Chapter XXVIII: Part 28

COMMENTARY. Many of the ancient authorities make no distinction between satyriasis and priapism, but, according to Cælius Aurelianus, the former is an acute and the latter a chronic disease. Prosper Alpinus, the modern Methodist, says, there is this difference between satyriasis and priapism—that in the former there is violent venereal desire, whereas, in the latter, there is continued erection, but no desire nor emission of semen. It seems, in short, to be a sort of chronic chordee.

Our author, Oribasius, Aëtius, and Actuarius, follow the principles of treatment laid down by Galen. The latter speaks of the anti-aphrodisiacal medicines mentioned by our author.

Alexander forbids the use of such things as are of an intensely cold nature, especially astringents and narcotics. He recommends friction, exercise of the upper parts of the body, and abstinence from flatulent food. All incentives to venery are of course to be avoided.

Avicenna agrees with the Greek authorities respecting the anti-aphrodisiastical properties of rue. Like them, he recommends emetics, but disapproves of drastic purgatives. When the affection is of an inflammatory kind, Haly Abbas recommends general bleeding, cupping, leeches, and applications of a cooling nature, such as vinegar, purslain, solatrum, gourd, &c. Alsaharavius recommends various refrigerant and anodyne remedies, internally and externally.

SECT. LVIII.—ON IMPOTENCE OF THE PARTS.

Those having this complaint have lost their venereal desires, and have become depressed in spirits on that account. The cause of it is a paralysis of the parts, or a defect of semen. Those things which engender semen are treated of under the head of Hygiene in the First Book; and there, too, the incentives to venery of a simple nature are mentioned; and we must now add those which are stronger. Wherefore we must use in general those applications called acopa which are recommended for paralysis; but in particular levigate a burnt swift (_stellio_), and, adding oil to it, anoint the great toe of the right foot, and then try the venereal act; and when you wish to give over, wash away the ointment from the toe. And the composition from swifts called polymigmaton is a very efficacious application; or propomata from medicines which rouse to erection must be taken, such as this: Of pepper, of pine-nuts, of Macedonian parsley, of the shavings of hartshorn, of turpentine, equal parts; mix with honey.—_Another_: Of raw chick-peas, of pine-nuts, of each, oz. ij; of rocket, of pepper, of each, oz. j; mix with honey, and give two drachms in wine. And the compound medicine called satyriaca, and such like, will be applicable. But we must also attend to the other causes of the complaint, and apply remedies corresponding to them.

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COMMENTARY. This Section is mostly abridged from Aëtius (xi, 35.)

Octavius Horatianus recommends moderate exercise, friction of the extremities, and particularly of the groins, with pepper, euphorbium, and the like; applying plasters (dropaces) of the same to the groins and loins, or making suppositories of them; giving flatulent food, such as rocket, pepper, and the seeds of tares; lying upon a downy bed; having the attendance of females; and indulging in obscene reading.

See a long list of aphrodisiacal medicines in Myrepsus (40); and in Avicenna (iii, 20, 1, 18.) In the latter we remark the nettle, lupine, rocket, asparagus, parsley, cresses, beans, cinnamon, and an animal called _dabet alurel_, which we conjecture to be the stellio or swift. Haly Abbas treats minutely of this affection, according as it arises from paralysis of the part or defect of semen. In the latter case, as he considers the state of the parts to be connected until a dry and cold intemperament, he recommends juicy flesh, beans, vetches, sweet wine, and so forth. He approves of a hot bath in which violets have been boiled. He also gives calefacients, such as rocket, ginger, asparagus, onions, and the like. Alsaharavius mentions various causes of impotence. One of them is, “excessus delectationis ad illam quam diligit.”

The aphrodisiacal properties of rocket are mentioned by Juvenal (Sat. ix, 134.) See also Pliny (H. N. xix, 6.) Juvenal appears to allude to aphrodisiacal friction. (Sat. vi, 52.)

Athenæus gives a marvellous account of the efficacy of aphrodisiacal medicines. (Deipnos. i, 11.) See the thirty-sixth Section of the First Book of this work.

SECT. LIX.—ON MATTERS RELATING TO THE GENITAL ORGANS AND ANUS.

