fcl fe felfc4; L^k^t^J^ 
 
 THE HISTORY 
 
 e 
 OF 
 
 ANCIENT GYNAECOLOGY 
 
BY THE SAME AUTEOIl. 
 
 LAWSON TAIT'S PERINEAL OPERATIONS, WITH AN ESSAY 
 ON CURETTAGE OF THE UTERUS. 
 
 Wltli 16 illustrations. 
 
 PREFACE BY LAWSON TAIT. 
 
 Price 3s. 6d. 
 
THE HISTORY 
 
 OP 
 
 ARCIEOT GYI^iEOOLOaY 
 
 W. J. STEWART McKAY, M.B., M.Ch., B.Sc. 
 
 Senior Surgeon to the Lewisham Hospital foe Women and Children, Sydney 
 Late Surgeon to the Benevolent Asylum Maternity Hospital, Sydney 
 Fellow of the British Gynaecological Society, and of the 
 Obstetrical Society of London 
 
 LONDON 
 BAILLIERE, TINDALL AND COX 
 
 20 & 21, KING WILLIAM STREET, STRAND 
 1901 
 
 [All rights reserved] 
 
Sioniedical 
 
 II 
 
 1901 
 
 ^0 
 THE MEMOKY OF 
 
 LAWSON TAIT, 
 
 WHOSE LABOURS HAVE SO ENRICHED-, 
 
 IN MODERN TIMES, 
 
 THAT BRANCH OF BIEDICINB 
 
 THE EARLY HISTORY ' OF WHICH 
 
 THESE PAGES ATTEMPT TO RELATE. 
 
"I sum up witli the writer of the Book of Maccabees : 
 
 ' If I have done well, and as befits the subject, it is what 
 
 I desire : and if I have done ill, it is what I could attain 
 
 unto.' " 
 
 Geouge Eliot. 
 
 " I know not how it is with you : 
 I love the first and last^ 
 The whole field of the present view, 
 The whole flow of the past." 
 
 R. L. Stevenson, 
 
PREFACE. 
 
 The history of obstetrics has been written, in a manner to 
 leave nothing to be desired, by Jacques de Siebold ; but 
 neither the history of ancient g3'ra?cology nor even that of 
 modern gynaecology has yet been attempted. 
 
 I have in the following pages endeavoured to place before 
 the reader all that can be culled from ancient authors on the 
 subject of the diseases of women. 
 
 Beginning with the Papyrus Ebers, the oldest medical 
 work extant on Egyptian medicine, I have gone through the 
 works of the Hindu, the Greek, and the Eoman writers down 
 to the time of Paulus ^gineta, and I have abstracted, if not 
 all the passages, at least all that are of importance and 
 interest, on the subject of gynecology. 
 
 In dealing with each author, I have first given a sketch of 
 his life and an account of his works, then a resume of his 
 writings on gynaecology, after which I have placed under the 
 various headings all the facts concerning the diseases of 
 women contained in the author's work. 
 
 When, however, I had comj^leted my task, I felt that, if 
 anyone wished to learn what the ancients knew about any 
 individual subject connected with gynaecology, it would take 
 some time to ascertain the views of each author. I therefore 
 
X PREFACE. 
 
 determined to follow the example of Darwin, who in some of 
 his work, such, for instance, as the "Movement in Plants," 
 had written a resum^ in order that the reader may, if he 
 thinks fit, read the last " chapter first, as it includes a 
 summary of the whole volume, and he will see what points 
 interest him, and on which he requires the full evidence." 
 In this last chapter I have also allowed myself more liberty 
 in discussing some matters connected with gynaecology, 
 allusion to which in the body of the work would have been 
 out of place. 
 
 That the general practitioner knows little of the history of 
 medicine is due to the fact that systematic lectures on the 
 subject are not usually given in English medical schools, 
 and also because "England alone among the nations dis- 
 tinguished by their contributions to the art has produced 
 no complete work of importance dealing with its history " 
 (Withington). 
 
 But though the knowledge may be wanting among the 
 rank and file of the profession, we would hardly have expected 
 that such writers as Greig Smith and Gaillard Thomas, when 
 dealing with the historical aspect of gynaecological operations, 
 would have made such statements as, " Soranus the Younger 
 made important contributions to gynaecology. He was 
 educated at Alexandria, and went to Eome in the year 
 220 B.C."; and, "Soranus of Ephesus, in his book on 
 'Diseases of Women,' published a century before Christ," 
 etc. Soranus, we might remark en jjassant, lived during the 
 reigns of Trajan and Hadrian, a.d. 98-138. 
 
 But, if I point out the errors of others, let me at once say 
 that this volume has many defects, and that no one is more 
 conscious of the fact than myself ; but I would ask the reader 
 to remember that it has been written in a country where 
 every book that one wants to refer to has to be brought from 
 
PREFACE. XI 
 
 Europe ; and often one must wait, not for months, but for 
 years, before some of these works can be procured. 
 
 In spite, however, of these disadvantages, I have neglected, 
 I beheve, no work among the ancient classical authors of any 
 importance which contains any passages on gynecology. Had 
 I been in Europe, I should have glanced through the works 
 of Eros and Marcellus, and I should have endeavoured to 
 have consulted a work mentioned by Daremberg in the first 
 volume of his edition of Oribasius. Therein he says: "J'ai 
 copie a Florence le traite, encore inedit, de Metrodore, intitule 
 Ilepl Tcoi' yvvaLKeicov 'jradoiv. II ne consiste guere qu'en 
 recettes." I should also have consulted a work by one 
 Cleopatra, entitled "De Passionibus Mulierum," a treatise 
 which is attributed either to the authoress of a work on 
 cosmetics, which was written about the first century after 
 Christ, or to the Egyptian Queen. 
 
 The only work that I regret that I have not been able to 
 see is one by Theodorus Priscianus, or, as he is sometimes 
 called, Octavius Horatianus, a writer who lived in the fourth 
 century after Christ, and who was the author of a Latin work 
 entitled " Pierum Medicarum Libri Quatuor," the third book 
 of which treats of the diseases of women. I have been 
 unable to see any extracts of importance from this treatise, 
 and Greenhill says of the whole work: "The style and 
 language of the work are bad, and altogether it is of little 
 interest and value." 
 
 Not until I had finished this work had I an opportunity of 
 examining a copy of the Talmud. The Talmud represents the 
 oral law of the Jewish people, and the work was compiled by 
 the Piabbins after the second destruction of Jerusalem under 
 Hadrian. The text of the work is called the Mishna, while 
 the commentaries on the text, written by various learned 
 Eabbins, are called the Gemara ; but while there is but one 
 
\ 
 
 xii PREFACE. 
 
 Mishna, there are two Gemara — one known as the Jerusalem, 
 the other as the Babylonian ; these commentaries on the 
 Mishna were compiled during the first five centuries a.d. 
 
 We find many passages in the Gemara bearing on medicine, 
 surgery, and gynaecology, written by Kabbins who had made 
 a special study of medical science ; and these commentaries 
 show us that, while Talmudic medicine lacked originality, the 
 Eabbins were intimately acquainted with Greek medicine.^ 
 
 1 have had an opportunity of examining a copy of the 
 Jerusalem Talmud."^ This, however, contains fewer chapters 
 on the subject of medicine than the Babylonian Talmud; and 
 while there are numerous passages bearing on gynaecology, 
 yet, after making a resume of what I had abstracted, I did not 
 consider the result of sufficient interest to be included in this 
 work. A few points noted may, however, be alluded to here. 
 The Eabbins were fond of making vaginal examinations, and 
 they were observant enough to discover the hymen. This 
 the Greeks had apparently failed to do, if we are to form a 
 judgment from the anatomical writings of Soranus. Another 
 point of interest was that, by vivisecting animals, they found 
 that the uterus could be cut out without the death of the 
 animal resulting, and they were intrepid enough to undertake 
 embryotomy, and to perform Cesarean sections not only on 
 the dead, but also on the living.^ Lastly, the frequent mention 
 of gonorrhoea confirms the opinion that I had already arrived 
 at, that gonorrhoea existed among the ancients, and played an 
 important role in the etiology of the diseases of the female 
 j^enerative organs. 
 
 ^ "Der mediciiiische Inlialt des Talmud ist in Westenlichten der spiiteren 
 griechischen Heilkunde entlehnt" (Haeser). Bergel, however, attacks this 
 assertion. 
 
 2 "Le Talmud de J(irusalem," Schwab, Paris, 1878-89. 
 
 ' Those who are curious to learn more of the medicine and gynojcology of the 
 Talmudists may consult the following works : Rabbinowicz, "La Medicine du 
 Thalmud," Paris, 1880 ; Israels, "Tentanien Historico-medicum exhibens Collec- 
 tanea Gynrecologica ex Talmude 13abylonico," 1848. 
 
PREFACE. xiii 
 
 As it would have been impossible to have written the sketch 
 of the history of gyna3cology without at the same time giving 
 an outline of the history of medicine and surgery, I have, 
 when necessary, compiled from Haesar, Puschmann, Sprengel, 
 Daremberg, Bass, and others, sufficient of the general history 
 of ancient medicine to enable the reader to appreciate the 
 progress made by gynaecology when compared with the 
 progress made by the other branches of medicine. But 
 in this outline I have been careful not to overburden the 
 text with references, for to those acquainted with the history 
 of ancient medicine such references are not necessary, while 
 to those unacquainted with the subject such references would 
 be useless. When, however, I have quoted any passages 
 bearing on the particular subject of this history, I have been 
 careful to give such references as will enable anyone acquainted 
 with the originals to verify them. 
 
 There is but one sad memory connected with this book. 
 Mr. Lawson Tait, my teacher and friend, had from the 
 outset encouraged me to undertake this task, and, with 
 his usual impulsive generosity, had agreed to read it through, 
 and to write an introductory chapter on the subject with 
 which his name must be for ever connected ; for who will 
 deny that he has added to the advancement of operative 
 gynaecology more than anyone who has preceded him '? This 
 man was a genius, and if ever man took a knife into his hand 
 who understood his work, this was the man. He had a brain 
 that was omniscient ; he came to his work primed with the 
 experience of the difficulties of 3,000 cases of abdominal 
 section ; he dealt with each case with a master's hand, not 
 with the empiric touch that so many display. Those who 
 knew him intimately knew him to be a genius ; and when the 
 tongue of envy has ceased, and age has paid its just tribute to 
 this man, then, and not till then, will gyntecologists acknow- 
 
xiv PREFACE. 
 
 ledge their real indebtedness to this great and marvellous 
 surgeon. 
 
 Lastly I wish to acknowledge my indebtedness to the 
 authors named in the list of books consulted, which I have 
 chiefly used in compiling this work. 
 
 I wish to thank Miss Lewington for the great pains she has 
 taken in caligraphing the whole work. 
 
 W. J. STEWAET McKAY. 
 Sydney, New South Wales, 
 August \st, 1900. 
 
PREFATORIAL NOTE BY THE PUBLISHEPxS. 
 
 Owing to the lamented death of the late Mr. Lawson Tait, 
 who had kmdly offered to supervise this work while passing 
 through the press, we were glad to avail ourselves of the able 
 services of Dr. J. Knott, of Dublin, who has kindly read the 
 proofs, and made many necessary alterations and corrections. 
 The residence of the author at the Antipodes rendered it 
 obviously impossible for him to do this without incurring 
 unnecessary delay. 
 
 B. T. & C. 
 
LIST OF WORKS CONSULTED. 
 
 Haeser: Lehrbuch der Geschichte der Medicin, 1875. 
 
 Freind : The History of Physick from the Time of Galen to the Beginning 
 
 of the Sixteenth Century, 1725. 
 Sprengel : Versuch einer pragmatischen Geschichte der Arzneikiuide, 1792. 
 Daremberg : Histoire des Sciences Medicales, 1870. 
 X Whewell : History of the Inductive Sciences, from the EarUest to the 
 
 Present Time, 1840. 
 Siebold : Versuch einer Geschichte der Gerburtshulfe, 1839. French 
 
 edition by Herrgott, 1893. 
 Encyclopaedia Britannica : Eighth Edition, articles " Anatomy," by 
 
 Craigie; "Medicine," by Laycock. Ninth Edition, articles "Medi- 
 cine," by Payne ; " Anatomy," by Turner. 
 Bostock: "History of Medicine," Cyclopaedia of Practical Medicine, 
 
 Vol. I., 1833. 
 Bouchut : Histoire de la Medecine et des Doctrines Medicales, 1873. 
 Dezeimeris : Dictionnaire Historique de la Medecine Ancienne et 
 
 Moderne, 1831. 
 Bass : Gnmdriss der Geschichte der Medicin, translated by Henderson, 
 
 1889. 
 Russell : History and Heroes of the Art of Medicine, 1861. 
 Berdoe : The Origin and Growth of the Healing Art, 1893. 
 Witlaington : Medical History from the Earliest Times, 1894. 
 Puschmann : A History of Medical Education, translated by Hare, 1891. 
 Greenhill : Smith's Dictionary of Greek and Roman Biography and 
 
 Mythology, articles on the Greek and Roman Physicians. 
 Cullen : Works, article " History of Medicine," Vol. I., 1827. 
 Ashhurst : The International Encyclopaedia of Surgery, article "History 
 
 of Surgery," by Fisher, Vol. VI., 1886. 
 y Mann: The American System of Gynaecology and Obstetrics, article 
 
 " Historical Sketch of Gynaecology," by Jenks, Vol. I., 1887. 
 V Thomas : Diseases of "Women, " Historical Sketch of Gynaecology," sixth 
 
 edition, 1891. 
 Mahaffy : Alexander's Empire, 1890. 
 
xviii LIST OF WORKS CONSULTED. 
 
 Gibbon : The Decline and Fall of the Roman Empire. 
 
 Joachim : " Papyrus Ebers," Das alteste Buch tiber Heilkunde, 1890. 
 
 Brugsch : Notice Raisonnee d'un Traite Medical datant du XlVieme 
 
 Siecle avant notre Ere, et contenu dans un Papyrus Hieratique du 
 
 Musee Royal de Berlin, Leipzig, 1863. 
 Wise : Review of the History of Medicine, 1867. 
 Wise : Hindu System of Medicine, 1860. 
 Royle : An Essay on the Antiquity of Hindu Medicine, 1837. 
 Bhagvat Sinh Jee : A Short History of Aryan Medical Science, 1896. 
 Littre : CEuvres Completes d'Hippocrate, 1859-61. 
 Adams : The Genuine Works of Hippocrates, Sydenham Society, 
 
 London, 1849. 
 Dewez : Moschionis de Mulierum Passionibus, 1793. 
 Mulligan : A. Corn. Celsi Medicinae Libri Octo, 1826. 
 Nisard : Celse, Traite de la Medecine, 1846. 
 Bostock and Riley : The Natural History of Pliny, 1856. 
 Ermerins : Sorani Ephesii, Liber de Muliebribus Aflfectionibus, 1869. 
 Herrgott : Soranus d'Ephese, Traite des Maladies des Femmes ; et 
 
 Moschion, 1895. 
 Kuhn : Medicorum Grsecorum Opera quae extant, Galen, Vols. I. -XX., 
 
 1821-33. 
 Galeni Omnia quae extant Opera : Juntarum Quarta Editio Venet., 1565. 
 Cornarius : Aetii Medici Graeci contractae ex Veteribus Medicinae Tetra- 
 
 biblos, 1549. 
 Adams : The Extant Works of Aretaeus the Cappadocian, Sydenham 
 
 Society, London, 1856. 
 Bussemaker et Daremberg : CEuvres d'Oribase, Vols. I.-VL, 1851-76. 
 Daremberg : CEuvres de Rufus d'Ephese, 1879. 
 Daremberg : CEuvres Anatomiques, Physiologiques et Medicales de 
 
 Galien, 1856. 
 Adams : The Seven Books of Paulus iEgineta, Sydenham Society, 
 
 London, 1844-57. 
 Sprengel : Dioscorides, 1829-30. 
 
 Franvius : Erotiani Galeni et Herodoti Glossaria in Hippocratem, 1780. 
 Schwab : Le Talmud de Jerusalem, 11 vols., 1878-90. 
 
CONTENTS. 
 
 Introductory 
 Egypt - 
 
 Hindu Medicine 
 Grecian Medicine 
 
 Hippocrates - - - - 
 
 CHAPTER VI. 
 The Alexandrian Schools - 
 
 CHAPTER VII. 
 Medicine in Rome - 
 
 CHAPTER VIII. 
 
 RUFUS EpHESIUS and DlOSCORIDES - 
 
 PART I. 
 CHAPTER I. 
 
 CHAPTER II. 
 CHAPTER III. 
 CHAPTER IV. 
 CHAPTER V. 
 
 CHAPTER IX. 
 
 Soranus 
 
 PAGK 
 1 
 
 CHAPTER X. 
 The Medical Profession in Rome 
 
 15 
 
 23 
 
 31 
 
 56 
 
 61 
 
 79 
 
 84 
 
 121 
 
XX CONTENTS. 
 
 CHAPTER XL 
 
 PAGE 
 
 Aret^us - - - - - - - 128 
 
 CHAPTER XH. 
 Galen ...---- 133 
 
 CHAPTER Xni. 
 The Byzantine Period— The State of Medicine after 
 
 THE Death of Galen - - - - - 149 
 
 CHAPTER XIV. 
 
 Oribasius - - - - - - - 158 
 
 CHAPTER XV. 
 MOSCHION - - - - - - - 171 
 
 CHAPTER XVI. 
 Aettus .-.---- 179 
 
 CHAPTER XVII. 
 
 Aetius {Continued) - - - - - - 199 
 
 CHAPTER XVIII. 
 Paulus ^gineta - - - - - - 223 
 
 CHAPTER XIX. 
 The Arabian Writers . . - - . 236 
 
 PART II. 
 
 CHAPTER XX. 
 
 Resume of the Anatomy of the Female Genital Organs 240 
 
 CHAPTER XXI. 
 
 RfeuME OF Physical Examinations of the Pelvic 
 
 Organs ..----. 251 
 
 CHAPTER XXII. 
 Resume of the Diseases of Women - - 288 
 
The History 
 
 Ancient Gynecology. 
 
 PART I. 
 CHAPTER I. 
 
 INTRODUCTOEY. 
 
 In seeking for materials for a history of ancient gynaecology 
 we must travel back to the sixteenth century e.g., and examine 
 the pages of the Papyrus Ebers. This papyrus is the oldest 
 work on medicine that we possess, and in its pages we find 
 some facts concerning gynaecology ; unfortunately for our 
 purpose, the Hermetic Book which was devoted to the con- 
 sideration of the diseases of women has not been preserved. 
 
 We next come to examine the works of the Hindu writers, 
 and, fortunately for English readers, Dr. Wise, of the Bengal 
 Medical Service, has left us two works which deal very 
 thoroughly with ancient Hindu medicine. The works to 
 which Wise specially devoted his labours are the " Charaka 
 Veda" and the " Sushruta Veda." The period at which 
 these Vedas were composed has not been definitely deter- 
 mined, but portions of these works date back to 900 e.g., and 
 
 1 
 
2 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 as they contain many passages bearing on the diseases of 
 women, they enable us to see the great antiquity of certain 
 therapeutic agents used in the treatment of gynaecological cases 
 at the present time. 
 
 We then come to the Grecian period, and to the genuine 
 works of Hippocrates (born 460 b.c.) ; these, however, contain 
 little of interest on our subject. On the other hand, among 
 the works attributed to Hippocrates, but now considered 
 spurious, we have several treatises on gynsecology which 
 contain a surprising number of accurate observations, and 
 convince us that gynaecology was a branch of medicine that 
 had received a large share of attention among the Greeks. 
 
 From Greece we travel to Alexandria (third and fourth cen- 
 turies B.C.), but we seek in vain for materials for our work, 
 for time has not preserved for us any of the many treatises 
 which we have reason to believe were written on the diseases 
 of women by those who studied in the schools of the Egyptian 
 Athens. 
 
 Turning to the West, we now come to the Koman period, 
 and in the first centuries of the Christian era we encounter 
 several authors whose works contain the facts we seek. 
 
 The first of these writers was Celsus (50 b.c. — 7 a.d.), who 
 lived in the reigns of Augustus and Tiberius, and who has 
 left us, in his most gracefully- written work on medicine, some 
 observations on the anatomy of the uterus, and some descrip- 
 tions of gyngecological operations. Pliny (23-79 a.d.), who 
 lived soon after Celsus, has recorded, in his encyclopaedic 
 work on natural history, many therapeutic agents in use in the 
 treatment of the diseases of women. Soranus of Ephesus, who 
 lived in the reigns of Trajan and Hadrian, has left us a most 
 brilliant and interesting work on gynaecology and obstetrics ; 
 while Eufus, also of Ephesus, has given us a catalogue of the 
 
INTRODUCTORY. 3 
 
 terms applied to the various parts of the female organs of 
 generation. 
 
 Travelling down the stream of time, we meet with Aretseus, 
 of the first, and Dioscorides, of the first or second century, and 
 we find something of interest in both these writers' works. We 
 next come to the illustrious Galen (born 170 a.d.), whose 
 monumental labours have, however, not enriched the field of 
 gynaecology, though we find among his genuine works an 
 interesting treatise on the dissection of the female genital 
 organs, as well as many observations on the physiology of 
 these parts. 
 
 Leaving Italy, we turn once more to the East, and under the 
 Byzantine rule we find Oribasius (326 — 403 a.d.) compiling his 
 vast encyclopaedia of seventy volumes, from whose pages we 
 are able to glean some facts about our subject. At the same 
 Court, in the sixth century, Aetius composed his medical and 
 surgical treatises in sixteen books, the last of which is devoted 
 to the diseases of women. This work is of the greatest im- 
 portance to us, for while it contains much that Soranus has 
 already given us, it at the same time gives us chapters from 
 such authors as Archigenes and Philumenus, whose works 
 have perished for ever. We shall also notice the curious 
 work of Moschion, which is now known to be only an abbre- 
 viation of the larger treatise of Soranus. 
 
 Lastly, we come to the seventh century, and to the brilliant 
 resume of ancient medicine contained in the great work of 
 Paulus ^gineta. 
 
 Here our labours cease ; for with the death of Paul the 
 Dark Ages began, and the gynaecology contained in the works 
 of the Arabian authors is only a servile copy from the works 
 of those who had preceded them. 
 
 1—2 
 
CHAPTER II. 
 
 EGYPT. 
 
