CHAPTER I
Treating of the several Maladies incident to the womb, with proper remedies for the cure of each.
The womb is placed in the hypogastrium, or lower part of the body, in the cavity called the pelvis, having the straight gut on one side to
protect it against the hardness of the backbone, and the bladder on the other side to protect it against blows. Its form or shape is like a virile member, with this exception, that the man's is outside, and the woman's inside.
It is divided into the neck and body. The neck consists of a hard fleshy substance, much like cartilage, and at the end of it there is a membrane placed transversely, which is called the hymen. Near the neck there is a prominent pinnacle, which is called the door of the womb, because it preserves the matrix from cold and dust. The Greeks called it clitoris, and the Latins praeputium muliebre, because the Roman women abused these parts to satisfy their mutual unlawful lusts, as St. Paul says, Romans 1. 26.
The body of the womb is where the child is conceived, and this is not altogether round, but dilates itself into two angles; the outward part is full of sinews, which are the cause of its movements, but inside it is fleshy. It is wrongly said, that in the cavity of the womb there are seven divided cells or receptacles for the male seed, but anatomists know that there are only two, and also that those two are not divided by a partition, but only by a line or suture running through the middle of it.
At the bottom of the cavity there are little
holes called cotyledones, which are the ends of certain veins or arteries, and serve breeding women to convey nourishment to the child, which is received by the umbilical and other veins, to carry the courses to the matrix.
As to menstruation, it is defined as a monthly flow of bad and useless blood, and of the super-abundance of it, for it is an excrement in quality, though it is pure and incorrupt, like the blood in the veins. And that the menstruous blood is pure in itself, and of the same quality as that in the veins, is proved in two ways.—First, from the final object of the blood, which is the propagation and preservation of mankind, that man might be conceived; and that, being begotten, he might be comforted and preserved both in and out of the womb, and all allow that it is true that a child in the matrix is nourished by the blood. And it is true that when it is out of it, it is nourished by the same; for the milk is nothing but the menstruous blood made white in the breast. Secondly, it is proved to be true by the way it is produced, as it is the superfluity of the last aliment of the fleshy parts.
The natural end of man and woman's being is to propagate. Now, in the act of conception one must be an active agent and the other passive, for if both were similarly constituted, they
could not propagate. Man, therefore, is hot and dry, whilst woman is cold and moist: he is the agent, and she the passive or weaker vessel, that she may be subject to the office of the man. It is necessary that woman should be of a cold constitution, because a redundancy of Nature for the infant that depends on her is required of her; for otherwise there would be no surplus of nourishment for the child, but no more than the mother requires, and the infant would weaken the mother, and like as in the viper, the birth of the infant would be the death of the parent.
The monthly purgations continue from the fifteenth to the forty-sixth or fiftieth year; but a suppression often occurs, which is either natural or morbid: the courses are suppressed naturally during pregnancy, and whilst the woman is suckling. The morbid suppression remains to be spoken of.
CHAPTER II
Of the Retention of the Courses.
The suppression of the menstrual periods, is an interruption of that accustomed evacuation of blood, which comes from the matrix every month, and the part affected is the womb.
CAUSE.
The cause of this suppression is either external or internal. The external cause may be heat or dryness of air, want of sleep, too much work, violent exercise, etc., whereby the substance is so consumed, and the body so exhausted that nothing is left over to be got rid of, as is recorded of the Amazons who, being active and constantly in motion, had their courses very little, if at all. Or it may be brought about by cold which is very frequent, as it vitiates and thickens the blood, and binds up the passages, so that it cannot flow out.
The internal cause is either instrumental or material; in the womb or in the blood. In the womb, it may be in various ways; by humours, and abscesses and ulcers, by the narrowness of the veins and passages, or by the adipose membrane in fat bodies, pressing on the neck of the
matrix, but then they must have hernia, zirthilis, for in men the membrane does not reach so low; by too much cold or heat, the one vitiating the action, and the other consuming the matter through the wrong formation of the uterine parts; by the neck of the womb being turned aside, and sometimes, though rarely, by a membrane or excrescence of the flesh growing at the mouth or neck of the womb. The blood may be in fault in two ways, in quantity and in quality; in quantity, when it is so consumed that no surplus is left over, as in viragoes or virile women, who, through their heat and natural strength, consume it all in their last nourishment; as Hippocrates writes of Prethusa, for when her husband praised her overmuch, her courses were suppressed, her voice changed and she got a beard with a manly face. But I think, rather that these must be Gynophagi, or woman-eaters, rather than women-breeders, because they consume one of the principles of generation, which gives a being to the world, viz., the menstruous blood. The blood may likewise be lost, and the courses checked by nosebleeding, by bleeding piles, by dysentery, commonly called the bloody flux, by many other discharges, and by chronic diseases. Secondly, the matter may be vitiated in quality, and if it be sanguineous, sluggish,
bilious or melancholy, and any of these will cause an obstruction in the veins.
