The uterus is often ulcerated from difficult labour, extraction of the fœtus, or forced abortion, or injury of the same occasioned by acrid medicines, or by a defluxion, or from abscesses which have burst. If, therefore, the ulceration be within reach, it is detected by the dioptra, but if deep-seated, by the discharges; for the fluid which is discharged varies in its qualities. When the ulcer is inflamed, the discharge is small, bloody, or feculent, with great pain; but when the ulcer is foul, the discharge is in greater quantity, and ichorous, with less pain. When the ulcer is spreading, the discharge is fetid, black, attended with great pains, and other symptoms of inflammation; irritation is produced by relaxing medicines, and relief by the opposite class. When the ulcer is clean, the fluid is small in quantity, consistent, without smell, thick, white, with an agreeable sensation. When the ulcer is inflamed, we must use those things recommended for inflammations. When it is foul, we must inject the juice of ptisan with honey, or basilicon ointment with the oil called Susinum; or honied water, having fenugreek, mallows, bran, or lentil without its husk, boiled in it; and in order to clean it the more, horehound or vetches may be added; or mixing with honey the flour of vetches, or iris, or round alum, or the like, we may inject them; and externally we may apply cataplasms of the same things mixed with honied water. And this medicine is particularly applicable: The finest saffron is triturated with a woman’s milk, and being added to rose-cerate with the grease of a goose, is rubbed upon flocks of wool. But the following is a more effectual application, and one proper for violent pains: Poppy-heads are mixed in diluted must for three days, and then boiled until they become soft; then rose-leaves, dr. v, and saffron, dr. iij, are pounded together, and the decoction of the poppy-heads mixed with them; then wax, dr. ij, melted with rose-oil, are poured on them, and applied on a pessary, anointing with rose-oil. The same good effects may be derived from the preparation of eggs, saffron, rose-oil, the grease of a goose, and stag’s marrow. And the Egyptian ointment without the verdigris answers admirably for the cure of ulceration. When the ulcer is spreading and attended with inflammation, we must apply a cataplasm of warm bread mixed with hydromel, oil, marshmallows, fenugreek, and fatty dates. We must inject also the juice of plantain, of nightshade, of knotgrass, and of endive, first by themselves, but afterwards with austere wine or vinegar. When the ulcer spreads and is without inflammation, we may inject more tonic remedies, such as the decoction of pomegranate-rind, of roses, of olive shoots, of cypresses, of quinces, of bramble, of myrtles, of lentisk, of buckthorn, of sumach, in astringent wine, and afterwards with alum, acacia, lycium, and hypocistis. A hip-bath is also to be prepared from these decoctions. When these things do not succeed, we must use an injection, at first of paper with oxycrate, and then of vinegar, or of the powder called anthera, or of chalcitis, or of copperas, in the same liquids; or of the remedies for dysentery. We must allow wholesome food in small quantities. When the ulcer has become clean, we must bathe more frequently, administer food freely, and give wine, so that the body may soon recover its flesh. In place of a pessary, we may inject the preparation from mulberries, mixed with calamine, Cretan cistus, or plumbago. Externally we may apply the epulotic plaster to the abdomen and loins; for the powers of cataplasms, as well as those of plasters, may be thus communicated by the insensible pores of the skin.
Commentary. Our author has described the treatment of ulcers in the womb so fully and judiciously, that little of importance can be added to it. It is mostly compiled from Aëtius, who, in his turn, professes to have copied from Archigenes, Aspasia, and Asclepiades.
Aretæus says that of ulcers in the womb some are broad, attended with pruritus and a discharge of thick matter without fetor. These are not dangerous. But when the discharge is thin, ichorous, and fetid, when the lips of the sore are callous, and when it spreads like a phagedenic ulcer, it is of a malignant kind. His chapter on the treatment is lost.
Unfortunately there is also a hiatus in the text of Celsus, which detracts from the value of his account.
