The menstrual evacuation is sometimes retained owing to a weakness of the
whole body, and sometimes owing to a particular affection of the uterus
itself, from local coldness, or a blow, or a congenital intemperament,
or from some sustained injury, for the most part from abortions, or from
a primary affection of some of the more important organs, such as the
liver, belly, and chest, or from some such part labouring under a chronic
affection. When suppressed, it becomes the cause of many and protracted
complaints. If, therefore, the discharge be suppressed or delayed, owing
to a primary affection of any of the internal parts, we must first direct
our particular attention to the cure of the part originally affected,
and afterwards think of the uterus. The symptoms of these we have
already mentioned. When none of them therefore is present, it is clear
that the uterus is the original seat of the complaint; and when neither
the age, habit, nor any other thing prevents, we must have recourse to
venesection, yet not before the regular period of menstruation, but ten
days after it is past. The quantity to be taken must not be more than two
pounds and a half, nor less than one; and whether we bleed or not, we
must purge with the hiera of colocynth, giving it to the amount of two
drachms, in six heminæ of honied water. But when fever is present, it
is not expedient to purge with hiera, but it will be advisable to open
a vein during the first days of the fever. After the purging, we must
give recruiting things for a few days, and afterwards recommend exercise
by walking, friction of the lower extremities, and the bath. The most
proper food will be that which is of easy digestion and humid, such as
all sweet pot-herbs, and fishes taken from among rocks, the more tender
parts of fowls, milk, honied cakes, thin white wine not very old; flesh
and pulse, except ptisan, are improper. When the accustomed period is at
hand, give of sea-fishes the cartilaginous, and the mollusca, as they are
called, and the testacea, and headed leeks (_porrum capitatum_), boiled
with rue and pepper; and let the woman drink the decoction of them, and
apply ligatures to the lower extremities for three or four days. When
the expected period is at hand, the ligatures are to be removed, and
she is to take beforehand fragrant draughts of myrrh, to the amount
of an obolus, or the size of a bean; or of castor with must, or with
honied water; or the decoction of mugwort; or of sage after the bath in
must, and in that of wormwood. The wine of wormwood should be drunk as
a propoma during the whole time of treatment. When the period has gone
past, and no discharge, or at least none of any consequence has taken
place, we must open a vein at the ankle, and abstract blood; but after
the seventh or eighth day we must purge with hiera; and after the fourth
day a calefacient plaster (_dropax_) is to be applied to the lower part
of the belly, loins, and thighs. Having drunk water for three days,
let a cataplasm, made of equal portions of mustard and soaked bread,
be applied until the equinox, after which let the patient bathe. Next
month, let dried figs instead of bread be mixed with the decoction of
fenugreek, of mallows, of pennyroyal, of rue, and of mugwort. And let oil
of lilies (_susinum_) or of marjoram be injected into the vagina; and
let the pessary called Enneapharmacus, or the Olibanius be introduced.
A pessary consists of carded wool, rounded to the shape of the finger,
and impregnated with the medicines. This mode of treatment is generally
sufficient for restoring the menstrual evacuation; but if stronger
medicines are required, they are as follows: Illyrian iris drunk with
wine and cyperus, the root of wakerobin, cassia, the schenanth, valerian,
a decoction of the root of elicampane, myrrh to the size of a Grecian
bean drunk with must in half a hemina of honied water, and two heminæ of
the decoction of dittany, and ammoniac, and sagapene. To persons whose
stomachs are less easily deranged, a small quantity of opopanax, made
into a little ball, and steeped in boiled honey, may be given. Moreover,
certain common seeds are calculated to promote the menstrual evacuation,
but in an inferior degree, such as fennel, cumin, parsley, Cretan carrot,
hartwort, bishop’s weed, sison, chick-peas, juniper-berries, and all the
diuretics. But the following things are to be applied _per vaginam_:
Myrrh triturated with the decoction of wormwood, or of lupines; or
triturated with the juice of rue; bdellium, in like manner; storax, the
gum of the wild olive, and that of the juice of rue, in like manner; or
the long birthwort made into the form of a collyrium; and so also the
root of the great centaury, or of hellebore, or of the juice of scammony,
and the medullary part of the wild gourd by itself, and mugwort formed
with rue and galbanum, applied in the form of a fumigation. These things
are calculated also to expel the fœtus.
* * * * *
COMMENTARY. One may find in Hippocrates a long list of medicines
possessed of real or imaginary virtues as emmenagogues; such as
cantharides, myrrh, peony, cumin, elaterium, squills, the fruit of
juniper, seseli, thyme, St. John’s wort, rue, castor, elicampane, nettle,
sage, &c. Of these some were given by the mouth, and others applied
upon pessaries. He also recommends fumigations with aromatics. The
pessaries were supposed to be likewise capable of producing abortion;
but Hippocrates, in his Oath, forbids to give them to pregnant women.
It appears from Juvenal that fœticide was a very common practice in his
time (see Sat. vi); and various methods of performing it are described by
Avicenna (iii, 21, 2), which we forbear to explain, lest our pages should
be instrumental in increasing the frequency of this disgusting crime. It
would seem that the ancient Lydians practised some Malthusian process to
prevent conception. See Athen. (Deip. xii, 11, with the notes of Casaubon
and Schweigh.) Aristotle says that, with this intention, some anointed
the os uteri with oil of juniper, or with ceruse and frankincense mixed
with oil. (H. A. vi, 3.) Aëtius makes mention of a mixture of alum,
galbanum, with wine, &c. being used for this purpose. (xvi.)
