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infant would weaken the mother, and like as in the viper, the birth of the infant would be the death of the parent.

The monthly purgations continue from the fifteenth to the forty-sixth or fiftieth year; but a suppression often occurs, which is either natural or morbid: the courses are suppressed naturally during pregnancy, and whilst the woman is suckling. The morbid suppression remains to be spoken of.

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CHAPTER II

_Of the Retention of the Courses._

The suppression of the menstrual periods, is an interruption of that accustomed evacuation of blood, which comes from the matrix every month, and the part affected is the womb.

CAUSE.

The cause of this suppression is either external or internal. The external cause may be heat or dryness of air, want of sleep, too much work, violent exercise, etc., whereby the substance is so consumed, and the body so exhausted that nothing is left over to be got rid of, as is recorded of the Amazons who, being active and constantly in motion, had their courses very little, if at all. Or it may be brought about by cold which is very frequent, as it vitiates and thickens the blood, and binds up the passages, so that it cannot flow out.

The internal cause is either instrumental or material; in the womb or in the blood. In the womb, it may be in various ways; by humours, and abscesses and ulcers, by the narrowness of the veins and passages, or by the adipose membrane in fat bodies, pressing on the neck of the matrix, but then they must have hernia, zirthilis, for in men the membrane does not reach so low; by too much cold or heat, the one vitiating the action, and the other consuming the matter through the wrong formation of the uterine parts; by the neck of the womb being turned aside, and sometimes, though rarely, by a membrane or excrescence of the flesh growing at the mouth or neck of the womb. The blood may be in fault in two ways, in quantity and in quality; in quantity, when it is so consumed that no surplus is left over, as in viragoes or virile women, who, through their heat and natural strength, consume it all in their last nourishment; as Hippocrates writes of Prethusa, for when her husband praised her overmuch, her courses were suppressed, her voice changed and she got a beard with a manly face. But I think, rather that these must be _Gynophagi_, or woman-eaters, rather than women-breeders, because they consume one of the principles of generation, which gives a being to the world, viz., the menstruous blood. The blood may likewise be lost, and the courses checked by nosebleeding, by bleeding piles, by dysentery, commonly called the bloody flux, by many other discharges, and by chronic diseases. Secondly, the matter may be vitiated in quality, and if it be sanguineous, sluggish, bilious or melancholy, and any of these will cause an obstruction in the veins.

SIGNS.

Signs which manifest the disease are pains in the head, neck, back and loins; weariness of the whole body (but especially of the hips and legs, because the womb is near those parts); palpitation of the heart. The following are particular signs:–If the suppression arises from a cold, the woman becomes heavy, sluggish, pale and has a slow pulse; Venus’ combats are neglected, the urine is thick, the blood becomes watery and great in quantity, and the bowels become constipated. If it arises from heat, the signs are just the opposite. If the retention be natural and arises from conception, this may be known by drinking hydromel, i.e., water and honey, after supper, before going to bed, by the effect which it has; for if after taking it, she feels a heating pain about the navel and the lower parts of the abdomen, it is a sign that she has conceived, and that the suppression is natural.

PROGNOSTICS.

The whole body is affected by any disorder of the womb, and especially the heart, the liver and the brain, and there is a singular sympathy between the womb and those three organs. Firstly, the womb communicates with the heart by the mediation of those arteries which come from the aorta. Hence, when menstruation is suppressed, fainting, swooning, a very low pulse, and shortness of breath will ensue. Secondly, it communicates with the liver by the veins derived from the hollow vein. Obstructions, jaundice, dropsy, induration of the spleen will follow. Thirdly, it communicates with the brain by the nerves and membranes of the back; hence arise epilepsy, madness, fits of melancholy, pains in the back of the head, unaccountable fears and inability to speak. I may, therefore, well agree with Hippocrates that if menstruation be suppressed, many dangerous diseases will follow.

CURE.

In the cure of this, and of all the other following cases, I shall observe the following order:–The cures will be taken from surgical, pharmaceutical and diuretical means. The suppression has a plethoric effect, and must be removed by the evacuation; therefore we begin with bleeding. In the middle of the menstrual period, open the liver vein, and two days before, open the saphena in both feet; if the repletion is not very great apply cupping glasses to the legs and thighs, although there may be no hope of removing the suppression. As in some women, the cotyledones are so closed up that nothing but copulation will open them, yet it will be well to relieve the woman as much as possible by opening the hemoroid veins by applying a leech. After bleeding let the place be prepared and made flexible with syrup of stychas, calamint, betony, hyssop, mugwort, horehound, fumitary, maidenhair. Bathe the parts with camomiles, pennyroyal, savias, bay-leaves, juniper-berries, rue, marjoram, feverfew. Take a handful each of nep, maidenhair, succory and betony leaves and make a decoction, and take three ounces of it, syrup of maidenhair, mugwort and succory, half an ounce of each. After she comes out of her bath, let her drink it off. Purge with _Pill agaric, fleybany, corb, feriae_. In this case, Galen recommends _pilulae of caberica coloquintida_; for, as they are good for purging the bad humours, so also they open the passages of the womb, and strengthen it by their aromatic qualities.

If the stomach be over-loaded, let her take an emetic, yet such a one as may work both ways, lest if it only works upwards, it should check the humours too much. Take two drachms of trochisks of agaric, infuse this in two ounces of oxymel in which dissolve one scruple and a half of _electuary dissarum_, and half an ounce of _benedic laxit_. Take this as a purge.

After the humour has been got rid of, proceed to more suitable and stronger remedies. Take a drachm and a half of trochisk of myrrh; ten grains of musk with the juice of smallage; make twelve pills and take six every morning, or after supper, on going to bed. Take half an ounce of cinnamon, two drachms each of smirutium, or rogos, valerin aristolochia; two scruples each of astrumone root and saffron; two drachms of spec. diambia; four scruples of trochisk of myrrh; two scruples tartari vitriolari; make half into a powder; make lozenges with mugwort water and sugar, and take one drachm of them every morning; or mix a drachm of the powder with one drachm of sugar, and take it in white wine. Take two drachms each of prepared steel and spec. hair; one scruple each of borax and spec. of myrrh, with savine juice; make it up into eighty-eight lozenges and take three every other day before dinner. Take one scruple of castor, half a drachm of wild carrot seed with syrup of mugwort, and make four pills, take them in the morning fasting, for three days following, before the usual time of purging. Take five drachms each of agaric, aristolochia, and juice of horehound; six drachma each of rhubarb, spikenard, aniseed, guidanum, asafoetida, mallow-root, gentian, of the three peppers and of liquorice: make an electuary with honey, and take three drachms for a dose. For phlegmatic constitutions nothing can be better than the decoction of guaiacum wood with a little disclaim, taken fasting in the morning, for twelve days consecutively, without producing sweating.

Treat the lower parts of the body to suffumigating, pessaries, ointments and injections; for fumigating use cinnamon, nutmeg, the berries of the bay tree, mugwort, galbanum, molanthium, amber, etc. Make pessaries of figs and the bruised leaves of dog’s mercury, rolled up in lint, and if a stronger one is required, make one of myrrh, opopanax, ammoniac, galbanum, sagepanum, mithridate, agaric, coloquintida, tec. Make injections of a decoction of origane mugwort, dog’s mercury, betony, and eggs; inject into the womb with a female syringe. Take half an ounce each of oil of almonds, lilies, capers, camomiles; two drachms each of laudanum and oil of myrrh; make a salve with wax, with which anoint the place; make injections of fenugreek, camomiles, melilot, dill, marjoram, pennyroyal, feverfew, juniper berries and calamint; but if the suppression arises from a lack of matter, then the courses ought not to be brought on until the spirits be raised and the amount of blood increased; or if it arises from affections of the womb itself, as dropsy or inflammation, then particular care must be used; but I will not lay stress on this here, but will mention the remedies in their order.

If the retention comes from repletion or fullness, if the air be hot and dry, take moderate exercise before meals, and very light diet and drinks, and with your food take garden savory–thyme and origane, if it arises from emptiness and defect of matter: if the weather be moist and moderately hot, avoid exercise and late hours; let your food be nourishing and easy of digestion, such as raw eggs, lamb, chickens, almonds, milk and the like.

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CHAPTER III

_Of Excessive Menstruation._

The learned say, that truth is manifested by comparing contraries, and so, as I have above spoken of the suppression of menstruation, it is now necessary that I should treat of excessive menstruation, which is no less dangerous than the former. This immoderate monthly flow is defined as a sanguineous discharge, as it consists merely of blood, wherein it differs from the false courses or whites, of which I shall speak further on. Secondly, it is said to proceed from the womb; for there are two ways in which the blood issues forth; one by the internal veins of the body of the womb (and this is properly called the monthly flow), the other is by those veins which terminate in the neck of the matrix, which Aetius calls haemorrhoids of the womb. In quantity, Hippocrates said, it should be about eighteen ounces, and they should last about three days: and when the faculties of the body are weakened by their flow, we may take it that the discharge is inordinate. In bodies which abound in gross humours, this immoderate flow sometimes unburdens nature of her load and ought not to be checked without a physician’s advice.

CAUSE.

The cause is either internal or external. The internal cause is threefold; in the substance, the instrument or the power. The matter, which is the blood, may be vitiated in two ways; first, by the heat of the constitution, climate or season, heating the blood, whereby the passages are dilated, and the power weakened so that it cannot retain the blood. Secondly, by falls, blows, violent motions, rupture of the veins, etc. The external cause may be the heat of the air, heavy burdens, unnatural childbirth, etc.

SIGNS.

In this excessive flow the appetite is lessened, conception is checked and all the functions weakened; the feet swell, the colour of the face changes, and the whole body is weakened. If the flow comes from the rupture of a vein, the body is sometimes cold, the blood flows out in streams, suddenly, and causes great pain. If it arises from heat, and the orifice of the vein is dilated, there is little or no pain, but yet the blood flows faster than it does when caused by erosion, but not so fast as it does in a rupture. If caused by erosion, the woman feels a scalding of the passage, and it differs from the other two, in so much as it does not flow so quickly or so freely as they do. If it is caused by weakness of the womb, the woman feels a dislike for sexual intercourse. Lastly, if it proceeds from the defective quality of the blood let some of it drop into a cloth, and when it is dry, you may judge, of the quality by the colour. If it be passionate it will be yellow; if melancholy, it will be black, and if phlegmatic, it will be waterish and whitish.

PROGNOSTICS.

