belly, anasarca of the limbs which pit upon pressure, short breathing, debility, and so forth. He admits the difficulty of curing such complaints, but directs it to be attempted with diuretics, epithemes, masticatories, a desiccative diet, and exercise. He details many interesting histories of the complaint.
The account which Aretæus gives is nearly the same as our author’s. It is sometimes, he says, attended with a white discharge, and sometimes with a red, of which there are several varieties. It occurs at irregular periods, and in some instances when it continues long it will prove fatal by hemorrhage. The symptoms are various according to the nature of the discharge. His chapter on the treatment is lost.
Aëtius has treated of the red flux and of the white separately. When the discharge is red, he begins with venesection, and then applies to the parts sponges soaked in astringent decoctions, the preparation of which he has described at great length. When the discharge is white, he recommends gestation, vociferation, walking, friction, and applications which are both astringent and detergent. Galen correctly remarks that women of a loose phlegmatic habit of body are most subject to the whites.
Oribasius and Nonnus are little different from our author.
Octavius Horatianus approves of an astringent and desiccative regimen. His advice is to produce vomiting frequently with radishes, to use exercise gradually increased, to change the air frequently, and to apply depilatories, calefacient plasters, and sinapisms to the part. If the discharge is copious, and attended with pain, he advises bleeding.
Eros recommends fumigations with the vapours of various herbs, after which calefacient oils are to be applied upon wool to the part.
The works of the Arabians contain nothing remarkable on this head. Haly Abbas recommends venesection when the discharge is bloody; but, if it consist of other humours, he directs us to administer medicines which promote their discharge; and also to use astringent and stimulant pessaries. Alsaharavius recommends the same medicines, and likewise in particular the warm bath.
SECT. LXIV.—ON INFLAMMATION OF THE UTERUS, AND CHANGE OF ITS POSITION.
Inflammation of the uterus takes place from several causes; for it may arise from an injury, from retention of the menses, from cold and inflation, not unfrequently from abortions, and from parturition after a misconception. Inflammation of the uterus is accompanied with acute fever; pain of the head and tendons, of the balls of the eyes, of the wrists and of the fingers; retraction of the neck, and retroversion; sympathy of the stomach; and the mouth of the womb is shut up; the pulse small and dense. If the inflammation be weak, they have not violent pain in the uterus; but if it be strong, the pain is of the pulsatory kind, which, when the whole of the uterus is affected, darts through the whole of it, but when the inflammation is confined to a spot, the pain indicates the seat of it. When, therefore, the posterior parts only are inflamed, the pain is in the loins, and hardened lumps of fæces are confined by the compression of the rectum; but when the anterior parts are affected the pain is seated at the pubes, and there is strangury or dysuria from pressure on the bladder. When the sides are inflamed, there is tightness of the groins and heaviness of the limbs; but when the fundus is affected the pain is principally near the navel, with swelling thereof; and when the inflammation is in its mouth there is pain in the hypogastrium, and if the finger be introduced per vaginam, the mouth of the womb will feel hard and unyielding. As to the treatment we must, in the first place, use embrocations of wine and oil, or of wine and rose-oil to the pubes and loins, by means of folds of clean wool without a bandage; and abstinence from food is to be persevered in for three days, after which we are to let blood from the arm, if nothing contraindicate. The patient is to be supported with chondrus out of honied water, bread, or soft eggs, every alternate day. But after the fifth day we are to apply a cataplasm made of fine flour, linseed, or fenugreek, with honied water, in which the heads of poppy have been boiled and thrown away, and oil along with them. But if the inflammation be of an erysipelatous nature, and cannot endure heat, boil melilot in must, and having pounded, add the yelks of roasted eggs, with rose-oil, oil of apples, or of saffron, and apply as a cataplasm; or having boiled dates in diluted wine, pound with fine polenta, and some of the afore-mentioned ointments, and apply as a cataplasm; and when the complaint is on the decline add the cerate of nard or of privet. Throughout the whole treatment the patient must sit in hip-baths prepared from the decoction of fenugreek, linseed, mallows, mugwort, and oil; and those who cannot bear these heating things must use rose-oil dissolved in hot water. Recourse must be had to pessaries, and injections prepared from the sordes of unwashed wool and butter, stag’s marrow, the grease of geese, the ointment called Susinum, and Tuscan wax. When the patients can endure heating things, the pessary called the Golden will suit with them, and the Enneapharmacus; but when they cannot endure heating things, the pessaries are to be prepared from eggs, rose-oil, the fat of geese, or of domestic fowls. For inflammations attended with a greater degree of heat, melt diachylon-plaster in a double vessel with rose-oil, and add the juice of plantain, or of endive, of succory, or of intybus. Or use the following: Of the fresh fat of geese, or of swine, dr. iv; of the cerate of roses, or of the Susinum, oz. ij; of the yelks of roasted eggs, oz. j; of saffron, dr. j; of myrrh, three oboli; of opium, two oboli; or, instead of opium, the decoction of poppy-heads. When the pain is great, give poppy-juice (opium) to the size of a lentil, with woman’s milk, or the juice of fenugreek, as an application per vaginam. For inflammation with hardness, dissolve the ointment called Tetrapharmacum in rose-oil, and introduce or inject. And when there is derangement of the position of the uterus, it is to be treated like inflammation during the violence of the attack; but, during the remissions or decline, emollients are to be applied; and when the complaint is protracted, alteratives (metasyncritica) are to be used. But if there is hardness externally, we must have recourse to malagmata; that from melilots, that of Muasræus, the Icesian, that from apples invented by Serapion, and that from wheat. The diet at first should be light; but when the complaint begins to decline the patient may use the bath, and take a more varied and generous diet.