 The records that we possess of the medical works of the 
 Egyptians are not many, but as they are the oldest writings 
 on medicine that we have, they give us a considerable insight 
 into the state of medical science fourteen or fifteen centuries 
 before the Christian era. 
 
 Before these authentic records came to light we were 
 perhaps accustomed to accord to the Egyptians too great 
 credit for their medical knowledge. Be this as it may, there 
 can, however, be no doubt that medicine was extensively 
 cultivated by the Egyptians, and in certain directions they 
 made considerable advances, for the good results that followed 
 their treatment made the Egyptian physicians much sought 
 after in their own and other countries. Still, these early 
 promises were not fulfilled, and having advanced to a certain 
 point, Egyptian medicine appears to have come to a standstill. 
 Many reasons have been put forward to explain this fact, the 
 most probable conjecture being the too intimate association 
 of medicine with the sacerdotal class. Whether the priests 
 were the actual practitioners or not cannot be ascertained ; 
 but this much is certain, that the healing was chiefly per- 
 formed in and around the temples, either by priest-physicians 
 or physicians under the patronage of the officials of the 
 
EGYPT. 5 
 
 temple.^ Prayers were combined with medical treatment in 
 sickness, and were specially written for each case. ** In 
 conformity with the priestly character of the doctors, they 
 offered up these prayers themselves, and ascribed at least as 
 much importance to them as they did to their medical 
 directions. 
 
 " Many doctors were members of the great priest colleges, 
 and lived in the teaching institutions belonging to the 
 temples. They there taught medicine and carried on medical 
 practice. 
 
 "Whether there existed, in addition to the doctors par- 
 taking of the priestly character, other practitioners who learnt 
 and practised their calling as empirics is not certain, but is 
 probable."^ 
 
 ** Instruction was founded upon the ' Sacred Books,' in 
 which all the wisdom of the Egyptians was contained. Thoth, 
 the god of Wisdom, was looked upon as the author, * who also 
 conferred enlightenment upon doctors.' The Sacred or Her- 
 metic Books formed a kind of encyclopaedia, and consisted of 
 forty-two parts. . . . With medicine the last six books were 
 concerned, being called the ' Ambres.' 
 
 " It is not probable that medical teaching confined itself to 
 the medical works belonging to the hermetic writings, or to 
 the works illustrating these, in which the libraries connected 
 with the temple schools were without doubt very rich. . . . 
 The rule existed in Egypt that patients should be brought 
 into the temple to await help and the alleviation of their 
 pains at the hands of the priests. The latter were also called 
 to the dwellings of those sick people who were too ill to be 
 brought into the temple."^ 
 
 1 Herodotus, iii., 1. 129. 
 
 2 Puscbmann, "A History of Medical Education from the Most Remote to 
 tlie Most Recent Times," translated by Hare. London, 1891. ^ lUd. 
 
6 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 According to Diodorus Siculus the ancient Egyptian 
 physicians were supposed to treat their patients according to 
 the rules in the Hermetic Books. *' Provided he followed 
 them implicitly, no blame was incurred though the patient 
 died ; if he departed from those in the least, and at the same 
 time the case ended fatally, his own life became the forfeit."^ 
 This, however, was probably only relative ; Aristotle^ says that 
 the treatment was not to be altered until after the fourth day ; 
 and Finlayson^ remarks : " The complicated formulae and 
 large choice of alternative remedies indicated in the Ebers 
 Papyrus would seem to show that no great weight was 
 attached to strict adherence to special methods, deviation from 
 which was fatal." The Egyptians probably knew next to 
 nothing about anatomy, as their religion forbade dissection, 
 and the embalmers probably learnt little. After the Para- 
 schistes had made the preliminary abdominal incision, the 
 Taricheutse were accustomed to pass their hands through the 
 incision into the body and remove the heart and kidneys and 
 digestive organs. If they were accustomed to remove the 
 uterus and ovaries, they must have gained some knowledge of 
 the organs, but we have no authority for saying that the 
 uterus was really removed. The custom that the Egyptians 
 followed, that of making models of the parts that had been 
 healed and then hanging them in the temples, may have been 
 useful for clinical instruction. 
 
 If we are to believe the account given by Herodotus, the 
 idea of specialism originated in Egypt. He says : " The art of 
 medicine is thus divided among them : each physician applies 
 himself to one disease only, and not more. All places abound 
 
 1 Millar, " Disquisitions in the History of Medicine, " Edinburgh, 1811. 
 
 2 Aristotle, "Politics," Book III., c. 15. 
 
 ' Finlayson, "Ancient Egyptian Medicine," Brit. Med. Journal, vol. i., 
 p. 748, 1893. 
 
EGYPT. 7 
 
 in physicians. Some physicians are for the eyes, others for 
 the head, others for the teeth, others for parts about the belly, 
 and others for internal disorders."^ 
 
 The chief records that we possess that have aided us in 
 elucidating the state of Egyptian medicine are as follows : 
 
 1. The large and small Papyrus Brugseh contained in the 
 Berlin Museum. The date of the larger, known as the Berlin 
 Papyrus, is about the fourteenth century. This has been 
 published in facsimile by Brugseh, and commented on by 
 Chabas, Eenouf, and others. Chabas draws attention to the 
 fact that out of 170 medical receipts ia the work twenty-eight 
 are for enemata. 
 
 2. The British Museum Medical Papyrus, whose date is 
 1100 B.C. This has not yet been published, but Buch has 
 given an account of it. 
 
 3. Various fragments at Leyden, Turin, Boulogne, and 
 Paris — none of great importance. 
 
 4. The Papyrus Ebers, whose date is set down as 1550 e.g. 
 Joachim has made a translation into German of this, the 
 oldest and most important of the papyri that deal with 
 Egyptian medicine. In his Introduction he says : " The 
 Ebers Papyrus is at present preserved in the University 
 Library at Leipzig. It surpasses in importance all other 
 medical papyri in the richness of its contents and its com- 
 pleteness and perfection ; it is the largest, the most beautifully 
 written, and the best preserved of the medical papyri. It 
 was obtained by Ebers during his stay ia Egypt in the winter 
 of 1872-73 from a citizen of Luxor. 
 
 " On the back of the first page there is a calendar from 
 which Ebers tried to determine the date of the writing. From 
 
 ^ Herodotus, ii. 84. 
 
8 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 the dates in this calendar Ebers fixed the composing of the 
 Papyrus to the years 1553-1550 b.c. 
 
 '* What are we to understand by the Ebers Papyrus ? 
 
 "Its editor declares it to be the book irepl (fiapfxaKwv men- 
 tioned by Clement of Alexandria, and maintains this opinion 
 in his latest work on his Papyrus . . . 
 
 ** We know that Clement of Alexandria, who lived in the 
 second century after Christ, and who is considered one of the 
 best authorities on Egypt, relates that forty-two Hermetic 
 Books existed there, thirty- six of which treated of philosophy, 
 and the remaining six of medicine. They were as follows : 
 
 1. Ilept Tr^s Tov (Toyfji.aTO'S KaTacrKevrjs. 
 
 2. Uepl vocrwv. 
 
 3. Ilepi opydviov. 
 
 4. Uepl (jiapiJidKOiv. 
 
 5. Uepl ocf}daXfJ.(Ji}v. 
 
 6. IIep6 Twv yvvaiKLwv^ (vocrwv). 
 
 "This opinion of the learned investigator, that the Ebers 
 PajDyrus was the Trepl <fiap[xdKO)v, I cannot at all share. In a 
 work of such a name the physician aims at a treatise on 
 individual remedies, their influence, application, injurious 
 effects, etc. The contents of the papyrus do not by any 
 means answer to this ; they treat rather of diseases of the 
 organs, particularly disorders of the stomach, affections of the 
 eyes, diseases of women, and also of the construction of the 
 human body. I believe, therefore, that we must understand 
 by the Ebers Papyrus a kind of medical compendium. It is 
 hardly necessary to say that by this it loses nothing either in 
 character or importance, especially as regards the history of 
 medicine " (Joachim-Finlayson). 
 
 ^ yvvaiKflwv (?). 
 
EGYPT. 9 
 
 Ebers himself thinks that the papyrus has been a compila- 
 tion, several treatises having been combined to make one 
 large complete work. This papyrus contains some passages 
 which deal with the diseases of women ; and these we shall 
 now proceed to extract, first, however, drawing attention to 
 the fact that among the Hermetic Books there was a special 
 work on gynaecology. 
 
 The Passages bearing on Gynecology in the Ebers 
 Papyrus. 
 
 On page 170^ we have prolapse of the uterus mentioned 
 thus : "A remedy to enable the uterus of a woman to return 
 to its proper region "; then follow several prescriptions, some 
 prepared with honey and petroleum, which had apparently 
 to be smeared on with the finger of the patient, and the 
 uterus was then to be pressed upon and returned to its place. 
 The fumes of wax and hot charcoal are also recommended to 
 be allowed to penetrate the uterine cavity of the prolapsed 
 womb. 
 
 Page 171 : A receipt is given to enable a woman to give 
 birth to a child, and on the next page abortion is apparently 
 alluded to, for a receipt is given to detach or disperse (ahlosen, 
 loslosen, abschneiden, enthinden) the foetus in the womb. One 
 of these remedies the author directs to be rolled into a round 
 mass and to be placed in the vulva. Another is to be smeared 
 on the womb, and another to be injected into the vulva. 
 
 Page 173 : The beginning of a remedy to prevent both breasts 
 from sinking. In a note on the word '* breast," Joachim 
 quotes Liiring as taking the Egyptian word henti to mean 
 " die Papillen der Brust," while Stern interprets it as " ovaria 
 uteri mulieris." 
 
 1 Joachim's German translation. 
 
lo THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 The passage then runs : " If the patient has a flow of blood, 
 and the period comes on suddenly, so that the blood is poured 
 out, then you know that the patient is not suffering from the 
 mesu disease [Fluor Albus ?]. 
 
 " When we wish to prevent a patient from suffering from 
 fluor albus we proceed as follows : The dried liver of a swallow 
 is taken and rubbed up with some sour milk ; this is then to 
 be placed on the breast, belly, and joints." 
 
 Then comes a remedy against a bad breast. 
 
 Page 174 : A remedy against corrosion of the vulva pro- 
 ducing round pustule in the vagina. 
 
 Page 175 : A remedy to prevent disease starting in the 
 labia, and against shooting pains in the vulva, and round 
 pustule originating in the vagina. 
 
 Page 176 : A receipt to cool the vulva or uterus, and to 
 disperse inflammation from these parts. This was to consist 
 of palm fruit and cypress blended with oil, and this was 
 looked upon as an astringent remedy. Mention is also made 
 of peppermint- water, which was used for vaginal injections. 
 
 Page 177 : " When you examine a woman and find that the 
 fluid that escapes from her vulva is like water, and you also 
 find that the sediment of the water resembles warm blood, 
 then you must tell her that she has the axat disease in her 
 vulva." A note to axat says that Brugsch's interpretation is 
 kratzen, ritzen, renkratzen, i.e., pruritus. The remedy for 
 this case is to prepare for the patient jaspis, which attracts 
 water, and rub it up with honey and collyrium, and after 
 preparing a pessary of linen with it, introduce the pessary and 
 leave it in the vagina for four days. 
 
 Page 177 : "When you make an examination of a patient 
 and find that she has disease on one side of her womb, you 
 tell her that she has an obstruction to her menstruation; 
 
EGYPT. II 
 
 then, having made your diagnosis, prepare a remedy which is 
 applied to the womb." 
 
 Page 177 : ** If you examine a woman who has Hved for a 
 number of years without menstruating, and she vomits some- 
 thing like foam, and her womb is as if a fire were placed 
 beneath it, and then you find that she recovers again, after 
 having vomited, you say to her, * It is an incoming of blood 
 into your womb.' " 
 
 Page 178 : A remedy for painful inflammation of the vulva 
 or uterus ; there is also given a receipt for a remedy which 
 was introduced into the uterus. 
 
 The above passages are almost the sum-total of the gynae- 
 cology contained in the Ebers Papyrus. Analyzed, these 
 passages show us that even thus early some attention was 
 paid to the diseases peculiar to women, and since we are given 
 to understand that one of the Hermetic Books was entirely 
 devoted to the Diseases of Women, we have here only a small 
 scrap of the knowledge of the physicians of those far-off times 
 in this branch of medicine. 
 
 We see from the first and second passages quoted from 
 page 177 that examinations of the vagina and cervix were 
 made, and this is confirmed by the third extract from the 
 same page, where obstructions to menstruation are alluded 
 to as being possible from disease of the one side of the 
 cervix. 
 
 Of the greatest interest is the passage on page 173, which 
 Joachim considers alludes to the breasts, Liiring to the 
 nipples, but which Stern reads as prolapse of the ovaries. If 
 the latter were indeed the correct reading, it would mean that 
 the Egyptians not only knew of the existence of the ovaries 
 (learnt from the rites preceding the embalming process), but 
 it would also imply that they had acquired sufficient skill in 
 
12 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 vaginal examinations to ascertain the position and malposi- 
 tions of the ovaries. This is perhaps expecting too much. 
 
 With regard to anatomy, they evidently made a distinction 
 between the uterus, the vagina, and the external genitals, for 
 we have three distinct words used in the Papyrus. Thus, on 
 page 170 the uterus is evidently alluded to in referring to the 
 treatment of prolapsus, and the term met-ret is used. On 
 page 174 the vagina is referred to and the term sM is used, 
 while in the other passages the general term at is used, 
 translated by Joachim usually as vulva, which may be taken 
 in a broad sense to mean uterus, vagina, or the external 
 organ of generation, or merely the latter as implied nowadays. 
 
 The cervix was recognised by inspection in cases of prolapse 
 and by palpation, as shown in the passage on page 177, where 
 obstruction from disease on one side of the cervix is referred 
 to. The uterine canal was recognised, for fumigation is 
 recommended first in case of prolapse ; and, on page 178, 
 the remedy is intended for introduction into the uterus. 
 
 The therapeutic means employed are clearly set forth. 
 Vaginal and rectal injections with medicated fluids were much 
 practised, and it is to be noted that the Papyrus Brugsch, as 
 M. Chabas has pointed out, contains twenty-eight medical 
 receipts for enemata. With regard to the origin of the enema, 
 we may here allude en passant to the fable handed down to us 
 by Diodorus Siculus and Pliny, who imagined that the ibis 
 gave the first idea of such a procedure, as it is generally 
 supposed that the bird used its bill as a cannula for injecting 
 water into its bowels. The mistake originated from the fact 
 that the hieroglyphs to express the god Thoth (Tahuti) were 
 the same as those used to express the ibis, while the bill of 
 the bird acting as a cannula was a gratuitous piece of imagina- 
 tion. We have also here mentioned for the first time in 
 
EGYPT. 13 
 
 medicine the suppository and the pessary. The suppository 
 is described on page 171 as composed of drugs rolled into a 
 bolus and introduced into the vagina ; while, on the other 
 hand, the pessary is frequently mentioned, and was made by 
 impregnating a piece of lint with various drugs, then rolling 
 it into a rod-shaped body so as to apply it to the part to be 
 treated. The pessary here referred to had, however, nothing 
 in common with the mechanical pessary of to-day, except that 
 it helped to support the womb in cases of prolapsus. 
 
 Fumigation, which in later years became such an important 
 therapeutic process with the Greeks, is shown to have been 
 used in these early times. 
 
 When at last we come to deal with the actual diseases 
 mentioned, we find the first record of complete prolapse of 
 the uterus, and its treatment by local applications and reposi- 
 tion. We can well imagine how common must have been 
 this complaint in those ancient times, when the patients, 
 during labour, were entirely in the hands of midwives, the 
 physician being probably called in only in cases of great 
 emergency — a custom which holds good among some nations, 
 such as the Chinese, even at the present day, where, as 
 Wise points out, "a false shame prevents the Chinese 
 females from receiving assistance from the male sex. They 
 often lose their lives by such conduct in case of haemorrhage, 
 cross-births, etc." 
 
 With regard to the other diseases, we may make an ap- 
 proximate guess on the following grounds. It is an assured 
 fact, as mentioned in Genesis, that prostitution existed thus 
 early. One Tamar, sitting by the roadside, is mentioned, 
 and her relations with Judah. Not only did prostitution 
 exist, but we have apparent evidence that gonorrhoea, but not 
 syphilis, also existed. In Leviticus xv. 2 we have the follow- 
 
14 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 ing passage : "When any man hath a running issue^ out of 
 his flesh, because of his issue he is unclean," and the infec- 
 tious nature of the disease is alluded to. Later on (Deuter- 
 onomy xxiv. 1) we find that " when a man hath taken a 
 wife and married her, and it come to pass that she finds no 
 favour in his eyes, because he hath found some uncleanness 
 in her, then let him write her a bill of divorcement." Now, 
 if gonorrhoea existed, it follows naturally that Bartholinian 
 gland abscesses existed, as also did vaginitis, endometritis, 
 salpingitis, and pyo-salpinx. There can be little doubt that 
 some of these diseases were treated, and it is probable that 
 the priest-physicians, if they lacked gynsecological material 
 from the modesty of the Egyptian women (though the revels 
 at the feast of Bubastis in later years show us little modesty), 
 could have obtained plenty of subjects among the prostitutes 
 of the times, who would naturally be desirous of being cured 
 of their complaints. 
 
 ^ The Septuagint Version renders the Hebrew word " Hazzab " — the man with 
 the issue, by 6 yovoppvrjs — the man with a gonon-hcea. We shall see, however, 
 that the term "gonorrhoea" was often used by the ancients where we now use 
 the term "spermatorrhoea." 
 
CHAPTER III. 
 
 HINDU MEDICINE. 
 
 ** The ancient history of the Hindus is divided into three 
 epochs : an age of freedom, of conquest, and of servitude. 
 The first is the ancient Vedic or independent period, which 
 Max Miiller divides into three periods. The first embraces 
 the period when the Aryan race had recently settled in India, 
 and extended from 1200 to 1000 b.c. The second, the 
 Mantra period, from 1000 to 800 b.c, when the Vedic hymns 
 were stored up in the memory. The third, or Brahmanam 
 period, extended from 800 to 600 b.c, when there was a 
 gradual advancement of the priestly class, and the separation 
 was made of the sacerdotal from the other classes. It was 
 during this period that the four sacred Vedas were supposed 
 to have been collected."^ 
 
 The Vedas are four in number, viz., Eig-Veda, Yajur-Veda, 
 Sama-Veda, and Atharva-Ve'da, and were received from 
 Brahma, one having been produced from each of his four 
 mouths. Later on, Brahma produced the second class of 
 sacred books, called the Upavddas, one of which is called the 
 Ayur-Veda, and contains the medical writings of highest 
 antiquity and importance among the Hindus. 
 
 The oldest of these is that known as the Charaka Ayur- 
 
 ^ Wise, "Review of the History of Medicine," vol. i., p. 11. 
 
i6 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 Veda. This work is said to have been communicated by 
 Atreya to Agnivesha, and by the latter to Charaka, who con- 
 densed it or expanded it according as he considered fit ; the 
 result is a work of some 120 chapters in eight divisions. The 
 thirtieth chapter of the sixth division is devoted to the diseases 
 of the generative organs. 
 
 Later than this work comes the Susruta Ay ur- Veda. 
 Susruta appears to have been the pupil of Charaka, and one 
 Dhanwantari revealed this Ayur-Veda to Charaka, who in turn 
 taught his pupil. Dhanwantari himself obtained his know- 
 ledge from Indra through the Aswins from Dacsha, who 
 received it from Brahma. The work is more surgical than 
 the other, though it deals with general diseases and the 
 management of women and children ; it also ranks first in 
 merit, and is more systematic. 
 
 The date of these works has given rise to much controversy. 
 Professor Wilson says that " from the Charaka and Susruta 
 being mentioned in the Puranas, the ninth or tenth century is 
 the most modern limit of our conjecture, while the style of 
 the authors, as well as these having been the heroes of fable, 
 indicates a long anterior date." Wise says the Charaka and 
 Susruta must have been prepared in a very early age, probably 
 from the third to the ninth or tenth century before the 
 Christian era. Webb and Eoyle^ have shown that the writings 
 are of great antiquity. 
 
 Glancing now through these two works, we shall first 
 examine the method of obtaining anatomical knowledge. 
 
 The anatomy of the Hindus was very superficial, although 
 dissections were not forbidden : " a man should dissect in 
 order that he may know the different parts of the body." 
 Though an unclean thing to touch, yet the code of Manu had 
 
 ^ Roylc, " An Essay on the Antiquity of Hindoo Medicine," London, 1837. 
 
HINDU MEDICINE. 17 
 
 directed " that one who has touched a corpse is made clean by 
 bathing." The description given of the manner of preparing 
 the body for dissection is not at all pleasant. It was first 
 placed for some days in a stream, until it became putrid, and 
 then the skin was removed by a brush, and the different parts 
 of the body were examined. 
 
 There is one passage in this work on the anatomy of the 
 uterus which is of interest, as it would apparently refer to the 
 Fallopian tubes : *' The menses have two canals, the roots of 
 which are the uterus, and the dhamanee vessels, which convey 
 the menses. When they are wounded, barrenness is caused, 
 and the menses cease." Dhamanee vessels, Wise explains, are 
 tubular vessels, such as veins, etc. 
 
 " The means by which the young practitioner is to obtain 
 dexterity in the use of his instruments are of a mixed char- 
 acter. . . . Some are striking specimens of the lame con- 
 trivances to which the want of the only effective vehicle of 
 instruction, human dissection, compelled the Hindus to have 
 recourse. . . . Thus, the different kinds of incision — longi- 
 tudinal, transverse, inverted and circular — are dkected to be 
 practised on flowers, bulbs and gourds."^ Although the 
 Hindus may have had only a superficial knowledge of 
 anatomy, this did not prevent them from attempting major 
 operations, and in their writings we have mention of abdom- 
 inal sections. Taking for granted that these works were 
 written 500 e.g., then the following passages are the first 
 mention of such operations ; but if these works date later than 
 this, then the Alexandrian surgeons have a prior claim, for 
 we shall see later on that they deliberately operated on the 
 abdominal organs. In the chapter on "Enlargement of the 
 Abdomen " (Udara) the following passage occurs : 
 
 ^ Wilson, Oriental Magazine, Calcutta, February and JIarcli, 1823. 
 