If convulsions are joined to the flow, it is dangerous, because that intimates that the noble parts are affected, convulsions caused by emptiness are deadly. If they continue long, they will be very difficult to cure, and it was one of the miracles which our Saviour Christ wrought, to cure a woman of this disease of twelve years standing.

To conclude, if the flow be excessive, many diseases will follow, which will be almost impossible to cure; the blood, being consumed together with the innate heat, either morbid, dropsical, or paralytical diseases will follow.

CURE.

The cure consists in three particulars. First, in expelling and carrying away the blood. Secondly, in connecting and removing the fluxibility of the matter. Thirdly, in incorporating the veins and faculties. For the first, to get rid of the superfluous blood, open a vein in the arm, and draw off as much blood as the strength of the patient will allow; not all at one time, but at intervals, for by those means the spirits are less weakened, and the reaction so much the greater.

Apply cupping glasses to the breasts and also over the liver, and to correct the flexibility of the matter, purgative means, moderated by astringents, may be employed.

If it is caused by erosion, and salt phlegm, prepare with syrup of violets, wormwood, roses, citron peel, succory, etc. Then make the following purge:–mirabolans, half an ounce; trochisks of agaric, one drachm; make a decoction with the plantain-water, and add syrup of roses lax. three ounces, and make a draught.

If caused by any mental excitement, prepare the body by syrup of roses, myrtles, sorrel and parsley, mixed with plantain-water, knot-grass and endive. Then purge with the following draught:–Take one drachm each of the void of mirabolans, and rhubarb, cinnamon fifteen grains; infuse for a night in endive water; add to the strained water half an ounce of pulp of tamarinds and of cassia, and make a draught. If the blood be waterish as it is in dropsical subjects and flows out easily on account of its thinness, it will be a good plan to draw off the water by purging with agaric, elaterium and coloquintida. Sweating is also useful in this case, as by it the noxious matter is carried off, and the motion of the blood to other parts. To produce sweating, employ cardus water, and mithridate, or a decoction of guaiacum and sarsaparilla. Gum guaiacum is also a great producer of perspiration, and sarsaparilla pills, taken every night before going to bed are also highly to be recommended. If the blood pours out, without any evil quality in itself, then strengthening means only should be employed, which is a thing to be done in cases of inordinate discharge.

Take one scruple of ol. ammoniac, one drachm of treacle, half an ounce of conserve of roses and make an electuary with syrup of myrtle, or if the discharge be of long standing take two drachms of matrix, one drachm of olilanum troch. de carbara, a scruple of balustium; make into a powder and form into pills with syrup of quinces, and take one before every meal. Take two scruples each of troch. dechambede, scoriaferri, coral and frankincense; pound these to a fine powder, and make into lozenges with sugar and plantain water. Asses’ dung is also approved of, whether taken inwardly with syrup of quinces or applied outwardly with steeled water. Galen by sending the juice of it into the womb by means of a syringe for four days consecutively, cured this immediate flow, which could not be checked in any other way. Let the patient take one scruple and a half of pilon in water before going to bed; make a fumigation for the womb of mastic, frankincense and burnt frogs, adding the hoof of a mule. Take an ounce each of the juice of knot-grass, comfoly and quinces; a drachm of camphor; dip a piece of silk or cotton into it and apply it to the place. Take half an ounce each of oil of mastic, myrtle, and quinces; a drachm each of fine bole and troch. decardas, and a sufficient quantity of dragon’s blood, make an ointment and apply it before and behind. Take an ounce and a half each of plantain, shepherd’s purse and red rose leaves; an ounce of dried mint, and three ounces of bean flour; boil all these in plantain water and make two plasters:–apply one before and one behind. If the blood flows from those veins which are terminated at the neck of the matrix, then it is not called an undue discharge of the _menses_, but haemorrhoids of the womb. The same remedy, however, will serve for both, only the instrumental cure will be a little different; for in uterine haemorrhoids, the ends of the veins hang over like teats, which must be removed by cutting, and then the veins closed with aloes, fine bole, burnt alum, myrrh, mastic, with comfoly-juice and knot grass, laid upon it like a plaster.

[Illustration: _Position of the Embryos in a plural conception_]

[Illustration: Process of Delivery.]

The air should be cold and dry, and all motion of the body should be prohibited. Her diet should consist of pheasants, partridges, grouse, rabbits, calves’ feet, etc., and her drink should be mixed with the juice of pomegranates and quinces.

* * * * *

CHAPTER IV

_Of the Weeping of the Womb._

The weeping of the womb is an unnatural flow of blood, coming from it in drops, like tears, and causing violent pains in it, and occurring at no fixed period or time. By some it is supposed to be produced by the excessive flow of the courses, as they flow copiously and freely; this is continued, though only little at a time, and accompanied by great pain and difficulty of passing it, and on this account it is compared to the strangury.

The cause is in the power, instrument or matter; in the power, on account of its being enfeebled so that it cannot expel the blood, and which, remaining there, makes that part of the womb grow hard, and distends the vessels, and from that, pains in the womb arise. In the instrument, from the narrowness of the passage. Lastly, it may be the matter of the blood which is at fault, and which may be in too great quantities; or the quality may be bad, so that it is thick and gross and cannot flow out as it ought to do, but only in drops. The signs will best be ascertained by the patient’s own account, but there will be pains in the head, stomach and back, with inflammation, difficulty of breathing and excoriation of the matrix. If the patient’s strength will permit it, first open a vein in the arm, rub the upper parts and let a cord be fastened tightly round the arm, so that the force of the blood may be carried backward; then apply such things as may relax the womb, and assuage the heat of the blood, as poultices made of bran, linseed, mallows, dog’s mercury and artiplex. If the blood be viscous and thick, add mugwort, calamint, dictain and betony to it, and let the patient take about the size of a nutmeg of Venic treacle, and syrup of mugwort every morning; make an injection of aloes, dog’s mercury, linseed, groundsel, mugwort, fenugreek, with sweet almond oil.

Sometimes it is caused by wind, and then bleeding must not be had recourse to, but instead take one ounce of syrup of feverfew; half an ounce each of honey, syrup of roses, syrup of stachus; an ounce each of calamint water, mugwort, betony and hyssop, and make a julep. If the pain continues, use this purge:–Take a drachm of spec. Hitrae, half an ounce of diacatholicon, one ounce of syrup of roses and laxative, and make a draught with a decoction of mugwort and the four cordial flowers. If it proceeds from weakness, she must be strengthened, but if from grossness of blood, let the quality of it be altered, as I have shown in the preceding chapter. Lastly, if her bowels are confined, move them by an injection of a decoction of camomiles, betony, feverfew, mallows, linseed, juniper-berries, cumminseed, aniseed, melilot, and add to it half an ounce of diacatholicon; two drachms of hiera piera, an ounce each of honey and oil and a drachm and a half of sol. nitre. The patient must abstain from salt, acid and windy food.

* * * * *

CHAPTER V

_The false Courses, or Whites._

From the womb, not only the menstruous blood proceeds, but many evacuations, which were summed up by the ancients under the title of _rhoos gunaikeios_,[6] which is the distillation of a variety of corrupt humours through the womb, which flow from the whole body or a part of it, varying both in courses and colour.

CAUSE.

The cause is either promiscuously in the whole body, by a cacochymia; or weakness of it, or in some of its parts, as in the liver, which by a weakness of the blood producing powers, cause a production of corrupt blood, which then is reddish. Sometimes, when the fall is sluggish in its action, and does not get rid of those superfluities engendered in the liver, the matter is yellowish. Sometimes it is in the spleen when it does not cleanse the blood of the dregs and rejected particles, and then the matter which flows forth is blackish. It may also come from a cold in the head, or from any other decayed or corrupted member, but if the discharge be white, the cause lies either in the stomach or loins. In the stomach, by some crude substance there, and vitiated by grief, melancholy or some other mental disturbance; for otherwise, if the matter were only crude phlegm and noways corrupt, being taken into the liver it might be converted into the blood; for phlegm in the ventricle is called nourishment half digested; but being corrupt, though sent into the liver it cannot be turned into nutriment, for the second decoction in the stomach cannot correct that which the first corrupted; and therefore the liver sends it to the womb, which can neither digest nor reject it, and so it is voided out with the same colour which it had in the ventricle. The cause may also be in the veins being overheated whereby the spermatical matter flows out because of its thinness. The external causes may be moistness of the air, eating bad food, anger, grief, sloth, too much sleep, costiveness.

The signs are bodily disturbances, shortness of breathing, and foul breath, a distaste for food, swollen eyes and feet, and low spirits; discharges of different colours, as red, black, green, yellow and white from the womb. It differs from the flowing of the courses and from too abundant menstruation, in so far as it keeps no certain period, and is of many colours, all of which spring from blood.

If the flux be phlegmatic, it will last long and be hard to cure, but if sickness or diarrhoea supervene, it carries off the humour and cures the disease. If it is abundant it does not last so long, but it is more dangerous, for it will cause a cleft in the neck of the womb, and sometimes also an excoriation of the matrix; if melancholy, it must be dangerous and obstinate. The flux of the haemorrhoids, however, assists the cure.

If the matter which flows out be reddish, open a vein in the arm; if not, apply ligatures to the arms and shoulders. Galen boasts that he cured the wife of Brutus, who was suffering from this disease, by rubbing the upper part with honey.

If it is caused by the brain, take syrup of betony and marjoram. Give as a purgative _Pill. coch._ or _Agaric_; make nasalia of sage, or hyssop juice, betony, flagella, with one drop of oil of _Elect. Dianth. Rosat. Diambrae, diamosci dulus_, one drachm of each, and make lozenges to be taken every morning and evening. _Auri Alexandrina_, half a drachm at night on going to bed. If these things have no effect, try suffumigation and plasters, as they are prescribed above.

If it arises from crudities of the stomach or from a cold, disordered liver, take a decoction of _lignum sanctum_ every morning, purge with _pill de agaric, de hermadact, de hiera, diacolinthis, foetid-agrigatio_; take two drachms of elect. aromet-roses, one scruple each of dried citron peel, nutmeg, long pepper; one drachm of draglanga; half a scruple each of _fantalum album_, ling, aloes; six ounces of sugar, with mint water: make lozenges of it, and take them before meals. If there be repletion besides the rigidity of the liver, purging by means of an emetic is to be recommended, for which take three drachms of the electuary diasatu. Galen allows diuretical remedies, such as _aqua petrofolma_.