Octavius Horatianus recommends a potent remedy for putrid ulcers of the uterus which supervene upon wounds. It is a trochisk formed of arsenic, quicklime, sandarach, burnt paper, and the like. Although the case recently reported of the man who killed his wife, by introducing into her vagina the oxyd of arsenic, ought to teach us caution, we can certainly conceive that such an application, if properly managed, might prove safe and effectual. It ought also to be kept in mind that the orpiment of the ancients was less virulent than the arsenic of the moderns.
Scarcely any additional information is to be learned from the Arabians. The following application recommended by Avicenna seems to be a judicious one: Take equal parts of litharge, ceruse, and sarcocolla; make a cerate with wax and rose-oil. When the ulcers are attended with a bloody discharge, Haly Abbas directs us to use pessaries and injections of an astringent nature, consisting of galls, hypocistis, plantain, rose-oil, and the like. When the discharge is whitish and purulent, he recommends the tepid bath and injections of barley-gruel, honey, &c. For relieving the pain he recommends an ointment containing litharge, frankincense, axunge, fresh butter, strained wax, and rose-oil. Alsaharavius recommends similar remedies.
SECT. LXVII.—ON CANCER.
Of cancers in the womb, some are attended with ulceration, and some are without it. In those cases in which the part is not ulcerated, a tumour is found about the mouth of the womb, hard, unequal, callous, of a feculent colour, and red, but sometimes also somewhat livid; and they have violent pains in the groins and abdomen, the lower part of the belly, and the loins, which are exasperated by handling and complicated applications. When the cancer is ulcerated, in addition to the pains, hardness, and swelling there are phagedenic and unequal ulcers to be seen, which for the most part are foul, callous, white, and having ugly scabs on them; but some appear clean, some feculent, or livid, or red, or bloody. The discharge from them always is a thin ichor, watery, black, or tawny, and fetid; but blood also is sometimes discharged along with the other symptoms of an inflamed uterus already mentioned. Wherefore the complaint is incurable, as Hippocrates has pronounced, but may be alleviated by hip-baths from fenugreek, and mallows, and by cataplasms of a like nature. And the exacerbations of the complaint may be much alleviated by common mallows, or marshmallows, softened by boiling in honied water, and pounded with a little rose-oil, and applied; and by a cataplasm of dried figs and melilots, rue, frankincense, and navew bruised carefully with oil, and also by that from dates boiled in must, containing also the yelks of eggs, and fine flour; or that from poppies with coriander, knotgrass, or endive. These things are to be applied during the violence of the pains; after which a cerate may be applied from rose-oil, or myrtle-oil, or the oil from the flowers of wild vines, or that of apples with dates boiled in must. But one particularly recommended is that from the sediment found in copper vessels, which being burnt, is reduced to a powder, and mixed with the cerate of roses until it acquire the consistence of a plaster. These are the external applications. But oil applied internally is soothing to the parts. And when they become ulcerated, the milk of a woman may be injected, and the tepid juice of plantain. But if they bleed, the infusion of knotgrass with a little rosemary proves soothing; and so also do pessaries medicated with saffron, women’s milk, and the juice of poppies, and the sordes of unwashed wool. But the following is one of the best applications, and answers also for affections of the anus: Of washed Italian litharge, oz. vj; of male frankincense, of the sordes of unwashed wool, of fresh axunge, of newly-made butter, of Tuscan wax, of each, oz. ij; of rose-oil, oz. iv; triturate the litharge with the juice of endive, and add to the other things when melted. Food of easy distribution and wholesome may be given, and some watery wine; avoiding acrid food and repletion, for they are apt to be troubled with indigestion.
Commentary. Hippocrates (de Morb. Mulier. ii, 24) gives a long account of cancer of the womb, which, when fairly formed, he pronounces to be utterly incurable. He directs us, however, to try the effect of fumigating the womb by introducing into it a pipe attached to a pot. Steams from garlic and the fat of seals are to be applied in this manner.
Aëtius gives from Archigenes exactly the same account as our author.