 2 
 
1 8 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 " Baddagiida. — This form [of swelling of the abdomen] is 
 produced by the accumulation of indigestible matters with the 
 food. The person has stercoral vomiting. The stools are in 
 small quantities, and are evacuated with great pain ; the 
 umbilicus and heart are much swelled. 
 
 " In this disease it is recommended to give ghee internally, 
 and rub it over the abdomen, while persj)iration is produced 
 by hot baths. When the remedies are of no use and the 
 situation of the patient desperate, an operation is recom- 
 mended, which is to be performed in the following manner : 
 Below and on the left side of the umbilicus, and four fingers' 
 breadth from the linea alba, an incision is to be made four 
 fingers' breadth in length, and the breadth of four fingers of 
 the gut is to be drawn out, and the substance, whether hair, 
 or stone, or a bad secretion, which was the cause of the 
 disease is to be removed. Ghee and honey is to be rubbed 
 over the wound in the intestine, and it is then returned into 
 the abdomen. Apply sutures, and treat the internal wound 
 as recommended in such cases " (Wise). 
 
 Sir Bhagvat Sinh Jee, in his work on Medical Science,^ adds 
 to the above information the following : " Abdominal opera- 
 tions, however, and operations in the mouth or about the anus, 
 should be performed when the XDatient is fasting. The opera- 
 tion should be performed with the utmost care ; after it is 
 over, a sesamum poultice should be applied to the wound, and 
 a cloth bandage be tied round it. A certain incense should 
 be kept burning in the operation-room." 
 
 In the treatment of ascites we see the first use of the 
 (Southey's) trocar : "A friend is to hold the patient in a 
 reclining posture by the armpits. The practitioner then 
 
 ^ Bhagvat Siuh Jee, "A Short History of Aryan Medical Science." London, 
 1896. 
 
HINDU MEDICINE. 19 
 
 introduces a trocar an inch below and on the left side of the 
 umbilicus; the trocar is removed, and a tube is put in its 
 place. The morbid fluid is for sixteen days to be allowed 
 slowly to evacuate itself, and a light bandage is to be placed 
 round the abdomen after the operation, so that the air may 
 not swell the abdomen." 
 
 With regard to the instruments, there were 125 enumerated. 
 Among these may be mentioned twenty-four forms of forceps 
 or pincers ; tubular instruments like catheters, twenty 
 varieties; bougies, thirty sorts; three-sided needles; and a 
 rectal speculum. The actual cautery is also mentioned ; like- 
 wise enemata, and suppositories and pessaries. 
 
 Coming now to the diseases of women mentioned in these 
 works, the information is not very full. It is pointed out that 
 there are twenty-four diseases of the female organs of genera- 
 tion, and they run after the following style : 
 
 1. Udaberta : when the menses are discharged with great 
 pain and are frothy. 
 
 2. Bandhya : difficult menstruation ; dysmenorrhoea (nos- 
 tartoboh), when the menses are stopped by the accumulation 
 of unhealthy humours in the part. 
 
 3. Bipluta : continued pain in the genital organs. 
 
 4. Paripluta : severe pain during connection. 
 
 5. Batala : in this disease the vagina is contracted and 
 rough, accompanied with pain. 
 
 6. Menorrhagia (prodoroh) is described — accompanied by 
 fever and pain over the body, giddiness, fainting, thirst, and 
 great heat. 
 
 9. Patragani : when the infant dies, or abortion has taken 
 place, with a great discharge of blood. 
 
 12. Karnini : when phlegm and blood are deranged in the 
 vagina, small granulations form, like the grains of rice. 
 
 2—2 
 
20 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 17. Palani : when a large man has connection with a small 
 and young female, he injures the parts and produces this 
 disease. 
 
 18. Mahati : when the vagina is very large. 
 
 19. Suchibuktra : when the entrance is very small. 
 
 The treatment of these diseases will vary, according to the 
 humour diseased. 
 
 When the air is diseased, apply warm fomentations, such 
 as steam-baths, etc., and poultices ; use also injections of 
 heated oleaginous medicines, which cure diseased air. A 
 piece of cloth soaked in oil is to be kept in the vagina. If 
 there is a bad smell, use the decoction of astringent barks. 
 
 In dysmenorrhoea the pubes should be rubbed with oil and 
 ghee, and the vagina is to be kept distended with a roller of 
 cloth. 
 
 The treatment of menorrhagia should resemble that of 
 hsemorrhagia, such as the application of cold and astringent 
 medicines, avoiding venery, and living on cooling and simple 
 food. 
 
 Kanda (Utero-vaginal Tumours). — These may arise from 
 mechanical injury of the part. When air produces the 
 disease, the tumour is dry and of a dirty or yellow colour, 
 and has furrows on its surface. When phlegm produces the 
 tumour, it is like the colour of the indigo flower, and is very 
 itchy. 
 
 Treatment. — In the treatment of these tumours use the 
 flesh of the shell-fish and the pulp of tamarinds ; rub them 
 together, and apply the mixture to the tumour. A paste 
 made of the flowers of Gossa is to be applied to the part, and 
 will be found of great use. 
 
 In treating of the cure of piles, varicose disease of the 
 vagina is referred to : Tumours, like those of piles, sometimes 
 
HINDU MEDICINE. 21 
 
 form in the cavities of the ear, nose, mouth, vagina and penis. 
 Also, in referring to the operation on piles, the lithotomy 
 position is described. The patient is to be placed upon a 
 table, with a good light thrown upon the part. He is to be 
 supported by two assistants holding his head and shoulders, 
 and his loins are to be elevated with a soft cushion. The 
 knees and legs are to be raised and separated by a bandage 
 passing round the knees, feet and neck. The passage shows 
 the great antiquity of this position. 
 
 Stone in the female bladder was operated on. If the supra- 
 pubic operation were undertaken, this was always performed 
 by the husband of the woman, as it was considered dangerous. 
 Speaking of the operation for stone on the female, the passage 
 says : "In females the bladder is situated near the uterus, 
 and care must therefore be taken not to thrust the knife 
 directly forward, as it will wound the uterus, and the urine 
 will pass through the vagina, forming a fistula." 
 
 With regard to urethral injections, the directions are, for 
 the female, that the tube should be four fingers' breadth in 
 length, and the opening capable of allowing the passage of 
 a small pea ; the tube should be smeared with oil and gently 
 introduced, and marks should be fixed on the tube to prevent 
 it being introduced too far. The bladders of pigs, bufi"aloes, 
 etc., were used for injecting these fluids into the bowel, 
 vagina, and bladder ; the injection-pipe was made of gold, 
 silver, copper, iron, hard wood, or ivory. Nutrient enemata 
 of animal and vegetable broths were often used. Fumigation 
 of various parts by means of a tube was often resorted to. 
 
 Summary. — We see from the short review of Hindu medicine 
 that these people made considerable progress in surgery. 
 Their instruments were numerous, and embraced the three- 
 sided surgical needle. Their anatomy was superficial, yet 
 
2 2 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 they did not shrink from performing abdominal sections. 
 We find them using the rectal speculum, catheters made 
 of various metals, irrigators formed from the bladders of 
 cattle or made like leather bags. The gynaecologists used 
 the medicated pessary, the vaginal douche, hot fomentations 
 and fumigations, while poultices were in general demand. 
 In cases of abdominal dropsy the trocar was resorted to 
 and the fluid drained off, while it is more than likely that 
 ovarian cysts were occasionally tapped, being mistaken for 
 cases of ascites. 
 
 The actual diseases mentioned under the heading of 
 Gynecology are chiefly the disorders of menstruation ; and 
 the treatment of them by rest, fomentations, and vaginal 
 injections is excellent. 
 
 We may finish this brief review by a quotation from Wise, 
 to whom we are so indebted for our knowledge of these 
 ancient works. He says : " Considering these various circum- 
 stances and points of resemblance, it is impossible to divest 
 one's self of the conviction that there were once communities 
 in Hindustan possessing eminent scholars, who cultivated 
 literature and science, by which the Egyptian and Grecian 
 philosophers profited. Such an early state of civilization in 
 India reached back at least a thousand years before Christ,^ 
 and the study of medicine was pursued with success centuries 
 before it could have been so advanced in character and so 
 permanent in its influence as Alexander the Great found 
 it in the fourth century b.c.^ It is to the Hindus we owe the 
 first system of medicine." 
 
 ^ Max Miillcr liolds that in the Vcdic period Indian works were transmitted 
 by oral tradition alone, and that no written documents are demonstrable prior 
 to the time of Azoka, B.C. 259-222 (Baas). 
 
 ^ Hass declares that Susruta never existed (Baas). 
 
CHAPTER IV. 
 
 GEECIAN MEDICINE. 
 
 Origin of Grecian Medicine. — The origin of Grecian medicine 
 has given rise to much sxDeculation, for we have but a scanty 
 knowledge of medicine previous to the works of Hippocrates 
 (B.C. 460). 
 
 For some centuries anterior to this date Grecian medicine 
 was intimately connected with Grecian philosophy. It is, 
 however, proved beyond doubt that Grecian medicine existed 
 long antecedent to Grecian philosophy. Two theories exist 
 to choose from, when dealing with the origin both of the 
 medicine and the philosophy of the Greeks. The first is 
 that Hindu medicine and philosophy came to great perfection 
 long before the Greeks had advanced to eminence as a nation, 
 and therefore when they did introduce medicine, and later 
 on philosophy, into Greece, that the introduction was made 
 from Egypt and from India ; and such writers as Wise, 
 Littre, Niebuhr, Weber, Hurschberg, Pocock, Diarz, have 
 given their support to the view that Hippocrates and the 
 earlier Greeks were largely indebted to India and Egypt for 
 their knowledge of medicine. 
 
 The other view is that Grecian philosophy was indigenous, 
 and that while a small amount of knowledge may have been 
 
x^ 
 
 24 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 derived from outside sources, still, these two branches of 
 knowledge, medicine and philosophy, were practically off- 
 springs of the Grecian mind. The matter may be easily 
 settled by saying that, if Grecian medicine arose de novo 
 in Greece, its origin was remote, and as years passed by it 
 grew and was shaped by the marvellous intellects of that 
 brilliant nation ; while if it was derived from foreign sources, 
 among which undoubtedly may be reckoned Egypt and India, 
 then it was altered and so improved as to become almost a 
 new creation. 
 
 Whether derived originally from outside sources or not, 
 there can be no doubt that, when once medicine existed as a 
 recognised branch of learning, it received great assistance 
 from the knowledge derived from philosophers and medical 
 men by their travels through Egypt and the East. Thus, 
 it is related that Pythagoras (b.c. 608), the philosopher, spent 
 twenty-two years in Egypt, Chaldea, and Eastern Asia, 
 making investigations into various branches of science, in- 
 cluding medicine. 
 
 Hellenic Medicine previous to Hippocrates. — Whilst the 
 oldest documents that we now possess on Grecian medicine 
 are those classed under the general title " The Works of 
 Hippocrates," it has become manifest, after a careful study 
 of these works, that many other medical works must have 
 existed in Greece previous to 430 e.g., the period in which 
 Hippocrates lived and flourished. We know these works 
 only by a few fragments or quotations, preserved in later 
 works. How much the world would have been richer in 
 knowledge if the Alexandrian Library had not been destroyed 
 by the Caliph Omar (a.d. G42) we shall never know, but that 
 an enormous number of works on every possible subject did 
 exist may be surmised, when it is remembered that the books 
 
 I 
 
GRECIAN MEDICINE. 25 
 
 of this library, among other things, supplied fuel for 4,000 
 baths for six months. 
 
 By a singular coincidence, we are not in possession of works 
 dating immediately after Hippocrates, so that two lacunae 
 exist. 
 
 Previous to the times in which Hippocrates practised, Greek 
 medicine had four sources, and it will be necessary to glance 
 at these in order to comprehend the sources from which 
 Hippocrates gained much of his knowledge, and in order to 
 understand how medical, surgical, or gynsecological cases 
 came to be studied, recorded, and treated. 
 
 Usually, in tracing the history of Hellenic medicine, three 
 classes of practitioners only have been described, it being 
 taken for granted that the priests at the temples and the 
 Asclepiadse were one and the same. This, however, does not 
 seem to have been the case, as will presently be shown. 
 
 To Asclepius is assigned the honour of having originated 
 Grecian medicine- No doubt Asclepius was a purely mythical 
 personage ; but as those who gained experience in curing 
 gradually became prominent personages, they became known 
 under the name of Asclepiadae, and they found it advisable to 
 bring about the idea that Asclepius was a divine person, and 
 that they were his real descendants. Be this as it may, there 
 sprang up many temples in which Asclepius was worshipped, 
 and his aid was besought in case of sickness. These temples 
 were presided over by priests who in time no doubt acquired 
 some medical knowledge, but they were not the Asclepiadae 
 proper ; these latter were the trained medical practitioners 
 of the period attached to the temples. As Puschmann says, 
 the priests of the temples of Asclepius were not doctors, as 
 many assume. Certainly there were among them, as among 
 then- assistants, the Zakoroi, many who were skilled in 
 
26 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 medical science; indeed, they had probably learned the 
 subject systematically. But between the healing art as 
 practised in the Asclepian temples and that of the profes- 
 sional doctors the great distinction existed that in the former 
 case it was held to be not a part of the human understanding, 
 but a divine revelation. 
 
 The name of a temple of healing was the Asclepieum, and 
 such temples were founded in various parts of Greece. The 
 situation of the temple was often chosen on account of the 
 thermae, which could be used as an aid, if necessary, in curing 
 the patients. Schultze gives a list of over sixty of these 
 Asclepian temples. 
 
 Let us glance for a moment at one of them. We find it 
 situated in some healthy locality, such as a well-wooded hill, 
 surrounded by artistically laid - out gardens, in which was 
 often found some mineral spring.^ In the building itself we 
 find statues and frescoes, and on the walls are votive tablets 
 on which are recorded the disease, its history, and the course 
 of treatment adopted to cure it. Often casts of the diseased 
 parts were made and placed by the side of the tablets, 
 making them more valuable as clinical histories. The 
 temples were kept scrupulously clean, and all those who 
 came as patients were enjoined to have a bath before pre- 
 senting themselves for treatment. But the patients were not 
 treated straight away. Probably the priests did not feel quite 
 equal to that ; so they adopted the plan of making the patient 
 sleep during the night in the temple, where, thinking of his 
 woes, he generally dreamt, and in his dreams the deity 
 revealed himself to him, and the treatment of the disease 
 was pointed out. When, however, this did not occur, the 
 
 ^ Thermae arc frequently mentioned by Soranu3 in the treatment of 
 gjTirecological cases, and Oribasius, quoting Antylhis, recommended them to 
 women who are irregular at the periods. 
 
GRECIAN MEDICINE. 27 
 
 patient told his dreams to the priests, and the priest then 
 shaped the treatment. If the patient, however, did not 
 dream, then it was necessary for him to sleep several nights 
 in the temple ; and if he still failed to dream, then a priest 
 generally slept by him and did the dreaming by proxy. 
 Deceit could only be the natural sequence of such a modus 
 operandi; and we see this clearly in those cases where the 
 priests actually used to go to the trouble of disguising them- 
 selves during the night, and so persuade the patient that he 
 had dreamed or had seen a vision. As all these plans must 
 have quite failed to bring relief in true organic disease, it is 
 probable that the patients would then seek the aid of the 
 second class of healers, viz., the Asclepiadse, or real doctors. 
 These passed as the descendants of Asclepius ; and so im- 
 portant was the direct descent supposed to be that later on it 
 was found expedient to construct a genealogical tree for Hip- 
 pocrates, showing that he was descended directly from the 
 divine Asclepius. This idea of divine descent was convenient, 
 and brought gain to the practitioner and respect for his 
 teaching. It must, however, have been abused, for there was 
 nothing to prevent anyone from passing as a branch of the 
 family. It was probably for this reason that there came to be 
 formed a kind of guild, or society, of medical men, which not 
 only contained the so-called true descendants, but also pupils 
 and others who had real medical knowledge. The guild 
 itself is what we now understand by the Asclepiadse. They 
 settled near the temples (the Asclepiea) because there was 
 most material there, since patients came to consult the deity 
 first, and no doubt, having got little satisfaction, they turned 
 to the true medical practitioners. There does not, however, 
 appear to have been any unfriendly rivalry between the priests 
 and the Asclepiadse, for each was a mutual benefit to the 
 
28 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 other. There being plenty of material, clinical instruction 
 was given and students were trained, and these latter were 
 enjoined to keep their knowledge to themselves, and later on 
 were received as practitioners on taking the oath so well 
 known in connection with the name of Hippocrates. In such 
 a manner was Hippocrates trained when a young man. 
 
 It may be asked, Did the Asclepiadse practise outside the 
 boundary of the temples ? Though Schultze thinks that they 
 did not, it is highly probable that they did, if we consider 
 Hippocrates in later times as an example. Anyhow, if the 
 Asclepiad^e did not practise away from the temples, then 
 there existed other doctors who practised, but who did not 
 belong to the guild. These physicians, accompanied by their 
 assistants and pupils, visited patients at their homes, or saw 
 them at the latreion attached to their residence. The latreion 
 would appear to have corresponded to the Poliklinik that 
 German surgeons so frequently have attached to their private 
 hospitals in German cities. Here they receive patients and 
 teach students, and, if necessary, operate on the patients. 
 So in the days of Hippocrates the physicians and surgeons 
 saw patients at the latreion, and, if necessary, operated on 
 them, and in some cases allowed them to remain as residents 
 of the institution. We may say that this was also the pre- 
 cursor of the modern hospital, and as nowadays cleanliness 
 and order are thought so essential, so in these past ages some 
 attention was paid to these subjects. " The napkins must be 
 kept clean, be of soft texture, as also the linen used for the 
 eyes, and the sponges for the wounds : for these things are of 
 great importance for the healing." 
 
 Besides those practitioners who visited patients at their 
 homes, there were midwives who attended women during their 
 confinement. According to Plato, the midwife had to ad- 
 
GRECIAN MEDICINE. 29 
 
 minister medicines, and to give remedies to hasten labour, to 
 tie the cord and cut it, and to provoke al)ortions. They also 
 treated women for gynaecological diseases, for the midwife is 
 mentioned several times in the Hippocratic works on gynae- 
 cology, and in the " Hippolytus " the nurse tells Phsedra that 
 if her disorder is one that cannot be revealed to men, then 
 there are women who understand such matters. 
 
 The third group to be considered comprised the philo- 
 sophers. 
 
 They became connected with medicine by reason of their 
 investigations into disease and into anatomy. They were not 
 content to merely put forward theories ; they wished to ascer- 
 tain by a close investigation into the structure of animals 
 whether they could get any nearer to the origin of things. 
 Some of these philosophers became actual medical practi- 
 tioners, whilst others were content to be investigators in com- 
 parative anatomy. 
 
 There can be little doubt that medical science gained by its 
 association with the philosophers, not because they added 
 much to the knowledge of surgery or pathology, but rather 
 in a general way, by bringing their clear, far-seeing intellects 
 to bear on obscure points, they enabled the actual practi- 
 tioners with the facts before them to gradually draw true and 
 proper conclusions. They, in fact, rather aided the science 
 than, say, the art of surgery, and by their dissections added 
 many new facts to comparative anatomy ; and, lastly, they 
 helped to found a proper nomenclature of diseases. 
 
 The fourth group that must be mentioned comprises those 
 who advocated the gymnasium as a means for restoring 
 health. So important was physical training in the Greek 
 mind that the education of a Greek youth was divided into 
 three parts — grammar, music, gymnastics. It will be easily 
 
30 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 perceived how admirably the Greeks were adapted to bring 
 gymnastic exercise forward as a therapeutic agent, and by 
 exercise, massage, and other branches of their art to obtain 
 results with which we now are familiar since the adoption of 
 massage and the Swedish movements in modern times. 
 Massage is mentioned by Soranus as being employed in 
 gynaecological cases ; thus, in dealing with amenorrhoea 
 (cap. 48), he not only mentions general massage by a 
 specially-trained rubber, but also alludes to massage of the 
 uterus itself, in order to strengthen that organ. 
 
CHAPTER V. 
 
 HIPPOCEATES. 
 
 Hippocrates is the first writer among the Greeks, whose 
 works we possess, who deals with gynsecology. The passages 
 contained in his genuine works are few, and are of little 
 importance ; but in the Hippocratic collection there are four 
 books which are devoted to the diseases of women, and in 
 these we have the first and oldest complete treatises on 
 gynaecology. 
 
 Hippocrates is supposed to have been born about 460 e.g., 
 and was a contemporary of Plato, Socrates, Xenophon, 
 Pericles, ^schylus, Sophocles, Euripides, Aristophanes, and 
 Herodotus ; he thus lived at a time when the most brilliant 
 Greek minds were giving forth to the world their immortal 
 ideas. As stated in a previous chaiDter, he is said to have 
 been a descendant of Asclepius ; his father being a physician, 
 he probably received his first instruction in medicine at the 
 Schools of Cos. He visited many cities, practising his pro- 
 fession, and no doubt teaching students, he himself being 
 content to become a student and learn philosophy from 
 Georgias and Democritus, the latter being not only a philo- 
 sopher, but a physician and a scientist. After travelling for 
 some time, he returned home and practised at Cos ; and 
 having access through his descent to the clinical records of 
 
32 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 the Asclepieum at Cos, he was enabled to make notes from 
 the collection, which he afterwards used in composing his 
 work on Prognostics. After Hippocrates began to practise, 
 his fame spread far and wide, and he was frequently called on 
 to go considerable distances to perform operations and give 
 advice in difficult cases. This goes to show that the medical 
 practice of the Asclepiadse was not confined to the neighbour- 
 hood of .the Asclepieum. Adams thinks that it was on account 
 of the wandering life which Hippocrates led, and from the 
 fact that he no doubt was a consultant for many years, that 
 he was prevented from giving much time to obstetrics and 
 gynaecology. 
 
