In this connection, as indeed in the discussion of the female genital
organs generally, we once again meet with the difficulty due to the
indefiniteness of the names given to the several parts. Not only do
the Greeks constantly make use of the general expression αἰδοία, μόρια
(privates, parts), but they likewise employ ὑστέρον and μήτρα (the
womb) sometimes as meaning the vagina, sometimes the uterus, though
it is true the later Writers like _Galen_[388] designate the vagina ἡ
ὑστέρα, the uterus ὁ ὑστέρος, yet without keeping consistently to the
distinction. The same applies to the use in Latin of _locus_ (place),
_pars_ (part), and _vulva_ (womb), which last word stands for the
uterus in _Celsus_, _Pliny_ and most of the later Writers.
Passing over the indefinite expressions _dolores_ (pains),
_inflammatio_ or _phlegmoné_ (inflammation) of the genitals, although
the treatment prescribed for them clearly implies that very often
ulceration was concurrently present, we find the various kinds of
ulcers of the female genitals most fully and systematically described
by _Aretaeus_,[389] _Paulus Aegineta_ (III. 65-68.) and _Aëtius_[390]
following Archigenes, Soranus and Aspasia.[391][392]
_Abscesses_ _Aëtius_ says (loco citato, ch. 110.) occur on the female
_labia_; if these extend in the direction of the anus, they must not
be opened with the knife, as fistulas are liable to be set up, but
there is no fear of this when they extend towards the urethra. The
same author (p. 109.) speaks of _pustulae scabrae_ (scabrous, scurfy
pustules) in the vagina and orifice of the womb, which throw off
bran-like scales, as also (ch. 108.) of _tubercula miliaria_ (miliary
tubercles) in the same localities. These may no doubt be recognized
by touch, but are better diagnosed by means of the uterine speculum,
or _Dioptra_, and _ex coitus affrictu_ (in consequence of friction
in coition) interfere with menstruation and conception. Obviously
what is here pointed to is the swollen mucous glands, which in our
modern practice likewise are frequently observed in gonorrhœal cases.
Often the ulcers take a form characterized by _fissures_ (ῥαγάδες,
_fissurae_,—fissures, _rimae_,—cracks), particularly at the orifice of
the uterus.[393] Sometimes they become callous, at others give rise to
morbid outgrowths; as a rule the discharge is a thin watery juice, and
pain is felt during coition.[394]
Ulcers strictly so called, says Aretaeus, are either superficial, in
fact rather excoriations than ulcers, and far-spreading; they itch
as though salt had been sprinkled on the surface, give off a small
quantity of thick pus, free from smell, and are not malignant. To this
class probably belong the aphthae-like ulcers of Hippocrates.[395] In
other cases they are more deep-seated; being then painful, discharging
an evil-smelling pus, and having a less mild character than the
former, but still not such as to be described as malignant. If they
penetrate yet deeper, the edges then become rough, the discharge
takes the form of a malodorous juice, while the pain is more severe
than in the other kinds. The actual tissue of the womb is partially
destroyed in the latter case, while morbid outgrowths form, which make
cicatrization extremely difficult. This last kind was known also as
_phagedaena_, (eating ulcer); it is dangerous, especially if the pain
increases and the patient falls into low spirits. An offensive juice is
discharged, so foul that the patient herself is hard put to bear it;
the ulcer is highly intolerant of being touched for the application
of remedial means; it may end fatally, and is known under the name
of “Crab-ulcer”. Νομὴ (spreading ulcer),[396] carbuncle and _sordida
ulcera_ (foul ulcers) of the uterus are mentioned by _Aëtius_ (loco
citato), who shows the mode of investigating them by means of the
uterine speculum and a treatment consisting mainly of injections[397]
and pessaries prepared of a number of different remedies. Not
unfrequently unskilful treatment of ulcers of the vagina occasioned
morbid outgrowths, which according to _Celsus’_ teaching,[398] must be
removed by surgical means. Lastly the fact that ulcers of the genital
organs of women were prejudicial to men who consummated coition with
them and were for that reason dreaded by them, is clearly implied in
the narrative of _Cedrenus_.[399]