If the discharge be angry, treat it with syrup of roses, violets, endive and succory; give a purge of mirabolans, manna, rhubarb, and cassia. Take two drachms of rhubarb, one of aniseed, and one scruple and a half of cinnamon; infuse them into six ounces of syrup of prunes, and add one ounce of strained manna, and take it in the morning as required. Take one drachm each of the following drugs: _diatonlanton, diacorant, diarthod, abbaris, dyacydomei_, four ounces of sugar, and make into lozenges with plantain water. If the gall be sluggish, and does not stir the bowels, give warm injections of a decoction of the four mollifying herbs, with honey of roses and aloes.

If the flow be bilious, treat the patient with syrup of maiden-hair; epithynium, polypody, borage, buglos, fumitary, hart’s tongue and syrups, bisantius, which must be made without vinegar, else it will assist the disease instead of nature, for melancholy is increased by the use of vinegar, and both Hippocrates, Silvius and Avenzoar reject it as injurious for the womb, and therefore not to be used internally in uterine diseases. _Pilulae sumariae, pilulae lud. delupina, lazuli diosena_ and _confetio hamec_ are purges of bile. Take two ounces of pounded prunes, one drachm of senna, a drachm and a half each of epithimium, polypody and fumitary, and an ounce of sour dates, and make a decoction with endive water; take four ounces of it and add three drachms of hamesech and three of manna. Or take a scruple each of _pil. indic. foetid, agarici, trochis ati_; one scruple of rhubarb pills, six grains of lapis lazuli, make into pills with epithimium, and take them once a week. Take three drachms of elect. loetificans. Galen three drachms, a drachm each of _diamargaritum, calimi, diamosci dulus_; a drachm of conserve of borage, violets and burglos; one drachm of candied citron peel, seven ounces of sugar, and make into lozenges with rose water.

Lastly let the womb be cleansed of all corrupt matter, and then be strengthened. In order to purify it, make injections of the decoction of betony, feverfew, spikenard, bismust, mercury and sage, and add two ounces each of sugar and sweet almond oil; pessaries may also be made of silk or cotton, softened in the juice of the above mentioned herbs.

You must prepare trochisks, thus, to strengthen the womb. Take one ounce each of mugwort, feverfew, myrrh, amber, mace, storax, ling aloes and red roses, and make lozenges or troches with mucilage of tragacanth; throw one of them on to hot coals and fumigate the womb with red wine, in which mastic, fine bole, malustia and red roots have been decocted; anoint the matrix with oil of quinces and myrtles, and apply a plaster to it, for the womb; and let the woman take _diamosdum dulco_, _aract_, and _slemoticum_ every morning.

A drying diet is recommended as best, because in these cases the body abounds with phlegmatic and crude humours. On this account, Hippocrates advises the patient to go to bed supperless. Her food should consist of partridges, pheasant and grouse, roasted rather than boiled, too much sleep must be prohibited whilst moderate exercise is very advisable.

FOOTNOTES:

[6] The female flowing.

* * * * *

CHAPTER VI

_The Suffocation of the Mother._

This, which if simply considered, will be found to be merely the cause of an effect, is called in English, “the suffocation of the mother,” not because the womb is strangled, but because by its retraction towards the midriff and stomach, which presses it up, so that the instrumental cause of respiration, the midriff, is suffocated, and acting with the brain, cause the animating faculty, the efficient cause of respiration, also to be interrupted, when the body growing cold, and the action weakened, the woman falls to the ground as if she were dead.

Some women remain longer in those hysterical attacks than others, and Rabbi Moses mentions some who lay in the fit for two days. Rufus writes of one who continued in it for three days and three nights, and revived at the end of the three days. And I will give you an example so that we may take warning by the example of other men. Paroetus mentions a Spanish woman who was suddenly seized with suffocation of the womb, and was thought to be dead. Her friends, for their own satisfaction, sent for a surgeon in order to have her opened, and as soon as he began to make an incision, she began to move, and come to herself again with great cries, to the horror and surprise of all those present.

In order that the living may be distinguished from the dead, old writers prescribe three experiments. The first is, to lay a feather on the mouth, and by its movements you may judge whether the patient be alive or dead; the second is, to place a glass of water on the breast, and if it moves, it betokens life; the third is, to hold a bright, clean, looking-glass to the mouth and nose, and if the glass be dimmed with a little moisture on it, it betokens life. These three experiments are good, but you must not depend upon them too much, for though the feather and the glass do not move, and the looking-glass continues bright and clear, yet it is not a necessary consequence that she is dead. For the movement of the lungs, by which breathing is produced, may be checked, so that she cannot breathe, and yet internal heat may remain, which is not evident by the motion of the breast or lungs, but lies hidden in the heart and arteries.

Examples of this we find in flies and swallows, who seem dead to all outward appearances, breathless and inanimate, and yet they live by that heat which is stored up in the heart and inward arteries. At the approach of summer, however, the internal heat, being restored to the outer parts, they are then brought to life again, out of their sleeping trance.

Those women, therefore, who apparently die suddenly, and from no visible cause, should not be buried until the end of three days, lest the living be buried instead of the dead.

CURE.

The part affected is the womb, of which there are two motions–natural and symptomatic. The natural motion is, when the womb attracts the male seed, or expels the infant, and the symptomatical motion, of which we are speaking, is a convulsive drawing up of the womb.

The cause is usually in the retention of the seed, or in the suppression of the menses, which causes a repletion of the corrupt humours of the womb, from which a windy refrigeration arises, which produces a convulsion of the ligaments of the womb. And just as it may arise from humidity or repletion, so also, as it is a convulsion, it may be caused by dryness or emptiness. Lastly also, it may arise from abortion or from difficult childbirth.

SIGNS.

On the approach of suffocation of the womb the face becomes pale, there is a weakness of the legs, shortness of breathing, frigidity of the whole body, with a spasm in the throat, and then the woman falls down, bereft of sense and motion; the mouth of the womb is closed up, and feels hard when touched with the finger. When the paroxysm or the fit is over, she opens her eyes, and as she feels an oppression of the stomach, she tries to vomit. And lest any one should be deceived into taking one disease for another, I will show how it may be distinguished from those diseases which most resemble it.

It differs from apoplexy, as it comes without the patient crying out; in hysterical fits also the sense of feeling is not altogether destroyed and lost, as it is in apoplexy; and it differs from epilepsy, as the eyes are not distorted, and there is spongy froth from the mouth. That convulsive motion also, which is frequently accompanied by symptoms of suffocation, is not universal, as it is in epilepsy, but there is some convulsion, but that without any violent agitation. In syncope both breathing and the pulse fail, the face grows pale, and the woman faints suddenly; but in hysterical attacks there are usually both breathing and pulse, though these are indistinct; the face is red and she has a forewarning of the approaching fit. It cannot, however, be denied that syncope may accompany this feeling of suffocation. Lastly, it can be distinguished from lethargy by the pulse, which is rapid in the former, but weak in the latter.

CURE.

In the cure of this affection, two things must be taken care of:–_In the first place_, nature must be stimulated to expel these hurtful humours which obscure the senses, so that the woman may be brought back from that sleepy fit. _Secondly_, during the intervals of the attack, proper remedies must be employed, in order to remove the cause.

To stimulate nature, apply cupping-glasses to the hips and navel: apply ligatures to the thighs, rub the extremities with salt, mustard and vinegar, and shout and make a great noise in her ears. Hold asafoetida to the nose, or sacopenium steeped in vinegar; make her sneeze by blowing castor-powder, white pepper and hellebore up her nose; hold burnt feathers, hair, leather, or anything else with a strong, stinking smell under her nose, for bad odours are unpleasant to nature, and the animal spirits so strive against them, that the natural heat is restored by their means. The brain is sometimes so oppressed, that it becomes necessary to burn the outer skin of the head with hot oil, or with a hot iron, and strong injections and suppositories are useful. Take a handful each of sage, calamint, horehound, feverfew, marjoram, betony and hyssop; half an ounce of aniseed; two drachma each of coloquintida, white hellebore and salgem; boil these in two quarts of water till reduced to half; add two ounces of castor oil and two drachms of hiera piera and make an injection of it. Or take two ounces of boiled honey, half a scruple of spurge, four grains of coloquint, two grains of hellebore and drachm of salt; make a suppository. Hippocrates mentions a hysterical woman who could only be relieved of the paroxysms by pouring cold water on her: yet this is a strange cure, and should only be administered in the heat of summer, when the sun is in the tropic of Cancer.

If it be caused by the retention and corruption of the seed, let the mid-wife take oil of lilies, marjoram and bay leaves, and dissolve two grains of civet in them, and the same quantity of musk, and at the moment of the paroxysm let her dip her finger into the mixture and put it into the neck of the womb, and tickle and rub it with it.

When the fit is over, proceed to remove the cause. If it arises from suppression of the menses, look in Chapter XI, p. 102, for the cure. If it arises from the retention of the seed, a good husband will administer the cure, but those who cannot honourably obtain that remedy, must use such means as will dry up and diminish the seed, as diaciminum, diacalaminthes, etc. The seed of the agnus castus is highly valued as a draught, whether taken inwardly, applied outwardly or used as a suffumigation. It was held in high esteem by the Athenian women, for by its means they remained as pure vessels and preserved their chastity, by only strewing it on the bed on which they lay, and hence the name of _agnus castus_, which was given to it, as denoting its effects. Make an issue on the inside of each leg, four inches below the knee, and then make lozenges of two scruples of agric, half a scruple each of wild carrot seed and ligne aloes; three drachms of washed turpentine, and make a bolus with a conserve of flowers. Eight drachms of castor taken in white wine are very useful in this case, or you may make pills of it with dog’s tooth, and take them on going to bed. Take an ounce of white briony root dried and cut up like carrots, put it into a little wine and place it on the fire, and drink when warm. Take one scruple each of myrrh, castor and asafoetida; four grains each of saffron and rue-seed, and make eight pills and take two every night on going to bed.

Galen, from his own experience, recommends powdered agaric, of which he frequently gave one scruple in white wine. Put a head of bruised garlic on the navel at bed time, and fasten it with a swathing band. Make a girdle for the waist of galbanum, and also a plaster for the stomach, and put civet and musk on one part of it, which must be applied to the navel. Take two drachms each of pulvis benedict, and of troches of agaric, a sufficient quantity of mithridate, and make two pessaries, and that will purge the matrix of wind and phlegm; foment the private parts with salad oil in which some feverfew and camomiles have been boiled. Take a handful of roseleaves and two scruples of cloves, sew them in a little cloth and boil them for ten minutes in malmsey; then apply them, as hot as they can be borne, to the mouth of the womb, but do not let the smell go up her nose. A dry diet must still be adhered to and the moderate use of Venus is advisable. Let her eat aniseed biscuits instead of bread, and roast meat instead of boiled.

