Fissures occur about the mouth of the uterus from difficult parturition,
and at first they escape notice while the pains from the labour are
recent; but afterwards they are slightly felt, either upon manual
inspection or during coition, when they bleed, owing to the friction.
They are also discovered when the vagina is distended, for ruptures
in the circle of the mouth are perceived. In these cases all surgical
aid, and medicines of an irritating nature, must be avoided, and
recourse had to the simpler hip-baths and pessaries. The medicine called
Tetrapharmacon diluted is befitting. But if it be callous, we must use
that from paper, with rose-oil. If they cannot bear the strength of
it, mix Illyrian iris with turpentine, and apply it. When the ulcers
are cicatrized, it will be proper to use the medicine from cadmia, or
some of the applications to the anus, such as that from litharge. It
sometimes happens that these fissures, becoming chronic, are converted
into condylomata, in which case the callus is to be removed by similar
remedies, and the condylomata cicatrized. Hemorrhoids form about the
mouth and neck of the uterus, which will be discovered by the speculum;
for eminences may be detected which, during the exacerbations, are
painful, bloody, and red, but, during the remissions, are wrinkled,
free from pain, somewhat livid, and emit a slight discharge. If
possible, therefore, in these cases, one must seize upon them during the
remissions with a forceps and cut them out; or if not, we may touch them
with astringent medicines, sometimes applying dried pomegranate-rind
with galls, or something such; and sometimes using those recommended
for hemorrhages of the uterus, which will apply both for fluxes and
hemorrhoids. These are recognized by the uterus discharging blood
constantly, or if at intervals, not in the menstrual period.
* * * * *
COMMENTARY. This section is mostly compiled from Aëtius (xvi, 97,
107.) The astringent applications recommended by Aëtius contain alum,
pomegranate-rind, ceruse, litharge, burnt lead, hypocistis, &c. For
condylomata, the Pseudo-Dioscorides recommends an application containing
arsenic. (Euporist. ii, 218.)
Avicenna and Rhases give a similar account of these complaints. They
direct us to apply to hemorrhoids either such astringents as those
directed above, or to remove them by a ligature. Haly forbids caustic
medicines, as they may prove injurious to the uterus; and prefers
extirpating them by a surgical operation. For fissures he directs us
to use basilicon, with the fat of a duck or hen, and oil of violets,
along with pitching and cataplasms. Alsaharavius directs us to extirpate
hemorrhoids by an operation; and when the basilicon ointment does not
succeed with the condylomata, to treat them similarly. As the ancients
have not described polypus uteri by name, we are inclined to think that
they must have comprehended it and all the other tumours about the uterus
under the general appellation of hemorrhoids.