Part 98

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.

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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.

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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.

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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.

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