* * * * *

CHAPTER VII

_Of the Descending or Falling of the Womb._

The descent of the womb is caused by a relaxation of the ligatures, whereby the matrix is carried backward, and in some women it protrudes to the size of an egg, and there are two kinds of this, distinguished by a descending and a precipitation. The descending of the womb is, when it sinks down to the entrance of the private parts, and appears either very little or not at all, to the eye. Its precipitation is when it is turned inside out like a purse, and hangs out between the thighs, like a cupping glass.

CAUSE.

This is either external or internal. The external cause is difficult childbirth, violent pulling away, or inexperience in drawing away the child, violent coughing, sneezing, falls, blows, and carrying heavy burdens. The internal cause, is generally the flow of too much moisture into these parts, which hinders the operation of the womb, whereby the ligaments by which the womb is supported are relaxed. The particular cause, however, lies in the retention of the _semen_, or in the suppression of the monthly courses.

SIGNS.

The principal gut and the bladder are often so crushed, that the passage of both evacuations is hindered. If the urine flows out white and thick, and the midriff is interfered with, the loins suffer, the private parts are in pain, and the womb descends to them, or else comes clean out.

PROGNOSTICS.

If an old woman is thus affected, the cure is very difficult, because it weakens the womb, and therefore, though it may be put back into its proper place, yet it is apt to get displaced again, by a very slight amount of illness. And also with younger women, if this disease is inveterate, and if it is caused by putrefaction of the nerves, it is incurable.

CURE.

The womb, being placed by nature between the straight gut and the bladder, ought not to be put back again until the powers of both are excited. Now that nature is relieved of her burden, let the woman be laid on her back so that her legs may be higher than her head; let her feet be drawn up towards her private parts, and her knees spread open. Then apply oil of sweet almonds and lilies, or a decoction of mallows, beet, fenugreek and linseed, to the swelling; when the inflammation is reduced, let the midwife rub her hand with oil of mastic, and restore the womb to its proper place. When the matrix is up, the patient’s position must be changed. Her legs must be put out quite straight and laid together, and apply six cupping glasses to her breast and navel. Boil feverfew, mugwort, red rose leaves and comfrey in red wine; make a suffumigation for the matrix, and apply sweet scents to her nose. When she comes out of her bath, give her an ounce of syrup of feverfew with a drachm of dog’s tooth (_mithridate_). Take three drachms each of laudanum and mastic, and make a plaster for the navel of it, and then make pessaries of asafoetida, saffron, comfrey, and mastic, adding a little castor oil.–Parius in such cases makes his pessaries only of cork, shaped like a small egg; he covered them with wax and mastic dissolved together, and fastening them to a thread, he put them into the womb.

The immediate danger being now removed and the matrix returned to its natural place the remote cause must be got rid of. If she be of full habit of body open a vein, after preparing her with syrup of betony, calamint, hyssop and feverfew. Give a purge, and if the stomach be oppressed with any crude matter relieve it by emetics and by sudorifics of lignum sanctum and sassafras taken twenty days consecutively, which dry up the superfluous moisture, and consequently suppress the cause of the disease.

The air should be hot and dry, and her diet hot and attenuating. Let her abstain from dancing, jumping, sneezing, as well as from all mental and bodily emotions, eat sparingly, not drink much, and be moderate in her sleep.

* * * * *

CHAPTER VIII

_Of the Inflammation of the Womb._

The phlegmon, or inflammation of the matrix, is a humour which affects the whole womb, and is accompanied by unnatural heat, by obstruction and by an accumulation of corrupt blood.

CAUSE.

The cause of this affection is suppression of the courses, fullness of body, the immoderate use of sexual intercourse, frequent handling the genitals, difficult child-birth, violent motions of the body, falls, blows, to which may be added, the use of strong pessaries, whereby the womb is frequently inflamed, cupping glasses, also, fastened to the _pubis_ and _hypogastrium_, draw the humours of the womb.

SIGNS.

The signs are pains in the lower parts of the body and head, humours, sickness, coldness in the knees, throbbing in the neck, palpitation of the heart. Often, also, there is shortness of breath because of the heart which is close to the midriff, and the breasts sympathising with the swollen and painful womb. Besides this, if the front of the matrix be inflamed, the privates suffer, and the urine is suppressed, or only flows with difficulty. If the hinder part be inflamed, the loins and back suffer, and the bowels are very costive; if the right side be inflamed, the right hip suffers, and the right leg is heavy and moves slowly, so that at times she seems almost lame. If, however, the left side of the womb be inflamed, then the left hip suffers and the left leg is weaker than the right. If the neck of the womb is affected, by putting her finger in, the midwife feels that its mouth is contracted and closed up, and that it is hard round it.

CURE.

In the cure, first of all, let the humours which flow to the womb be expelled. To effect this, after the bowels have been loosened by cooling clysters bleeding will be necessary. Therefore, open a vein in the arm, if she is not with child; the day after strike the saphena in both feet, fasten ligatures and cupping glasses to the arm, and rub the upper part. Purge gently with cassia, rhubarb, senna and myrobalan. Take one drachm of senna, a scruple of aniseed, myrobalan, half an ounce, with a sufficient quantity of barley water. Make a decoction and dissolve syrup of succory in it, and two ounces of rhubarb; pound half an ounce of cassia with a few drops of oil of aniseed and make a draught. At the commencement of the disease, anoint the private parts and loins with oil of roses and quinces: make plasters of plantain, linseed, barley meal, melilot, fenugreek, white of eggs, and if the pain be intense, a little laudanum; foment the genitals with a decoction of poppy-heads, purslace, knot-grass and water-lilies. Make injections of goat’s milk, rose water, clarified whey and honey of roses. When the disease is on a decline, use injections of sage, linseed, mugwort, pennyroyal, horehound, fenugreek, and anoint the lower parts of the stomach with oil of camomiles and violets.

Take four ounces each of lily and mallow roots, a handful of dog’s mercury, a handful and a half each of mugwort, feverfew, camomile flowers and melilot, bruise the herbs and roots, and boil them in a sufficient quantity of milk; then add two ounces each of fresh butter, oil of camomiles and lilies, with a sufficient quantity of bran, make two plasters, and apply one before and the other behind.

If the tumour cannot be removed, but seems inclined to suppurate, take three drachms each of fenugreek, mallow roots, boiled figs, linseed, barley meal, dove’s dung and turpentine; half a drachm of deer’s suet, half a scruple of opium and make a plaster of wax.

Take bay leaves, sage, hyssop, camomiles, and mugwort, and make an infusion in water.

Take half a handful of wormwood and betony and half a pint each of white wine and milk, boil them until reduced to half; then take four ounces of this decoction and make an injection, but you must be careful that the humours are not brought down into the womb. Take three drachms each of roast figs, and bruised dog’s mercury; three drachms each of turpentine and duck’s grease, and two grains of opium; make a pessary with wax.

The room must be kept cool, and all motions of the body, especially of the lower parts, must be prohibited. Wakefulness is to be recommended, for humours are carried inward by sleep, and thus inflammation is increased. Eat sparingly, and drink only barley water or clarified whey, and eat chickens and chicken broth, boiled with endive, succory, sorrel, bugloss and mallows.

* * * * *

CHAPTER IX

_Of Scirrhous Tumours, or Hardness of the Womb._

A _scirrhus_, or a hard unnatural swelling of the matrix is generally produced by neglected, or imperfectly cured phlegm, which, insensibly, hinders the functions of the womb, and predisposes the whole body to listlessness.

CAUSE.

One cause of this disease may be ascribed to want of judgment on the part of the physician, as many empirics when attending to inflammation of the womb, chill the humour so much that it can neither pass backward nor forward, and hence, the matter being condensed, turns into a hard, stony substance. Other causes may be suppression of the menses, retention of the _Lochein_, commonly called the after purging; eating decayed meat, as in the disordered longing after the _pleia_ to which pregnant women are often subject. It may, however, also proceed from obstructions and ulcers in the matrix or from some evil affections of the stomach or spleen.

If the bottom of the womb be affected, she feels, as it were, a heavy burden representing a mole,[7] yet differing from it, in that the breasts are attenuated, and the whole body grows less. If the neck of the womb be affected, no outward humours will appear; its mouth is retracted and feels hard to the touch, nor can the woman have sexual intercourse without great pain.

PROGNOSTICS.

Confirmed scirrhus is incurable, and will turn to cancer or incurable dropsy, and when it ends in cancer it proves fatal, because as the innate heat of these parts is almost smothered, it can hardly be restored again.

CURE.

Where there is repletion, bleeding is advisable, therefore open a vein in one arm and in both feet, more especially if the menses are suppressed.

Treat the humours with syrup of borage, succory made with a poultice, and then take the following pills, according to the patient’s strength.

Hiera piera six drachms, two and a half drachms each of black hellebore and polypody; a drachm and a half each of agaric, lapis lazuli, sal Indiae, coloquintida, mix them and make two pills. After purging, mollify the hardness as follows:–the privy parts and the neck of the womb with an ointment of decalthea and agrippa; or take two drachms each of opopanax, bdellium, ammoniac and myrrh, and half a drachm of saffron; dissolve the gum in oil of lilies and sweet almond and make an ointment with wax and turpentine. Apply diacatholicon ferellia below the navel, and make infusions of figs, mugwort, mallows, pennyroyal, althea, fennel roots, melilot, fenugreek and the four mollifying herbs, with oil of dill, camomiles and lilies dissolved in it. Take three drachms of gum bdellium, put the stone pyrites on the coals, and let her take the fumes into her womb. Foment the privy parts with a decoction of the roots and leaves of dane wort. Take a drachm each of gum galbanum and opopanax, half an ounce each of juice of dane wort and mucilage of fenugreek, an ounce of calve’s marrow, and a sufficient quantity of wax, and make a pessary. Or make a pessary of lead only, dip it in the above mentioned things, and put it up.

The atmosphere must be kept temperate, and gross and salt meats such as pork, bull beef, fish and old cheese, must be prohibited.