Ulcers on the pudenda and about the anus, when free from inflammation, require very desiccative applications, such as that from burnt paper, dried burnt dill, and burnt gourd. For humid and recent ulcers, aloes is a good application, when sprinkled on them dry in a fine powder. But the medicine which gives least pain, and is as efficacious as any other, is pompholyx. If the ulcers are more humid, the bark of the pine by itself and bloodstone are proper; but if the ulcers are also deep, manna must be mixed with them; and if the ulcer be spreading, we must apply a cataplasm of dried lentil with pomegranate-rind, and use the plaster called Coracum from oxymel, the trochisk called Bithynus, and that from paper. Fissures in the privy parts and anus are remedied by roasted rosin (_colophony?_) rubbed with rose-oil, so as to become of the consistence of bath-sordes, and having the yelk of an egg and opium mixed; or the ashes of the dried leaves of ivy burnt, when pounded with rose-oil in a leaden mortar, may be applied. And the trochisk from wine and oil and that from Phrygian stone are excellent applications for fissures and foul ulcers about the corona glandis, more especially when the prepuce cannot be drawn back.—Another simple application, which also blunts acrimony: Of cadmia burnt and washed, oz. ij; of the rose-leaves stripped of their nails (i. e. the white parts of the leaves), oz. vj; sprinkle it dry, having first wiped the part with wine.—The following is an application for condylomata: Of chalcitis, of uncleansed wool, of cerate, of hart’s marrow, of bramble-leaves, equal parts, with cerate; and that from wine and oil in like manner. But if a concealed ulcer is found on the penis within its opening (_the urethra_), which is discovered from pus or blood being evacuated without urine, it may be cured by first washing it with honey diluted with much water, and then with milk, and then mixing with the milk the collyrium of aster; or the white trochisk, or that from lotus is to be put into a leaden mortar, and the parts anointed, by dipping a feather in it; and then a small twisted tent of scraped linen may be anointed with it and applied. A most excellent application is the one containing of galls, of pompholyx, of starch, and of aloes, equal parts, triturated with rose-oil and the juice of plantain.

_For pains of the privy parts._ Apply equal parts of butter and of rosin, both properly melted; or apply equal parts of myrrh and of roasted rosin (_colophony or fiddlers’ rosin?_) triturated with the juice of the plantain.

_For swelling of the penis._ Of tender vine-leaves, dr. j; of ceruse, dr. v; triturate and apply; bathe with cold sea-water; enjoin rest; and apply bandages to the penis. The lixivial ashes of vine-twigs applied with vinegar cure thymous tumours of the penis, and do not permit them to increase again; and so in like manner the ashes of the burnt bark of willows. In general the thymus, myrmecia, and acrochordon will be eradicated by strongly corrosive applications, and become dead when treated with septics. But, in particular, elaterium when applied with salts is useful, also unripe figs with vinegar, nitre, and flour, and the juice of the fig when rubbed in; the burnt head of an anchovy pickled, verdigris calcined with native sulphur, the juice of tithymallus (_spurge?_) when rubbed in, the leaves of basil with copperas, or the fruit of the large sunflower applied with wine.

_For inflammation of the anus._ Of ceruse, oz. iv; of pompholyx, oz. j; or of soft cadmia, of frankincense, oz. j; of the juice of endive, one hemina; mix, adding the juice by degrees until it be all consumed, and then having made a cerate of two ounces of wax, and one pound of rose-oil, mix; and having shaved the part, soften with this strongly. Inject by an instrument for extricating pus, and apply a bandage above. It is of use for inflammatory fissures, and ulcers of the anus attended with heat or pruritus.

_For erysipelas about the anus._ Of diachylon plaster, lb. j; of rose-oil, q. s; of pure bread, lb. j; of saffron, oz. j; of opium, oz. j. The saffron and opium are macerated in must, and the bread in water; then, when they are pounded, the diachylon and rose-oil are put into them and allowed to soften. It is also applicable to gout attended with the greatest heat.—_Another, applicable also to inflammation of the anus_: Triturate ceruse with wine and rose-oil in a leaden mortar with a leaden pestle, anoint with it; or, having triturated ceruse, the white of an egg, and rose-oil in the same mortar until it become of the consistence of bath-sordes, anoint with it.