 The Hippocratic Treatises. — Among the works that have 
 been handed down to us bearing the name of Hippocrates, 
 there are some which are undoubtedly the '* Genuine Works 
 of Hippocrates," while there are many which are definitely 
 proved, by ancient and modern authors, not to have been 
 written by him. Of the sixty odd works comprised in the 
 collection, probably about thirteen were written by Hippocrates 
 at various periods of his life. Of the remaining works, some 
 were written by authors anterior to Hippocrates ; others by 
 his disciples during his life or immediately after his death ; 
 while others were even composed at a later date. With 
 regard to the " Genuine Works of Hippocrates," we shall see 
 in examining them that they contain only a few passages 
 which deal with the diseases of women ; while, on the other 
 hand, among the Hippocratic collection we shall find a 
 particular series of works, supposed to have been written after 
 the death of Hippocrates, but previous to the time of Aris- 
 totle, which deals specially with gynaecology. The series is 
 written, according to Littr^, by one author, and deals with 
 " Generation," " On the Nature of the Infant," " On Disease," 
 
HIPPOCRATES. 33 
 
 " On the Diseases of Women," ** On the Diseases of Young 
 Women," *' On Unfruitful Women." The name of the author 
 of this series has not been ascertained ; according to Erotion 
 and Galen's references to these works, it would appear that 
 they considered Hippocrates himself as the author ; but 
 modern authorities reject this theory. The works on the 
 diseases of women are certainly among the most valuable on 
 gynaecology that have been handed down to us by ancient 
 authors, and we purpose to examine them minutely later on ; 
 for the present we shall merely refer to the few passages in 
 the " Genuine Works of Hippocrates " before we take our 
 leave of him. 
 
 The Gynaecology contained in the " Genuine Wokks of 
 Hippocrates."^ 
 
 He appears to have been acquainted with the shape of 
 the uterus, and imagined that it acted in such a way as to 
 suck and draw juices from various parts of the body (" Ancient 
 Medicine," 22). In the treatise on "Air, Water, and Places," 
 he says that the drinking of unwholesome water will cause 
 dropsy of the uterus. Adams, commenting on this passage, 
 says : "It may appear singular that hydatids of the womb 
 should be particularly prevalent in the case of women that 
 drink unwholesome water from marshes, and yet our author's 
 observation is confirmed by a modern authority, as quoted 
 by Coray." 
 
 It is evident that these authors have mistaken hydatidi- 
 form degeneration of the ovum for hydatid disease of the 
 uterus, and that Hippocrates does not refer to the latter 
 disease in the passage alluded to, but to the former disease. 
 
 ^ Adams, "The Genuine Works of Hippocrates." London, 1849. 
 
 3 
 
34 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 In " Airs," he remarks that calculi do not form so readily in 
 women, for in them the urethra is short and wide, so that in 
 them the urine is easily expelled. 
 
 In the " Epidemics," B. I. vi., he says that in some fevers 
 women have pains in the uterus and menstrual disorders. 
 
 In the " Epidemics," B. I. iv., he alludes to the use of 
 pessaries and suppositories in puerperal fever, and describes 
 a ease of miscarriage followed by death on the seventh day 
 (B. Ill, Case xi.). 
 
 " Aphorisms," V. 28 : Fumigation with aromatics pro- 
 motes menstruation, and would be useful in many other 
 cases, if it did not occasion heaviness in the head. 
 
 V. 32 : Haemoptysis in a woman is removed by an eruption 
 of the menses. 
 
 V. 36 : When the menstrual discharge is of a bad colour 
 and irregular, it indicates that the woman stands in need of 
 purging (uterine ?). 
 
 V. 43 : If erysipelas of the womb seizes a woman with 
 child, it will probably prove fatal. 
 
 V. 47 : If the portion of the uterus seated near the hip 
 joint suppurate, it gets into a state requiring to be treated 
 with tents. 
 
 V. 50 : If you wish to stop the menses in a woman, apply 
 as large a cupping instrument as possible to the breasts. 
 
 V. 51 : When women are with child, the mouth of the 
 womb is closed. 
 
 V. 54 : WT:en the mouth of the uterus is hard, it is also 
 necessarily shut. 
 
 V. 58 : Strangury supervenes upon inflammation of the 
 rectum and of the womb, etc. 
 
 VI. 29 : A woman does not take the gout unless her 
 menses be stopped {vide Garrod and Haig). 
 
HIPPOCRATES. 35 
 
 " Hsemorrhoids," 7 : Haemorrhoids in a woman are treated 
 by fomentations. 
 
 In the Oath this sentence occurs : "I will not give to any 
 woman a pessary to produce abortion." 
 
 The above are the only passages in the " Genuine Works " 
 which refer to gynaecology, and, as we see, they are of very 
 slight importance. 
 
 The question may be asked, How is it that in the works of 
 a man of such extensive medical knowledge as Hippocrates 
 we have so little that bears on gynaecology ? The answer will 
 fall under one of the following headings : (1) That Hippo- 
 crates was too busy with his general work to pay any attention 
 to a special subject such as gynaecology ; (2) that he was 
 well versed in, and wrote on, all branches of medicine and 
 surgery, and that he did write on gynaecology ; (3) that those 
 who compiled the Hippocratic Collection abstracted all the 
 observations on gynaecology from the " Genuine Works," and 
 placed them in the works devoted to women's diseases. 
 
 The most probable explanation is that, while Hippocrates 
 had some slight general knowledge of gynaecology, he had not 
 studied the subject deeply, inasmuch as we find only a few 
 stray observations in his works ; and particularly does this 
 apply to his "Aphorisms," a work into which he sought, in 
 his mature years, to put his conclusions on every branch of 
 medicine. Now, in the fifth division of his "Aphorisms" he 
 devotes the paragraphs from No. 28 to 62 to comments on 
 obstetrics, and incidentally mentions once or twice the 
 diseases of women in a few paragraphs, all of which appear in 
 the non-genuine works, and may only be interpolations in the 
 genuine works. Is it likely that in a work which is justly 
 considered one of the most remarkable ever written by a 
 single individual — is it likely, we say, that he would willingly 
 
 3—2 
 
36 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 have withheld his knowledge of gynaecology, if he had had 
 any, from a work which he wished to be considered a complete 
 commentary on medicine ? 
 
 The Gynaecology contained in those Works of the Hippo- 
 'CRATic Collection w^hich are not considered Genuine. 
 
 The works which we have now to consider are in all 
 probability by the same author. The first, entitled Hepl 
 yvvai-K€iQ)v, is in two books, the first book consisting of 110 
 chapters, whilst the second contains 102. The second work, 
 Uepl a<^6p(t>v, on Sterility, consisting of thirty-six chapters, 
 may be taken as a continuation of the two preceding books, 
 the opening sentence stating that the author has already dealt 
 with the diseases of women in the preceding works. The 
 fourth work, Ilepi ryvvaLKeir]<i (pvato'?, consisting of 109 chap- 
 ters, appears to be composed of extracts from the books " On 
 the Diseases of Women," though both Littrd and Daremberg^ 
 think that this work may not be framed from the latter work, 
 and Ermerins attributes it to Euryphon Cnidius. We shall 
 now proceed to take extracts from these four works, placing 
 them under several headings, so that they may be compared 
 more readily with the extracts to be made from later authors :^ 
 
 Anatomy. — Neither Hippocrates nor the author whose works 
 are now under consideration have left us any remarks on the 
 anatomy of the female genital organs ; nor, indeed, are the 
 genital organs mentioned in the fragment Hepl dvaT0fM7J<; con- 
 tained in the collection. 
 
 Our author has some idea of the length of the uterus, for 
 
 ^ Daremberg, loc. cil., p. 127. 
 
 ' The following abljreviatioiis will be used to indicate the particular work from 
 which the extract is made : "Diseases of Women," D. 0. W. ; "Sterility," S. ; 
 "The Nature of Women," N. 0. W^. The edition of Littru is the one quoted 
 from. 
 
HIPPOCRATES. 37 
 
 in gi\^ng instructions concerning the dilatation of the cervix 
 he directs that the dilators are to be introduced for a distance 
 of four fingers' breadth, which would be 2*8 inches. 
 
 Whether our author really comprehended the true position 
 of the fundus is not clear. The chapters on displacement 
 of the uterus appear to us to show that the position of the 
 fundus was often guessed at from the position of the cervix, 
 and that the absurd notions that existed about the uterus 
 being displaced up to the liver and to the heart really arose 
 from knowing nothing of the bimanual method of examina- 
 tion. The introduction of the metal sounds and wooden 
 dilators must have shown them at times that the uterus 
 varies in position, and they could thus form ideas of the 
 position of the fundus ; but even granting this, unless they 
 knew what was normal, they could come to no correct con- 
 clusion as to what was abnormal. Adams says in one of his 
 commentaries on Paul : " Bernard justly remarks that if the 
 ancients had not been familiar with inspectiones cadaverum, 
 they could not have described the diseases of particular parts 
 of the uterus so accurately as they have done." Puschmann 
 says : " Speaking generally, they appear to have confined 
 themselves to opening the thoracic and abdominal cavities ; 
 and the position and form of the contained organs are fairly 
 correctly described." If we grant that our author and his 
 contemporaries enjoyed the privilege of making inspectiones, 
 then the normal position occupied by the uterus must sooner 
 or later have become known to them ; we, at all events, are 
 certain that Herophilus dissected the human uterus at a 
 somewhat later period than the works we are dealing with. 
 
 Physical Examination of the Pelvic Organs. — Inspection and 
 palpation of the abdomen and the organs of generation were 
 practised to some extent. In speaking of retention of the 
 
38 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 menstrual fluid, pain and pulsation of the hypogastric region 
 are mentioned, and " pain on palpation" (D. 0. W., 1, 2, 170). 
 The liver and spleen are described as being palpated in 
 another of the Hippocratic works. 
 
 Vaginal examinations were made not only by the medical 
 man, but also by the midwife : " after the fumigation and 
 the bath, the midwife introduces her finger and straightens 
 and corrects the orifice of the uterus " (N. 0. W., 40). The 
 patient herself is also advised to practise examinations on 
 herself, so that she may become familiar with the state of the 
 OS in sterility and other conditions (S., c. i. ; Littre, 213) ; 
 "the patient during the fumigation should examine the os 
 with her finger if she can reach it " (D. 0. W., ii. 133). 
 
 Neither the bimanual nor the rectal examination is men- 
 tioned by our author. 
 
 The Position of the Patient. — During treatment the patient 
 in some cases lay on her back, with her feet elevated and her 
 thighs separated (D. 0. W., 144). In other cases she lay on 
 her side. Thus, in treating a case of displacement of the 
 uterus soon after labour, " the woman will lie on the opposite 
 hip to the displacement " (N. 0. W., 25). In other cases the 
 foot of the bed was raised (D. 0. W., 149) ; or the patient's 
 legs were crossed, the one thigh over the other ; or in cases 
 of prolapse the body of the patient was attached to a frame- 
 work, by which means she was inverted, and succussion was 
 practised (N. 0. W., 5). 
 
 Therapeutic Agents. 
 
 Instruments used in Examinations. — The speculum is not 
 mentioned by our author, and we have no descriptions which 
 will enable us to determine whether retractors were used in 
 order to aid the insertion of the dilators into the os, or for 
 
HIPPOCRATES. 39 
 
 inspecting the cervix. Nevertheless, we may presume that 
 the vagmal speculum was in use, since Hippocrates mentions 
 that the ulcerated parts of the rectum were examined by a 
 speculum;^ and Galen, in his "Explanatio Vocum Hippo- 
 cratis," in deJBning KaroTTTijp, says that it is the instrument 
 by which the seat is dilated, while ScoTrrpa is the instrument 
 by which the female parts are inspected. 
 
 Sound. — Sounds made of lead were used for opening the 
 mouth of the womb previous to fumigation; when it is 
 necessary to make a fumigation, ** the patient will make use 
 of the sound of lead, so that the uterine orifice will be open 
 for the fumigation " (D. 0. W., i. 11). The leaden sound 
 was also used to straighten or rectify the deviating uterus ; 
 thus, in speaking of lateral displacement of the uterus, the 
 orifice is described as being deviated and in close proximity 
 to the side of the pelvis ; "after the fumigation the woman 
 with her finger carries the orifice of the uterus away from the 
 ischium, and then straightens it with rods of pine-wood or 
 lead {orav he uTroarrjar], i^opOovv Tolcn haihioLcn koX tcC 
 
 /LtoXt/SStftj). 
 
 Uterine Dilators. — Dilators made of pine-wood are described 
 at considerable length (D. 0. W., ii. 133), while mention is 
 also made of some dilators composed of lead and of tin 
 (S., 217). After dilating the cervix, a hollow leaden pipe was 
 used to keep up the dilatation (D. 0. W., ii. 133). The 
 finger is referred to as a dilator (N. 0. W., 37). 
 
 Uterine Catheters. — These were used for washing out the 
 uterine cavity. The end of the tube will be polished like 
 a sound and made of silver. A perforation will be made in 
 the side, having beyond it the small tip of the catheter. 
 There will also be other perforations, which will be placed 
 
 1 "On Fistulre," c. 3. 
 
40 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 at equal distances on each side of the catheter throughout 
 its length ; these holes will not be large, but narrow. The 
 extremity of this injection-pipe will be solid — all the rest 
 of it hollow. To the pipe will be attached a bladder (of a 
 sow) which has been first well scraped. Then place the milk 
 of a mare in the bladder, first taking the precaution to close 
 the holes in the injection-pipe with a linen rag. Having 
 filled the bladder with the milk, it is then tied so as to 
 close it, and, the injection -pipe having been placed in the 
 uterus (the rag first being removed), the bladder is pressed 
 and the uterus washed out (S., 222). A number of formulae 
 for injections are given (c. 80, D. 0. W.). 
 
 Besides the uterine irrigations, the uterus was treated by 
 infusions (e7;\^uToi/), which, according to Littre, appear to 
 have differed from the injections (Kkvafio'i) in consistence. 
 It seems to us that these infusions were really poured into the 
 vagina, the patient being in a position that prevented the 
 escape of the fluid from the vagina for some time, and by 
 this means some of the fluid would enter the uterus. Thus, 
 in treating of abortion, with retention of the ovum, the patient 
 is placed " with her feet at a higher level than her head, and 
 the infusion is made to enter the uterus ; the woman lying 
 down meantime prevents the fluid escaping " (D. 0. W., 
 i. 78). 
 
 Vaginal irrigation was largely used in all vaginal and 
 uterine diseases, and is mentioned very frequently by our 
 author. 
 
 Sitz-haths are mentioned in several passages. Thus, in 
 speaking of aphthae of the genitals, he says : *' If strangury 
 supervenes, a sitz-bath of decoction of roses or of briars, 
 of myrtle or of olive-tree or sage, is recommended " (D. 0. W., 
 ii. 210). 
 
HIPPOCRATES. 41 
 
 Itcctal injections are mentioned several times. 
 
 Fumigations were very extensively employed in every class 
 of vaginal and uterine disease. The author frequently refers 
 to the notion that the uterus was attracted by fragrant odours 
 and repelled by disagreeable ones. The technique of fumiga- 
 tion is well shown by the following extract : Take a vessel 
 that holds about 4 gallons {hvo eKTem), and fit a lid into it 
 so that no vapour can escape from it ; next pierce a hole in 
 the lid, and into this aperture force a reed about a cubit in 
 length, in such a way that the vapour in the vessel cannot 
 escape along the reed. The cover is then fixed on the vessel 
 with clay. Then dig a hole about 2 feet deep and sufficiently 
 large to receive the vessel, and burn wood until the sides of 
 the hole become very hot. After this the next step is to 
 remove the wood and the larger pieces of charcoal which 
 have the most flame, but we should leave the ashes and 
 cinders. When the vessel is placed in position and heated, 
 and the vapour begins to issue out, if it is found to be too hot 
 we should wait a time ; if, however, it be of the proper 
 temperature, the reed should be introduced into the uterine 
 orifice, and the uterine fumigation be made. We should be 
 careful to keep the patient covered, lest she should take a 
 chill. 
 
 Before the heating of the vessel is begun, the materials to 
 be used for the fumigation are placed in the vessels with 
 some water. During the fumigation the patient, if she can 
 reach her os, should examine it to notice its condition. The 
 fumigation was supposed to fill the uterus with vapour, to 
 open its orifice, and sometimes even to rectify its position 
 (D. 0. W., ii. 133) ; in fact, the fumigation was evidently 
 a very favourite method of treating nearly all uterine diseases. 
 The ancients regarded it as a most important step in the 
 
42 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 treatment, and it was in their eyes as important as the anti- 
 septic douche is to us nowadays. 
 
 Fumigation was also used for diagnostic purposes (D. 0. W., 
 146). 
 
 Fomentations were in use. In treating of acute metritis 
 after abortion, our author says : *' In dealing with such a 
 case, when pains are present bathe the patient with a quantity 
 of hot water, and apply hot fomentations over the seat of the 
 pains" (D. 0. W., i. 63). 
 
 Cataplasms were also in use in our author's days. " If, on 
 account of a watery flux (from the uterus), the lower portion 
 of the abdomen is painful, then mix honey with linseed-meal, 
 and make a good cataplasm for the belly" (D. 0. W., il 198). 
 Various receipts for cataplasms are given in N. 0. W., 102. 
 
 Cautery. — This is referred to in the operation for opening 
 of a pelvic abscess above the pubes (D. 0. W., 134). 
 
 Anointing portions of the body with grease in case of pain 
 and in treating uterine affections was practised (D. 0. W., 
 ii. 210). 
 
 Bleeding is mentioned by our author in a case where labour 
 should be accelerated (D. 0. W., i. 77), and again in dealing 
 with sterility (S., 241). 
 
 Cupping is described as being used after the reduction of 
 a prolapsed uterus, the cup being applied to the haunch 
 (N. 0. W., 5). It was also applied below the breast in case 
 of menorrhagia (D. 0. W., ii. 110). 
 
 Pessaries. — The pessary {irpoaOeTov) is mentioned in almost 
 every chapter of these works. They were the stock remedies 
 in vaginal and uterine disease, and were prepared by rolling 
 a piece of lint or wool into an oblong-shaped body, and then 
 applying the medicinal substances to the surface of the lint. 
 The lint or wool was also occasionally soaked in the ingredients. 
 
HIPPOCRATES. 43 
 
 To the pessary a string was attached, so that it might the 
 more easily be abstracted. The pessaries mentioned by our 
 author were the ** emollient," to be used in reducing inflam- 
 mation in and around the womb and for softening the cervix. 
 An example is one composed of myrrh, 1 part ; pitch, wax, and 
 goose-grease, 2 parts (D. 0. W., ii. 158). The '* astringent " 
 pessaries were used for restraining female discharges. An 
 example is sumach with honey in dark wine (N. 0. W., 29). 
 The "purgative" pessary was for ridding the uterus of 
 discharges or the products of conception, and for producing 
 the menstrual discharge. Pessaries were also in use for 
 procuring abortions, and were made of cantharides, elaterium, 
 eolocynth, etc. Hippocrates in his Oath forbids the use of 
 such. Pessaries were also used to enable the woman to 
 conceive. Thus a pessary would be placed in the vagina 
 in the morning, another one later on in the day ; then, after 
 the evening meal, the patient would be douched, and would 
 then retire to rest. 
 
 Pessaries are mentioned as being placed in the uterine 
 cavity (D. 0. W., ii. 133). 
 
 Before a pessary was applied, the patient generally bathed 
 herself and had a fumigation, and then bathed herself again 
 after the pessary was removed (D. 0. W., ii. 163). 
 
 Besides the various formulae scattered throughout these 
 works, our author has collected innumerable formulae into 
 special chapters, such as 84 and 205, D. 0. W. 
 
 Suppositories. — The /3d\avo<; is not very frequently men- 
 tioned, but it was in use for the bowels. Pieference is made 
 to it in N. 0. W., 30, D. 0. W., 92, 130, and in a few other 
 places. It was made by mixing the ingredients and rolling 
 them into an oval ball, while in other cases wool was saturated 
 / with the ingredients (D. 0. W., ii. 177). 
 
44 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Tents. — These were made of linen or raw flax rolled into a 
 narrow, rod-like body, and were used for keeping open a 
 wound such as would be made in operating on an empyema. 
 
 Our author mentions tents made of raw flax {/xotovv 
 oDfMoXiva)), which were to be introduced into the mouth of 
 the uterus in treating a case of induration of the cervix and 
 stenosis of the os. The tents were to be three in number — 
 the first small, the second a little larger, and the third as 
 large as the little finger, and the length to be the breadth of 
 four fingers (2-8 inches). They were to be rubbed with goose- 
 grease and applied after an aromatic fumigation, in order 
 that they might slowly dilate the cervix (D. 0. W., ii. 157). 
 
 The mechanical pessary was represented by a pomegranate 
 split into two halves, one half being introduced into the vagina 
 in case of prolapse of the uterus (D. 0. W., 142). 
 
 1. Peeitoneum and Connective Tissue. 
 
 Parametritis and Pelvic Abscess. — In dealing with a case of 
 lateral displacement of the uterus, the author says : " If the 
 uterus is in contact with the ischium and presses on it, an 
 induration will form in the flank. There will be pains in the 
 lower part of the abdomen, and these extend to the flank, the 
 loins, and legs. There will be abdominal distension and the 
 formation of pus, while the wound that results has need of 
 tents, and the patients die from the diarrhoea that supervenes 
 unless the knife or the cautery be used. The treatment is by 
 fumigation, purgatives, and hot baths, while the patient after 
 an interval endeavours to restore the mouth of the uterus to 
 its proper position by pressing it towards the sound side" 
 (D. 0. W., ii. 134). 
 
 In dealing with retention of the menstrual fluid, the author 
 says: "In some cases, after suppression for two or three 
 
HIPPOCRATES. 45 
 
 months, the retamed fluid becomes purulent, which fact is 
 recognised by the intense pain and pulsation in the hypo- 
 gastric region, and by pain developed on palpation. Some- 
 times the pus is evacuated by the front-passage, and ulceration 
 of the womb may be the result. If the pus does not escape 
 by the vagina, it may find its way to the groin and be there 
 discharged. In other cases, after a few months' suppression, 
 the menstrual fluid may be carried towards the flank, and 
 may form a tumour, without suppuration, above the groin, 
 the swelling becoming large and red. These have been 
 incised, but this is a dangerous practice, unless pus has 
 formed in the tumour " (D. 0. W., i. 2). 
 
 Pelvic 2oeritonitis, apart from general peritonitis, is not 
 mentioned by our author, nor are diseases of the ovary and 
 Fallopian tubes referred to. 
 