FOOTNOTES:

[7] _Mole_: “A somewhat shapeless, compact fleshy mass occurring in the uterus, due to the retention and continued life of the whole or a part of the foetal envelopes, after the death of the foetus (a _maternal or true mole_); or being some other body liable to be mistaken for this, or perhaps a polypus or false mole.” (_Whitney’s Century Dictionary_.)

* * * * *

CHAPTER X

_Of Dropsy of the Womb._

Uterine dropsy is an unnatural swelling, caused by the collection of wind or phlegm in the cavity, membranes or substance of the womb, on account of the want of innate heat and of sufficient alimentation, and so it turns into an excrescence. The causes are, too much cold and moisture of the milt and liver, immoderate drinking, eating insufficiently cooked meat, all of which by causing repletion, overpower the natural heat. It may likewise be caused by undue menstruation, or by any other immoderate evacuation. To these may be added abortions, subcutaneous inflammations and a hardened swelling of the womb.

SIGNS.

The signs of this affection are as follows:–The lower parts of the stomach, with the genitals, are swollen and painful; the feet swell, the natural colour of the face is lost, the appetite becomes depraved, and there is a consequent heaviness of the whole body. If the woman turns over in bed a noise like flowing water is heard, and sometimes water is discharged from the womb. If the swelling is caused by wind and the stomach feels hot, it sounds like a drum; the bowels rumble, and the wind escapes through the neck of the womb with a murmuring noise. This affection may be distinguished from true conception in many ways, as will be shown in the chapter on _conception_. It is distinguished from common dropsy, by the lower parts of the stomach being most swollen. Again, it does not appear so injurious in this blood-producing capability, nor is the urine so pale, nor the face so altered. The upper parts are also not so reduced, as in usual dropsy.

PROGNOSTICS.

This affection foretells the ruin of the natural functions, by that peculiar sympathy it has with the liver, and that, therefore, _kathydria_, or general dropsy will follow.

CURE.

In the cure of this disease, imitate the practice of Hippocrates, and first mitigate the pain with fomentations of melilot, dog’s mercury, mallows, linseed, camomiles and althoea. Then let the womb be prepared with syrup of stoebis, hyssop, calamint, mugwort, with distilled water, a decoction of elder, marjoram, sage, origan, spearage, pennyroyal, and betony. Purge with senna, agaric, rhubarb, and claterium. Take spicierum hier, a scruple each of rhubarb, agaric lozenges, and make into pills with iris juice.

When diseases arise from moistness, purge with pills, and in those affections which are caused by emptiness or dryness, purge by means of a draught. Apply cupping glasses to the stomach and also to the navel, especially if the swelling be flatulent. Put a seton on to the inside of each leg, the width of a hand below the knee. Take two drachms each of sparganium, diambrae, diamolet, diacaliminti, diacinamoni, myrrh lozenges, and a pound of sugar; make these into lozenges with betony water, and take them two hours before meals. Apply a little bag of camomiles, cummin and melilot boiled in oil of rue, to the bottom of the stomach as hot as it can be borne; anoint the stomach and the privates with unguent agripp, and unguent aragon. Mix iris oil with it, and cover the lower part of the stomach with a plaster of bay berries, or a cataplasm made of cummin, camomiles, briony root, adding cows’ and goats’ dung.

Our modern medical writers ascribe great virtues to tobacco-water, injected into the womb by means of a clyster. Take a handful each of balm of southernwood, origanum, wormwood, calamint, bay berries and marjoram, and four drachms of juniper berries; make a decoction of these in water, and use this for fomentations and infusions. Make pessaries of storax, aloes, with the roots of dictam, aristolochia and gentian, but instead of this you may use the pessary prescribed at the end of Chapter XVII. Let her take aromatic electuary, disatyrion and candied eringo roots, every morning.

The air must be hot and dry, moderate exercise is to be taken and too much sleep prohibited. She may eat the flesh of partridges, larks, grouse, hares, rabbits, etc., and let her drink diluted urine.

* * * * *

CHAPTER XI

_Of Moles[8] and False Conceptions._

This disease may be defined as an inarticulate shapeless piece of flesh, begotten in the womb as if it were true conception. In this definition we must note two things: (1) because a mole is said to be inarticulate or jointless, and without shape, it differs from monstrosities which are both _formata_ and _articulata_; (2) it is said to be, as it were a true conception, which makes a difference between a true conception, and a mole, and this difference holds good in three ways. First, in its genus, because a mole cannot be said to be an animal: secondly, in the species, because it has not a human figure and has not the character of a man; thirdly, in the individual, for it has no affinity to the parent, either in the whole body, or in any particular part of it.

CAUSE.

There is a great difference of opinion amongst learned writers as to the cause of this affection. Some think, that if the woman’s seed goes into the womb, and not the man’s, that the mole is produced thereby. Others declare that it springs from the menstruous blood, but if these two things were granted, then virgins, by having their courses or through nocturnal pollutions, might be liable to the same things, which none have ever been yet. The true cause of this fleshy mole is due both to the man and from the menstruous blood in the woman both mixing together in the cavity of the womb. Nature finding herself weak there (and yet wishing to propagate her species), labours to bring forth a defective conception rather than nothing and instead of a living creature produces a lump of flesh.

SIGNS.

The signs of a mole are these. The _menses_ are suppressed, the appetite becomes depraved, the breasts swell and the stomach becomes inflated and hard. So far the symptoms in a pregnant woman and in one that has a mole are the same, but now this is how they differ. The first sign of difference is in the movements of a mole. It may be felt moving in the womb before the third month, whereas an infant cannot be so felt; yet this motion cannot proceed from any intelligent power in the mole, but from the capabilities of the womb, and of the seminal vigour, distributed through the substance of the mole, for it does not live an animal, but a vegetable life, like a plant. _Secondly_, in a mole the stomach swells suddenly, but in true conception it is first contracted, and then rises by degrees. _Thirdly_, if the stomach is pressed with the hand, the mole gives way, and returns to its former position as soon as the hand is removed. But a child in the womb does not move immediately though pressed with the hand, and when the hand is removed it returns slowly or not at all. _Lastly_, no child continues in the womb more than eleven months, but a mole continues for four or five years, more or less, sometimes according as it is fastened to the matrix; and I have known a mole pass away in four or five months. If, however, it remains until the eleventh month, the woman’s legs grow weak and the whole body wastes away, but the stomach still increases, which makes some women think that they are dropsical, though there is no reason for it, for in dropsy the legs swell and grow big, but in a mole they wither and fall away.

CURE.

In the school of Hippocrates we are taught that bleeding causes abortion, by taking all the nourishment which should preserve the life of the embryo. In order, therefore, that this faulty conception may be deprived of that nourishing sap by which it lives, open the liver vein and saphena in both feet, apply cupping glasses to the loins and sides of the stomach, and when that has been done, let the uterine parts be first softened, and then the expulsive powers be stimulated to get rid of the burden.

In order to relax the ligatures of the mole, take three handfuls of mallows with their roots, two handfuls each of camomiles, melilot, pellitory of the wall, violet leaves, dog’s mercury, fennel roots, parsley, and one pound each of linseed and fenugreek; boil them in oil and let the patient sit in it up to her navel. When she comes out of her bath, she should anoint her private parts and loins with the following ointment:–“Take one ounce each of oil of camomiles, lilies and sweet almonds: half an ounce each of fresh butter, laudanum and ammoniac, and make an ointment with oil of lilies. Or, instead of this, you may use unguentum agrippae or dialthea. Take a handful of dog’s mercury and althea roots; half a handful of flos brochae ursini; six ounces of linseed and barley meal. Boil all these together in honey and water and make a plaster, and make pessaries of gum galbanum, bdellium, ammoniac, figs, pig’s fat and honey.

After the ligaments of the mole are loosened, let the expulsive powers be stimulated to expel the mole, and for doing this, all those drugs may be used which are adapted to bring on the courses. Take one ounce of myrrh lozenges, half an ounce each of castor, astrolachia, gentian and dittany and make them into a powder, and take one drachm in four ounces of mugwort water. Take calamint, pennyroyal, betony, hyssop, sage, horehound, valerian, madder and savine; make a decoction in water and take three ounces of it, with one and a half ounces of feverfew. Take three scruples each of mugwort, myrrh, gentian and pill. coch.; a drachm each of rue, pennyroyal and opopanax, and the same of asafoetida, cinnamon, juniper-berries and borage, and make into pills with savine juice, to be taken every morning. Make an infusion of hyssop, bay leaves, bay berries, calamint, camomiles, mugwort and savine. Take two scruples each of sacopenium, mugwort, savine, cloves, nutmeg, bay berries; one drachm of galbanum; one scruple each of hiera piera and black hellebore, and make a pessary with turpentine.

But if these medicaments are not procurable, then the mole must be pulled out by means of an instrument called the _pes gryphis_,[9] which may be done without much danger if it be performed by a skilful surgeon. After she has been delivered of the mole (because the woman will have lost much blood already), let the flow of blood be stopped as soon as possible.

Apply cupping glasses to the shoulders and ligatures to the arms, and if this be not effective, open the liver vein in the arm.

The atmosphere of the room must be kept tolerably dry and warm, and she must be put on a dry diet, to soothe the system; she must, however, drink white wine.

FOOTNOTES:

[8] _Mole_: “A somewhat shapeless, compact fleshy mass occurring in the uterus, due to the retention and continued life of the whole or a part of the foetal envelopes, after the death of the foetus (_a maternal or true mole_); or being some other body liable to be mistaken for this, or perhaps a polypus or false mole.” (_Whitney’s Century Dictionary_.)

[9] _Griffin’s claw_, a peculiar hooked instrument.

* * * * *

CHAPTER XII

_Of Conception and its Signs, and How a Woman may know whether it be Male or Female._

Ignorance often makes women the murderesses of the fruit of their own body, for many, having conceived and finding themselves out of order, and not rightly knowing the cause, go to the shop of their own conceit and take whatever they think fit, or else (as the custom is) they send to the doctor for a remedy, and he, not perceiving the cause of their trouble, for nothing can be diagnosed accurately by the urine, prescribes what he thinks best; perhaps some diuretic or cathartic, which destroy the embryo. Therefore Hippocrates says, it is necessary that women should be instructed in the signs of conception, so that the parent as well as the child may be saved from danger. I shall, therefore, lay down some rules, by which every woman may know whether she is pregnant or not, and the signs will be taken from the woman, from her urine, from the child and from experiments.

SIGNS.

