XXXVIII. Περὶ γυναικείων—On the Diseases of Women.
We have already stated in our critical remarks on the fourth book, “On Diseases,” that it and the present treatise are evidently the productions of the same author. Although Erotian and Galen[252] make reference to it as if acknowledging it to be the production of Hippocrates, its claim is rejected by Foës, Schulze, Gruner, and Ackerman, and all the modern authorities of any note. Its connection with the treatises “De Genitura” and “De Natura Pueri,” is pointed out by Foës and Gruner; and Littré does not hesitate to refer to the same author the whole of the following treatises, “De Genitum,” “De Natura Pueri,” “De Morbis,” iv., “De Morbis Mulierum,” “De Morbis Virginum,” “De Sterilibus.” Although not the composition of Hippocrates, all these treatises are, without doubt, of high antiquity, and were anterior to the age of Aristotle.
The work now under consideration contains much valuable matter, and deserves a careful perusal. I feel rather at a loss what selections to make from it, as a specimen of its contents, but shall be brief on the present occasion, more especially as I have no difficulty in establishing the point, that the treatise in question is not one of the genuine works of Hippocrates.
The observations contained in the first part of it, on menstruation and the causes of sterility, are ingenious. For the cure of sterility, fumigation of the uterus is recommended, and a minute description is given of the mode of performing this process, by means of a tube introduced into the os uteri, and connected with a vessel which emits aromatic fumes. When sterility is connected with the shutting up of the os uteri, the author gives directions for expanding it by means of a wooden or leaden pipe. We need scarcely remark, that this practice has been revived of late years. A minute description is given of a malformation of the vagina, in which the passage is nearly obliterated by a membrane. Allusion is probably made here to a preternatural rigidity of the hymen. The author directs the membrane to be fairly torn, and the part dressed with wine and myrrh. In transverse and footling presentations of the child it will be best, he says, to bring it down by the head. Both cases are said to be dangerous, so that either the mother or child is lost, and sometimes both. Treating of retention of the placenta, the author remarks, that if it is not cast off it becomes putrid, and thus comes away on the sixth or seventh day, or later. To promote its expulsion, he recommends southernwood, dittany, the flowers of the white violet, and asafœtida. The process of abortion, and the unpleasant circumstances connected with retention of the placenta in this case, are given with much accuracy. Hydrops uteri is described at considerable length. For an account of it, see Paulus Ægineta, Vol I., p. 573, Syd. Soc. edition, and the modern authorities there referred to. For ulcers of the womb, he recommends applications consisting of many stimulating ingredients, such as the flos argenti, etc. The subject of difficult delivery is resumed; when the arm or leg of a living child is protruding, it is directed to be pushed back, and the child turned to the head; and if the fœtus be dead, either the same thing may be done, or the projecting part may be cut off, and the head opened with a sharp knife, and the bones thereof extracted, and the body brought along. The chest also may be opened, if there be any difficulty in extracting the body. The author expresses himself strongly in regard to the danger of abortions. All abortions, he says, are attended with more danger than deliveries at the full time. Artificial abortion never takes place without violence, whether produced by medicine, a draught, or food, or a suppository, or any other means.
The second book commences with a description of fluor albus, an affection to which the old are stated to be more subject than the young. It arises from suppression of the menses, from parturition, or a fever. Among other means which he speaks of for the cure of it, he mentions the application of cupping-instruments to the mammæ. Astringents from the vegetable kingdom are to be administered, such as sumach boiled in vinegar, mulberries, or the like. A full account of the red fluor, or uterine hemorrhage, is also given. It is said to be connected principally with parturition. The treatment which is recommended can scarcely be improved upon, even after the lapse of two thousand years: a sponge is to be wetted and applied to the pudenda; soft garments are to be moistened with cold water, and laid on the belly; and the foot of the bed is to be raised. When the hemorrhage is connected with putridity many women thus perish, indeed few recover. A long description is given of hysterical convulsions which is said principally to attack antiquated maids and widows. It is remarked that hysterical complaints bring on cough, and other pectoral complaints. A very striking and accurate description is given of procidentia uteri. Inflation of the womb is also described. On it see Paulus Ægineta, Vol. I., p. 632, Syd. Soc. edition. There is also a curious description of the mole. The clitoris is described under the name of columna.[253]
From the extracts now given, it will be seen that these Books contain a great variety of most important matter. Indeed, there are few treatises in the Collection more deserving of an attentive perusal. They furnish the most indubitable proofs that the obstetrical art had been cultivated with most extraordinary ability at an early period. Beyond all doubts the complaints of women, and the accidents attending parturition, must at that time have come under the jurisdiction of the male practitioner. But, considering the wandering life which Hippocrates led, and that during the best part of it he must have been what is now called a consulting physician, it is not at all likely that he could have acquired that acquaintance with the minutiæ of obstetrical practice which this work displays. It is not, then, at all probable that he can be the author of it.
XXXIX. Περὶ ἀφόρων—On Sterile Women.
This treatise is closely connected with the preceding one, both in matter and style. It relates to a subject which, as we have shown, is also treated of in the other work, I mean sterility, the most common cause of which is held to be the state of the os uteri, when it is oblique to the passages of the vagina, constricted from cicatrices, or otherwise diseased. Distinct directions are given for opening the mouth of the womb, after which a cleansing application, composed of cantharides and myrrh, is to be made to it. The mole, and procidentia uteri, are described in nearly the same terms as in the preceding treatise. Though it bears a great resemblance, then, to the work “On the Diseases of Women,” it is not likely, as suggested by Albertus Fabricius,[254] that it is an appendix to it, for why should an author treat twice of the same subject in the same work?
XL. Περὶ παρθενίων—On the Complaints of Young Women.
Foës looks upon this little tract as being the prelude to the greater work “On the Diseases of Women.” It is destitute of all claims to be held as genuine, and accordingly no critic, ancient or modern, stands up for it. Gruner is inclined to ascribe it to the author of the treatise “On the Sacred Disease,” but I see no grounds for this opinion, except it be that, in the two treatises, there is a certain similarity of views with regard to the nature of the hysterical convulsion. This, however, is not a sufficient reason for deciding that they both must have come from the same source, for all the ancient authorities, from Hippocrates to Actuarius, held pretty much the same ideas regarding the nature of “Uterine suffocation.” See Paulus Ægineta, III., 71. The author of this little fragment gives very naïve advice to virgins who are subject to hysterics; instead of making costly oblations of garments and the like to Diana, as recommended by the prophets, he gravely advises them ὡς ταχίστα συνοικῆσαι ἀνδρασι.