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.