_For acute pain of the anus._ Of the tender leaves of henbane, of the tender leaves of purslain, of crumbs of bread soaked in wine, of the yelks of roasted eggs, equal parts; of rose-oil, q. s. After fomenting the part with the decoction of roses and melilots, apply this cataplasm.

_An excellent application for inflammation of the anus, and, excrescences thereof._ Of ceruse, of litharge, of ammoniac perfume, of bdellium, of each, scr. vj; of turpentine, oz. j; of wax, oz. ss; triturate the powders with the juice of nightshade, of henbane, or of purslain; and having mixed the soluble articles, take, and having softened them with rose-oil, use. And the composition called Phicotyche, and that from plumbago, are excellent applications for inflammations of the fundament. And the trochisks from lotus, from winter-cherry, and that from roses are esteemed applications for the anus and privy parts.

_For excrescences of the anus._ When these excrescences are inflamed, we must use the general applications already mentioned, and in particular the following trochisk: Of ceruse, oz. iij; of pompholyx, oz. j; of litharge, oz. ij; of mastich, scr. iij, add to the juice of henbane. When they are free from inflammation, sprinkle the ashes of burnt cypress balls, having first washed the parts with wine, or the ashes of the burnt peel of dried gourd, or of the bones of dates in like manner, or the ashes of eggshells and of fennel; or having mixed the juice of pomegranate leaves with an equal portion of white wine, wash with it for seven days. For callous excrescences: Triturate quicklime and arsenic with strong vinegar. It will answer well if you anoint with it in the sun.

_On hemorrhoids or piles._ When piles discharge more than is proper, the consequence is, that the system is reduced to a watery state, and they lose their appetite. There is risk both from the hemorrhage becoming too profuse, and from its being altogether suppressed; and therefore the treatment is attended with difficulty. Wherefore, when the piles are numerous, one ought always to be left for the sake of purging the system. Some also are seated high up and do not make their appearance, which renders them difficult to be cured. Blind piles discharge nothing, but are on that account more painful than the others. On them, therefore, rub the juice of sow-bread, which will open them. For immoderate discharges, take of the Egyptian thorn, of the leaves of the elder, of mugwort, of each, oz. v; boil in eight heminæ of water to one-half, and add of ironwort oz. iv. The herbs are then to be thrown away, and to the decoction the following things are to be added in powder: Of melanteria, of round alum, of each, dr. viij; of litharge, dr. iv; of galls, oz. iij; of misy, dr. ij; of endive, dr. ij. Dissolve this powder in the decoction, and bathe with it seven times in the day; but on the following day bathe with an equal quantity of another preparation of the same kind, and on the third in like manner. If any part of them remain on the fourth day, pierce it with a needle, and if it has any feeling, or bleeds, prepare a decoction like the former, but add only one-half of the powder; but when you have washed until it touch with the powder, that they may be properly burnt. For the inflammation apply a bread-poultice.—_Another_: Having soaked pure bread in primary sauce, and haring burnt it in a new pot, triturate, and apply it, having first bathed with wine. It is applicable also to excrescences.—_Another_: Of endive, dr. ij; of chalcitis, dr. j; of misy, dr. j; of copperas, dr. iij; of fissile alum, dr. ix; of burnt copper, dr. j; of melanteria, dr. j; use in a powder. The food for those who have immoderate discharges should be such as forms but little blood, and is not excrementitious, of a desiccant and astringent nature, such as chondrus soaked in oxycrate, rice, and halica, and of pot-herbs, intybus, succory, and purslain, and of wines such as are astringent. For blind piles, food of an opposite description is proper, but particularly the fish called calamary, the cuttle-fish, polypus, the torpedo, and the cartilaginous fishes; for these things raise a tumult in the blood. Emmenagogues are also proper remedies in this case.

_For procidentia ani._ Of the fruit of heath, of galls, of ceruse, of acacia, of the juice of hypocistis, of pine-bark, of frankincense, of Aminæan myrrh, equal parts; apply in a powder, having first bathed with austere wine.—_Another_: Of the dross of lead, of Syriac sumach, of each, oz. viij; of the flowers of roses, dr. iv; of Aminæan myrrh, dr. ij; use like the first.—_Another_: Of pine-bark, of manna, of litharge, of each, dr. viij; of dried cypress balls, of plumbago, of each, dr. ij; use as directed above. Bathing with the patient’s own urine while yet warm is also useful.