Commentary. Aëtius has given from Philumenus a very circumstantial account of the symptoms and treatment of inflammation of the uterus; but, upon the whole, it is little different from our author’s. He also gives, from Aspasia, a fuller account of displacement of the uterus. Without doubt he alludes to retroversion and anteversion of the uterus, as they are called in modern works on midwifery. These cases generally occur in the first months of pregnancy, but there are instances of their happening in the unimpregnated state. (See Burns’ Midwifery, i, 19.) The symptoms, as described by Aëtius, are sufficiently well marked; retention of the fæces, owing to the rectum being obstructed by a tumour; pains in the region of the pubes, and sometimes retention of urine. He directs us to draw off the water by means of a catheter, and to bleed, give emmenagogues, and apply pessaries according to circumstances. Avicenna and Haly Abbas make mention of displacement of the womb, but they appear to have derived all their information from Aëtius.
We shall give a brief outline of Serapion’s treatment in cases of uterine inflammation. He properly begins with bleeding first from the arm, and afterwards at the ankle. He then gives a laxative medicine, and applies a plaster to the region of the uterus. When the complaint is at its acme, he directs us to use fomentations prepared by adding sedatives to such medicines as pomegranate-rind, endive, fleawort, fenugreek, chamomile and dill. When the inflammation does not abate, he directs us to encourage suppuration by the combination of maturative with calefacient medicines, such as a plaster containing fenugreek, barley-flour, figs, pigeon’s dung, &c. Haly’s plan of treatment is little different: General bleeding according to circumstances; cooling draughts composed of purslain, violets, spinage, &c.; plasters of violets, camphor, &c.; hot baths prepared with melilot, mallows, linseed, &c. When there is heat in the parts, he directs us to introduce oil of roses, with the whites of eggs, the grease of hens, &c. to which opium may be added. When the pain is violent, he particularly recommends cooling injections. Alsaharavius recommends bleeding from the arm and at the ankle, diluent and cooling draughts, local applications containing opium, seed of fenugreek, plantain, house-leek, &c. and the tepid bath.
Rhases says that when the womb is displaced, there is vehement pain with distension of the parts; the woman cannot rise nor sit but with difficulty; the urine is retained and sometimes the fæces. He directs us to restore the uterus to its position by drawing its mouth in the opposite direction. Displacement of the womb is also briefly noticed by Hippocrates (de Morb. Mulier. i); by Dioscorides (Meth. Med. i, 37); and by Soranus (Ap. Phys. et Med. Min. ed. Ideler, 256.)
Many of the ancient authorities describe the uterus as consisting of two cavities, separated from one another by a membrane. See, in particular, Theophilus (Comm. in Hipp. Aph. ii, 469, ed. Dietz.) Galen, however, would appear to have been better informed (t. v, 789, ed. Kühn.) The uterus, moreover, is correctly described by Soranus (Ap. Phys. et Med. Min. 256), and by Moschion. (vi.)
SECT. LXV.—ON ABSCESS OF THE UTERUS.
When the inflammation is converted into abscess, all the symptoms formerly mentioned become more intense; and, besides, there are irregular attacks accompanied with rigor, which at first are attended with intense pain; but when suppuration has fairly taken place, there is some remission of it. About the time of the abscess’ bursting, the pains, however, become more keen and seem to attack in a pungent manner; the fevers formerly slight become more oppressive; sometimes there is obstruction of the urine, and sometimes of the fæces, occasioned by the pressure of the affected part of the uterus. Sometimes there is swelling in the region of the pubes, and a sense as it were of fluctuation, when the abscess is large. Abscess in the more exposed parts is discovered by means of the surgical instrument called dioptra, or the touch of the finger, and from the pains being more violent, owing to the nervous nature of the mouth; as when the collection is in the fundus and vagina it is attended with less pain, and no swelling is felt heavy upon the finger, and the mouth of the womb appears less tumid. Wherefore we must promote suppuration by cataplasms of fenugreek, linseed, barley, or wheaten flour intermixed with boiled figs, and sometimes with pigeons’ dung. Let the patient often use the hip-baths recommended for inflammation, and pessaries of turpentine, myrrh, grease of wool and butter. When the abscess bursts, if the matter pass to the bladder, we must give milk to drink, and draughts from the seeds of cucumber; but if it is discharged into the rectum we must throw up injections of lentils and pomegranate-rind. But if it burst into the womb, provided the pus be pure, we may inject rose-oil, or whitened oil, or the ointment composed of four ingredients, which is called basilicon, or fresh butter; but if a thin fetid ichor is discharged, as from a spreading ulcer, we must use an astringent injection of myrtles, dates, and dried lentils; and after the discharge of the humours, if there he inflammation, we must persevere with the cataplasms and hip-baths. When the aposteme is seated about the mouth of the uterus, and does not burst, after the parts which cover the pus have become thin, we must endeavour to procure the evacuation of the pus by a surgical operation, as will be explained in the Surgical part of the Work.