 2. Affections of the Uterus. 
 
 (a) Stenosis and Rigidity of the Cervix. — When a uterus is 
 displaced towards the ischium, unless the deviation be 
 corrected we shall find that displacement of the cervix will 
 lead to the os uteri becoming more or less closed and the 
 cervix contracted. The treatment is, to give fumigations, 
 as described above, which were supposed to open the uterine 
 orifice somewhat ; after this the patient bathes herself and 
 eats suitable food. This preliminary treatment is repeated 
 for five or six days, until the operator thinks the cervix is in 
 a fit condition for dilating it. This is done in the following 
 manner : After the fumigation we must endeavour to intro- 
 duce pessaries (rchv Trpoadercbv) made of pieces of very greasy 
 pine-wood ; these should be smeared with oil, and ought 
 to have a length of six fingers' breadth. There should be 
 five or six of these dilators, each ending in a point, and 
 
46 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 each one should be a little larger than the preceding one, the 
 largest being of the thickness of the index-finger, and of much 
 the same shape as a finger, being, in fact, small at the distal 
 extremity, and gradually becoming larger towards the proximal 
 end. The piece of wood forming the dilator should be as 
 smooth and as round as possible, and should have no splinters. 
 The technique of dilatation is as follows : Take the smallest 
 dilator first, and when it has been placed in position see that 
 the patient keeps very still, lest the pine rod slip out. At 
 first we should only introduce the point graduall}'^ by turning 
 the dilator round and pushing it at the same time. Having 
 introduced the point, the woman must be careful lest it slip 
 out, and we then push the dilator into the uterine cavity for 
 a distance equal to four fingers' breadth (2*8 inches). After 
 the first rod has been introduced it should be withdrawn, and 
 replaced by a larger one without delay, while the mouth of 
 the uterus is still open. It is also necessary to have a leaden 
 tube similar in shape to the largest dilator, but hollow, so as 
 to be able to contain a medicinal substance. The width of the 
 tube will be about that of a probe that is used for wounds ; 
 but, in order that the mouth of the tent {/xorov) may be 
 smooth and do no damage, the end of it should be prepared 
 in a similar fashion to the end of the dilators. When the 
 leaden tube is prepared it is filled with ground mutton-fat. 
 This done, the dilator is withdrawn, and replaced by the 
 leaden tube. If, however, when the leaden tube is placed in 
 the uterus it causes a burning sensation, it is replaced by a 
 pine dilator, the leaden pipe being placed in the meantime in 
 cold water, and then replaced in the uterus. Something must 
 always be kept in the uterus during the treatment. During 
 the daytime the pine dilator does well, while at night-time the 
 leaden one is to be used. If the woman happen by chance to 
 
HIPPOCRATES. 47 
 
 displace the tent, she must hnmediately replace it. If, in 
 dilating the uterus, we find that the pine dilators are too 
 large to enter the uterine orifice, we must use smaller ones. 
 In those cases where the os is not open, then fumigation 
 must be resorted to until the uterus is brought to a fit 
 condition. 
 
 When the uterus is sufficiently dilated, two pessaries are 
 prepared, each of about the size of an olive, and if of resin, 
 etc., they are to be dipped in rose-oil before being introduced 
 into the uterus, so as to prevent them from sticking when 
 being introduced into the uterine cavity. Before and after 
 introducing the pessaries the patient bathes herself (D. 0. W., 
 ii. 133). 
 
 In another passage the author says that dilatation of the 
 cervix is to be done with pine rods or leaden pipes (rolcrt 
 /AoXt/SStoio-i) — (D. 0. W., i. 13), while sounds of tin and lead 
 are also mentioned (S., 217). 
 
 Induration. — In treating of induration of the uterus, the 
 tissues round the orifice are described as hard, and the 
 orifice itself becomes closed. After using fumigations and 
 emollient pessaries to soften the cervix, a tent of raw flax 
 is introduced into the cervix, and after this has dilated the 
 canal, a second and larger one, and then a third one, is 
 introduced (D. 0. W., ii. 157). Obstruction to the uterine 
 orifice is mentioned in c. cxlvi., D. 0. W. 
 
 (6) Laceration and Erosion of Cervix. — If the uterus is 
 gaping contrary to nature, the periods are more abundant, 
 viscid, and come more frequently ; the sperm is not retained, 
 for the orifice, being in a gaping condition, is not capable of 
 retaining the sperm. The patient suffers from pains in the 
 lower part of the abdomen and the loins. The treatment is 
 by pessaries, astringents, and fomentations with a sponge on 
 
48 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 the regions below the level of the umbilicus (D. 0. W., 
 ii. 166). 
 
 If the uterus becomes of a scirrhous nature, the orifice 
 is rugged, and this can be detected by a vaginal examination 
 (D. 0. W., 155). 
 
 If clots of blood form in the uterus, the orifice becomes as 
 though full of grains of fitch (N. 0. W., 42). 
 
 During menstruation phlyctenules {<^\vKraivat) may develop 
 at the orifice of the womb (D. 0. W., ii. 173). 
 
 (c) Metritis. — If the uterus be inflamed, the menses are 
 suppressed and the cervix is closed. There is high fever and 
 delirium and an offensive discharge. If the patient is young, 
 she vomits anything she may eat. There are pains in the 
 lower part of the abdomen and in the loins, fainting, and 
 shivering of the whole body. The belly is sometimes hard, 
 sometimes soft : it rises up and becomes puffed out, and the 
 woman appears to be enceinte ; but sometimes the swollen 
 belly appears to be as though hollow. The author then goes 
 on to remark that the abdomen becomes filled with water, and 
 the periods become scanty and morbid. The feet swell at the 
 ankles. The treatment is by purgatives, administration of 
 uterine fumigations, passage of the leaden sounds, which are 
 to be washed in warm water before being inserted into the 
 cervix, and after passing these an injection is administered. 
 Three days are now to elapse, and then an injection of 
 vinegar is given to the patient ; and if the disease still 
 persists, drugs which evacuate water from the uterine tissues 
 are to be administered (D. 0. W., ii. 169). 
 
 The author remarks in another place that if a vaginal 
 examination is made while the patient is suffering from 
 metritis the disease is aggravated and the parts are irritated 
 (D. 0. W., ii. 171). 
 
HIPPOCRATES. 49 
 
 Metritis after an abortion is described thus : If the womb 
 becomes ulcerated, both blood and pus are discharged ; there 
 is a strong odour, acute pains in the loins, groin, and lower 
 part of the abdomen. The pains gradually ascend from the 
 flanks to the sides and the shoulder-blades, and sometimes 
 they reach to the clavicular regions, and there is intense 
 headache and delirium. After a time the woman swells 
 and grows weak, faints, and is feverish and chilly. Her legs 
 especially become swollen. The disease occurs after an 
 accouchement in which a woman aborts, and the fcetus is 
 found to be putrid, and the lochia do not appear, and the 
 uterus is very hot to the touch ; it also may occur after 
 discharges which are acrid and bilious and which corrode. 
 
 If called upon to treat such a case while the pains are 
 present, just bathe the patient with much hot water, and 
 apply hot fomentations to the painful parts. If the woman 
 is strong, make a uterine injection. The ulceration is to be 
 treated with oxide of lead, gall nuts, myrrh, calcined Egyptian 
 alum (D. 0. W., i. 63). 
 
 In the following chapter the author states that the con- 
 dition above described may be produced if the membranes 
 remain after labour, or it may occur after an abortion, or even 
 spontaneously. He advises that the ulcerated portion of the 
 cervix should be washed with warm water, and then cleaned 
 with a piece of soft linen or sponge dipped in warm water ; 
 after this a sponge should be dipped in wine and the ulcera- 
 tion treated with it ; then an ointment is to be applied, and 
 later on a fumigation (D. 0. W., i. 64). 
 
 Chronic metritis is described in the following way : If the 
 uterine orifice is open, the periods are more abundant and 
 abnormal, more watery and prolonged. If the morbid con- 
 dition continues, you will find the orifice partially opened, the 
 
 4 
 
5o' THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 uterus itself being in an adynamic {ahwa^iiif) condition from 
 the effects of the haemorrhage. The uterus is light but without 
 tone, and it falls, while its ligaments become relaxed. Pains 
 are felt in the lower part of the abdomen, flanks, and loins. 
 Such a condition may follow after an accouchement. The 
 treatment is by sitz-baths, injections, fumigations (D. 0. W., 
 ii. 167). 
 
 {cl) Disjjlacements of the Uterus (D. 0. W., xi. 137-142). — 
 In these chapters various displacements of the uterus are 
 mentioned, such as lateral displacement to the right, displace- 
 ment to the left, and to the front, so as to press on the 
 bladder, and to the seat {eSpijv). No directions, however, are 
 given to instruct the reader how these various displacements 
 are to be diagnosed, and considerable doubt exists in our 
 mind whether many of these displacements were not de- 
 scribed haphazard. Certainly some of them were imaginary, 
 such as displacement of the womb to the liver and heart, as 
 described in the chapter on Uterine Suffocation (D. 0. W., 
 i. 7). In short, we have no evidence that the bimanual 
 examination was practised by our author, and therefore we 
 are inclined to think, as stated above, that though the leaden 
 sounds and the dilators must have given them indications 
 of the position of the fundus, in many cases the supposed 
 position of the fundus was really guessed at from the position 
 of the cervix. 
 
 Again, it is abundantly clear that a pelvic suppuration 
 occurring to the right or left represented frequently to our 
 author a supposed displacement to one or other side ; likewise 
 suppuration above the pubes indicated to him an anterior 
 displacement ; thus, he says if the uterus is in contact with 
 the bladder, and prompt solution does not occur, the suppura- 
 tion suj)ervenes at the place where the uterus is adherent 
 
HIPPOCRATES. 51 
 
 (D. 0. W., 137). The effect of suppuration, as we know now^ is 
 frequently displacement, not vice versa. In c. 138 the author 
 states that any cause is sufficient to displace a uterus, if that 
 uterus has any lesion ; and the most likely causes of displace- 
 ments are, he says, cold to the feet and the loins, dancing, 
 winnowing, breaking sticks, or whilst running up or down 
 hill. 
 
 In c. 139 latent obliquity of the uterus is referred to. If 
 after a labour the uterus turns to the right, the lochia do not 
 flow, and there is pain in the lower part of the abdomen and in 
 the flanks ; while the right leg becomes heavy, engorged, and 
 shakes. On making an examination, the uterine orifice can 
 be touched, and the uterus itself is found to be smooth and 
 even. If, on the other hand, the uterus leans to the left, we 
 shall have acute and intense pains in the loins, flanks, and 
 legs, and the woman is lame (c. 140). Fumigations are the 
 chief remedies advised. 
 
 Lateral displacement with pelvic abscess is described in 
 c. 134 {ride ante). 
 
 The following is from c. 131 : If the uterus comes to lie in 
 the middle of the loins, there is pain in the lower portion of 
 the belly, the legs are drawn up, and there is pain in the hips, 
 and when the patient goes to stool she experiences sharp 
 pains and she has difficulty in defecation ; she passes her 
 urine in drops, and she may faint. The treatment is to inject 
 hot oil into the uterus by means of a cannula fixed to a 
 bladder ; hot baths, vapour baths, and fumigations are em- 
 ployed, until such time as the uterus is restored to its proper 
 position. 
 
 C. 132 : The os uteri may be displaced towards the hip 
 {l(j-)(iov). "We must first use a fumigation, and after this 
 introduce the finger and push the uterus from the hip, and 
 
 4—2 
 
52 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 rectify it with small pine rods or leaden sounds. When it 
 has regained its proper position, and the os is patent, treat 
 with pessaries, etc. 
 
 (e) Prolapse of the Uterus. — In c. 142, D. 0. W., the author 
 recognises partial prolapse of the uterus, i.e., when the uterus 
 approaches the mouth of the vagina. In such a case foetid 
 fumigations are recommended ; for the ancients thought that 
 the uterus was like an animal, and that foetid odours repelled 
 it. In the next chapter the next degree of prolapse is dealt 
 with. When the uterus comes to be external to the genital 
 parts there is inflammation of the vulva and seat ; the urine 
 is passed drop by drop and very frequently, and it irritates 
 the surrounding parts very much. Fumigations are recom- 
 mended, and the foot of the bed is to be raised. 
 
 In c. 144, D. 0. W., complete prolapse is dealt with. In 
 complete prolapse the uterus is placed outside the vulva, and 
 looks like a scrotum. The patient has pains in the lower 
 parts of the abdomen, in the loins, and in the groin. The 
 treatment consists in making cold applications to the genital 
 parts, cleansing the prolapsed parts, and washing them with 
 wine, the patient remaining in bed with the feet raised and 
 her thighs apart. Sponges are applied, which are kept in 
 position by bands passing round the loins ; the patient in the 
 meantime eats and drinks as little as possible for seven days. 
 If after this course of treatment reduction is obtained, all is 
 well ; otherwise the side of the uterus is incised, then bathed 
 and anointed with cerate ; the patient is fixed by her body to 
 a ladder with her head lower than her feet, and then by 
 manipulation the uterus is replaced. After this release her 
 and fix her thighs, the one over the other, and let her remain 
 thus for a day and a night, giving her a little cold ptisan to 
 drink, but nothing else. Next day she is to lie and rest on 
 
HIPPOCRATES. 53 
 
 her hip, and a large cupping-glass is to be applied for a con- 
 siderable time, but we are not to abstract any blood. The 
 patient is left resting for seven days, during which time she 
 has only ptisan ; if, however, she is very thirsty, she may 
 have a little water to drink. The remainder of the chapter is 
 devoted to diet, fumigation and injections, and the patient is 
 recommended to wear a diaper (a-cpevBoprj) when she begins to 
 move about. 
 
 C. 149, D. 0. W. : When the uterus does not remain in its 
 proper place, but goes from side to side, it occasions pain. 
 When the patient is in bed on her back, the uterus remains 
 in place, but if she rises it slips down. Eest, astringent 
 fomentations, and the raising of the foot of the bed, are steps 
 to be employed in the treatment. Then we should take a 
 pomegranate, its shape being chosen to suit the parts, and we 
 should divide it down through the umbilicus into two halves. 
 Then warm it in lukewarm wine ; after this thrust it as far as 
 possible (into the vagina), and then bind the patient with a 
 large sling bandage, which restrains it (the pessary) below 
 and prevents it from slipping out ; and so it can fulfil its 
 office. 
 
 Littre calls attention to the fact that in four passages — 
 c. 144, c. 248, D. 0. W. ; c. 5, N. 0. W. ; and c. 5 in the 
 work on "Excision of the Foetus" — the author, in speaking 
 of prolapse of the uterus, recommends that the sides of the 
 uterus should be incised. Thus, the directions in the work 
 on "Excision of the Foetus " are : "Incise the uterine tissues 
 obliquely, following its outline ; then wash it with linen in 
 order to excite inflammation in it." Littr^ asks, What were 
 the parts incised ? In the first passage they are designated 
 by the word Xeyua, a word which Galen, in his Glossary, 
 translates as " the sides of the orifice of the uterus." In the 
 
54 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 second and third passages the words are ciKpa^ ra<; ^i-qrpa'i, 
 which signify the side or the extremity of the uterus ; and 
 since in prolapse the uterus descends enveloped at the exterior 
 by the vagina, the expression can be taken to apply to the 
 sides of the orifice. In short, in four passages the terms are 
 vague. What was the object of the scarifying? The only 
 one that we can see is that perhaps the author practised it 
 in order to excite adhesive inflammation in the cervical region, 
 and by producing cicatrices endeavoured to keep the uterus 
 in its regular position. In c. 145, D. 0. W., the author 
 describes what appears to be inversion of the uterus ; he, 
 however, remarks that it is more common in women who 
 have not had children. 
 
 Cancer. — When we find that the uterus has become hard 
 and projects into the genital parts, and when the groins 
 become indurated and there is fever about the genital parts, 
 then we know that there are indications of a tendency to 
 cancerous degeneration. Clysters are recommended (c. 159, 
 D. 0. W.)- The subject is dealt with at greater length (c. 133, 
 D. 0. W.), and the author says that when cancer is once well 
 formed it is incurable. He, however, recommends fumiga- 
 tions to be tried. 
 
 Diseases of the Vulva. — Diseases of the vulva are hardly 
 mentioned by our author. Ulceration and aphthae of the 
 genitals are referred to, while vegetations if in excess are 
 recommended to be excised (N. 0. W., 65). 
 
 Atresia from ulceration of the labia is referred to, and 
 carcinomatous degeneration of the vulva is mentioned 
 (D. 0. W., 39). 
 
 Leucorrhoea. — This is referred to in several chapters. In 
 c. 24, D. 0. W., leucorrhoea is described as the flowing away of 
 the seed of the woman ; and Galen points out that this gave 
 
HIPPOCRATES. 55 
 
 rise to the term gonorrhoea (701^09, pieiv). In c. 15, N. 0. W., 
 leucorrhcea (Xei/xd?, poo9) is described as a flux similar to the 
 urine of the ass, and is attributed to the diseased state of the 
 humours of the body, the fluxion taking place from the 
 uterus. It is also referred to in cc. 116-119, and a treatment 
 is recommended in which the patient drinks enormous quan- 
 tities of milk every day. 
 
 Metrorrhagia is dealt with in several chapters — D. 0. W., 
 110, 112, 113, 115 — and it is noted that it occurs after 
 abortion, but no mention is made of any treatment resembling 
 curettage for its relief. 
 
 Hcematometra, Pyometra, Hydrometra. — A woman's periods 
 are suppressed if the os is closed or deviated, or if there is a 
 constriction at any part of the genital canal. If the periods 
 are suppressed until the sixth month and the woman is not 
 pregnant, then she will die, her symptoms at the time being 
 vomiting, intense thirst, great pain on palpating the womb 
 (which is distended with blood) in the hypogastric region ; 
 also there is suppression of urine. In some cases after sup- 
 pression for two or three months the retained fluid becomes 
 purulent, which is recognised by the intense pain and pulsa- 
 tion in the hypogastric regions, and pain on palpation ; some- 
 times the pus is evacuated by the front-passage, and ulcera- 
 tion of the womb may be the result (c. 2, D. 0. W.). 
 
 Hydrometra is mentioned in c. 178, D. 0. W. 
 
CHAPTER yi. 
 
 THE ALEXANDEIAN SCHOOLS. 
 
 At the time of the death of Hippocrates (357 b.c.) Greece had 
 already begun to decline in prosperity. The tide was slowly 
 rising that was to bear Hellenic art and science to Egypt, and 
 the man who was to found the new Athens was already born 
 (356 B.C.). Between the death of Hippocrates and the 
 establishment of the Alexandrian schools over fifty years 
 elapsed, and during that time medical and surgical works 
 were written and medical science still continued to flourish ; 
 but of these works we know but little. There is no doubt that 
 through the decline in the fortunes of Greece the develop- 
 ment of medicine received a check for the reason assigned by 
 Daremberg, who points out that medicine passed into the 
 hands of those *' qui n'avaient pas la force de continuer dans 
 les memos proportions I'edifice commence par les hippo- 
 eratistes." 
 
 Among the writers of this period who are of interest to us 
 may be mentioned the following : 
 
 Diodes Cari/stius, who lived, it is supposed, in the fourth 
 century b.c, not long after the days of Hippocrates. Though 
 we have only fragments of his works preserved through other 
 authors, we know that he was held in high estimation. He 
 
THE ALEXANDRIAN SCHOOLS. 57 
 
 was a writer on gynEecology, and Soranus refers to him in his 
 work on the ** Diseases of Women." 
 
 Praxagoras of Cos lived shortly after Diodes, and is of 
 interest to us inasmuch as Ccelius Aurelianus tells us that in 
 cases of intestinal obstruction he advised that purgatives and 
 enemata should first be tried, but if they failed that massage 
 of the abdomen should be practised ; and, as a last resource, 
 laparotomy should be performed with the idea of removing 
 the obstruction. If the bowels were incised, they were to be 
 sutured, and if an intussusception was present the intestines 
 were to be restored to their normal relations. 
 
 Besides these operations, the kidney was cut down on 
 in cases of suppuration, and paracentesis abdominis was 
 practised. Extensive operations could not, however, be 
 carried out, from deficient knowledge of anatomy, and from 
 the fact that tying the vessels for arresting the flow of blood 
 was as yet unknown, though, apparently, the difference between 
 arteries and veins was recognised by the author of the Hippo- 
 cratic work " De Articulis," by Diogenes Apolloniates, Eury- 
 phon, and Aristotle. 
 
 Alexander, the founder of the city that was destined to have 
 such an enormous influence on future learning, was born 
 356 B.C. His father, Philip II. of Macedon, having been 
 murdered (336 e.g.), the son was called to the throne. He 
 had enjoyed the benefit of having Aristotle for his tutor, and 
 from him he imbibed a love for the sciences, including 
 medicine. 
 
 Alexander in the year 334 b.c. prepared for an expedition 
 against Persia; and after a successful campaign against Darius, 
 and along the west coast of Asia Minor, he again attacked 
 Darius, and on defeating him he marched into Egypt, and 
 in the year 331 b.c. founded the city which bears his name. 
 
58 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 with the idea of making it the centre of commerce between 
 the old and the new world. 
 
 Alexander continued his campaigns, and by his uninterrupted 
 conquests he gradually extended his empire towards India. 
 This fact is of interest in the history of medicine, for it was 
 by this means that the Hindu medical men became acquainted 
 with Grecian medicine, while, on the other hand, the Greeks 
 learned from the Hindu medical men much that was valuable. 
 
 Alexander having died (323 e.g.), the problem of who was 
 to be his successor immediately intruded itself. While this 
 matter was being settled, certain of Alexander's generals were 
 sent from the immediate neighbourhood of the strife to govern 
 various provinces as satraps, with full military powers. 
 
 Among these generals was one Ptolemy, son of Lagus, 
 and he was despatched to govern Egypt. Here he firmly 
 established himself, and became the ancestor of a brilliant 
 line of Kings, and, in the words of Daremberg, " he did for 
 Alexandria what Pericles had done for Athens." 
 
 Ptolemy made Alexandria the greatest commercial city of 
 the world, then turned his attention to literature and science, 
 and founded the Library and the Museum of Alexandria ; and 
 these institutions were fostered and extended by the enthusiasm 
 and wisdom of his successor, Ptolemy Philadelphus. 
 
 In order to collect books for the library, and in order to 
 have men of culture as teachers in the colleges, anyone who 
 had a work to dispose of or who had brains to teach was 
 welcomed at Alexandria with open arms. It is probably to 
 this desire of having the works of such a celebrated man as 
 Hippocrates that we owe the manufacture of certain of the 
 works in the Hippocratic Collection. With regard to gynae- 
 cology, we shall see that it was in the Alexandrian library 
 that Aetius, 800 years later, probably compiled portions 
 
THE ALEXANDRIAN SCHOOLS. 59 
 
 of his excellent work on the " Diseases of Women," which has 
 fortunately come down to us. 
 