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COMMENTARY. Consult most of the works referred to in the fifty-fourth Section.

The first part of this Section is almost entirely taken from Galen (sec. loc. ix); the remainder seems to be abridged from Aëtius (xiv.) Galen (Meth. Med. v, 15) insists strongly that diseases of the penis should be treated with desiccative instead of epulotic applications.

No ancient author has treated so fully of diseases of the genital member as Celsus (vi, 18.) His description of the ulcers upon it is very minute. Ulcers, he remarks, are found either upon the prepuce, or on the glans, or beyond it on the member itself. If dry, they are first to be bathed with warm water, and then lycium (catechu?) out of wine, or the lees of oil boiled with the same, or butter with roses is to be applied. If there is a slight discharge, they are to be washed with wine; then honey and a fourth part of turpentine-rosin are to be added to the butter and roses for an application. When there is a purulent discharge it is to be washed away, and the part dressed with an application containing pepper, myrrh, saffron, and misy, boiled in austere wine to the thickness of honey. He mentions various other escharotics containing ærugo, alum, and the like. When at any time inflammation comes on, a cataplasm must be applied. Spreading ulcers are to be treated with applications containing the escharotics we have just mentioned. When a watery sanies runs from the sore it is to be treated with basilicon (tetrapharmacon) melted with roses and some frankincense; and it is to be frequently bathed with hot water and covered up from the cold. The tubercles called phymata are to be burnt down with medicines or a cautery of iron, and when the crust falls off, the squama æris is to be sprinkled on the part. Cancerous sores are to be extirpated by escharotics, as by a composition of quicklime, chalcitis (sulphate of copper?) and arsenic; or they are to be cut out and the part burnt. Phagedænic sores in like manner are to be burnt with medicines or the actual cautery.

Avicenna approves of Galen’s rule of treatment stated above. When sores are recent, he recommends in particular aloes, and when more humid, burnt copper. When an incarnant is required, frankincense is to be mixed. Prurigo is to be cured by venesection, purging, and liniments containing nitre, alum, sal ammoniac, or even stavesacre with vinegar or rose-oil. For prurigo, Alsaharavius recommends lotions of sea-water, decoctions of chamomile, saffron, and camphor pounded with vinegar, and the like applications. For hard pustules he recommends various corrosive applications, some of which contain arsenic. Haly Abbas remarks that ulcers on the genital membranes are attended with the same symptoms as those on other parts.

_On diseases of the anus._ Celsus has likewise treated very fully of these complaints. For rhagadia or fissures he recommends first the hot bath, and afterwards cooling ointments, such as old oil with litharge, and unwashed wool spread with a composition of liquid cerate and roses. The regimen is thus tersely pointed out: “Liquida, lenia, pinguia, glutinosa, meliora sunt.” The tubercle called condyloma is said to derive its origin from inflammation, and is to be treated at first by making the patient sit in a hip-bath of water having vervain boiled in it; and then lentil with some honey, or a composition containing chalcitis, or alum with ceruse and litharge, or the like, is to be applied. If these do not succeed, the escharotics, such as verdigris, antimony, &c., or even the more powerful caustics are to be used. He treats hemorrhoids upon much the same plan as our author. He begins by inculcating that there is danger in suppressing them suddenly. They are to be treated at first upon the soothing plan, by baths, emollient applications, and those directed for fissures. When these fail, strong caustics are to be applied, such as the composition consisting of arsenic, squama æris, and quicklime. Next day they are to be pierced with a needle. In certain cases he prudently directs bleeding from the arm. Procidentia ani is to be treated in the first place by fomenting the gut with austere wine and the like, and replacing it; and then applying the leaves of willow boiled in vinegar, a linen compress, wool, and a bandage. Fungous ulcers are to be bathed with tepid water, if in winter, or with cold if at any other season; and then sprinkled with squama æris, or dressed with a cerate containing the same with quicklime, &c. If these do not succeed, the parts must be burnt with potential or actual cauteries.

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:

“Expirantis adhuc scombri de sanguine primo,
Accipe fastosum munera cara garum.”

(Epigr. xiii, 56.)

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.

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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.

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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.

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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.

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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.