Commentary. Our author abridges the account given by Aëtius, but has omitted some things of importance. Aëtius directs us, when the abscess is forming, to apply fomentations by introducing a piece of sponge into the vagina, and to steam the uterus by means of a tube calculated to convey the fumes to it. When the pain is violent, poppy-heads are to be added to the cataplasms. The poppy is an ingredient in several of the cataplasms mentioned by Serapion. Avicenna’s treatment is perfectly similar. Oribasius remarks that an abscess may burst by the os uteri, the bladder, or into the rectum. When it makes its way into the rectum, Haly Abbas prescribes clysters composed of such articles as lentils, pomegranate-flowers, Armenian earth, rose-oil, ceruse, dragon’s blood, gum arabic, the yelk of an egg, and vinegar. His general treatment consists of pessaries, plasters, injections into the vagina, and clysters of various cooling and emollient articles.
SECT. LXVI.—ON ULCERATION OF THE WOMB.
The uterus is often ulcerated from difficult labour, extraction of the fœtus, or forced abortion, or injury of the same occasioned by acrid medicines, or by a defluxion, or from abscesses which have burst. If, therefore, the ulceration be within reach, it is detected by the dioptra, but if deep-seated, by the discharges; for the fluid which is discharged varies in its qualities. When the ulcer is inflamed, the discharge is small, bloody, or feculent, with great pain; but when the ulcer is foul, the discharge is in greater quantity, and ichorous, with less pain. When the ulcer is spreading, the discharge is fetid, black, attended with great pains, and other symptoms of inflammation; irritation is produced by relaxing medicines, and relief by the opposite class. When the ulcer is clean, the fluid is small in quantity, consistent, without smell, thick, white, with an agreeable sensation. When the ulcer is inflamed, we must use those things recommended for inflammations. When it is foul, we must inject the juice of ptisan with honey, or basilicon ointment with the oil called Susinum; or honied water, having fenugreek, mallows, bran, or lentil without its husk, boiled in it; and in order to clean it the more, horehound or vetches may be added; or mixing with honey the flour of vetches, or iris, or round alum, or the like, we may inject them; and externally we may apply cataplasms of the same things mixed with honied water. And this medicine is particularly applicable: The finest saffron is triturated with a woman’s milk, and being added to rose-cerate with the grease of a goose, is rubbed upon flocks of wool. But the following is a more effectual application, and one proper for violent pains: Poppy-heads are mixed in diluted must for three days, and then boiled until they become soft; then rose-leaves, dr. v, and saffron, dr. iij, are pounded together, and the decoction of the poppy-heads mixed with them; then wax, dr. ij, melted with rose-oil, are poured on them, and applied on a pessary, anointing with rose-oil. The same good effects may be derived from the preparation of eggs, saffron, rose-oil, the grease of a goose, and stag’s marrow. And the Egyptian ointment without the verdigris answers admirably for the cure of ulceration. When the ulcer is spreading and attended with inflammation, we must apply a cataplasm of warm bread mixed with hydromel, oil, marshmallows, fenugreek, and fatty dates. We must inject also the juice of plantain, of nightshade, of knotgrass, and of endive, first by themselves, but afterwards with austere wine or vinegar. When the ulcer spreads and is without inflammation, we may inject more tonic remedies, such as the decoction of pomegranate-rind, of roses, of olive shoots, of cypresses, of quinces, of bramble, of myrtles, of lentisk, of buckthorn, of sumach, in astringent wine, and afterwards with alum, acacia, lycium, and hypocistis. A hip-bath is also to be prepared from these decoctions. When these things do not succeed, we must use an injection, at first of paper with oxycrate, and then of vinegar, or of the powder called anthera, or of chalcitis, or of copperas, in the same liquids; or of the remedies for dysentery. We must allow wholesome food in small quantities. When the ulcer has become clean, we must bathe more frequently, administer food freely, and give wine, so that the body may soon recover its flesh. In place of a pessary, we may inject the preparation from mulberries, mixed with calamine, Cretan cistus, or plumbago. Externally we may apply the epulotic plaster to the abdomen and loins; for the powers of cataplasms, as well as those of plasters, may be thus communicated by the insensible pores of the skin.