The first day after conception, she feels a slight quivering and chilliness throughout her body; there is a tickling of the womb and a little pain in the lower parts of her stomach. Ten or twelve days after she feels giddy and her eyes dim and with circles round them; the breasts swell and grow hard, with some pain and pricking in them, whilst the stomach rises and sinks again by degrees, and there is a hardness about the navel. The nipples grow red, the heart beats unusually strongly, the natural appetite abates, and the woman has a craving after strange food. The neck of the womb is contracted, so that it can scarcely be felt when the finger is put in. And the following is an infallible sign; she is alternately in high spirits and melancholy; the monthly courses cease without any apparent cause, the evacuations from the bowels are retained unusually long, by the womb pressing on the large gut, and her desire for sexual intercourse is diminished. The surest sign is taken from the infant, which begins to move in the womb in the third or fourth month, and not in the manner of a mole, mentioned above, from side to side like a stone, but gently, as may be perceived by applying the hand cold upon the stomach.

SIGNS TAKEN FROM THE URINE.

The best writers affirm that the water of a pregnant woman is white and has little specks in it, like those in a sunbeam, ascending and descending in it, of an opal colour, and when the sediment is disturbed by shaking the urine, it looks like carded wool. In the middle of gestation it turns yellow, then red and lastly black, with a red film. At night on going to bed, let her drink water and honey, and if afterwards she feels a beating pain in her stomach and about the navel, she has conceived. Or let her take the juice of cardius, and if she brings it up again, that is a sign of conception. Throw a clean needle into the woman’s urine, put it into a basin and let it stand all night. If it is covered with red spots in the morning, she has conceived, but if it has turned black and rusty, she has not.

SIGNS TAKEN FROM THE SEX, TO SHOW WHETHER IT BE A MALE OR FEMALE.

If it is a male, the right breast swells first, the right eye is brighter than the left, the face is high-coloured, because the colour is such as the blood is, and as the male is conceived of purer blood and of more perfect seed than the female, red specks in the urine, and making a sediment, show that a male has been conceived, but if they are white, a female. Put the urine of the woman into a glass bottle, let it stand tightly stoppered for two days, then strain it through a fine cloth, and you will find little animals in it. If they are red, it is a male, but if white, it is a female.

The belly is rounder and lies higher with a boy than with a girl, and the right breast is harder and plumper than the left, and the right nipple redder, and the woman’s colour is clearer than when she has conceived a girl.

To conclude, the most certain sign to give credit to, is the motion of the child, for the male moves in the third month, and the female not until the fourth.

* * * * *

CHAPTER XIII

_Of Untimely Births._

When the fruit of the womb comes forth before the seventh month (that is, before it comes to maturity), it is said to be abortive; and, in effect, the children prove abortive, that is, do not live, that are born in the eighth month. Why children born in the seventh or ninth month should live, and not those born in the eighth, may seem strange, and yet it is true. The cause of it is ascribed by some to the planet under which the child is born; for every month, from conception to birth, is governed by its own planet, and in the eighth month Saturn predominates, which is dry and cold; and coldness, being an utter enemy to life, destroys the natural constitution of the child. Hippocrates gives a better reason, viz.:–The infant, being every way perfect and complete in the seventh month, wants more air and nourishment than it had before, and because it cannot obtain this, it tries for a passage out. But if it have not sufficient strength to break the membranes and to come out as ordained by nature, it will continue in the womb until the ninth month, so that by that time it may be again strengthened. But if it returns to the attempt in the eighth month and be born, it cannot live, because the day of its birth is either past or is to come. For in the eighth month Avicunus says, it is weak and infirm, and therefore on being brought into the cold air, its vitality must be destroyed.

CURE.

Untimely births may be caused by cold, for as it causes the fruit of the tree to wither and fall before it is ripe, so it nips the fruit of the womb before it comes to perfection, or makes it abortive;–sometimes by humidity, which weakens its power, so that the fruit cannot be retained until the proper time. It may be caused by dryness or emptiness, which rob the child of its nourishment, or by an alvine discharge, by bleeding or some other evacuation, by inflammation of the womb, and other severe disease. Sometimes it is caused by joy, anger, laughter and especially by fear, for then the heat forsakes the womb, and goes to the heart, and so the cold sinks into the womb, whereby the ligaments are relaxed, and so abortion follows. On this account, Plato recommended that the woman should avoid all temptations to excessive joy and pleasure, as well as all occasions for fear and grief. Abortion may also be caused by the pollution of the air by filthy odours, and especially by the smell of the smouldering wick of a candle, and also by falls, blows, violent exercise, jumping, dancing, etc.

SIGNS.

Signs of coming abortion are a falling away of the breast, with a flow of watery milk, pains in the womb, heaviness in the head, unusual weariness in the hips and thighs, and a flowing of the courses. Signs denoting that the fruit is dead in the womb are sunken eyes, pains in the head, frights, paleness of the face and lips, gnawing at the stomach, no movements of the infant; coldness and looseness of the mouth of the womb. The stomach falls down, whilst watery and bloody discharges come from the womb.

* * * * *

CHAPTER XIV

_Directions for Pregnant Women._

The prevention of untimely births consists in removing the aforementioned causes, which must be effected both before and after conception.

Before conception, if the body be too hot, dry or moist, employ such treatment as to counteract the symptoms; if the blood be vitiated purify it, if plethoric, open the liver vein; if gross, reduce it; if too thin strengthen and nourish it. All the diseases of the womb must be removed as I have shown.

After conception, let the atmosphere be kept temperate, do not sleep too much, avoid late hours, too much bodily exercise, mental excitement, loud noises and bad smells, and sweet smells must also be avoided by those who are hysterical. Refrain from all things that may provoke either urine or menstruation, also salt, sour, and windy food, and keep to a moderate diet.

If the bowels are confined, relieve the stomach with injections made of a decoction of mallows and violets, with sugar and salad oil; or make a broth with borage, buglos, beetroot, and mallows, and add a little manna to it. If, on the other hand, she be troubled with looseness of the bowels, do not check it with medical advice, for all the uterine fluxes have some bad qualities in them, which must be evacuated before the discharge is stopped.

A cough is another thing to which pregnant women are frequently liable, and which causes them to run great danger of miscarrying, by the shock and continual drain upon the vein. To prevent this shave off the hair from the coronal commissures, and apply the following plaster to the place.

Take half an ounce of resin, a drachm of laudanum, a drachm each of citron peel, lignaloes and galbanum, with a sufficient quantity of liquid and dry styrax. Dissolve the gum in vinegar and make a plaster, and at night let her inhale the fumes of these lozenges, thrown upon bright coals. Take also a drachm and a half each of frankincense, styrax powder and red roses: eight drachms of sandrich, a drachm each of mastic, benjamin and amber; make into lozenges with turpentine, and apply a cautery to the nape of the neck. And every night let her take the following pills:–Half an ounce each of hypocistides, terrae sigilatae and fine bole; two drachms each of bistort, alcatia, styrax and calamint, and one drachm of cloves, and make into pills with syrup of myrtles.

In pregnant women, a corrupt matter is generated which, flowing to the ventricle, spoils the appetite and causes sickness. As the stomach is weak, and cannot digest this matter, it sometimes sends it to the bowels which causes a flux of the stomach, which greatly adds to the weakness of the womb. To prevent all these dangers the stomach must be strengthened by the following means:–Take one drachm each of lignaloes and nutmeg; a scruple each of mace, cloves, mastic, laudanum; an ounce of oil of spikenard; two grains of musk, half an ounce each of oil of mastic, quinces and wormwood, and make into an ointment for the stomach, to be applied before meals. Instead of this, however, you may use cerocum stomachile Galeni. Take half an ounce each of conserve of borage, buglos and atthos; two drachms each of confection of hyacinths, candied lemon peel, specierum, diamarg, pulo. de genunis: two scruples each of nutmeg and diambra; two drachma each of peony roots and diacoratum, and make into an electuary with syrup of roses, which she must take twice a day before meals. Another affection which troubles a pregnant woman is swelling of the legs, which happens during the first three months, by the superfluous humours descending from the stomach and liver. To cure this, take two drachms of oil of roses, and one drachm each of salt and vinegar; shake them together until the salt is dissolved, and anoint the legs with it hot, rubbing it well in with the hand. It may be done without danger during the fourth, fifth and sixth months of pregnancy; for a child in the womb is compared to an apple on the tree. For the first three months it is a weak and tender subject, like the apple, to fall away; but afterwards, when the membranes become strengthened, the fruit remains firmly fastened to the womb, and not subject to mischances, and so it remains, until the seventh month, until when it is near the time, the ligaments are again relaxed (like the apple that is almost ripe).

They grow looser every day, until the appointed time for delivery; if, therefore, the body is in real need of purging, the woman may do it without danger in the fourth, fifth or sixth month, but neither before nor after that unless in the case of some violent illness, in which it is possible that both mother and child may perish. Apply plasters and ointments to the loins in order to strengthen the fruit in the womb. Take one drachm each of gum Arabic, galangale, bistort, hypocistid and storax, a drachm and a half each of fine bole, nutmeg, mastic, balaust, dragon’s blood and myrtle berries, and a sufficient quantity of wax and turpentine and make into a plaster. Apply it to the loins in the winter, and remove it every twenty-four hours, lest the loins should become overheated by it. In the interim, anoint the private parts and loins with _countess’ balsam_ but if it be summer time and the loins hot, the following plaster will be more suitable. Take a pound of red roses, two drachms each of mastic and red Sanders, one drachm each of bole ammoniac and red coral, two drachms and a half each of pomegranate seed and prepared coriander seed, two scruples of barberries, one ounce each of oil of mastic and of quinces, and plantain-juice.

Anoint the loins also with sandalwood ointment, and once a week wash them with two parts of rose-water and one of white wine mixed together and warmed at the fire. This will assuage the heat of the loins, get rid of the oil of the plaster from the pores of the skin, and cause the fresh ointment or plaster to penetrate more easily, and to strengthen the womb. Some think that a load-stone laid upon the navel, keeps a woman from abortion. The same thing is also stated of the stone called _aetites_ or eagle-stone, if it is hung round the neck. Samian stone has the same virtue.

* * * * *

CHAPTER XV

_Directions for Women when they are taken in Labour, to ensure their safe Delivery, and Directions for Midwives._

Having thus given the necessary directions to pregnant women, how to manage their health during their pregnancy, I will now add what is necessary for them to do, in order that they may be safely delivered.

