The seven books of Paulus Ægineta, volume 1 (of 3)

by Aegineta Paulus

SECT. LXIV.—ON INFLAMMATION OF THE UTERUS, AND CHANGE OF ITS POSITION.

Inflammation of the uterus takes place from several causes; for it may arise from an injury, from retention of the menses, from cold and inflation, not unfrequently from abortions, and from parturition after a misconception. Inflammation of the uterus is accompanied with acute fever; pain of the head and tendons, of the balls of the eyes, of the wrists and of the fingers; retraction of the neck, and retroversion; sympathy of the stomach; and the mouth of the womb is shut up; the pulse small and dense. If the inflammation be weak, they have not violent pain in the uterus; but if it be strong, the pain is of the pulsatory kind, which, when the whole of the uterus is affected, darts through the whole of it, but when the inflammation is confined to a spot, the pain indicates the seat of it. When, therefore, the posterior parts only are inflamed, the pain is in the loins, and hardened lumps of fæces are confined by the compression of the rectum; but when the anterior parts are affected the pain is seated at the pubes, and there is strangury or dysuria from pressure on the bladder. When the sides are inflamed, there is tightness of the groins and heaviness of the limbs; but when the fundus is affected the pain is principally near the navel, with swelling thereof; and when the inflammation is in its mouth there is pain in the hypogastrium, and if the finger be introduced per vaginam, the mouth of the womb will feel hard and unyielding. As to the treatment we must, in the first place, use embrocations of wine and oil, or of wine and rose-oil to the pubes and loins, by means of folds of clean wool without a bandage; and abstinence from food is to be persevered in for three days, after which we are to let blood from the arm, if nothing contraindicate. The patient is to be supported with chondrus out of honied water, bread, or soft eggs, every alternate day. But after the fifth day we are to apply a cataplasm made of fine flour, linseed, or fenugreek, with honied water, in which the heads of poppy have been boiled and thrown away, and oil along with them. But if the inflammation be of an erysipelatous nature, and cannot endure heat, boil melilot in must, and having pounded, add the yelks of roasted eggs, with rose-oil, oil of apples, or of saffron, and apply as a cataplasm; or having boiled dates in diluted wine, pound with fine polenta, and some of the afore-mentioned ointments, and apply as a cataplasm; and when the complaint is on the decline add the cerate of nard or of privet. Throughout the whole treatment the patient must sit in hip-baths prepared from the decoction of fenugreek, linseed, mallows, mugwort, and oil; and those who cannot bear these heating things must use rose-oil dissolved in hot water. Recourse must be had to pessaries, and injections prepared from the sordes of unwashed wool and butter, stag’s marrow, the grease of geese, the ointment called Susinum, and Tuscan wax. When the patients can endure heating things, the pessary called the Golden will suit with them, and the Enneapharmacus; but when they cannot endure heating things, the pessaries are to be prepared from eggs, rose-oil, the fat of geese, or of domestic fowls. For inflammations attended with a greater degree of heat, melt diachylon-plaster in a double vessel with rose-oil, and add the juice of plantain, or of endive, of succory, or of intybus. Or use the following: Of the fresh fat of geese, or of swine, dr. iv; of the cerate of roses, or of the Susinum, oz. ij; of the yelks of roasted eggs, oz. j; of saffron, dr. j; of myrrh, three oboli; of opium, two oboli; or, instead of opium, the decoction of poppy-heads. When the pain is great, give poppy-juice (opium) to the size of a lentil, with woman’s milk, or the juice of fenugreek, as an application per vaginam. For inflammation with hardness, dissolve the ointment called Tetrapharmacum in rose-oil, and introduce or inject. And when there is derangement of the position of the uterus, it is to be treated like inflammation during the violence of the attack; but, during the remissions or decline, emollients are to be applied; and when the complaint is protracted, alteratives (metasyncritica) are to be used. But if there is hardness externally, we must have recourse to malagmata; that from melilots, that of Muasræus, the Icesian, that from apples invented by Serapion, and that from wheat. The diet at first should be light; but when the complaint begins to decline the patient may use the bath, and take a more varied and generous diet.

Commentary. Aëtius has given from Philumenus a very circumstantial account of the symptoms and treatment of inflammation of the uterus; but, upon the whole, it is little different from our author’s. He also gives, from Aspasia, a fuller account of displacement of the uterus. Without doubt he alludes to retroversion and anteversion of the uterus, as they are called in modern works on midwifery. These cases generally occur in the first months of pregnancy, but there are instances of their happening in the unimpregnated state. (See Burns’ Midwifery, i, 19.) The symptoms, as described by Aëtius, are sufficiently well marked; retention of the fæces, owing to the rectum being obstructed by a tumour; pains in the region of the pubes, and sometimes retention of urine. He directs us to draw off the water by means of a catheter, and to bleed, give emmenagogues, and apply pessaries according to circumstances. Avicenna and Haly Abbas make mention of displacement of the womb, but they appear to have derived all their information from Aëtius.

We shall give a brief outline of Serapion’s treatment in cases of uterine inflammation. He properly begins with bleeding first from the arm, and afterwards at the ankle. He then gives a laxative medicine, and applies a plaster to the region of the uterus. When the complaint is at its acme, he directs us to use fomentations prepared by adding sedatives to such medicines as pomegranate-rind, endive, fleawort, fenugreek, chamomile and dill. When the inflammation does not abate, he directs us to encourage suppuration by the combination of maturative with calefacient medicines, such as a plaster containing fenugreek, barley-flour, figs, pigeon’s dung, &c. Haly’s plan of treatment is little different: General bleeding according to circumstances; cooling draughts composed of purslain, violets, spinage, &c.; plasters of violets, camphor, &c.; hot baths prepared with melilot, mallows, linseed, &c. When there is heat in the parts, he directs us to introduce oil of roses, with the whites of eggs, the grease of hens, &c. to which opium may be added. When the pain is violent, he particularly recommends cooling injections. Alsaharavius recommends bleeding from the arm and at the ankle, diluent and cooling draughts, local applications containing opium, seed of fenugreek, plantain, house-leek, &c. and the tepid bath.

Rhases says that when the womb is displaced, there is vehement pain with distension of the parts; the woman cannot rise nor sit but with difficulty; the urine is retained and sometimes the fæces. He directs us to restore the uterus to its position by drawing its mouth in the opposite direction. Displacement of the womb is also briefly noticed by Hippocrates (de Morb. Mulier. i); by Dioscorides (Meth. Med. i, 37); and by Soranus (Ap. Phys. et Med. Min. ed. Ideler, 256.)

Many of the ancient authorities describe the uterus as consisting of two cavities, separated from one another by a membrane. See, in particular, Theophilus (Comm. in Hipp. Aph. ii, 469, ed. Dietz.) Galen, however, would appear to have been better informed (t. v, 789, ed. Kühn.) The uterus, moreover, is correctly described by Soranus (Ap. Phys. et Med. Min. 256), and by Moschion. (vi.)