Commentary. Our author has described the treatment of ulcers in the womb so fully and judiciously, that little of importance can be added to it. It is mostly compiled from Aëtius, who, in his turn, professes to have copied from Archigenes, Aspasia, and Asclepiades.
Aretæus says that of ulcers in the womb some are broad, attended with pruritus and a discharge of thick matter without fetor. These are not dangerous. But when the discharge is thin, ichorous, and fetid, when the lips of the sore are callous, and when it spreads like a phagedenic ulcer, it is of a malignant kind. His chapter on the treatment is lost.
Unfortunately there is also a hiatus in the text of Celsus, which detracts from the value of his account.
Octavius Horatianus recommends a potent remedy for putrid ulcers of the uterus which supervene upon wounds. It is a trochisk formed of arsenic, quicklime, sandarach, burnt paper, and the like. Although the case recently reported of the man who killed his wife, by introducing into her vagina the oxyd of arsenic, ought to teach us caution, we can certainly conceive that such an application, if properly managed, might prove safe and effectual. It ought also to be kept in mind that the orpiment of the ancients was less virulent than the arsenic of the moderns.
Scarcely any additional information is to be learned from the Arabians. The following application recommended by Avicenna seems to be a judicious one: Take equal parts of litharge, ceruse, and sarcocolla; make a cerate with wax and rose-oil. When the ulcers are attended with a bloody discharge, Haly Abbas directs us to use pessaries and injections of an astringent nature, consisting of galls, hypocistis, plantain, rose-oil, and the like. When the discharge is whitish and purulent, he recommends the tepid bath and injections of barley-gruel, honey, &c. For relieving the pain he recommends an ointment containing litharge, frankincense, axunge, fresh butter, strained wax, and rose-oil. Alsaharavius recommends similar remedies.
SECT. LXVII.—ON CANCER.
Of cancers in the womb, some are attended with ulceration, and some are without it. In those cases in which the part is not ulcerated, a tumour is found about the mouth of the womb, hard, unequal, callous, of a feculent colour, and red, but sometimes also somewhat livid; and they have violent pains in the groins and abdomen, the lower part of the belly, and the loins, which are exasperated by handling and complicated applications. When the cancer is ulcerated, in addition to the pains, hardness, and swelling there are phagedenic and unequal ulcers to be seen, which for the most part are foul, callous, white, and having ugly scabs on them; but some appear clean, some feculent, or livid, or red, or bloody. The discharge from them always is a thin ichor, watery, black, or tawny, and fetid; but blood also is sometimes discharged along with the other symptoms of an inflamed uterus already mentioned. Wherefore the complaint is incurable, as Hippocrates has pronounced, but may be alleviated by hip-baths from fenugreek, and mallows, and by cataplasms of a like nature. And the exacerbations of the complaint may be much alleviated by common mallows, or marshmallows, softened by boiling in honied water, and pounded with a little rose-oil, and applied; and by a cataplasm of dried figs and melilots, rue, frankincense, and navew bruised carefully with oil, and also by that from dates boiled in must, containing also the yelks of eggs, and fine flour; or that from poppies with coriander, knotgrass, or endive. These things are to be applied during the violence of the pains; after which a cerate may be applied from rose-oil, or myrtle-oil, or the oil from the flowers of wild vines, or that of apples with dates boiled in must. But one particularly recommended is that from the sediment found in copper vessels, which being burnt, is reduced to a powder, and mixed with the cerate of roses until it acquire the consistence of a plaster. These are the external applications. But oil applied internally is soothing to the parts. And when they become ulcerated, the milk of a woman may be injected, and the tepid juice of plantain. But if they bleed, the infusion of knotgrass with a little rosemary proves soothing; and so also do pessaries medicated with saffron, women’s milk, and the juice of poppies, and the sordes of unwashed wool. But the following is one of the best applications, and answers also for affections of the anus: Of washed Italian litharge, oz. vj; of male frankincense, of the sordes of unwashed wool, of fresh axunge, of newly-made butter, of Tuscan wax, of each, oz. ij; of rose-oil, oz. iv; triturate the litharge with the juice of endive, and add to the other things when melted. Food of easy distribution and wholesome may be given, and some watery wine; avoiding acrid food and repletion, for they are apt to be troubled with indigestion.
Commentary. Hippocrates (de Morb. Mulier. ii, 24) gives a long account of cancer of the womb, which, when fairly formed, he pronounces to be utterly incurable. He directs us, however, to try the effect of fumigating the womb by introducing into it a pipe attached to a pot. Steams from garlic and the fat of seals are to be applied in this manner.
Aëtius gives from Archigenes exactly the same account as our author.
Aretæus describes the ulcerated cancer, and that kind in which there is no ulceration. He calls them chronic and fatal diseases.