When the time of birth draws near, the woman must be sure to send for a skilful midwife, and that rather too soon than too late. She must have a pallet bed ready to place it near the fire, so that the midwife and those who are to help her, may be able to pass round it, and give assistance on either side, as may be required. A change of linen must be in readiness, and a small stool to rest her feet against, as she will have more power when her legs are bent, than when they are straight.

When everything is thus ready, and when the woman feels the pains coming on, if the weather be not cold, she should walk about the room, rest on the bed occasionally, waiting for the breaking of the waters, which is a fluid contained in one of the outward membranes, and which flows out thence, when the membrane is broken by the struggles of the child. There is no special time for this discharge, though it generally takes place about two hours before the birth. Movements will also cause the womb to open and dilate, and when lying long in bed will be uncomfortable. If she be very weak she may take some mild cordial to give her strength, if her pain will permit her; and if the labour be tedious, she may be revived with chicken or mutton broth, or she may take a poached egg; but she must be very careful not to eat to excess.

There are many postures in which women are delivered; some sitting in a chair, supported by others, or resting on the bed; some again upon their knees and resting on their arms; but the safest and most commodious way, is in the bed, and then the midwife ought to observe the following rules:–Let her lay the woman upon her back, with her head a little raised by means of a pillow, with similar supports for her loins and buttocks, which latter should also be raised, for if she lies low, she cannot be delivered so easily. Then let her keep her knees and thighs as far apart as she can, her legs bent inward towards each other, and her buttocks, the soles of her feet and her heels being placed upon a small rest, placed for the purpose, so that she may be able to strain the stronger. In case her back should be very weak, a swathing band should be placed under it, the band being doubled four times and about four inches broad. This must be held by two persons who must raise her up a little every time her pains come on, with steady hands and in even time, but if they be not exact in their movements, they had better leave her alone. At the same time two women must hold her shoulders so that she may strain out the foetus more easily; and to facilitate this let one stroke or press the upper part of her stomach gently and by degrees. The woman herself must not be nervous or downhearted, but courageous, and forcing herself by straining and holding her breath.

When delivery is near, the midwife must wait patiently until the child’s head, or some limb, bursts the membranes, for if the midwife through ignorance, or through haste to go to some other woman, as some have done, tears the membrane with her nails, she endangers both the woman and the child; for by lying dry and lacking that slipperiness which should make it easy, it comes forth with severe pains.

When the head appears, the midwife must hold it gently between her hands, and draw the child, whenever the woman’s pains are upon her, but at no other times; slipping her forefingers under its armpits by degrees, and not using a rough hand in drawing it out, lest the tender infant might become deformed by such means. As soon as the child is taken out, which is usually with its face downwards,–it should be laid upon its back, that it may receive external respiration more freely; then cut the navel string about three inches from the body, tying the end which adheres to it with a silk string, as closely as you can; then cover the child’s head and stomach well, allowing nothing to touch its face.

When the child has been thus brought forth, if it be healthy lay it aside, and let the midwife attend to the patient by drawing out the afterbirth; and this she may do by wagging and stirring it up and down, and afterwards drawing it out gently. And if the work be difficult, let the woman hold salt in her hands, close them tightly and breathe hard into them, and by that she will know whether the membranes are broken or not. It may also be known by making her strain or vomit; by putting her fingers down her throat, or by straining or moving her lower parts, but let all be done immediately. If this should fail, let her take a draught of elder water, or the yolk of a new laid egg, and smell a piece of asafoetida, especially if she is troubled with a windy colic. If she happen to take cold, it is a great obstruction to the afterbirth; in such cases the midwife ought to chafe the woman’s stomach gently, so as to break, not only the wind, but also to force the secundine to come down. But if these should prove ineffectual, the midwife must insert her hand into the orifice of the womb and draw it out gently.

Having thus discussed common births, or such as are generally easy, I shall now give directions in cases of extremity.

* * * * *

CHAPTER XVI

_What ought to be done in cases of extremity, especially in women who, in labour, are attacked by a flux of blood, convulsions and fits of wind._

If the woman’s labour be hard and difficult, greater care must be taken than at other times. And, first of all, the situation of the womb and her position in lying must be across the bed, and she must be held by strong persons to prevent her from slipping down or moving during the surgeon’s operations. Her thighs must be put as far apart as possible, and held so, whilst her head must rest upon a bolster, and her loins be supported in the same manner. After her rump and buttocks have been raised, be careful to cover her stomach, belly and thighs with warm clothes, to keep them from the cold.

When the woman is in this position, let the operator put up his or her hand, if the neck of the womb be dilated, and remove the coagulated blood that obstructs the passage of the birth; and by degrees make way gently, let him remove the infant tenderly, having first anointed his hand with butter or some harmless salve. And if the waters have not come down, they may then be let out without difficulty. Then, if the infant should attempt to come out head foremost, or crosswise, he should turn it gently, to find the feet. Having done this, let him draw out one and fasten it with ribbon and then put it up again, and by degrees find the other, bringing them as close together and as even as possible, and between whiles let the woman breathe, and she should be urged to strain so as to help nature in the birth, that it may be brought forth. And to do this more easily, and that the hold may be surer, wrap a linen cloth round the child’s thighs, taking care to bring it into the hand face downwards.

In case of flux of blood, if the neck of the womb be open, it must be considered whether the infant or the _secundine_, generally called the afterbirth, comes first, and as the latter happens to do so occasionally, it stops the mouth of the womb and hinders the birth, and endangers both the woman’s and the child’s life. In this case the afterbirth must be removed by a quick turn. They have deceived many people, who, feeling their softness, have supposed that the womb was not dilated, and by that means the woman and child, or at least the latter, have been lost. When the afterbirth has been removed, the child must be sought for and drawn out, as directed above; and if the woman or the child die in such a case, the midwife or the surgeon are blameless because they have used their best endeavours.

If it appears upon examination that the afterbirth comes first, let the woman be delivered as quickly as possible, because a great flow of blood will follow, for the veins are opened, and on this account two things have to be considered.

_First_:–The manner in which the afterbirth advances, whether it be much or little. If the former, and the head of the child appears first, it may be guided and directed towards the neck of the womb, as in the case of natural birth, but if there appears any difficulty in the delivery, the best way is to look for the feet, and draw it out by them; but if the latter, the afterbirth may be put back with a gentle hand, and the child taken out first. But if the afterbirth has come so far forward that it cannot be put back, and the child follows it closely, then the afterbirth must be removed very carefully, and as quickly as may be, and laid aside without cutting the entrail that is fastened to it; for you may be guided to the infant by it, which must be drawn out by the feet, whether it be alive or dead, as quickly as possible; though this is not to be done except in cases of great necessity, for in other cases the afterbirth ought to come last.

In drawing out a dead child, these directions should be carefully followed by the surgeon, viz.–If the child be found to be dead, its head appearing first, the delivery will be more difficult; for it is an evident sign that the woman’s strength is beginning to fail her, that, as the child is dead and has no natural power, it cannot be assisting in its own delivery in any way. Therefore the most certain and the safest way for the surgeon is, to put up his left hand, sliding it into the neck of the womb, and into the lower part of it towards the feet, as hollow in the palm as he can, and then between the head of the infant and the neck of the womb. Then, having a forceps in the right hand, slip it up above the left hand, between the head of the child and the flat of the hand, fixing it in the bars of the temple near the eye. As these cannot be got at easily in the occipital bone, be careful still to keep the hand in its place, and gently move the head with it, and so with the right hand and the forceps draw the child forward, and urge the woman to exert all her strength, and continue drawing whenever her pains come on. When the head is drawn out, he must immediately slip his hand under the child’s armpits, and take it quite out, and give the woman a piece of toasted white bread, in a quarter of a pint of Hippocras wine.

If the former application fails let the woman take the following potion hot when she is in bed, and remain quiet until she begins to feel it operating.

Take seven blue figs, cut them into pieces and add five grains each of fenugreek, motherwort and rue seed, with six ounces each of water of pennyroyal and motherwort; reduce it to half the quantity by boiling and after straining add one drachm of troches of myrrh and three grains of saffron; sweeten the liquor with loaf sugar, and spice it with cinnamon.–After having rested on this, let her strain again as much as possible, and if she be not successful, make a fumigation of half a drachm each of castor, opopanax, sulphur and asafoetida, pounding them into a powder and wetting the juice of rue, so that the smoke or fumes may go only into the matrix and no further.

If this have not the desired effect, then the following plaster should be applied:–Take an ounce and a half of balganum, two drachms of colocynth, half an ounce each of the juice of motherwort and of rue, and seven ounces of virgin bees’ wax: pound and melt them together, spreading them on a cere-cloth so that they may spread from the navel to the os pubis and extending to the flanks, at the same time making a pessary of wood, enclosing it in a silk bag, and dipping it in a decoction of one drachm each of sound birthwort, savin colocinthis, stavescare and black hellebore, with a small sprig or two of rue.

But if these things have not the desired effect, and the woman’s danger increases, let the surgeon use his instruments to dilate and widen the womb, for which purpose the woman must be placed on a chair, so that she may turn her buttocks as far from its back as possible, at the same time drawing up her legs as close as she can and spreading her thighs open as wide as possible; or if she is very weak it may be better to lay her on the bed with her head downwards, her buttocks raised and both legs drawn up. Then the surgeon may dilate the womb with his speculum matrices and draw out the child and the afterbirth together, if it be possible, and when this is done, the womb must be well washed and anointed, and the woman put back to bed and comforted with spices and cordials. This course must be adopted in the case of dead children and moles, afterbirths and false births, which will not come out of themselves, at the proper time. If the aforementioned instrument will not widen the womb sufficiently, then other instruments, such as the drake’s bill, or long pincers, ought to be used.

If any inflammation, swelling or congealed blood happens to be contracted in the womb under the film of these tumours, either before or after the birth, let the midwife lance it with a penknife or any suitable instrument, and squeeze out the matter, healing it with a pessary dipped in oil of red roses.

If the child happens at any time to be swollen through cold or violence, or has contracted a watery humour, if it is alive, such means must be used as are least injurious to the child or mother; but if it be dead, the humours must be let out by incisions, to facilitate the birth.

If, as often happens, the child is presented feet foremost, with the hands spreading out from the hips, the midwife must in such a case be provided with the necessary ointments to rub and anoint the child with, to help it coming forth, lest it should turn into the womb again, holding both the infant’s arms close to the hips at the same time, that it may come out in this manner; but if it proves too big, the womb must be well anointed. The woman should also take a sneezing powder, to make her strain; the attendant may also stroke her stomach gently to make the birth descend, and to keep it from returning.