 At this period no doubt gynseeology flourished, as did all 
 the other branches of medicine ; but we have no author whose 
 work has been handed down to us to give us an accurate idea 
 of the knowledge of the times. We know, however, through 
 Galen that Herophilus, the celebrated anatomist, wrote a text- 
 book on " Midwifery, "1 and that, as he was a teacher of that 
 subject, he was probably also a gynaecologist. Haller says 
 that he was well versed in the anatomy of the genital organs 
 of both sexes, and both Galen and Soranus quote him when 
 dealing with the anatomy of the female pelvic organs. 
 
 With regard to abdominal section, we find that this branch 
 of surgery received an impetus because anatomical investiga- 
 tion was pursued with ardour ; for not only were bodies 
 handed over for dissection, but actually criminals were made 
 the subjects of dissections, " so that the investigators could 
 study the particular organs during life in regard to position, 
 colour, form, size, disposition, hardness, softness, smoothness, 
 and superficial extent, their projection and curvatures." The 
 outcome of these dissections was that Erasistratus, who shared 
 with Herophilus the honours of the period, deliberately 
 operated on the liver and spleen. " In cases of tumours of 
 the liver he did not scruple to make an ample division of the 
 integuments, and try applications to that viscus itself. He 
 followed the same practice in disease of the spleen." It was 
 during this period that Xenophon of Cos, one of the followers 
 of Erasistratus, first resorted to ligation of the vessels for the 
 arrest of haemorrhage. 
 
 Medicine during the development of the Alexandrian 
 schools became differentiated into three branches : dietetics, 
 
 ^ Soranus, c. xlvii., c. 1. 
 
6o THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 pharmacy, and surgery, and specialism took a more definite 
 form. 
 
 Among the authors who flourished at various periods of the 
 Alexandrian school were some whose works have not come 
 down to us, but who were nevertheless writers on gynaecology. 
 Thus, Simon is mentioned by Soranus ; Athenion, Miltiades, 
 Demetrius, and Xenophon, by other authors. 
 
 The Alexandrian school was not without rivals, and the 
 institutions that were founded in Syria and Pergamus soon 
 became celebrated. It was in connection with the latter 
 school that parchment was discovered, for the Ptolemies, 
 disliking the rivalry of the schools of Pergamus, prohibited 
 the exportation of papyrus from Egypt, and so a substitute 
 was found in parchment. 
 
CHAPTER VII. 
 
 MEDICINE IN EOME. 
 
 While the schools of Alexandria continued to flourish and 
 represent Greek science and medicine for hundreds of years, 
 the Roman Empire was gradually approaching maturity. 
 Having thus far been taken up in warlike pursuits, the 
 Romans had paid but little attention to the creation of a 
 literature or to the study of science. Medicine, therefore, 
 did not have a home among the people of Italy previous to 
 the second century before the Christian era ; Pliny even says 
 that the Roman people were without physicians for 600 years. 
 This statement must be taken to mean that no regular pro- 
 fession existed, but that domestic remedies were applied by 
 the head of the household, as instanced in the case of Porcius 
 Gate. 
 
 It was during the reign of Ptolemy Philadelphus that Rome 
 began to receive ambassadors from foreign Powers, and at the 
 same time luxury was first introduced among the people, and 
 with this luxury came an increase of those vices and diseases 
 which, though not unknown before, now spread rapidly among 
 the people. Here, then, was an opening for a medical man ; 
 and we are not surprised to find, about 219 b.c, a Greek 
 doctor named Archagathus setting up in Rome and perform- 
 ing all manner of operations. He was not, however, well 
 
62 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 received, and was soon christened Carnifex, or the Execu- 
 tioner. 
 
 Next came Asclepiades of Bithynia, about 100 b.c. He 
 had practised at Alexandria, and was a man of considerable 
 parts, and was therefore received with much favour, and soon 
 became the fashionable physician of Eome. 
 
 Coming now to the first years of the Christian era, we find 
 Eome much advanced in power by the great victories of 
 Scipio over Hannibal, to be shortly followed by the fall of 
 Carthage, and the crushing defeat of Mithridates by the 
 brilliant Pompey, whose deeds are in turn eclipsed by the 
 genius of Caesar, and later on by his nephew, the illustrious 
 Augustus, who, returning to Eome crowned with victory, 
 constituted himself Emperor of the mightiest monarchy of all 
 ages. Durmg his lifetime he was content " to preserve those 
 dominions which had been acquired by the policy of the 
 Senate, the active emulation of the Consuls, and the martial 
 enthusiasm of the people ";^ and his example having been 
 followed by his successors, Eome now entered on a time of 
 peace, luxury, and vice before unknown in the world's history. 
 Here, in that huge city whose inhabitants numbered four 
 millions (Lipsius), was the place for medical men, charlatans, 
 and quacks ; and here we cannot doubt that the gynaecologist 
 was much in demand, if, indeed, we are to take Messalina and 
 Agrippina as types of the morality of the day. " In the case 
 of Agrippina, who used to leave the palace of the Cffisars and 
 go to the brothels of Eome and stay there all night, having 
 coitus with anyone who cared to come, it is obvious that the 
 condition was one not of health ; it was one of disease, and it 
 is by no means improbable that both she and Messalina 
 suffered from eczema of the vagina."^ Public decency during 
 
 ^ Gibbon, " Decline and Fall of the Roman Empire," c. i. 
 * L. Brunton, " The Action of Medicines," p. 553. 
 
MEDICINE IN ROME. 63 
 
 the republican period was well observed in Eome, but during 
 the imperial times licentiousness often reigned supreme. 
 
 We need not enter into all the factors that helped to 
 produce a state of vice and immorality which led Juvenal to 
 exclaim : " Vice has culminated "; " no guilt or deed of lust 
 is wanting since Eoman poverty has disappeared." Our aim 
 is merely to give a glance at what existed in order to show 
 that a loose sexual relation existed between the people of all 
 ranks ; and this must have led to the spread of venereal 
 diseases, did such exist, a point, however, which we are unable 
 to prove ; while, on the other hand, if venereal disease did 
 not exist, this sexual excess at least tended towards the 
 creation of diseases of the organs of generation in both sexes. 
 Undoubtedly the conduct of the Emperors largely influenced 
 the sexual habits of the masses. Both Julius Caesar and 
 Augustus led dissolute lives, but neither equalled Tiberius, 
 whose amours at Capreae cannot be described.^ Caligula had 
 a brothel in his palace, and by taxing the keepers of the 
 lupanaria he was able to derive a substantial income from 
 their infamous calling. Nero, not content with visiting the 
 houses of prostitutes, dined in public with a crowd of these 
 creatures ; while he founded on the shores of the Gulf of 
 Naples houses of ill-fame, which he filled with the most 
 abandoned women. Need we allude to Galba, Otho, Vitellius, 
 Vespasian, Titus, or Domitian, each and all steeped in vice ? 
 Nor need we mention Commodus, further than to say that not 
 less than three hundred maidens ever surrounded him in his 
 palace ; whilst Elagabalus may be dismissed with the remark 
 that he has been fittingly compared to a wild beast. 
 
 But if the Emperors were saturated with vice and lust, 
 their wives were often little better ; and in Faustina, Agrip- 
 
 ^ Suetonius, " Tiberius, " c. xliv. 
 
64 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 pina, and Messalina we have examples of women who pre- 
 ferred the brothel to the palace ; for the wife of Claudius 
 loved to stand at the doors of the lupanaria decked in her 
 yellow wig,^ with bared breasts and gilded nipples,^ atque cera 
 poposcit. 
 
 Among all classes immorality reigned, and Juvenal has in 
 his sixth satire left us a picture of the habits of the Eoman 
 women — a picture painted by a master's fearless hand, which 
 shows a condition of society and a supremacy of lust never 
 before reached by any nation : an age in which the Spintria 
 and Fellator^ had an ode,* and those who were lingua maritus, 
 moechus ore had their admirers. 
 
 Amidst such surroundings, how could we expect that there 
 would be any female modesty, even if we sought it, among 
 the younger women ? for the walls of the private houses were 
 painted with lewd frescoes,^ and with designs similar to those 
 that may be seen in many of the houses of Pompeii to-day — 
 paintings whose artistic merits are quite overshadowed by 
 their obscene subjects. 
 
 Around the necks of the children, male and female, was 
 often hung a fascinum, to act as a charm against witchcraft ; 
 while in every field, and in many paths, were to be seen 
 statues of the god Priapus, always conspicuous, and always 
 an object of attention, 
 
 " Which maids peep at with hands before their face." ' 
 
 The baths were the resort of both sexes, who frequently 
 encountered one another in a nude condition,^ and the women 
 
 ^ Prostitutes were compelled by the Roman laws to dye their hair either blue 
 or yellow. Messalina, having black locks, was accustomed to wear a yellow wig 
 (Jlcivo galcro) when visiting tlie lupanar. It would appear that yellow hair has 
 a fascination at the present day for many of the clclicatcc. 
 
 ^ "Tunc nuda pajiillis constitit auratis," Juvenal, Sat. vi. 
 
 * Martial, xi. 31. ■* Ihid., xi. 61. ^ Suetonius, "Tiberius," xliv. 
 
 ' Martial, iii. 68. ' Pliny, H. N., xxxiii., c. liv. 
 
MEDICINE IN ROME. 65 
 
 put off their modesty with their garments ;^ while the ahptes 
 were wont to excite the passions during the massage move- 
 ments that followed the bath : 
 
 " Callidus et cristse digitos impressit aliptes."^ 
 
 No vice was neglected, and we therefore are not surprised 
 when Juvenal tells us that the women refused to bear children, 
 and abortion became the fashion — to such an extent, indeed, 
 that he exclaims : " Barely did a gilded bed contain a woman 
 lying-in, so potent are the arts^ and drugs^ of her that can 
 insure barrenness. The operation, however, frequently 
 proved fatal,^ and Suetonius® says that Julia, the daughter of 
 Titus, lost her life after Domitian (the advocate of KXivoTTakrj) 
 had obliged her to procure a miscarriage. 
 
 Amidst such depravity we should have expected to find 
 venereal diseases thriving apace, yet, strange to say, no 
 author has left us such a description of gonorrhoea as will 
 enable us to say that that disease really existed in those days. 
 Celsus (vi. 18) has painted us an exact picture of phimosis 
 and orchitis, but he does not say that these conditions were 
 due to sexual intercourse. 
 
 We do know, however, that certain diseases, classed under 
 the general term of morbus indecens, existed,'^ and these 
 diseases the Koman doctors refused to treat, and it was even 
 considered unbecoming to confess^ to them ; consequently the 
 
 ^ As Gyges said to King Candaules : a/xa 5^ kiOQvi. iKdvofi^vifi (TweKd^erai Kal 
 rrjv alSil) yvvr) (Herodotus). 
 
 * Juvenal, Sat. vi. 
 
 ^ "Est etiam aaneum spiculum, quo jugulatio ipsa dirigitur, creco latrocinio, 
 ilj.ppvoff<paKTr)v appellant; utique viventis infantis peremptorium," Tertiillian, 
 'Liber de Anima," ch. xiii. (Ramsbotham). 
 
 * Soranus, c. xvii., Tci (pddpLa. 
 
 ' " At tenerae faciunt, sed non impune, puells, srepe, suos utero qua necat, 
 ipsa perit " (Ovid). 
 
 * Domitian, c. xxii. ; Juvenal, Sat. ii. ; Plin., iv., Epist. xi. 
 
 ' Martial, xi. 62 : " Partem gulosam solvit indecens morbus." 
 ^ Celsus, vi. 18. 
 
66 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 slave doctors attended to their rich masters, while probably 
 the Archiatri saw to the poor.^ 
 
 Whether gonorrhoea was present or not, female diseases 
 were undoubtedly common, and we accordingly find that 
 gynaecology was one of the specialities that existed in Eome, 
 and gynaecologists^ were numerous. Soranus alludes to these 
 in the following lines : " Dicimus quosdam esse mulierum 
 medicos quia affectiones mulierum sanant ; et homines solent 
 obstetrices ad morbos vocare, quando mulieres proprium quid 
 patiuntur et quod illis cum viris baud commune sit " (c. xlvii.). 
 
 The Encyclopedists. 
 
 In the opening years of the Christian era we have first to 
 note the writings of the Encyclopaedists, whose labour it was 
 to collect and set forth what was known in literature and 
 science. Among the subjects included was medicine, and 
 had it not been for these writers we should never have even 
 heard of many authors whose works have been lost to us ; 
 thus, Pliny states that he consulted 2,000 books in compiling 
 his works, whilst Celsus mentions over ninety authors. 
 
 Celsus (B.C. 63 to A.D. 7) lived in the reign of Augustus, 
 but little is known of him personally. There seems to be 
 some doubt whether he was actually a physician himself, or 
 whether he studied medicine merely as a branch of general 
 science. He has left to us his work "De Medicina," divided 
 into eight books, and scattered throughout these there are a 
 few chapters and references to gynaecology and abdominal 
 surgery, which we shall now proceed to examine. 
 
 ^ Sanger, "History of Prostitution," 1895. 
 ^ larpol yvfaiKeioi, Hieser, op. cit., i. 430. 
 
MEDICINE IN ROME. 67 
 
 The GyncBcology contained in the Works of Celsus. 
 
 Anatomy. — The uterus (vulva) in young women is very 
 small, but in women, except when they are pregnant, it is not 
 much larger than a body that may be embraced by one's 
 hand. The vulva begins opposite the middle of the belly, in 
 a straight and thin neck which they call the passage, and from 
 thence it is turned a little to the right hip ; then, proceeding 
 above the rectum, connects its sides with the ilia of the 
 woman. 
 
 Therapeutics — Pessaries. — In B. V., c. xxi., our author 
 gives an account of pessaries and their use. He says that 
 the Greeks call them pessaries {irea-aov';), and that when 
 the medicinal substances are prepared they are applied to 
 soft wool {molli lana), which is then introduced into the 
 vagina. He then gives receipts for pessaries, to produce 
 the periods, to prevent inflammation of the uterus (from 
 Numenius), to cause the expulsion of a dead foetus, one for 
 hysteria due to uterine disease, and one for sterility. 
 
 Catheters. — Celsus says that the largest female catheter 
 should be 9 inches long, and the smallest 6 inches (B. VH., 
 xxvi.). 
 
 Digital dilatation of the uterus is referred to in describing 
 an obstetrical operation (B. VH., c. xxix.). 
 
 Friction. — B. II., c. xiv., is devoted to the subject of 
 massage ; its application to women is mentioned (B. IV., 
 
 C. XX.). 
 
 Peritoneum. — The peritoneum is alluded to in connection 
 ■with ruptures. Eupture of the peritoneum without any 
 lesion of the integuments is sometimes seen. In women the 
 accident often depends on the distension of the womb, and it 
 is especially at the groin where the condition is observed 
 (B. VII., c. xvii.). 
 
 5—2 
 
68 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 The origin of the word " peritoneum," from the Greek 
 7reptT6vai,o<i, is given (B. IV., c. i.). 
 
 Uterus. — The author remarks that after the stomach the 
 uterus is the organ that is most frequently affected by 
 disease, and that women affected with uterine disease some- 
 times lose their reason, or fall as though suffering from 
 epilepsy. In these cases, among other remedies, cold appli- 
 cations should be made to the region above the pubes. If 
 there be ulceration of the womb, it is to be treated by local 
 applications of caustic or cautery (B. VI., c. xviii.), and if 
 there be pain in the uterine region, use fumigations of 
 sulphur. General massage of the whole body is recom- 
 mended later on in the chr.pter. 
 
 Flux and menstrual disorders are also briefly noticed 
 (B. IV., c. XX.). 
 
 In B. v., c. xxvi., the following are given as symptoms to 
 indicate that the uterus (vulva) is wounded: Pains in the 
 groins, hip-bones and thighs ; blood escapes through the 
 wound and by the natural outlet ; bilious vomiting follows ; 
 the patient may lose the power of speech or may lose her 
 reason ; those who have their senses complain of pain in 
 the nerves and in the eyes, while those who succumb present 
 the same symptoms as those who die from a wound in the 
 heart. 
 
 In B. v., c. XXV., there is a receipt for insomnia caused by 
 pains in the uterus. 
 
 Prolapse of the Uterus. — In cases of prolapse of the womb, 
 the organ is first to be examined to ascertain if it is healthy 
 or diseased. According to its condition, it is to be treated by 
 astringent washes, etc., and then to be returned, after which 
 a medicated pessary is introduced, and the legs are bound 
 
MEDICINE IN ROME. 69 
 
 together so as to prevent the pessary and the womb from 
 slipping out. 
 
 Vagina. — Atresia of the vagina is referred to at length in 
 B. VII., c. xxviii. Celsus points out that the condition may 
 be either congenital or acquired through ulceration. If it is 
 a congenital condition, then a membrane will be found closing 
 the mouth of the vagina ; if due to ulceration, then the part 
 is filled with a fleshy substance. In congenital cases it is 
 only necessary to divide the membrane by two incisions made 
 X-wise, taking every care not to injure the urethra. If, how- 
 ever, we have to deal with a case resulting from ulceration, 
 then the incision must be a vertical one. Having seized the 
 edges of the incision by a vulsella or by a hook {vulsella vel 
 hamo), we must excise a small strip of tissue. Next introduce 
 into the wound a longitudinal tent {linamentum, XrifxviaKos:), 
 which has been dipped in vinegar, and this is covered by a 
 piece of unwashed (greasy) wool moistened with vinegar. On 
 the third day the wound is to be dressed. When healing 
 begins a leaden pipe is introduced, which is smeared with 
 substances likely to cause a cicatrix, and so prevent adhesion ; 
 and various drugs may be injected through the pipe with the 
 same object in view. 
 
 Vulva, — A swelling in the groin with fever often denotes 
 ulceration of the vulva (B. II., c. vii.). 
 
 Bladder. — Stone in the bladder is referred to in B. II., c. vii. 
 In cases of stone in the bladder, women are obliged to 
 frequently scratch the parts about the genitals, and if they 
 press the neck of the bladder with their finger they are able 
 to feel the stone. Later on in B. VII., c. xxvi., the operation 
 for stone in the female bladder is described. It is pointed out 
 by our author that in case of small stones no operation is 
 
70 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 needed, as they frequently pass by the urethra of their own 
 accord. If, however, they are large and the patient is a 
 virgin, then the operator should place his finger in the anus ; 
 but if the patient be a married woman, then the finger is 
 placed in the vagina. ** Tum, virgini quidem, sub ima 
 sinisteriore ora ; mulieri vero, inter urinae iter et os pubis, 
 incidendum est, sic, ut utroque loco plaga transverse sit." 
 The incision in virgins would appear from the above to have 
 been made along under the left edge of the labia on one side. 
 
 Abdominal Surgery. — In Book VII., chapter xvi., Celsus 
 deals with penetrating wounds of the abdomen, and as he 
 describes the technique of closing the abdominal wound and 
 other matters of interest, we shall extract his descriptions. 
 
 Our author says that wounds of the small intestines are 
 hopeless, but that surgical treatment for suturing the large 
 intestine is more hopeful. If we find that the intestines are 
 prolapsed through the wound, and the latter is not large 
 enough to enable us to return the bowel, then we must proceed 
 to enlarge the opening. If the bowel has become dry we must 
 wash it with water and oil. Then the assistant should hold 
 open the sides of the wound either with his fingers or with 
 two hooks, and he should take care that he has the peritoneal 
 edges. Having returned the intestines, they are to be gently 
 rolled about, so far so as to try to restore them to their original 
 position. Next proceed to examine the omentum, and, if 
 necessary, remove a piece with a pair of scissors (forjice). 
 
 In closing the abdominal wound it is necessary to have a 
 needle in each hand, threaded with a double thread, and to 
 commence by pushing the needle held by the left hand 
 through the right side of the wound from within outwards, 
 while the needle in the right hand is pushed through the left 
 side of the wound. The needles are then changed to the 
 
MEDICINE IN ROME. 71 
 
 opposite hands, and are again made to penetrate the side from 
 within out. Having closed the peritoneum thus, the skin is 
 then closed in the same manner. Glutinous substances are 
 then applied to the wound, and it is covered by a sponge or 
 greasy wool soaked in vinegar, the dressings being kept in 
 position by a bandage. 
 
 Operations for Uinhilical Hernia (B. VII., c. xiv.). — Our 
 author says that other writers, such as Meges, Sostratus, 
 Gorgias, and Heron, have given their views on the contents of 
 umbilical hernias, and mentions that the intestine, the 
 omentum, wind and fluid, may all be found in different 
 hernias. He then proceeds to give a differential diagnosis 
 whereby one may be able to distinguish the different 
 contents. 
 
 The treatment will vary according to the contents of the 
 hernia. If the swelling is due to gas or to carcinomatous- 
 like tissue, then these varieties should not be operated on. 
 Those which appear healthy should be excised and the wound 
 dressed with lint, and those which have fluid as their 
 contents should be incised and dressed with lint. For other 
 varieties the treatment will vary. Some operators, having 
 emptied the sac, squeeze it between two pieces of wood, and 
 so bring about gangrene. Others pass through the base of 
 the sac a needle threaded with a double thread ; each thread 
 is then tied separately, and so gangrene results. Some 
 operators in doing this latter operation first make a small 
 incision in the sac, into which the finger is introduced, and 
 so the reduction is made more certain. Another method is to 
 reduce the hernia, and then tie a cord round it and cauterize 
 the part above the ligature with the actual cautery or with 
 caustic. 
 
 Paracentesis Ahdominalis. — The first method described by 
 
72 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Celsus is to puncture the abdominal walls four fingers' breadth 
 below the umbilicus, and to the left, or we may puncture 
 through the umbilicus. Others, he says, first cauterize the 
 skin and then make an opening into the abdominal cavity, so 
 that the wound shall not close quickly. In tapping, the 
 operator is warned against injuring any bloodvessels if 
 possible. The trocar itself should be about the length of one's 
 finger, and ought to be pushed in suflSciently far to penetrate 
 through the peritoneum. Having made the puncture, it is 
 then necessary to introduce a cannula of lead or brass. The lips 
 of the protruding end are either turned back, or the median 
 portion of the tube is moulded into a circular swelling to 
 prevent the tube dropping out of the abdomen. After a 
 portion of the fluid has escaped the cannula may be plugged 
 (B. VII., c. XV.). 
 