Haly Abbas pronounces the disease to be incurable, but directs us to soothe the sufferings of the patient by various anodyne preparations. For this purpose he gives directions for the formation of several pessaries and injections, the principal ingredients of which are linseed, chamomile, fenugreek, coriander, beet, poppies, and the like. Alsaharavius also approves of such anodyne applications. Rhases enjoins abstinence from everything of an acrid nature, and such articles as engender black bile.
We will see the treatment of cancers in general detailed in the Fourth Book.
SECT. LXVIII.—ON SCIRRHUS AND SCLEROMA.
The uterus becomes scirrhous, sometimes all at once without any preceding complaint, but most frequently after having been preceded by inflammation, which has neither been resolved nor converted into an abscess. The disease called scleroma is a species of scirrhus, most frequently forming about the neck of the womb, and having also some swelling, but less resisting, and attended with moderate pain. These are accompanied with displacement to the opposite parts, swelling powerfully resisting in proportion to the pain, with heaviness and difficulty of motion, not of the limbs only but of the whole body, and aversion to exertions. When not properly cured, a dropsical cachexia supervenes. In the commencement we must have recourse to venesection, or purging with the hiera of Archigenes; then to cataplasms of dried figs, grease of wool, nitre, or wormwood, and cupping with scarifications; and to the soothing ointments (malagmata), namely the Polyarchium, that from seeds, and that from bay-berries; to hip-baths prepared with the decoction of dried figs, mugwort, pennyroyal, and marshmallows; to pessaries of turpentine, galbanum, myrrh, iris, and the grease of wool; to dropaces and the use of the natural baths, namely, the nitrous and bituminous. When the strength permits, a course of hellebore may also be tried.
An emollient pessary. Of Pontic wax, of nard ointment, of each, oz. iij; of the ointments of iris, that of privet, and that called Gleucinum, of each, oz. ij; of the grease of bears and geese, of butter, of the sordes of unwashed wool, of stags’ marrow, of turpentine, of each, oz. j.—Another: Of poley, dr. ij; of myrrh, dr. iv; having triturated with Mindesian wine, and mixed it with Irinum, give to be applied.—Another: Of Tuscan wax, of the fat of calves, of turpentine, of stags’ marrow, of Attic honey, of old oil, equal parts. The following is an alterative which answers also for inflation: Of the dried white grape without its stones, oz. iij; of the leaves of the green rue, oz. ij; of sea water, oz. iss; of cumin, dr. iv; of honey, q. s.; having anointed the pessary, dip it in the oil of privet, and apply. And the pessary called golden, the Libanian, and the Enneapharmacus suit well with this affection; but the Titian is more particularly applicable.
Commentary. Our author’s account of these diseases is taken from Aëtius, who professes to copy from Soranus the Methodist. None of the other authorities has treated of them so fully. Bernard justly remarks (ap. Nonni Ep. 208) that if the ancients had not been familiar with inspectiones cadaverum, they could not have described the diseases of particular parts of the uterus so accurately as they have done. Actuarius briefly states that scirrhus of the uterus is to be treated by applications of a digestive and emollient nature, namely, emollient oils and fats, mixed with such things as galbanum, bdellium, and the like.
Of the Arabians, Avicenna is the most minute, but his treatment is borrowed from the Greeks. Haly Abbas remarks that scirrhus has a tendency to terminate in dropsy, and it is attended with sallowness, weakness, loss of appetite, amenorrhœa, swelling of the breasts and belly. His remedies are similar to those for cancer.
See an interesting account of this disease by Lodovicus Mercatus (ap. Gynæcia, 951.)
SECT. LXIX.—ON THE MOLE.
The mole, too, is a scirrhous tumour, forming sometimes at the mouth and sometimes in the body of the womb, conveying to the touch the sensation of stone, and being attended with retraction of the parts above, and emaciation, paleness, loss of appetite, retention of the menses, and swelling of the breasts, so as in certain cases to raise suspicions at first of a conception; but in process of time the true nature of the complaint is developed. Sometimes also it raises suspicions of dropsy, from which it is to be distinguished by the hardness of the swelling, and from there being no sound of water when tapped by the fingers, as is the case in dropsy. In certain cases, however, the disease actually terminates in dropsy, which for the most part proves incurable. In some cases, it also brings on a discharge of blood. In general, therefore, it is proper that the patients should lie in a small, dark, and moderately cool house, upon a firm couch, with their feet raised, and in a state of quietude; for motion provokes discharges of every kind. And the swelling and hardness are to be cured by the remedies which we have mentioned for scirrhus and scleroma of the uterus; dropsical effusions by those recommended for dropsy; and hemorrhages by those for the flux. Some call by the name of mole an unorganized mass of flesh which forms on the coats of the womb, and is delivered like the fœtus. This species is to be managed by a relaxing treatment, so as to be speedily discharged.