SIGNS.
Signs which manifest the disease are pains in the head, neck, back and loins; weariness of the whole body (but especially of the hips and legs, because the womb is near those parts); palpitation of the heart. The following are particular signs:—If the suppression arises from a cold, the woman becomes heavy, sluggish, pale and has a slow pulse; Venus' combats are neglected, the urine is thick, the blood becomes watery and great in quantity, and the bowels become constipated. If it arises from heat, the signs are just the opposite. If the retention be natural and arises from conception, this may be known by drinking hydromel, i.e., water and honey, after supper, before going to bed, by the effect which it has; for if after taking it, she feels a heating pain about the navel and the lower parts of the abdomen, it is a sign that she has conceived, and that the suppression is natural.
PROGNOSTICS.
The whole body is affected by any disorder of the womb, and especially the heart, the liver
and the brain, and there is a singular sympathy between the womb and those three organs. Firstly, the womb communicates with the heart by the mediation of those arteries which come from the aorta. Hence, when menstruation is suppressed, fainting, swooning, a very low pulse, and shortness of breath will ensue. Secondly, it communicates with the liver by the veins derived from the hollow vein. Obstructions, jaundice, dropsy, induration of the spleen will follow. Thirdly, it communicates with the brain by the nerves and membranes of the back; hence arise epilepsy, madness, fits of melancholy, pains in the back of the head, unaccountable fears and inability to speak. I may, therefore, well agree with Hippocrates that if menstruation be suppressed, many dangerous diseases will follow.
CURE.
In the cure of this, and of all the other following cases, I shall observe the following order:—The cures will be taken from surgical, pharmaceutical and diuretical means. The suppression has a plethoric effect, and must be removed by the evacuation; therefore we begin with bleeding. In the middle of the menstrual period, open the liver vein, and two days before, open
the saphena in both feet; if the repletion is not very great apply cupping glasses to the legs and thighs, although there may be no hope of removing the suppression. As in some women, the cotyledones are so closed up that nothing but copulation will open them, yet it will be well to relieve the woman as much as possible by opening the hemoroid veins by applying a leech. After bleeding let the place be prepared and made flexible with syrup of stychas, calamint, betony, hyssop, mugwort, horehound, fumitary, maidenhair. Bathe the parts with camomiles, pennyroyal, savias, bay-leaves, juniper-berries, rue, marjoram, feverfew. Take a handful each of nep, maidenhair, succory and betony leaves and make a decoction, and take three ounces of it, syrup of maidenhair, mugwort and succory, half an ounce of each. After she comes out of her bath, let her drink it off. Purge with Pill agaric, fleybany, corb, feriae. In this case, Galen recommends pilulae of caberica coloquintida; for, as they are good for purging the bad humours, so also they open the passages of the womb, and strengthen it by their aromatic qualities.
If the stomach be over-loaded, let her take an emetic, yet such a one as may work both ways, lest if it only works upwards, it should check the humours too much. Take two drachms of
trochisks of agaric, infuse this in two ounces of oxymel in which dissolve one scruple and a half of electuary dissarum, and half an ounce of benedic laxit. Take this as a purge.
After the humour has been got rid of, proceed to more suitable and stronger remedies. Take a drachm and a half of trochisk of myrrh; ten grains of musk with the juice of smallage; make twelve pills and take six every morning, or after supper, on going to bed. Take half an ounce of cinnamon, two drachms each of smirutium, or rogos, valerin aristolochia; two scruples each of astrumone root and saffron; two drachms of spec. diambia; four scruples of trochisk of myrrh; two scruples tartari vitriolari; make half into a powder; make lozenges with mugwort water and sugar, and take one drachm of them every morning; or mix a drachm of the powder with one drachm of sugar, and take it in white wine. Take two drachms each of prepared steel and spec. hair; one scruple each of borax and spec. of myrrh, with savine juice; make it up into eighty-eight lozenges and take three every other day before dinner. Take one scruple of castor, half a drachm of wild carrot seed with syrup of mugwort, and make four pills, take them in the morning fasting, for three days following, before the usual time of purging. Take five drachms each of agaric,
aristolochia, and juice of horehound; six drachma each of rhubarb, spikenard, aniseed, guidanum, asafoetida, mallow-root, gentian, of the three peppers and of liquorice: make an electuary with honey, and take three drachms for a dose. For phlegmatic constitutions nothing can be better than the decoction of guaiacum wood with a little disclaim, taken fasting in the morning, for twelve days consecutively, without producing sweating.