Although Galen has treated very fully of this disease in different
parts of his works, and has explained satisfactorily the nature of
emmenagogues, we shall pass him by on the present occasion, in order
to afford us more room for doing justice to the views of Aëtius, whose
account of amenorrhœa we consider decidedly the best we ever met with.
Aëtius says that barren and pregnant women, singers, and dancers do not
menstruate, the menstrual superfluity in the latter being consumed by too
much exercise. It is undoubtedly true, as he remarks, that those who take
strong exercise have less discharge than women who lead an indolent life.
Sometimes, too, he says, a fat or lean state of the body will occasion
suppression of the menses, because fat persons have too little blood in
their veins, it being consumed in forming the fat; and hence too they
seldom conceive, or, if they do, their offspring is puny. In those, too,
who are much emaciated, the necessary sanguineous superfluity is wanting.
The menses may likewise be suppressed from disease, such as loss of
blood, profuse perspirations, vomiting, purging, or cutaneous eruptions.
Callosities, cicatrices, and other diseases of the uterus will likewise
occasion suppression. His treatment is judiciously varied according to
the cause of the complaint. Suppression, he says, brings on heaviness,
torpor, pain of the loins, of the hindhead, of the root of the eyes, &c.
When suppression arises from _a hot temperament_, it is to be treated
with cooling and diluent food, such as ptisan, milk, lettuces, domestic
kids and lambs, tender fishes and fowls, grapes, cucumbers, and a white
watery wine. Baths of common water are to be used. When connected with _a
cold temperament_, the patient is of a pale leaden colour, and her urine
watery. She is to live upon food of a heating nature, with a generous
fragrant wine, or the wine made with salt water, and must take active
exercise. The suitable medicines are those of a calefacient nature,
such as thyme, calamint, cassia, spikenard, or savin, taken in a white
old wine. He also recommends myrrh, assafœtida, opopanax, castor, sage,
rue, cumin, and the like, all of which are to be taken immediately after
the bath; and when these do not succeed, he directs us to purge or give
an emetic. Pessaries too may be used, but the more acrid substances,
such as elaterium, cantharides, and white hellebore, must be rejected,
as they are apt to occasion irritation and inflammation. Of his long
list of prescriptions for pessaries, we shall merely notice the one
consisting of turpentine, myrrh, honey, and saffron. When occasioned by
_fatness_, the principal reliance is to be put upon an attenuant diet,
but suitable fomentations and potions must not be neglected. Guarded
purging with drastic cathartics, such as scammony or spurge, has often a
good effect. Strong pessaries are likewise proper. When the suppression
is connected with _plethora_, the patient experiences pains about the
loins and lower part of the belly at the accustomed period, and a marked
fulness of the veins is perceptible. It is to be cured by copious
bleeding either from the arm or foot, by quietude, and the use of common
fomentations. Restriction as to the bath and food must be enjoined.
When connected with _emaciation_, the constitution is to be recruited
by suitable exercise and regimen, not neglecting pessaries and potions.
When occasioned by _vitiated humours_, such as bile or phlegm, the body
is to be purged with the proper medicines, and the parts fomented.
Fragrant articles are to be mixed with the food. The pessaries are to
be made of elaterium, sow-bread, or the like, if bile prevails; but of
anemone, pepper, or colocynth, if phlegm. When _a bleeding at the nose_
is the cause of suppression, it is to be cured by sweating, vomiting,
or other evacuations. But in this case, and when the suppression arises
from barrenness or excessive labour, no marked inconvenience is felt,
only conception cannot take place. When occasioned by _an indolent course
of life_ the proper remedies are suitable labour, exercise, gestation,
a thin white wine, and living on attenuant and humid food. When the
complaint is not connected with any of the causes or states above
described, it is to be presumed that it is occasioned by some organic
disease, which must be treated accordingly.
The same subject is well treated of by Avicenna, but we cannot afford
room for even an outline of his account. Like our author, he approves of
tight ligatures around the thighs, bleeding from the saphena; and among
his emmenagogues we remark savin, musk, castor, and myrrh. All these
occur also in Scrapion’s list. Haly Abbas recommends baths medicated with
various stimulant articles, such as fennel, rue, chamomile, parsley,
&c. He mentions pessaries and suppositories, or tents prepared with
attenuant and stimulant medicines, such as myrrh, wild marjoram, rue,
savin, hellebore, colocynth, wormwood, bulks gall, &c. He also speaks
of fumigations with the vapours of aromatics, such as castor, olibanum,
lignum aloes, &c. He approves of bleeding from the saphena, and of
applying cupping-instruments to the thighs, especially when there is any
determination to the nose. When connected with corpulence, he enjoins
strong exercise, attenuant food, restricted diet, and purgatives.
Alsaharavius treats fully of this complaint upon nearly the same plan as
Aëtius. He says the stronger emmenagogues are wild mint, juniper, black
hellebore, mastich, myrrh, colocynth, gentian, &c. To relieve the pains
which sometimes precede menstruation, he recommends the tepid bath,
moderate exercise, and attenuant food. Rhases recommends bleeding at the
ankle, savin, purging with hiera, black hellebore, &c.; pessaries of the
same, the hot bath, and stimulant friction.
Eros strongly recommends repeated bleeding at the ankle, the tepid bath,
purgatives, diuretics, and emmenagogues, such as savin, calamint, myrrh,
&c.