Commentary. By the first species of mole, fibrous tumour of the ovaria and perhaps also scirrhus of the neck of the womb are meant to be described. The other species is now well understood, and is described by many ancient authors. See an account of it at the end of Aristotle’s ‘History of Animals;’ also Pliny (H. N. vii, 15, and x, 64); Hippocrates (de Steril. xx); Plutarch (t. i, 252, ed. Xylander); Nonnus (212); Rhases (ad Mansor. ix, 88; Cont. xxii); Moschion (de Morb. Mul. 125); Actuarius (Meth. Med. i, 56.) Galen and Avicenna agree in representing the true mole as a corruption of the male semen, and consequently they believed that it never occurs in virgins. Hanneman and other modern authorities maintain the contrary. See ‘Dissertations on the Mole’ by Van Swieten (Comment. 1326), by Ambrose Paré (de Hom. Genit. xxxiii), by Martinus Akakia (ap. Gynæc. 773), by Lodovicus Mercatus (ap. Gynæc. 1013), by Leonardus Jacchinus (Comment. in Rhasis, ix, 71), and by Ruysch (Anat. Chirurg. Cent.)
Aëtius gives an account of the former species, but it is little different from our author’s. He recommends, in the first place, emollient applications of all kinds, namely, baths, pessaries, and fumigations, and afterwards dropaces, sinapisms, and the like. The same plan of treatment is pursued by Avicenna. Haly Abbas and Alsaharavius describe the two species of mole in exactly the same terms as our author. Rhases also describes the two species of mole, namely, the one which is hard and round, and the other or soft species to which the name is now generally restricted.
Hippocrates relates a curious case of a calculus which was discharged from the uterus of a woman sixty years old, who had long felt pain in that region dum venere uteretur. Aëtius also makes mention of the uterine calculus. Lodovicus Mercatus gives a curious account of this subject (Gynæc. 969.) Michaelis Angelus Morus relates a singular case of a woman who died of uterine calculi. (Mangeti Bibl. Chirurg. xviii.)
SECT. LXX.—ON INFLATION OF THE UTERUS.
The uterus becomes distended with air from cold, from abortion, or difficult parturition: its mouth being shut up, or a clot of blood being fastened in it. The air is sometimes contained in the cavity of the uterus itself, and sometimes in the pores of its body. These cases are attended with swelling about the pubes and hypogastrium, with hardness, and a pungent pain, shooting as far as the diaphragm, the stomach, and the groins. When tapped with the fingers it sounds like the swelling of tympanitis. Wherefore it is to be cured, in the first place, by venesection, if nothing prohibits its use; and then, during the exacerbations, by abstinence from food; by embrocations with oil of rue; by hip-baths of the decoction of rue, of pennyroyal, of mugwort, of cassia, and the like; by cataplasms from the seeds of parsley, of cumin, of fennel, of anise, of bishopsweed, and of the flower of iris; by dry cupping, and cupping with scarifications. But when the complaint is protracted, we must have recourse to purging with the hiera picra, dropaces, sinapisms, and the use of the natural baths. Let the midwife introduce her finger well oiled, and extract gently, if possible, the thrombus lying in the womb, by breaking it down, and then apply a cataplasm of figs, of nitre, and of wormwood. Emollient epithemes should be used, such as the Polyarchian, that from seeds, and that from bay-berries. The pessaries should consist of rue, honey, and nitre; but the following one will be particularly applicable: Of fat figs pounded, dr. j; of cumin, dr. ij; of aphronitrum, dr. j. But, owing to its acrimony, let it be previously dipped in milk. Emollient pessaries are also proper.
Commentary. This complaint is mentioned by Hippocrates (Epidem. vii), and by Galen (Meth. Med. xiv, 7, and de Causis Sympt. iii, 2.) Our author’s account of it is taken from Aëtius. Octavius Horatianus and Nonnus direct similar applications, only the former says nothing of bleeding. Haly Abbas, in like manner, omits venesection, but recommends applications consisting mostly of carminative substances, such as parsley, birthwort, dill, rue, and fennel. They are to be used in the form of baths, fomentations, and injections. Alsaharavius recommends bleeding, anointing the womb with oil of rue, baths prepared with rue, chamomile, mace, cumin, &c. cupping-instruments applied to the pubes, and so forth. Avicenna and Rhases refer to Aëtius and Paulus, and treat of the complaint in like manner.
See a full account of this disease by Lodovicus Mercatus (ap. Gynæc. 944.)
SECT. LXXI.—ON UTERINE SUFFOCATION, OR THE HYSTERICAL CONVULSION.