 Pliny (a.d. 23 to a.d. 79). — The next of the Encyclopaedists 
 was the celebrated author of the "Historia Naturalis." He 
 was not a physician, but in giving an account of the proper- 
 ties and uses of plants, and mineral and animal products, he 
 has dealt also with their medicinal virtues, and consequently 
 he has left us an extensive work on Materia Medica. He 
 frequently refers to the various herbs used in the treatment 
 of female complaints, and for convenience we have classified 
 them as follows : 
 
 1. Plants that are supposed to have an influence in pro- 
 moting the menstrual discharge : Elaterium, cabbage, parsley, 
 oreoselinum, rue, nep, porcilaca, mallow, adarca, hippoma- 
 rathrum, phu. 
 
 2. Plants that arrest hsemorrhage from the uterus : Cut leek 
 (especially after abortions), mint, heraclium, coriander, blite, 
 and gallic nard. 
 
MEDICINE IN ROME. 73 
 
 3. Plants that bring away the after-birth : Eue, penny- 
 royal, polium. 
 
 4. Plants used in fumigating the uterus : Garlic, rue, 
 ammi. 
 
 5. Plant used in pain in the uterus : Asparagus root. 
 
 6. Plants used for purging the uterus : Ocimum, ammi. 
 
 7. Plant used for restoring the uterus to its proper position : 
 Pennyroyal. 
 
 8. Plants used in obstruction of the uterus : Bulbed leek, 
 cyperus. 
 
 9. Plant used in case of suffocation of the uterus : Saco- 
 penium. 
 
 10. Plant used for menstrual derangement : Leucan- 
 themum. 
 
 11. Plants used to produce abortion : Mallow with goose 
 grease, sisymbrium. 
 
 12. Plants used to act on the uterus: Giant fennel, asarum, 
 anemone, eryngium, nettle, castor oil. 
 
 13. Plants used to cure " white flux " : Eose flowers, 
 scandix. 
 
 In B. XXVIIL, c. Ixxvii., and B. XXXIL, c. xlvi., there 
 are chapters devoted to " Remedies for Female Diseases," in 
 which Pliny mentions, among other diseases, ulceration of 
 the mouth of the womb. This he advised to have treated by 
 a pessary. 
 
 In B. XXI., c. xlvii., sponge tents {penicilli) are alluded 
 to, but not in connection with uterine diseases. We shall, 
 however, see that Aetius refers to their use in gynaecology. 
 
 In B. XXIX., c. X., the following occurs: "Ram's wool 
 washed in cold water and steeped in oil is used for female 
 complaints and to allay inflammation of the uterus. Pro- 
 cidence of the uterus is reduced by using this wool in the 
 
74 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 form of a fumigation. Greasy wool, used as a plaster and as 
 a pessary, brings away the dead foetus and arrests uterine 
 discharges."^ 
 
 In B. VII., c. iii., Pliny gives an account of hermaphro- 
 dites, and remarks that they were formerly called androgyni. 
 
 In B. VII., c. XV., he refers to moles and their influence 
 on menstruation, and he then adds a fabulous account of the 
 menstrual discharge, while in B. XXVIII. he gives a further 
 and more wonderful account of menstruation. 
 
 In B. XXIX., c. i., our author mentions a practice that 
 became common in Eome : " Emasculation, self-inflicted by 
 the use of pitch plasters as depilatories ; the public exposure, 
 too, of even the most delicate parts of the female body for the 
 prosecution of these practices."^ 
 
 Abdominal Surgery. — The only subject in connection with 
 abdominal surgery that we need refer to in our author's 
 works is his account of " those who have been cut out of the 
 womb" (B. VII., c. ix.). 
 
 The Csesarean operations referred to were performed on the 
 subject after her death, for he says in the opening words of 
 the chapter " that children who have cost their mother her 
 life are evidently born under favourable auspices."^ He then 
 enumerates the following as examples : " The first Scipio 
 Africanus, the first of the Caesars, was so named from having 
 been removed by an incision in his mother's womb. For a 
 similar reason, too, the Csesones were called by that name. 
 Manilius also, who entered Carthage with his army, was born 
 in a similar manner." 
 
 It may be remarked in connection with Julius Caesar that, 
 if he was delivered as above stated, yet his mother Aurelia 
 did not die at the time, but lived for many years after. 
 
 1 Riley's Pliny. 2 jua. 3 jud. 
 
MEDICINE IN ROME. 75 
 
 Furthermore, it is probable that this passage in Pliny first 
 suggested to Eousset (1581) to give the name " Cesarean " to 
 the operation : " Hunc nostrum partum Caesarei nomine 
 inscripserimus." 
 
 We may in this place take the opportunity of referring to 
 other cases of the Caesarean operation recorded by ancient 
 writers. Ovid tells us that Coronis having been destroyed by 
 Apollo, he thereupon removed from her womb Asclepius, the 
 God of Physic, " uteroque parentis eripuit." The same writer 
 also tells us that Bacchus^ was brought into the world in the 
 same way, " ab alvo eripitur." 
 
 It would appear from some passages in that part of the 
 Jewish Talmud called the Mishna, compiled at the end of the 
 second century a.d., that this operation had been performed 
 with success on some living women. ^ 
 
 It may also be noted that Numa Pompilius, the second 
 ruler of Eome (715 to 673 e.g.), is said to have ordered that 
 if any woman died whilst she was pregnant the child was 
 immediately to be cut out of the uterus. 
 
 Lastly, as we have already noticed in connection with 
 Hindu medicine, Caesarean section was practised after the 
 death of the mother {vide ante). 
 
 The Donaeia and Tabulae of the Temples. 
 
 Pliny tells us that it was " the practice for persons who 
 had recovered from a disease to describe in the temples of 
 that god the remedies to which they owed their restoration 
 to health, that others might derive benefit therefrom in a 
 
 ^ "Who denies Bacchus from the womb was torn ? 
 
 A god might well, when beasts were this way born." 
 
 Martial, i. 12. 
 ^ " Le Talmud de Jerusalem," Schwab. 
 
76 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 similar emergency."^ The tablets (tahidcs votivce) were sus- 
 pended on the walls, and accompanying the tablets there 
 were frequently suspended casts of the part moulded in terra 
 cotta ; or small models were made, representing the part, in 
 gold or silver, and these were presented to the god. The 
 votive tablets, as we have remarked before, served as clinical 
 records, and were used by Hippocrates in composing his 
 works. " When Pausanius, the tourist, visited the temple of 
 iEsculapius at Epidaurus (about 150 a.d.), he noticed six 
 pillars engraved with stories of patients, two of which have 
 been recently discovered in the excavations carried out there by 
 M. Cavoiadeas. They date from about the close of the fourth 
 century b.c." The following are two cases of abdominal 
 surgery : 
 
 " Sostrata pregnant (?) for a year. She came in a litter to 
 the temple, but since she saw no clear vision she returned 
 home. On the way a man of noble aspect met her and her 
 attendants near Kornus, and, hearing from the latter of her 
 evil plight, bade them set down the litter on which they 
 carried Sostrata ; then, opening her belly, he took out a vast 
 multitude of . . . (?) filling ...(?)... footpans, and 
 sewing her up, healed her. Then, bidding them send the 
 offerings for the cure to Epidaurus, Asclepius disappeared." 
 
 "A man with an ulcer in his stomach. He incubated and 
 saw a vision ; the god seemed to order his followers to seize and 
 hold him, that he might incise his stomach ; so he fled, but 
 they caught and tied him to the door-knocker (? irol poTrrov).^ 
 Then Asclepius opened his stomach, cut out the ulcer, sewed 
 him up again, and loosed his bonds. He went away whole, 
 but the floor of the chamber was covered with blood " 
 (Withington). 
 
 1 Pliny, xxix. 2 (Riley). ^ uSt poirTp6v (?). 
 
MEDICINE IN ROME. 77 
 
 The donaria, or anathemata, were the gifts to the gods, 
 and consisted either of a present of some kind, such as tools 
 of trade, surgical instruments, paintings, or casts of a diseased 
 part. 
 
 Luigi Sambon has given an account^ of the Roman donaria. 
 He says : " Hearts with their auricles very prominently 
 shaped, kidneys, uteri, ovaries, and coils of intestines, are 
 often found singly. . . . Reproductions of the vulva are often 
 found, sometimes offering the characteristics of childhood, at 
 other times those of puberty. Uteri are found in great 
 numbers, some generally of the size of the normal viscus 
 with a smooth surface ; others are larger in size and offer a 
 wrinkled surface and patulous cervix, as after delivery ; 
 they were offered as propitiatory gifts to insure an easy 
 labour, or given by way of thanksgiving after safe delivery, 
 or after recovery from difficult labour or disease. Some of 
 these uteri have on one side the appendages attached. I 
 have found that the left ovary and tube is far more com- 
 monly represented, proving even in those days a marked 
 prevalence of disease of the appendages of the left side. 
 
 ** Some uteri present a double opening at the os ; they are 
 undoubtedly representations of uteri septi. I have found 
 no other malformations of the womb represented by these 
 terra-cottas, such as uterus bicornis, although they are com- 
 paratively far more frequent. But this is not surprising, because 
 uterus septus is easily diagnosed during the life by a simple 
 manual examination if the septum extends as far as the os, 
 while other malformations are difficult to detect, except in 
 poat-mortem examinations. As the terra-cottas representing 
 uteri septi are rather frequent, although the malformation is 
 rare, I believe that the idea of twin pregnancy was closely 
 
 1 British Medical Journal, July 20, 1895. 
 
78 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 connected with it, and this double opening may be considered, 
 in most cases, as a conventional form indicating it." 
 
 Small cakes in the form of the male and female organs of 
 generation were sold by the bakers' girls for sacrifice to 
 Venus and Priapus. 
 
CHAPTER VIII. 
 
 EUFUS EPHESIUS AND DIOSCORIDES. 
 
 Rufus Ephesius is called so from the place of his birth. He 
 lived during the reign of Trajan (98-117 a.d.), according to 
 Suidas. Of his life we know nothing. He wrote several 
 medical works, some of which have been preserved, whilst 
 chapters of other works that have not come down to us have 
 been preserved in the works of Galen, Oribasius, Aetius, 
 Alexander of Tralles, Paulus, Ehazes, Ibn Baitar. Looking 
 through the passages from these authors contained inDarem- 
 berg's edition^ of Eufus, we find here and there a few sen- 
 tences which refer to gynaecological subjects (vide pp. 301, 
 312, 499, 500). 
 
 The chief works that we possess of our author are " De 
 Eenum et Vesica Morbis " (in the third chapter of which 
 there are a few lines on calculus in females) ; " De Medica- 
 mentis Purgantibus "; *' De Appellationibus Partium Cor- 
 poris Humani " (this latter work has an interest for us inas- 
 much as it contains a catalogue of the terms applied to the 
 various parts of the female genital organs). 
 
 The work consists of four parts : the first and fourth books 
 are the original treatise, the second and third are extracts 
 
 ^ Daremberg et Euelle, "(Euvtcs de Rufus d'Ephese." Paris, 1879. 
 
8o THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 from it ; whether they are all by the same author is not 
 decided. 
 
 One of the works published by Daremberg in his edition of 
 Eufus is entitled Ilepl aaTvpiaa/xov koX jovoppola<i, and deals 
 with spermatorrhoea, not gonorrhoea. 
 
 Besides the works mentioned above, we know from other 
 authors that Eufus wrote many treatises, such as a work on 
 gout and one on the bones ; in the latter work there is a 
 short description of the pelvis. In looking through the lists 
 compiled by Ackermann and Daremberg, the only notices of 
 possible gynaecological chapters are one on " Sterility " and 
 the " Suppression of the Periods," the latter being preserved 
 by Aetius (B. XVI., c. IL). 
 
 The description of the genital organs of women is found in 
 three places in the work " On the Names of the Parts of the 
 Body," and we shall proceed to examine these passages now. 
 
 P. 147 :^ " With regard to the privates of women, the 
 triangular extremity of the hypogastric region is called the 
 comb (/cret?), while others call it the iirLcreiov. The cleft in 
 the genitals is called the axi'O'f^ci. The small fleshy body 
 that hangs down in the mesial line is called the myrtle- 
 berry {fxvprov). By others it is called the hypodermis, by 
 others the clitoris {K\.eiTopi<i) ; while touching the clitoris 
 for lascivious purposes is expressed by the term KXecTopid^eiv. 
 The fivprox^i^'Xa are the fleshy parts on either side of the 
 
 *' Euryphon called them also steep edges (Kpij/xvos:). Nowa- 
 days for fxvpTox^iXa we substitute wings {TrrepvycofiaTo), and 
 for fivpTov we substitute vvfKprj." 
 
 It is to be observed that "nympha"and " clitoris " were used 
 by the ancients as synonymous terms, and in some later authors 
 
 ^ Daremberg's edition. 
 
RUFUS EPHESIUS AND DIOSCORIDES. 8i 
 
 (Aetius and Paul) directions are given for amputating the 
 nympha, meaning thereby the clitoris, 
 
 P. 158, 1. 184 : " The spermatic vessels (in the male) are four 
 in number — two varicose (/ct/ocroetS?;? = vas deferens) and two 
 glandular (aSeyoeiS?;? = prostate) ; some call them also genera- 
 tive veins. The portion of the varicose vessels which run to 
 the testicles {BiSvjxoi) are called irapaaTaTat (epididymis) ; 
 some authors have no objection to call the whole of these vessels 
 Trapaa-jaTai. It is proper to see if the same arrangement holds 
 good in both male and female : Herophilus, indeed, is of 
 opinion that females have not /ctpo-oeiSet? •7rapaaTaTa<; (vas 
 deferens) ; but we have seen in the uterus of a sheep varicose 
 vessels on either side springing from the testes ; these (Fallo- 
 pian tubes) opened into the cavity of the uterus, and from 
 these tubes mucous fluid escaped when they were pressed, so 
 there is a strong presumption that these are spermatic vessels 
 of the varicose species (/ctpcroetS?;'?) ; dissection would perhaps 
 demonstrate this." 
 
 To Piufus must be accorded the honour of having given us 
 the first description of the Fallopian tubes ; Galen, Oribasius, 
 and Aetius are the other authors who mention the tubes, 
 Soranus having overlooked them. 
 
 P. 160, 1. 193 : " The genital member of women is called 
 firjTpa and varepa ; Hippocrates called it both Se\cpv<; and 
 701/77. The branches which spring from the top (of the uterus) 
 on either side are the horns (Kepalai) and antennae (irXeKTavat) , 
 names which also apply to the vessels {d'yy€ta) which suspend 
 the uterus to the exterior (? round ligaments). The median 
 and most elevated portion of the uterus is the fundus {irvd p.njv) ; 
 the lateral portions are the shoulders (m/jloi) ; the extremity is 
 the isthmus and neck {avxv^ kuI rpdxv^o^). The mouth of 
 the neck is the first orifice (external os) ; Hippocrates named 
 
 6 
 
82 THE HISTORY OF ANCIENT GYNECOLOGY, 
 
 it afi^'iheov,^ from the circles of iron on the plough. The 
 cavity which is encountered after the uterus is the yvvaiKo<; 
 /coXtto? (female sinus = vagina) ; the pudendum (atSolov) com- 
 prises all that portion which is visible to the eye." 
 
 ***** 
 
 Pedacius or Pedanius Dioscorides lived probably in the first 
 century a.d. As he is not mentioned by Pliny, he was either 
 a contemporary or lived at a later period. He has left us his 
 work on Materia Medica, a work which has been translated 
 into many languages, and which enjoyed for many centuries 
 a well-merited popularity. 
 
 He was a physician by profession, and he has given us an 
 account of all the articles which were known in his times to 
 be efficacious in medicine. He frequently mentions drugs 
 used for the diseases of women. 
 
 Besides his great work on Materia Medica, there are some 
 minor writings attributed to him, and in one of these, entitled 
 Tlepl evTTopicrraiV aifkoiv re Kal crvvdeTcov (papfid-Kcov, which 
 is divided into two books, we have chapters Ixix.-c. of the 
 second book devoted ad uteri reliquorumque genitaliwn mem- 
 hroriim affectus remedia, i.e., remedies to be applied to the 
 diseases of the uterus and the rest of the generative organs. 
 
 Each chapter in the work begins with a short sentence 
 stating the disease for which the drugs in the chapter are 
 used. Thus, for instance, in chapter Ixxiv. we have the 
 following: "Irritating prurigo of the vulva and vagina 
 {koXttwv) is relieved by an infusion of portulaca juice, linseed 
 prepared in water-mead, fenugreek, the oil of lilies or Cyprus, 
 tragacanth, with water." 
 
 In the chapters devoted to gynecological remedies, the 
 
 1 dfKpidiov, Daremberg. 
 
RUFUS EPHESIUS AND DIOSCORIDES. 83 
 
 following conditions are mentioned : Inflammation and pain 
 in the uterus, for which pessaries are prescribed ; ulceration 
 of the vulva ; prolapse of the uterus ; menstrual disorders to 
 be treated by emmenagogues ; drugs to expel the foetus, aid or 
 prevent conception, and those which are to be used in cases 
 of suffocation of the uterus. 
 
 Our author gives no description of the diseases treated, and 
 his work may be compared to the "Therapeutic Index of 
 Diseases and Symptoms " found in some of our modern works 
 on materia medica and therapeutics. 
 
 6—2 
 
CHAPTEE IX. 
 
 SOEANUS. 
 
 The name Soranus belongs to at least three physicians, if not, 
 indeed, to four : (1) A native of Cos, who may have lived in 
 the second or third century b.c. ; (2) a native of Mallus in 
 Cilicia, and called Mallotes, who lived after the times of 
 Hippocrates ; (3) a native of Ephesus, son of Menander and 
 Phoebe, who, according to Suidas, practised in Eome during 
 the time of Trajan and Hadrian (a.d. 98-138), and who in his 
 younger days had studied at Alexandria ; (4) a native of 
 Ephesus, who lived at a later date than the third one 
 mentioned, our authority for this being also Suidas. 
 
 Dietz and Ermerins have come to the conclusion that the 
 third and fourth enumerated were one and the same. The 
 only objection to this hypothesis is, as pointed out by Green- 
 hill, that in the work " De Morbis Mulierum " the names of 
 several physicians occur who lived later than the times of 
 Soranus. As the text has probably been added to, this 
 objection need not have any more force than it has when 
 applied to many other ancient works. 
 
 Supposing, then, that we admit that there was only one 
 Soranus of Ephesus, and that he wrote the work " On the 
 Diseases of Women " that we are about to examine, then we 
 know of his life the barest facts. 
 
SORANUS. 8s 
 
 He was tutor to Attains ; he lived about the time of the 
 famous surgeon Archigenes, but died before Galen wrote his 
 work "De Methodo Medendi" (a.d. 178); he belonged to the 
 sect called Methodists. 
 
 His works, according to Ermerins, consist of fourteen 
 treatises. 
 
 The discovery of the work of Soranus on the diseases of 
 women durmg this century came about in the following 
 manner : 
 
 Fred. Eeinhold Dietz received a commission from the 
 Prussian Government to explore the public libraries of 
 Europe, in order to investigate the manuscripts of ancient 
 medical authors, which had not been sufficiently studied. 
 
 At Paris, in La Bibliotheque Eoyale, he came on a manu- 
 script, numbered 2,153, written in Greek, and which had been 
 copied in the fifteenth century. On studying this, he noticed 
 on p. 215 that the description of the genital organs in 
 women was in the same words as those used by Soranus in 
 the chapter from that author's works preserved in the 
 writings of Oribasius. The same chapter had also been 
 published in Paris m 1554, along with some chapters from 
 Eufus of Ephesus. 
 
 Further investigation of the matter led him to the con- 
 clusion that he was dealing with the work of Soranus " On 
 the Diseases of Women." In the library of the Vatican at a 
 later date he discovered another copy of the work, but not so 
 well preserved. 
 
 Keturning to Konigsberg with a copy of each manuscript, 
 he proceeded to study them, but unfortunately he died before 
 his labours were completed. The work was then taken in 
 hand by Lobeck, and published at Konigsberg in 1838. 
 
 Since that date it has engaged the attention of several well- 
 
86 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 known authors, among whom may be mentioned Haeser, 
 Pinoff, Guardia and Luneberg. Ermerins in 1869 published 
 an excellent edition of the Greek text, with notes and transla- 
 tions in Latin ; while Herrgott in 1895 brought out his edition 
 in French, the chapters being dovetailed with the correspond- 
 ing chapters of Moschion. 
 
 The work of Soranus that we shall now proceed to examine 
 is entitled Uepl yvvaiK€L(bv iradcov. It consists, in the edition 
 of Dietz, of a hundred and twenty-two chapters and a part of 
 the hundred and twenty-third. The number has been reduced 
 by Ermerins and Herrgott in their editions to sixty-six, as 
 Ermerins showed that many of the chapters were interpola- 
 tions from Aetius. Of the chapters, forty-six are contained in 
 the first part of the work, which is chiefly obstetrical, and 
 deals with the duties of midwives (for whom the work was 
 written), the care of a natural labour and miscarriages, and 
 with the care of the infant. The second part contains twenty 
 chapters, several of which are purely gynsecological. 
 
 Without entering into the subject-matter of these chapters, 
 which deal with obstetrics, we might, however, remark en 
 passant that among many excellent chapters, those on dystocia 
 ( chapters Ixii.-lxv.) stand out as among the most remarkable 
 handed down to us from ancient authors, and at once place 
 Soranus in the very highest position as an obstetrician, and 
 show beyond dispute that the obstetrical art had been brought 
 to great perfection in those ages. 
 
 What we have particularly to notice about Soranus is the 
 methodical manner in which he attacks his various subjects. 
 He does not merely mention the name of the disease, and 
 then proceed to rattle off a multitude of receipts for its cure, 
 as we so frequently find in the works of ancient authors who 
 have merely been compilers and copyists. Our author is 
 
SORANUS. 87 
 
 never content with such superficial methods. He gives some- 
 times a historical introduction concerning the views of his 
 predecessors, then he enumerates the causes of the trouble, 
 after which he alludes to the prominent symptoms, and then, 
 having given his reader a clear picture of the malady, he 
 proceeds to systematically attack the various phases of the 
 affection. In short, a careful study of this work of Soranus 
 must convince the reader that our author was certainly a 
 specialist in gynaecology, and that he thoroughly understood 
 his subject, and was not merely a compiler, but an original, 
 able and judicious thinker. His work, therefore, is one of the 
 three most important gynaecological treatises written previous 
 to the present century, the other two being the pseudo- 
 Hippocratic treatise that we have already examined, and the 
 work of Aetius, to be examined later on. 
 