It happens occasionally, that the child presenting itself with the feet first, has its arms extended above its head; but the midwife must not receive it so, but put it back into the womb, unless the passage be extraordinarily wide, and then she must anoint both the child and the womb, and it is not safe to draw it out, which must, therefore, be done in this manner.–The woman must lie on her back with her head low and her buttocks raised; and then the midwife must compress the stomach and the womb with a gentle hand, and by that means put the child back, taking care to turn the child’s face towards the mother’s back, raising up its thighs and buttocks towards the navel, so that the birth may be more natural.

If the child happens to come out with one foot, with the arm extended along the side and the other foot turned backwards; then the woman must be immediately put to bed and laid in the above-described position; when the midwife must immediately put back the foot which appears so, and the woman must rock herself from side to side, until she finds that the child has turned, but she must not alter her position nor turn upon her face. After this she may expect her pains and must have great assistance and cordials so as to revive and support her spirits.

At other times it happens that the child lies across in the womb, and falls upon its side; in this case the woman must not be urged in her labour; therefore, the midwife when she finds it so, must use great diligence to reduce it to its right form, or at least to such a form in the womb as may make the delivery possible and most easy by moving the buttocks and guiding the head to the passage; and if she be successful in this, let the woman rock herself to and fro, and wait with patience till it alters its way of lying.

Sometimes the child hastens simply by expanding its legs and arms; in which, as in the former case, the woman must rock herself, but not with violence, until she finds those parts fall to their proper station; or it may be done by a gentle compression of the womb; but if neither of them avail, the midwife must close the legs of the infant with her hand, and if she can get there, do the like by the arms, and so draw it forth; but if it can be reduced of itself to the posture of a proper birth it is better.

If the infant comes forward, both knees forward, and the hands hanging down upon the thighs, then the midwife must put both knees upward, till the feet appear; taking hold of which with her left hand let her keep her right hand on the side of the child, and in that posture endeavour to bring it forth. But if she cannot do this, then also the woman must rock herself until the child is in a more convenient posture for delivery.

Sometimes it happens that the child presses forward with one arm extended on its thighs, and the other raised over its head, and the feet stretched out at length in the womb. In such case, the midwife must not attempt to receive the child in that posture, but must lay the woman on the bed in the manner aforesaid, making a soft and gentle compression on her belly, oblige the child to retire; which if it does not, then must the midwife thrust it back by the shoulder, and bring the arm that was stretched above the head to its right station; for there is most danger in these extremities; and, therefore, the midwife must anoint her hands and the womb of the woman with sweet butter, or a proper pomatum, and thrust her hand as near as she can to the arm of the infant, and bring it to the side. But if this cannot be done, let the woman be laid on the bed to rest a while; in which time, perhaps, the child may be reduced to a better posture; which the midwife finding, she must draw tenderly the arms close to the hips and so receive it.

If an infant come with its buttocks foremost, and almost double, then the midwife must anoint her hand and thrust it up, and gently heaving up the buttocks and back, strive to turn the head to the passage, but not too hastily, lest the infant’s retiring should shape it worse: and therefore, if it cannot be turned with the hand, the woman must rock herself on the bed, taking such comfortable things as may support her spirits, till she perceives the child to turn.

If the child’s neck be bowed, and it comes forward with its shoulders, as it sometimes doth, with the hands and feet stretched upwards, the midwife must gently move the shoulders, that she may direct the head to the passage; and the better to effect it, the woman must rock herself as aforesaid.

These and other like methods are to be observed in case a woman hath twins, or three children at a birth, which sometimes happens: for as the single birth hath but one natural and many unnatural forms, even so it may be in a double and treble birth.

Wherefore, in all such cases the midwife must take care to receive the first which is nearest the passage; but not letting the other go, lest by retiring it should change the form; and when one is born, she must be speedy in bringing forth the other. And this birth, if it be in the natural way, is more easy, because the children are commonly less than those of single birth, and so require a less passage. But if this birth come unnaturally, it is far more dangerous than the other.

In the birth of twins, let the midwife be very careful that the secundine be naturally brought forth, lest the womb, being delivered of its burden, fall, and so the secundine continue longer there than is consistent with the woman’s safety.

But if one of the twins happens to come with the head, and the other with the feet foremost, then let the midwife deliver the natural birth first; and if she cannot turn the other, draw it out in the posture in which it presses forward; but if that with its feet downward be foremost, she may deliver that first, turning the other aside. But in this case the midwife must carefully see that it be not a monstrous birth, instead of twins, a body with two heads, or two bodies joined together, which she may soon know if both the heads come foremost, by putting up her hand between them as high as she can; and then, if she finds they are twins she may gently put one of them aside to make way for the other, taking the first which is most advanced, leaving the other so that it do not change its position. And for the safety of the other child, as soon as it comes forth out of the womb, the midwife must tie the navel-string, as has before been directed, and also bind, with a large, long fillet, that part of the navel which is fastened to the secundine, the more readily to find it.

The second infant being born, let the midwife carefully examine whether there be not two secundines, for sometimes it falls out, that by the shortness of the ligaments it retires back to the prejudice of the woman. Wherefore, lest the womb should close, it is most expedient to hasten them forth with all convenient speed.

If two infants are joined together by the body, as sometimes it monstrously falls out, then, though the head should come foremost, yet it is proper, if possible, to turn them and draw them forth by the feet, observing, when they come to the hips, to draw them out as soon as may be. And here great care ought to be used in anointing and widening the passage. But these sort of births rarely happening, I need to say the less of them, and, therefore, shall show how women should be ordered after delivery.

* * * * *

CHAPTER XVII

_How child-bearing Women ought to be ordered after Delivery._

If a woman has had very hard labour, it is necessary that she should be wrapped up in a sheep’s skin, taken off before it is cold, applying the fleshy side to her veins and belly, or, for want of this, the skin of a hare or coney, flayed off as soon as killed, may be applied to the same parts, and in so doing, a dilation being made in the birth, and the melancholy blood being expelled in these parts, continue these for an hour or two.

Let the woman afterwards be swathed with fine linen cloth, about a quarter of a yard in breadth, chafing the belly before it is swathed, with oil of St. John’s wort; after that raise up the matrix with a linen cloth, many times folded: then with a linen pillar or quilt, cover the flanks, and place the swathe somewhat above the haunches, winding it pretty stiff, applying at the same time a linen cloth to her nipples; do not immediately use the remedies to keep back the milk, by reason the body, at such a time, is out of frame; for there is neither vein nor artery which does not strongly beat; and remedies to drive back the milk, being of a dissolving nature, it is improper to apply them to the breasts during such disorder, lest by doing so, evil humours be contracted in the breast. Wherefore, twelve hours at least ought to be allowed for the circulation and settlement of the blood, and what was cast on the lungs by the vehement agitation during labour, to retire to its proper receptacles.

Some time after delivery, you may take a restrictive of the yolks of two eggs, and a quarter of a pint of white wine, oil of St. John’s wort, oil of roses, plantain and roses water, of each an ounce, mix them together, fold a linen cloth and apply it to the breast, and the pains of those parts will be greatly eased.

She must by no means sleep directly after delivery; but about four hours after, she may take broth, caudle or such liquid victuals as are nourishing; and if she be disposed to sleep it may be very safely permitted. And this is as much, in the case of a natural birth, as ought immediately to be done.

But in case of an extremity or an unnatural birth, the following rules ought to be observed:–

In the first place, let the-woman keep a temperate diet, by no means overcharging herself after such an extraordinary evacuation, not being ruled by giving credit to unskilful nurses, who admonish them to feed heartily, the better to repair the loss of blood. For that blood is not for the most part pure, but such as has been retained in the vessels or membrane better voided, for the health of the woman, than kept, unless there happen an extraordinary flux of the blood. For if her nourishment be too much, which curding, very often turns to imposthumes.

Therefore, it is requisite, for the first five days especially, that she take moderately panado broth, poached eggs, jelly of chickens or calves’ feet or fresh barley broth; every day increasing the quantity a little.

And if she intend to be a nurse to the child, she may take something more than ordinary, to increase the milk by degrees, which must be of no continuance, but drawn off by the child or otherwise. In this case likewise, observe to let her have coriander or fennel seeds boiled in barley broth; but by all means, for the time specified, let her abstain from meat. If no fever trouble her, she may drink now and then a small quantity of pure white wine or of claret, as also syrup of maidenhead or any other syrup that is of an astringent quality, taken in a little water well boiled.

After the fear of fever or contraction of humour in the breast is over, she may be nourished more plentifully with the broth of capons, pullets, pigeons, mutton, veal, etc., which must not be until after eight days from the time of delivery; at which time the womb, unless some accident binds, has purged itself. It will then likewise be expedient to give cold meats, but let it be sparingly, so that she may the better gather strength. And let her, during the time, rest quietly and free from disturbance, not sleeping in the day time, if she can avoid it.

Take of both mallows and pellitory of the wall a handful; camomile and melilot flowers, of each a handful; aniseed and fennel of each two ounces; boil them in a decoction of sheep’s head and take of this three quarts, dissolving in it common honey, coarse sugar and fresh butter and administer it clysterwise; but if it does not penetrate well take an ounce of catholicon.

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CHAPTER XVIII

_Acute Pains after Delivery._

These pains frequently afflict the woman no less than the pain of her labour, and are, by the more ignorant, many times taken the one for the other; and sometimes they happen both at the same instant; which is occasioned by a raw, crude and watery matter in the stomach, contracted through ill digestion; and while such pains continue, the woman’s travail is retarded.

Therefore, to expel fits of the cholic, take two ounces of oil of sweet almonds, and an ounce of cinnamon water, with three or four drops of syrup of ginger; then let the woman drink it off.

If this does not abate the pain, make a clyster of camomile, balm-leaves, oil of olives and new milk, boiling the former in the latter. Administer it as is usual in such cases. And then, fomentation proper for dispelling the wind will not be amiss.

If the pain produces a griping in the guts after delivery, then take of the root of great comfrey, one drachm, nutmeg and peach kernels, of each two scruples, yellow amber, eight drachms, ambergris, one scruple; bruise them together, and give them to the woman as she is laid down, in two or three spoonfuls of white wine; but if she be feverish, then let it be in as much warm broth.

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THE

FAMILY PHYSICIAN

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BEING

CHOICE AND APPROVED