Uterine suffocation is a rising up of the uterus, affecting sympathetically the most important parts, as the carotid arteries, the heart, and the membranes of the brain. The patients experience, when the attack is at hand, languor of mind, fear, atony of the limbs, paleness of the countenance, and sadness of the eyes; and when the suffocation comes on there is deep sleep, mental aberration, loss of the senses and of speech, with contraction of the limbs; the cheeks then begin to redden, and the countenance becomes turgid; but when the attack is going off, some moisture is to be felt about the genital organs; and rumbling of wind in the intestines precedes the remission. The uterus is then gradually relaxed, and thus they recover their understanding and senses. The disease comes on periodically like epilepsy, and is occasioned by the uterus being gorged, or from semen or some other matter having become putrid in it. Of those attacked with it the greater number speedily recover, but some die suddenly during the paroxysms, their pulse becoming dense and palpitating irregularly, and then asphyxia taking place; a little perspiration bedewing the surface of the body; and the respiration being at first feeble but afterwards becoming completely stopped. This affection attacks most frequently in winter and autumn, especially young women who are prone to venery, the barren particularly, if their sterility be brought on by medicines, and others of a cold nature. During the paroxysms, therefore, ligatures are to be applied around the extremities, and the limbs and whole body rubbed as for the recovery of persons in deliquium animi. Things of a strongly fetid smell are to be applied to the nose, such as an extinguished lamp, castor, liquid pitch, gum vernix, burnt wool and rags. Some have even brought close to the nose a chamber-pot containing stale urine or fæces. It answers well to apply a cupping-instrument to the groins and hypogastrium, with great heat, either performing dry cupping or cupping with scarifications. When the complaint is protracted, carminatives will prove useful, such as collyria introduced into the anus, or cumin and nitre with honey. Hardened fæces may also be discharged from the bowels by means of clysters, lest by their presence they occasion pressure; and, in order to draw back the uterus to its situation, fragrant ointments are to be injected into the parts, such as those of marjoram and Indian leaf. Mustard may be applied to the nose and likewise to the feet, in the form of a cataplasm. One should call aloud to them in a shrill tone of voice, and rouse them thereby; and sternutatories of castor, fuller’s herb, and pepper may be applied. When the paroxysm remits we may compel them to vomit, and keep them from food altogether or allow them but little. After the seventh day we must purge them with the hiera from colocynth. After the third, we must apply cupping-instruments to the loins and flanks, and then we may give a draught of castor, sometimes in a decoction of mugwort and sometimes in honied water; for in some cases this alone is sufficient for a complete cure. But hip-baths and emollient pessaries are also to be applied. Such is the treatment for the paroxysms; but for the recovery of the general system, we begin with venesection and proceed to purging with hiera, and then give the medicine called picra from aloes to the amount of dr. j, with three cupfuls of honied water in succession, or dr. ij with six cupfuls at intervals. Dropaces, cupping, and sinapisms must also be used, and the acopa from euphorbium; then exercises, friction, vociferation, and, last of all, the use of the natural baths.
Commentary. See Hippocrates (de Nat. Muliebri); Galen (sec. loc. ix, de Loc. Affect. vi, 5); Aretæus (Morb. Acut. ii, 11); Celsus (iv, 20); Moschion (de Morb. Mul. 129); Eros (ap. Gynæcia); Aëtius (xvi, 78); Oribasius (Synops. ix, 47); Leo (vi, 20); Actuarius (Meth. Med. iv, 8); Nonnus (210); Alexander Aphrodisiensis (Probl. ii, 64); Serapion (v, 27); Avicenna (iii, 20, iv, 16); Haly Abbas (Pract. viii, 12; Theor. ix, 39); Alsaharavius (xxv, 2, 12); Rhases (ad Mansor. ix, 87, and Contin. xxii.)
From the days of Hippocrates to those of Actuarius, and long afterwards, the hysterical convulsion was accounted for in the manner explained by our author. It accords not well with modern ideas upon the subject; and provided it be admitted as a fact that men are sometimes, though rarely, seized with hysterical convulsions, there can be no doubt but the ancient hypothesis must at once fall to the ground. Perhaps a stickler for the ancient doctrine, while he admitted with Aretæus that men are subject to complaints resembling hysterics, might hold with a late intelligent writer, Mr. Tait, that men are never affected with the real hysterical convulsion.
According to Hippocrates, this complaint most frequently attacks antiquated virgins or young widows. If the womb, he says, ascend to the liver, the patient suddenly becomes speechless, her teeth are fixed, and her colour becomes pale. His treatment consists of applying a tight swath round the middle, giving fragrant wine, applying fetid things to the nose, and fragrant things to the uterus. The belly is to be purged, and castor and fleawort given internally. Herodotus, the historian, mentions that the ancient Scythians used castor for the cure of complaints of the uterus. (iv.)
Galen is at great pains to explain how the uterus is retracted upwards and to the sides by its ligaments, but his explanation is too long for our limits, and therefore we must content ourselves with referring the curious reader to it. (De Loc. Affect. u. s.) He says, in another place, that when uterine suffocation takes place, there is loss of sense and of motion, a small feeble pulse, and sometimes asphyxy. He recommends agaric and plantain in wine; smelling to bitumen, castor, liquid pitch, cedar rosin, &c.; fumigating the parts with hartshorn, and applying to them rue and honey upon wool.
