It is a common direction, applicable both to the man and the woman, to
preserve the whole body in a proper temperament, by exercise, food,
baths, and everything else in moderation. What is most especially to be
attended to is, not to allow them to get into a fat habit of body; for
fat persons are unfit for the propagation of children, owing to the want
of agreement in their genital organs, and because they do not emit much
semen. Nor are those who are much emaciated more so. All things which
are heating and moderately flatulent assist, such as taking heating
wine in moderation; and of pot-herbs, the rocket, clary (_horminum_),
hedge-mustard, and the like; but they must, by all means, abstain from
calamint and rue. When conception will not take place, owing to some
cacochymy, we must purge it away, or dilute it by a proper diet. But
women must attend particularly to the state of the uterus, and that the
menstrual evacuation be not obstructed. When, therefore, the monthly
purgation is near, the woman must attend particularly to take food
and drink in moderation, and also some of those things which promote
the discharge, such as the fragrant and acrid pot-herbs, as scandix,
samphire, fennel, parsley, and alsander. And the intemperaments of the
womb must be rectified. Wherefore the cold intemperaments of the uterus
are indicated by retention of the menses, a cold and incrassating diet,
and some torpor about the pubes, loins, and legs; and these persons, if
they become perfectly congealed in habit, have no venereal desires at
all. Wherefore we must endeavour, in every other way, but particularly by
all kinds of fomentations, and by fumigation with aromatics, to recall
the natural heat. And it will not be at all improper to drink of castor
and of some of the aromatic seeds, such as cumin, anise, the flowers of
pennyroyal, and the fruit of junipers, mixing some pepper with each.
Fumigations of the womb may be applied either by sitting on a proper
chair, and receiving the vapours which arise, or by injections of hot
water in which sage, mugwort, rue, cumin, pennyroyal, sweet flag, and
the aromatic seeds have been boiled. A cataplasm of any of them may also
be applied to the lower part of the belly. The epitheme of Polyarchus is
also appropriate. Frictions of the lower part of the belly and nates are
no less proper. The woman may also use pessaries of myrrh, rue, galbanum,
and castor, having previously fomented with honied water or salt water.
The pessary called Goné is also an excellent one. Warmer intemperaments
of the uterus are indicated by the whole body being hotter than usual,
by the menses being voided in small quantity and with pain, and by the
privy parts of the woman being ulcerated. They are to be remedied by such
things as are moderately moistening and cooling, such as the pot-herbs,
lettuces, mallows, blite, gourd, cucumber, pompion, orach, and purslain,
and by the other articles of food of a like nature; and we must apply to
the bladder, abdomen and loins, all cooling things, such as cataplasms
and liniments made of the juices of herbs. If the woman cannot conceive
owing to humidity of the uterus, it is indicated by there being much
moisture of the parts during the venereal act, and by the menses being
thin and in great quantity. A desiccative diet, therefore, suits with
these cases; also exercises and frictions of the upper parts; emetics
and dry food in moderate quantities. It will likewise answer well to
strengthen the uterus by austere medicines, such as the decoction
of lentisk, of myrtles, of roses, and of sumach; or also by that of
pomegranate flowers, of the tender shoots of bramble, and of galls.
When the uterus is drier than common, it is to be cured by the opposite
remedies, I mean by baths and unguents, a moistening diet of pot-herbs,
wine in moderation, and that not very old. But if conception be prevented
by thick humours, and if they be of a pungent nature, the woman must be
purged in a way suitable to each humour, and more particularly with the
picra from aloes; then an injection with the whey of women’s milk is to
be administered, and a more suitable diet thought of. Pituitous humours
are to be evacuated by exercise, sudorifics and emetics, or downwards by
the bowels. The following medicine may be given: Of dodder of thyme, of
euphorbium, of pepper, of carrot-seed, of the seed of Macedonian parsley,
equal parts; triturate all together, and give to the amount of two
drachms to drink. This purges well and heats the womb, so that it often
makes the menses flow in cases where this discharge was stopped. As soon
as this correction has become apparent, and the menses flow properly,
then one must enjoy the woman as soon as the menstrual evacuation stops.