Treat the lower parts of the body to suffumigating, pessaries, ointments and injections; for fumigating use cinnamon, nutmeg, the berries of the bay tree, mugwort, galbanum, molanthium, amber, etc. Make pessaries of figs and the bruised leaves of dog's mercury, rolled up in lint, and if a stronger one is required, make one of myrrh, opopanax, ammoniac, galbanum, sagepanum, mithridate, agaric, coloquintida, tec. Make injections of a decoction of origane mugwort, dog's mercury, betony, and eggs; inject into the womb with a female syringe. Take half an ounce each of oil of almonds, lilies, capers, camomiles; two drachms each of laudanum and oil of myrrh; make a salve with wax, with which anoint the place; make injections of fenugreek, camomiles, melilot, dill, marjoram, pennyroyal, feverfew, juniper berries and calamint; but if the suppression arises
from a lack of matter, then the courses ought not to be brought on until the spirits be raised and the amount of blood increased; or if it arises from affections of the womb itself, as dropsy or inflammation, then particular care must be used; but I will not lay stress on this here, but will mention the remedies in their order.
If the retention comes from repletion or fullness, if the air be hot and dry, take moderate exercise before meals, and very light diet and drinks, and with your food take garden savory—thyme and origane, if it arises from emptiness and defect of matter: if the weather be moist and moderately hot, avoid exercise and late hours; let your food be nourishing and easy of digestion, such as raw eggs, lamb, chickens, almonds, milk and the like.
CHAPTER III
Of Excessive Menstruation.
The learned say, that truth is manifested by comparing contraries, and so, as I have above spoken of the suppression of menstruation, it is now necessary that I should treat of excessive menstruation, which is no less dangerous than the former. This immoderate monthly flow is defined as a sanguineous discharge, as it consists merely of blood, wherein it differs from the false courses or whites, of which I shall speak further on. Secondly, it is said to proceed from the womb; for there are two ways in which the blood issues forth; one by the internal veins of the body of the womb (and this is properly called the monthly flow), the other is by those veins which terminate in the neck of the matrix, which Aetius calls haemorrhoids of the womb. In quantity, Hippocrates said, it should be about eighteen ounces, and they should last about three days: and when the faculties of the body are weakened by their flow, we may take it that the discharge is inordinate. In bodies which abound in gross humours, this immoderate flow sometimes unburdens nature of her load and ought not to be checked without a physician's advice.
CAUSE.
The cause is either internal or external. The internal cause is threefold; in the substance, the instrument or the power. The matter, which is the blood, may be vitiated in two ways; first, by the heat of the constitution, climate or season, heating the blood, whereby the passages are dilated, and the power weakened so that it cannot retain the blood. Secondly, by falls, blows, violent motions, rupture of the veins, etc. The external cause may be the heat of the air, heavy burdens, unnatural childbirth, etc.
SIGNS.
In this excessive flow the appetite is lessened, conception is checked and all the functions weakened; the feet swell, the colour of the face changes, and the whole body is weakened. If the flow comes from the rupture of a vein, the body is sometimes cold, the blood flows out in streams, suddenly, and causes great pain. If it arises from heat, and the orifice of the vein is dilated, there is little or no pain, but yet the blood flows faster than it does when caused by erosion, but not so fast as it does in a rupture. If caused by erosion, the woman feels a scalding of the passage, and it differs from the other two,
in so much as it does not flow so quickly or so freely as they do. If it is caused by weakness of the womb, the woman feels a dislike for sexual intercourse. Lastly, if it proceeds from the defective quality of the blood let some of it drop into a cloth, and when it is dry, you may judge, of the quality by the colour. If it be passionate it will be yellow; if melancholy, it will be black, and if phlegmatic, it will be waterish and whitish.
