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.