Celsus thus marks the distinction between the epileptic and hysterical convulsion: “Interdum etiam sic exanimat ut tanquam comitiali morbo prosternat. Distat tamen hic casus, eo quod neque oculi vertuntur, nec spumæ profluunt, nec nervi distenduntur; sopor tantum est.” If the strength permit, he approves of venesection, or of cupping the groins without scarifications; then fetid things are to be applied to the nose, and fragrant things to the uterus, the whole body is to be rubbed, sinapisms are to be put to the lower part of the belly, and castor, gith, and dill given internally.
Aretæus surpasses every other ancient author in his description of this affection. He sets out with pronouncing the uterus to be, as it were, an animal within an animal, wandering upwards, downwards, and to either side, being attracted by fragrant things and flying from fetid. When, therefore, it ascends upwards, it occasions compression of the liver, diaphragm, lungs, or heart, and sympathetically with the last, also of the carotids. It is accompanied with heaviness of the head and loss of sensibility. Nearly allied to it, but yet a different affection, is a complaint which attacks men, having therefore no connexion with the uterus, and not being relieved by fetid things. He says that, when the attack proves fatal, the pulse sinks and becomes irregular and intermittent, there is a strong sense of suffocation, loss of speech, loss of sensibility, respiration unequal or not even perceptible, sudden and unexpected death. For some time after the countenance does not put on the appearance of death, but is redder than natural, and the eyes project. He also gives a good account of the treatment, which, however, cannot be said to differ in any material respect from that of Galen and Celsus, as explained above. The same may be said of Oribasius, Nonnus, and Octavius.
Aëtius is very minute in his description. He remarks that after respiration by the mouth is stopped, the arteries may continue to beat, as is the case with reptiles in winter. The disease, he says, is occasioned by a flatulent refrigeration, and not by inflammation, as Soranus has said.
Actuarius accounts for the complaint and describes it in the same terms as the preceding writers. As it occurs principally with virgins and widows, he prescribes for them the Hudibrastic mode of wooing widows!
Eros gives the same account of the symptoms and treatment as the others.
Moschion, however, disapproves entirely of the common practice of applying fetid things to the nose, ligatures to the extremities, and fragrant pessaries to the uterus. On the contrary, he recommends warm fomentations, injections of warm water thrown into the uterus, rubbing the body with warm hands, and when the disease gets into the chronic state, giving alteratives (metasyncritica) and hellebore.
According to Leo, men who have been long restricted from venery are subject to the hysterical convulsion.
See, in Alexander Aphrodisiensis, an ingenious explanation why fetid substances applied to the nose and fragrant ones to the parts below were supposed to prove beneficial in such cases. It is too long for our purpose.
The account which Plato gives of the nature of the uterus and the phenomena of hysterics ought perhaps not to be taken in too literal a sense, considering that philosopher’s well-known propensity to mystification. He says, that part in women which is called the womb being an animal desirous of generation, if it become unfruitful for a long time, turns indignant, and, wandering all over the body, stops the passages of the spirits and the respiration, and occasions the most extreme anxiety and all sorts of diseases. (Timæus.)
The Arabians describe and treat the complaint exactly like our author. Serapion says that the uterus is delighted with fragrant things, and flies from fetid, not because it is an animal but from a natural property. He recommends ligatures to the extremities, purging with hiera picra, bleeding if not contra-indicated, the application of fetid things to the nose, and of fragrant things to the uterus, and so forth. Avicenna states that the affection arises from the menstrual discharge or semen being retained in the uterus. Haly Abbas adopts this explanation. He says the uterus affects the brain and heart sympathetically, giving rise to apoplexy, epilepsy, and other serious complaints. Young women, especially widows, are most liable to it. He says it is often periodical like epilepsy. His treatment consists of ligatures to the extremities, with friction, sprinkling rose-water on the face, applying fetid things to the nose, and the other means used in cases of suspended animation. At the same time he directs us to apply fragrant things to the parts of generation, and dry cupping to the hypogastric region. This is the treatment during a fit. To remove the tendency to the affection he recommends the warm bath medicated with wormwood, bay-leaves, marjoram, &c. fetid pills, hiera picra, and the like; and when connected with suppression of the menstrual discharge, he directs bleeding at the ankle, or even at the arm, if there be fulness and redness of the face. If the woman is unmarried, he recommends a change of life. Alsaharavius states that there is this difference between the hysterical and the epileptic convulsion, that in the former the woman does not lose her senses nor emit foam at the mouth. Like Haly, he directs us to bleed at the ankle when the menses are obstructed, to apply cupping-instruments to the thighs and hypogastric region, and to take diuretics and emmenagogues. There is nothing peculiarly interesting in Rhases, as his account of the disease is collected from preceding authors. One of them seems to say that the ascension of the uterus is not real but apparent. He remarks that affections of the uterus are attended with pain of the occiput.