PROGNOSTICS.
If convulsions are joined to the flow, it is dangerous, because that intimates that the noble parts are affected, convulsions caused by emptiness are deadly. If they continue long, they will be very difficult to cure, and it was one of the miracles which our Saviour Christ wrought, to cure a woman of this disease of twelve years standing.
To conclude, if the flow be excessive, many diseases will follow, which will be almost impossible to cure; the blood, being consumed together with the innate heat, either morbid, dropsical, or paralytical diseases will follow.
CURE.
The cure consists in three particulars. First,
in expelling and carrying away the blood. Secondly, in connecting and removing the fluxibility of the matter. Thirdly, in incorporating the veins and faculties. For the first, to get rid of the superfluous blood, open a vein in the arm, and draw off as much blood as the strength of the patient will allow; not all at one time, but at intervals, for by those means the spirits are less weakened, and the reaction so much the greater.
Apply cupping glasses to the breasts and also over the liver, and to correct the flexibility of the matter, purgative means, moderated by astringents, may be employed.
If it is caused by erosion, and salt phlegm, prepare with syrup of violets, wormwood, roses, citron peel, succory, etc. Then make the following purge:—mirabolans, half an ounce; trochisks of agaric, one drachm; make a decoction with the plantain-water, and add syrup of roses lax. three ounces, and make a draught.
If caused by any mental excitement, prepare the body by syrup of roses, myrtles, sorrel and parsley, mixed with plantain-water, knot-grass and endive. Then purge with the following draught:—Take one drachm each of the void of mirabolans, and rhubarb, cinnamon fifteen grains; infuse for a night in endive water; add to the strained water half an ounce of pulp of
tamarinds and of cassia, and make a draught. If the blood be waterish as it is in dropsical subjects and flows out easily on account of its thinness, it will be a good plan to draw off the water by purging with agaric, elaterium and coloquintida. Sweating is also useful in this case, as by it the noxious matter is carried off, and the motion of the blood to other parts. To produce sweating, employ cardus water, and mithridate, or a decoction of guaiacum and sarsaparilla. Gum guaiacum is also a great producer of perspiration, and sarsaparilla pills, taken every night before going to bed are also highly to be recommended. If the blood pours out, without any evil quality in itself, then strengthening means only should be employed, which is a thing to be done in cases of inordinate discharge.
Take one scruple of ol. ammoniac, one drachm of treacle, half an ounce of conserve of roses and make an electuary with syrup of myrtle, or if the discharge be of long standing take two drachms of matrix, one drachm of olilanum troch. de carbara, a scruple of balustium; make into a powder and form into pills with syrup of quinces, and take one before every meal. Take two scruples each of troch. dechambede, scoriaferri, coral and frankincense; pound these to a fine powder, and make into lozenges with sugar and plantain water. Asses' dung is also approved
of, whether taken inwardly with syrup of quinces or applied outwardly with steeled water. Galen by sending the juice of it into the womb by means of a syringe for four days consecutively, cured this immediate flow, which could not be checked in any other way. Let the patient take one scruple and a half of pilon in water before going to bed; make a fumigation for the womb of mastic, frankincense and burnt frogs, adding the hoof of a mule. Take an ounce each of the juice of knot-grass, comfoly and quinces; a drachm of camphor; dip a piece of silk or cotton into it and apply it to the place. Take half an ounce each of oil of mastic, myrtle, and quinces; a drachm each of fine bole and troch. decardas, and a sufficient quantity of dragon's blood, make an ointment and apply it before and behind. Take an ounce and a half each of plantain, shepherd's purse and red rose leaves; an ounce of dried mint, and three ounces of bean flour; boil all these in plantain water and make two plasters:—apply one before and one behind. If the blood flows from those veins which are terminated at the neck of the matrix, then it is not called an undue discharge of the menses, but haemorrhoids of the womb. The same remedy, however, will serve for both, only the instrumental cure will be a little different; for in uterine haemorrhoids, the ends of the
veins hang over like teats, which must be removed by cutting, and then the veins closed with aloes, fine bole, burnt alum, myrrh, mastic, with comfoly-juice and knot grass, laid upon it like a plaster.
The air should be cold and dry, and all motion of the body should be prohibited. Her diet should consist of pheasants, partridges, grouse, rabbits, calves' feet, etc., and her drink should be mixed with the juice of pomegranates and quinces.