When flatus in the womb prevents conception, the symptoms of which may be
recognized from what we have said on inflation of the uterus, it is to be
cured first by a spare diet, and administering cumin, dill, parsley-seed,
and that of rue and anise; and by giving many of the aromatics, some to
drink and others by pessaries. When the mouth of the uterus is shut up,
it must be opened by injections of aromatics, and by using fomentations
from mallows, linseed, fenugreek and oil, and sometimes of honey; or, by
the stronger ones, composed of mugwort, fleabane, calamint, pennyroyal
and chamomile. In addition to these we may use turpentine, nitre, wild
cucumber, elaterium, cassia, and tar-water. When the mouth of the womb
gapes, the diet, fomentations and medicines should be of a desiccant
nature and astringent; and the flowers of pomegranates, lentisk, the
roots of brambles, myrtle-berries, and those things applicable for a
humid intemperament. Distortions of the uterus are to be rectified
by fomentations and emollient pessaries. In such cases, coition _a
posteriori_ would seem to promote conception.
* * * * *
COMMENTARY. Hippocrates, in his ingenious work on Sterility, assigns the
following causes for a woman’s not conceiving: First, because the os
uteri is turned obliquely from the passage to it. Second, because the
inside of the uterus being too smooth, either naturally or in consequence
of the cicatrices of ulcers, it will not retain the semen. Third, when,
owing to suppression of the menses, any obstruction takes place about the
os uteri, it is apt to prevent impregnation. Fourth, when menstruation
does not take place, the veins of the uterus become so gorged with blood
that they do not retain the semen; or, on the contrary, the same effect
may arise from profuse menstruation whereby the retentive faculty of the
vessels is weakened; or a return of the menstrual fluid in too great
quantity may wash away the semen. Fifth, prolapsus uteri, by rendering
the mouth of the womb hard and callous, prevents impregnation. The
treatment is delivered at so great length that we cannot venture even to
give an abridgment of it.
Aëtius treats very fully of sterility, but his views are much the same as
our author’s. See also Oribasius (Synops. ix, 45.)
In cases of sterility, Octavius Horatianus directs us to ascertain
whether the os uteri be turned aside or shut up. He delivers the
treatment of these cases with singular minuteness. His principal remedies
are pessaries, which of course are composed of various ingredients. We
shall give the composition of one of the simplest of them in his own
words: “Nullo etenim remedio meliore et magis innoxio, aut corrigi matrix
poterit, aut purgari, quam usus nitri suppositione.” That is to say, a
suppository of soda is one of the safest and most effectual remedies.
Serapion, like Aëtius and Paulus, regulates his treatment entirely upon
the principle of correcting the intemperaments, which he considers as
the most common causes of sterility. A humid intemperament, he says,
occasions sterility in the same manner that wet ground proves injurious
to seed which is sown upon it; and a hot intemperament dries up the semen
as the earth scorches the seed during the heat of the dog-days. Such
being his ideas of the causes of sterility, one can readily comprehend
his principles of treatment. Avicenna, Rhases, and Avenzoar likewise
direct their attention to the correction of the intemperaments, but
also recommend attention to any other local complaint about the genital
organs. Haly Abbas, among other remedies, directs us to correct the state
of the uterus by means of stimulant fumigations. One of his prescriptions
contain arsenic. This would prove a potent but dangerous application.
Alsaharavius expresses his distrust in the virtues of many specifics
which had long retained celebrity for the cure of sterility. Like the
others, he directs us to find out the cause of it, and remove it if
possible by suitable remedies.
Plutarch thus enumerates the causes which had been supposed to explain
why a woman does not conceive after every act of coition. Diocles,
the physician, maintained that it is either because no semen has been
emitted, or less than necessary; or because it does not contain the
prolific principle; or from a deficiency of heat, coldness, moisture,
or dryness; or from relaxation of the uterus. The Stoics held that it
is from the obliquity of the penis, so that it does not project the
semen straight forward; or from the disproportion between the genital
members. Erasistratus taught that it is occasioned by callosities and
fleshy excrescences; or from the uterus being more spongy or smaller than
natural. (De Placit. Philos. v, 9.) The causes of barrenness are fully
and ingeniously treated of in the tenth book of Aristotle’s ‘History of
Animals,’ which, however, is of very doubtful authenticity.