Part 99

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.

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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.

SECT. LXXII.—ON PROLAPSUS UTERI.

Prolapsus of the uterus takes place rarely indeed, but from a variety of causes; for it is occasioned either by a woman’s falling from a height and pitching upon her bottom, whereby the ligaments are ruptured which keep the viscus in its position; or by the tearing away of the secundines, which drag the uterus along with them when they adhere, as in difficult labour; or by the awkward performance of embryotomy; or by a blow, or mental emotions, such as when the loss of children has been communicated, or an irruption of the enemy, or by a dangerous voyage, or some such cause, by which the uterus has fallen down, owing to a relaxation of the whole system, or owing to paralysis and atony of the parts, which happens most especially to those in the decline of health. It is towards its mouth that it falls down. Some, indeed, have related that the whole uterus has been prolapsed, which is incredible; for how could it have been reduced and fixed in its place? Wherefore, we must first evacuate the hardened fæces by a clyster and bring about a discharge of the urine, in order that the uterus may be freed from all compression, and then place the patient in a supine position, having her bottom elevated, her thighs bent, and her legs separated; and then take a hasp of wool, in figure and thickness resembling the female vagina, and this being bound round with a slender piece of cloth, and dipped in the juice of acacia, or of hypocistis dissolved in wine, is to be applied to the uterus, and all the projecting part pushed upwards gently, until the whole swelling is restored to the vagina; after which the pubes is to be covered externally with a piece of sponge squeezed out of oxycrate; and the woman is to be laid with her legs stretched out and applied so that the one may lie over the other. After this, cupping-instruments with much heat are to be fixed to the navel and the loins on both sides, and things of a fragrant smell applied. On the third day, while the wool is still remaining in the vagina, let the woman sit in a hip-bath of dark-coloured austere wine slightly warmed, or in a decoction of myrtle, lentisk, and pomegranate-rind. After these things, let the wool be taken away and another fold applied soaked in the medicine. Cataplasms are to be applied externally to the hypogastrium, of dates, polenta, or dried lentils, and pomegranate-rind with oxymel. And every third day let the same thing be done until the cure be completed. But if the prolapsed part cannot be reduced, and mortify in the course of time, we may take it away without apprehending any danger: for they relate that the whole uterus, having become mortified, has been taken away, and yet the woman lived.

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COMMENTARY. This complaint is particularly well treated of by the Father of Medicine. He has even described the case of a complete procidentia, when, he says, the uterus hangs down like a scrotum. Hippocrates directs us to make cold applications to the pudenda; to wash the part with an astringent lotion, and restore it to its place. He afterwards gives directions to make the woman lie upon her back with her legs crossed and tied together; and if the disease be likely to return, he recommends cupping and pitching of the hypogastrium.

Celsus mentions prolapsus, and recommends for it hip-baths of salt or astringent water, and local applications of a styptic nature after the womb has been replaced.

Aretæus, with his usual talent for description, draws a melancholy picture of a woman labouring under a complete procidentia uteri. He says it is occasioned by abortions, violent concussion, or severe labour; and explains very well how this happens from relaxation or rupture of the ligaments of the uterus.

Our author takes his account almost word for word from Aëtius, who acknowledges his obligations to Soranus.

Alsaharavius recommends nearly the same plan of treatment as Hippocrates; and directs us, when the attempts at reduction fail, to extirpate the womb by an operation. Avenzoar relates a case in which he saw the whole uterus projecting externally. He did not know the issue, only he was sure that the disease subsisted for a considerable time. He also relates another case upon the authority of a friend of undoubted veracity. Haly Abbas likewise mentions that the uterus sometimes protrudes fairly out, and enumerates the same causes of the complaint as our author. He relates that cases have occurred of the whole uterus having become putrid and been removed entire. Rhases, Avicenna, and Serapion, appear to have derived all their information from Aëtius and Paulus. Rhases directs us to bathe the parts with styptic decoctions, to put the woman into a bath medicated with roses, myrrh, &c., to reduce the womb, and retain it with compresses soaked in an astringent solution.

Eros recommends baths composed of the decoctions of acorns, pomegranate-rind, sumach, galls, &c.; also astringent fomentations, and a cooling diet.