Of Medicine, in Eight Books

by Aulus Cornelius Celsus

But if from those causes, which I mentioned, there appears to be danger of a fistula, to close it the more easily, or at least to contract it, a leaden pipe must be introduced into the anus[(34)]; and the legs being extended, the thighs and ancles must be tied together, till there be a cicatrix as good as we can obtain.

CHAP. XXVIII. OF THE OPERATIONS REQUIRED WHEN A MEMBRANE, OR FLESH OBSTRUCTS THE VAGINA IN WOMEN.

The foregoing diseases may happen both to men and women. But some are peculiar to women; as in the first place, where the vagina, by its lips being joined, does not admit of coition. And this happens sometimes in the womb of the mother; at other times, from an ulcer in those parts, and the lips, in healing, having by bad management been united. If it be from the birth, a membrane obstructs the vagina: if from an ulcer, it is filled up with flesh.

In the membrane an incision must be made in two lines crossing each other, in the form of the letter X, great care being taken not to wound the urinary passage; and then the membrane is to be cut out. But if flesh has grown there, it is necessary to open it in a straight line; then taking hold of it with a vulsella or hook, to cut off a small habenula, as it were, from the orifice of the vagina, after which must be introduced a piece of lint rolled in a long form (by the Greeks called lemniscus) dipped in vinegar; and over this sordid wool moistened with vinegar is to be bound on; the third day, these are to be removed, and the part dressed like other wounds. And when it begins to heal, it is proper to introduce into the part a leaden pipe armed with a cicatrizing medicine; and over that to apply the same medicine, till the wound be cicatrized.

CHAP. XXIX. THE METHOD OF EXTRACTING A DEAD FOETUS OUT OF THE WOMB.

When a woman conceives, if the foetus dies in the womb, near the time of delivery, and cannot come away of itself, an operation is necessary. This may be reckoned amongst the most difficult: for it both requires the highest prudence and tenderness, and is attended with the greatest danger. But above all, the wonderful nature of the womb, as in other cases, so in this also, is easily discovered.

In the first place, it is proper to lay the woman on her back, across a bed, in such a posture, that her ilia may be compressed by her thighs: whence it happens, that both the bottom of her belly is presented to the view of the physician, and the child is forced to the mouth of the womb; which is close shut, when the foetus is dead, but at intervals opens a little. The physician, making use of this opportunity, having his hand anointed, ought to introduce, at first, the fore-finger, and keep it there till the mouth be opened again, and then he must introduce another finger, and the rest upon the like opportunities offering, till his whole hand be within it. Both the capacity of the womb, and the strength of its nerves, and the habit of the whole body, and even the fortitude of the mind conduce much to the facility of doing this: especially, as in some cases, it is necessary to have both hands within the womb.

It is of importance, that both the bottom of the belly, and the extremities of the body be as warm as possible; and that an inflammation be not begun, but that help be administered instantly, while the case is recent. For if the body be already swelled, the hand can neither be introduced, nor the fœtus brought away without the greatest difficulty; and together with a vomiting and tremor, there generally follow mortal convulsions. When the hand is introduced upon the dead fœtus, it immediately discovers its posture: for it is either turned upon the head, or the feet, or lies transverse but commonly in such a manner; that either its hand or foot is near.

The intention of the physician is, by his hand, to turn the child, either upon its head, or even upon its feet, if it happened to be in a different posture. And if there is no other hinderance, taking hold of the hand or foot puts the body in a better posture: for the hand being laid hold of, will turn it upon the head, and the foot upon its feet. Then if the head is nearest, a crotchet should be introduced, in every part smooth, with a short point, which is properly fixed, either in the eye, or the ear, or the mouth, sometimes even in the forehead; and then being drawn outwards, brings away the child. Yet it is not to be extracted at any moment of time indifferently: for should it be attempted, when the mouth of the womb is shut, there being no exit for the child, it breaks to pieces, and the point of the crotchet slips upon the mouth of the womb itself, and there ensue convulsions, and extreme danger of death. Therefore, it is necessary to forbear, when the womb is shut; and when it opens, to draw gently; and every such opportunity to extract it gradually. The right hand must draw the crotchet, the left being kept within, must pull the child, and at the same time direct it.