 A Rl^SUMK OF THE WoRK OF SoRANUS. 
 
 Soranus opens his work with an introductory chapter in 
 which he considers the best method of dividing his subject. 
 The first chapter deals with the special qualities that a mid- 
 wife should possess, and, among other points, our author lays 
 it down as a rule that her nails should be trimmed and 
 rounded so that they will not wound the organs. He wisely 
 remarks that she should be discreet, inasmuch as she is often 
 trusted with family secrets. In the next chapter he further 
 deals with the qualifications of the midwife, for the work was 
 evidently written especially for their instruction. With regard 
 to the study of anatomy, he says that, while it is his intention 
 to explain the structure of the female genital organs, he con- 
 siders such knowledge of little importance ; but he remarks 
 that others will more readily believe us when we contend that 
 the study of the anatomy of the parts is useless, if we first 
 
88 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 show that we have some knowledge of anatomy. Soranus 
 thereupon gives the famous chapter on the anatomy of the 
 genital organs in woman that was preserved in the works of 
 Oribasius, and which led Dietz to his discovery of the long- 
 lost work of Soranus. We shall reproduce this chapter 
 in full. 
 
 After the chapter on anatomy, we have several which deal 
 with menstruation, the virgin state and fecundity. In the 
 chapter on conception, he asks the question, " What time is 
 the most favourable for conception?" and he answers, " Just 
 after the menstrual period." This observation is in accord- 
 ance with recent researches. In the chapter on the signs of 
 conception, he remarks that the retention of the seed in any 
 part (of the genital canal) would not be conception, con- 
 ception being the retention of the seed in the uterus itself. 
 Herrgott queries whether Soranus here had ectopic pregnancy 
 in his mind's eye. In chapter xiv. the treatment of the woman 
 when enceinte next engages our author's attention, and among 
 the things mentioned by him in this chapter are massage, 
 inunction, the hot and the vapour bath. Abortion is con- 
 sidered at length, and the various methods practised in 
 our author's day are described. He himself recommends the 
 third month as the most favourable for miscarriage. He like- 
 wise describes the methods adopted for preventing conception, 
 and among other methods he describes the inserting into the 
 mouth of the womb a plug of lint, and the use of astringent 
 pessaries before coitus. 
 
 Chapter xix. deals with the membranes developed round the 
 foBtus, and our author makes the mistake of saying that there 
 are four vessels in the umbilical cord. A natural labour is 
 then fully described, and the use of the obstetrical chair is 
 referred to. 
 
SORANUS. 89 
 
 In chapter xxii. mention is made of the removal of the 
 membranes, and a mmute description of fumigation of the 
 uterus by means of a small silver vessel is given at length. 
 The method described by our author was most probably the 
 one in general use, for the large cumbersome apparatus 
 described in the pseudo-Hippocratic works would have been 
 used only by the well-to-do, as it is extremely unlikely that 
 such an apparatus could have been sent to the patient's house 
 on each occasion ; and, secondly, on account of the method of 
 using it, by inserting it in a specially heated hole in the floor, 
 it was very inconvenient and expensive. 
 
 We then have several chapters on the care of the infant 
 and some of its slight ailments. This concludes the first part 
 of the work. 
 
 The second part deals more with gynaecology than the first, 
 and opens at chapter xlvii., in which the author considers the 
 question whether these are diseases which are peculiar to 
 women alone, and he agrees with those who deny this proposi- 
 tion. He, however, refers to the fact that there are specialists 
 who make the diseases of women a special study, and that 
 midwives are accustomed to call those practitioners to their 
 aid in cases where these special organs are diseased. 
 
 In chapter xlviii. our author enters at length into a con- 
 sideration of retention of the menses, scanty menstruation 
 and dysmenorrhoea. The able and methodical manner in 
 which these subjects are handled shows our author at his best, 
 and one has no hesitation in pointing to this chapter as being 
 one of the finest in the works on ancient medicine that have 
 been handed down to us. He gives us in this chapter a 
 complete insight into the excellent therapeutic agents em- 
 ployed by himself and his contemporaries, and no chapter 
 that we can call to mind could establish more thoroughly the 
 
go THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 fact that minor gynaecology had made very considerable 
 advances among the ancients. 
 
 We then have an excellent chapter on uterine haemorrhage, 
 and we have mention made of the vaginal speculum for the 
 first time, and the plugging of the uterus with sponges. The 
 various fluxes of the uterus and vagina are dealt with, but we 
 cannot distinguish from the descriptions any one that could 
 be taken to refer to gonorrhoea, though the disease probably 
 existed in our author's day. 
 
 The remaining gynaecological chapters deal with the atonic 
 uterus, the description of which appears to correspond to 
 cases of subinvolution. Then there are chapters on uterine 
 paralysis, uterine deviations, air in the uterus, which is really 
 a description of septic metritis, and the finger is mentioned as 
 being used as a curette to remove retained clots, etc. There 
 are chapters also on inflammation of the uterus, and the last 
 portion of the work is devoted to the celebrated chapters on 
 dystocia and prolapse of the womb ; in the chapter dealing 
 with the latter hysterectomy is referred to. Fibroid of the 
 uterus is also mentioned. 
 
 Anatomy. 
 
 Uterus. — The uterus, r/ fiyrpa, is called also varepa and 
 BeX(})v<i — jxrjTpa because it is mother {/x'^Tijp) of the foetuses 
 born from it, or because it makes those having it mothers ; 
 according to some, because it has a measured period {fxirpov 
 Xpovov) for menstruation and bringing forth ; varepa because 
 it exhibits its functions late (vo-repou), or because it occupies, 
 if not exactly, at any rate on the whole, the lowest jmrt of the 
 female intestines ; SeX<^u? because it brings forth brothers 
 {aheX^oi). 
 
 Its Position. — It lies in the space between the acetabula. 
 
SORANUS. 91 
 
 between the bladder and the rectum, resting upon the latter, 
 but beneath the bladder either in whole or in part, according 
 to change in its size. For in infants it is smaller than the 
 bladder, and hence comes to be entirely under it; but in 
 virgins at puberty it reaches the same height as the bladder. 
 In those more advanced in age and in married persons, 
 especially multiparas, it is even larger, so that it extends to 
 where the colon stops. It is still larger in pregnancy, as any- 
 one can see, the peritoneum and hypogastrium being pushed 
 forward according to the development of the fcetus, with its 
 membranes and fluids. After delivery it becomes contracted, 
 but retains a larger size than before pregnancy. Under these 
 circumstances, accordingly, it is larger than the bladder, and 
 does not lie right under it ; for, in front, the neck of the 
 bladder projects beyond, ending in the urethra and being 
 stretched alongside of the whole vagina, but it falls short of 
 the uterus above. Behind, the fundus of the uterus lies 
 higher than the fundus of the bladder, being under the 
 umbilicus, so that the cavity of the bladder lies upon the 
 neck of the uterus, and its fundus upon the cavity of the 
 latter. 
 
 Ligaments. — The uterus is connected by thin membranes, 
 above with the bladder, below with the rectum, to the sides 
 and behind with the parts springing from the ilia and sacrum. 
 When these (membranes) are shortened by inflammation, it 
 is dragged on and lies to the side ; when they are weakened 
 and relaxed, it falls down, not because it is an animal, as some 
 have thought, but having, as it were, a sensitiveness, and thus 
 being contracted by astringents and relaxed by emollients. 
 The shape of the uterus is not convoluted as in the brutes, 
 but more like a cupping-glass. For, beginning from the 
 rounded and broad end at the fundus, it contracts sensibly to 
 
92 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 the narrow mouth. The first and projecting part of it is 
 called (TTOfiiov ; next comes the Tpd)(r)\o'i, then the av^w > 
 these last two together form the Kav\6<i. Where it broadens 
 out beyond the constriction of the neck, we have first the 
 wfjioi, then the irXevpa, last of all the TrvOfxrjv, beneath which 
 is the 0d(Ti<;. The whole space is called kvto<;, <yd(TTpa, KoXnro'i. 
 The OS uteri lies in the centre of the female genital organs, 
 for the cervix is closed in by the labia ; the os is removed 
 from these, in some more, in some less, according to age : in 
 adults, generally 3J or 4 inches ; in those who have borne 
 children it comes to be nearer through elongation of the 
 cervix. The size (of the os uteri) varies, and is in most 
 persons normally as large as the outer end of the auditory 
 meatus. It opens at certain times — as in the orgasm of 
 coitus to receive the semen, during menstruation that the 
 blood may escape, in pregnancy according to the growth of 
 the embryo, and in labour to the greatest extent, until it will 
 admit the full-sized hand. In texture it is soft and fleshy in 
 virgins, like the sponginess of the lungs or the smoothness of 
 the tongue ; but in those who have borne it becomes more 
 callous, like the head of a polypus, or, as Herophilus says, 
 like the end of a bronchus, becoming hard through the 
 passage of discharges and by parturition. 
 
 Structure. — The whole uterus is as far as possible fibrous, 
 not composed of fibres alone, but also of veins, arteries, and 
 flesh. Of these, the fibres come from the membranes of the 
 spine, but the arteries and veins from the vena cava and the 
 large artery lying on the spinal column : for two veins spring 
 from the vena cava and two arteries from the large artery, of 
 which one vein and artery run towards each kidney ; but 
 before these enter the kidneys they bifurcate, two branches 
 going to each kidney and two embracing the uterus, so that 
 
SORANUS. 93 
 
 the latter receives four vessels, two arteries and two veins. 
 From these an artery and vein pass to each ovary. 
 
 Ovaries. — The ovaries grow out from the side near the 
 isthmus, about opposite to the middle of the uterus. They are 
 not of firm consistence, are glandular, and are covered with 
 their own membranes. In shape they are, unlike the male 
 organs, long and somewhat flat, and are round and broad at 
 their base. The spermatic vessel from the uterus is carried 
 out of each ovary, and, being placed along the sides of the 
 uterus as far as the bladder, enters into the neck of the latter. 
 Whence it appears that the seed of the female, inasmuch as it 
 is poured out, does not play a part in the production of life. 
 Of this we shall speak when we treat of the seed. There are 
 some, amongst whom is Chius, who say that there are 
 suspensory ligaments for the ovaries, and we have seen the 
 same with our own eyes in a woman suffering from hernia, in 
 whom durmg the operation the ovary fell down through 
 relaxation of the vessels which support and surround it, and 
 with these the suspensory ligament came down. 
 
 Surfaces of the Uterus. — The whole uterus is made up of two 
 coats, which differ in their arrangement like parchment. The 
 outer is more fibrous and smooth, and firm and white ; the 
 inner is more fleshy and villous, and soft and red, intertwined 
 throughout with vessels, which are most numerous and note- 
 worthy over the broadest part of the body, where the seed 
 becomes adherent, and from which the menstrual discharge 
 takes place. These two coats are kept together by softer 
 and more fibrous bands; and, accordingly, when these are 
 stretched the uterus frequently falls down, the fibrous coat 
 remaining in its place, the other one descending inverted. 
 Further, commonly in multiparas the uterus has folds run- 
 ning towards the body, usually two, and closely folded, so as 
 
94 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 to be like felt ; in those who have borne, the whole uterus is 
 stretched out and becomes rounded. Diodes says that there 
 are cotyledons in the cavity of the uterus called irXeKTavat,, or 
 Kepalai, which are nipple-like growths, broad at the base and 
 narrowing to the top ; that they lie on both sides, being 
 devised by Nature for the sake of teaching the embryo to 
 practise beforehand how to draw at the nipples of the breast. 
 But they make anatomy speak falsely, for the cotyledons are 
 not found, and what they say about them is contrary to 
 Nature, as has been proved in treatises on generation. 
 
 Sympathetic Relations of the Uterus. — We must not suppose 
 that the uterus is essential to life, for not only does it fall 
 down, but in some it may be cut away without causing 
 death, as Themiso has recorded, and they say that in Galatia 
 pigs fatten after the uterus is cut out. Nevertheless, it affects 
 sympathetically the stomach and membranes. It has, more- 
 over, a certain sympathetic relation to the mammae. At all 
 events, when it grows larger at puberty the breasts also 
 swell out simultaneously ; and although it brings the seed 
 to perfection, yet the mammte prepare milk for the nourish- 
 ment of the offspring when born, and when the menses flow 
 freely the milk dries up, while as long as the milk comes 
 freely the discharge does not appear ; so also in those past 
 their prime, when the uterus grows smaller the mammas 
 likewise somehow waste away, and when the embryo is 
 diseased their size is reduced ; in fact, when in the pregnant 
 we see the breasts fall away and contract, we anticipate that 
 there will be a miscarriage. So much for the nature of the 
 uterus. 
 
 Vagina. — The female pudenda are also called koXtto^ 
 >yvvaiK€io<;. The wall is fibrous and somewhat rounded, like 
 intestine, more roomy at its inner and narrower at its outer 
 
SORANUS. 95 
 
 end, and in it sexual intercourse takes place. It is attached 
 internally to the cervix uteri, externally to the labia, inferiorly 
 to the breech, laterally to the fleshy parts of the aeetabula, 
 superiorly to the neck of the bladder ; for this last, as we 
 have said, extending beyond the os uteri, and being placed 
 close above the genitals, opens at its end into the urethra. 
 Accordingly, it is evident that the vagina lies beneath the 
 neck of the bladder, but upon the anus and the sphincter 
 and the lowest part of the rectum. Its length, as we have 
 mentioned above, varies not only with age or with sexual 
 intercourse, in which the cervix, being elongated like the 
 male organ, takes up some part of the vagina, but also some 
 have by nature a longer cervix and others a very much 
 shortened one. The length (of the vagina) is in most adults 
 4 inches. It is certainly closed and narrower in virgins, 
 being furnished with folds held together by vessels taking 
 their rise from the uterus ; these cause pain in first sexual 
 intercourse, when the folds are opened out, for they are 
 broken and discharge the blood usually seen. For the view 
 is false that a thin partition -membrane has grown up, 
 barricading the vagina, that this is broken, and causes pain 
 at first sexual intercourse, or sooner when menstruation sets 
 in, and that, grown thicker, it produces the disease called 
 atresia : for, in the first place, it is not found in dissection ; 
 and, in the second place, in virgins it ought to offer resistance 
 to examination with a probe, for the probe penetrates deeply ; 
 in the third j)lace, if the membrane was the cause of pain in 
 intercourse, excessive pain must necessarily accompany the 
 appearance of menstruation, and not be delayed till coitus. 
 Further, if the membranes becoming thick caused atresia, we 
 should find it in the same place constantly, in the same way 
 in which we always see other parts each in its own place. 
 
96 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 But in cases of atresia the obstructing membrane is found 
 at one time near the labia, at others in the middle of the 
 vagina, at others at the os uteri. So much for the vagina. 
 
 External Genitals. — The parts seen outside are called 
 TTTepvydii/jiaTa, forming, as it were, the lips of the vagina. 
 They are thick, fleshj'-, and extending down beside each thigh, 
 as it were, diverging from each other ; above they end in what 
 we call vvfiwr), which is the beginning of the two labia. In 
 Nature this fleshy prominence is muscular, and it is called 
 "nymphe," through its being covered as brides are veiled. 
 Below the clitoris another fleshy prominence lies concealed, 
 which belongs to the neck of the bladder : it is called the 
 urethra, the rough portion forming a fold which is called 
 
 Bladdee. — The female bladder differs from that of the 
 male ; for the former is larger, and has the neck curved ; 
 the latter is smaller, with a straight neck.^ 
 
 Physical Examination of the Pelvic Organs. 
 
 Inspection, palpation and percussion are mentioned by our 
 author. In discussing a case of septicaemia after labour, he 
 says when the belly is percussed it is found to be tympanitic 
 (c. Ivi.). In diagnosing a fibromyoma {/JivXr)) from dropsy, it 
 is pointed out that in the case of the former the tumour does 
 not yield to the pressure of the hand, nor is there a depression 
 formed as in cases of dropsy (on pressure), while the tumour 
 is further distinguished from tympanitis by the absence of 
 the tympanitic sound on percussion, and from dropsy by the 
 absence of a wave of fluctuation on palpation (c. Iviii.). In- 
 
 1 The above translation is by Freeland Barbour, and was published in the 
 Edinhurgh Medical Journal, vol. xxiv., p. "231, 1889. I have not altei'ed his 
 words in any way, altliough there are some passages that I should have been 
 inclined to have translated somewhat differently. 
 
SORANUS. 97 
 
 spection is so frequently referred to that we need give no 
 illustrations. 
 
 Vaginal Examinations. 
 
 In describing the conduct of a labour, our author says : 
 " The midwife should introduce into the vagina the index 
 finger of the left hand, the nail of which has been evenly 
 pared " (c. xxi.), " so as not to lacerate the organs " (c. i.). 
 
 The midwife should introduce into the uterine orifice her 
 finger, which has been covered with grease (c. xvi.). 
 
 Deviations of the uterus may be recognised by introducing 
 the finger into the vagina (c. Iv.). 
 
 The finger is described as being introduced into the uterine 
 cavity to explore it, and to remove any adherent blood-clots 
 (c. Ivi.). Women were accustomed to examine themselves, and 
 in dealmg with the subject of " prevention of conception " we 
 have the following: "To prevent conception, the woman 
 before coitus should smear her cervix with rancid oil, or with 
 honey, or with a decoction of cedar-oil, or she should push 
 into the os a thin strip of lint, or introduce into the vagina 
 an astringent pessary " (c. xvii.). 
 
 Eectal Examination. 
 
 In the differential diagnosis of inflammation of the rectum 
 from peri-uterine inflammation, the author directs that the 
 finger should be introduced into the rectum to aid us in 
 coming to a conclusion (c. Ix.). 
 
 The Position of the Patient. 
 
 During treatment, among the positions mentioned, Soranus 
 alludes to the suspension of the patient head downwards in 
 case of prolapse of the uterus, but is not in favour of it 
 (c. Ixvi.). 
 
 7 
 
98 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 He recommends the foot of the bed to be raised sometimes 
 (c. xlix.), and the patient's legs to be crossed (c. xlix.), while 
 in some forms of dystocia he places the patient on her knees 
 (c. Ixiv,). 
 
 In dealing with a case which he supposes to be peri-uterine 
 inflammation, but which is probably a case of prolapsed 
 ovary or salpingitis, he says that the tumour, which may be 
 felt by a rectal examination, will alter its position if the 
 patient be placed in the knee-elbow position (c. Ix.). 
 
 Therapeutic Agents. 
 Instruments used in Examinations and Operations. 
 
 Speculum. — In cases of haemorrhage from the vulva, we can 
 distinguish the place from which the blood is proceeding with 
 more exactness by using the speculum (c. xlix.). 
 
 Sound. — In plugging the os in case of hsemorrhage, a sound 
 (fi-^Xv, specillum) is to be used (c. xlix.). 
 
 Uterine Dilators. — Uterine dilatation is alluded to in several 
 chapters (c. xlviii.), but the method of dilating by means of 
 sounds is not mentioned. The finger, however, is referred to 
 as a dilator (c. xvi., c. xxi.). 
 
 Catheters. — In dystocia, if there be a stone in the bladder, it 
 should be pushed up towards the fundus of the bladder by a 
 catheter (c. Ixiv.). Catheters for drawing off the urine (c. xvi., 
 c. xxi.), pipes for fumigating the uterus (c. li.), and a cannula 
 for irrigating the uterine cavity (c. Ivi.), are all referred to by 
 our author, but the technique of the latter operation is not 
 described at length. Vaginal and rectal injections are fre- 
 quently mentioned (cc. xlviii., xlix., Ix., Ixiv.). 
 
 Sitz-baths, vapour baths, baths of oil, and the thermce are 
 frequently mentioned by our author in the treatment of his 
 cases (cc. xiv., xv., xvii., xlviii., xlix.). Patients are advised to 
 
SORANUS. 99 
 
 refrain from the bath during the menstrual flow, especially 
 during the first day (c. v.), unless baths are especially ordered 
 by a medical adviser. 
 
 Fumigations. — In describing the various lines of treatment 
 adopted by his predecessors in cases of retention of the 
 secundines, Soranus says : " Strato, pupil of Erasistratus, 
 used to place in a small vessel of silver or bronze, which was 
 closed with a cover made of tin, the following herbs. . . . 
 Having adjusted a small tube to the vessel, the mouth of the 
 tube was placed in the vagina, and the vessel was then gently 
 heated." Our author points out that this treatment may 
 result in the vagina being severely burnt (c. xxii.). 
 
 Fomentations and Cataplasms. — Fomentations were applied 
 by means of flax, wool or sponges ; the latter, after being 
 dipped in hot water or oil, were squeezed, and on being 
 applied were covered by cloths (c. xlviii.). 
 
 Dry heat was applied by means of oval-shaped vessels filled 
 with hot water, or by means of bladders filled with hot oil 
 (c. xlviii.). The cataplasms were made of linseed or of warm 
 flour in small bags (c. xlviii.). 
 
 Bleeding, cupping and leeches are frequently mentioned by 
 Soranus. 
 
 Massage. — In the chapter on the retention of the menstrual 
 fluid, our author says : "If menstruation is absent after an 
 illness, it is the proper thing to massage the uterus, for fric- 
 tion will strengthen this organ " (c. xlviii.). Later on in this 
 chapter he advises exercise and walking and general massage of 
 the body, and particularly recommends massage of the uterus 
 itself. He refers in another place to the massage being per- 
 formed by one specially trained in rubbing (c. xlviii.). 
 
 Pessaries. — The pessary, and less frequently the sup- 
 pository, are mentioned by our author (cc. xlix., Iviii., Ixvi.) ; 
 
 7—2 
 
loo THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 he contents himself with the receipts of but a few, and does 
 not give the long lists to be found in the works of Aetius 
 or Paulus. 
 
 Trochischi, such as were usually used for the rectum, are 
 mentioned in the treatment of erosion of the cervix (c. xlix.). 
 
 Uterine Plugs. — In treating haemorrhage of the uterus, 
 Soranus advises that occasionally some soft linen be soaked 
 in an astringent liquid, and that it should then be inserted by 
 means of a sound into the uterine orifice. Again, he advises 
 that a small sponge, longitudinal in shape, be taken, and, after 
 being soaked in astringents, that it should be deeply inserted 
 through the os uteri in order to form an effectual plug. After 
 a time the sponge should be replaced by another (c. xlix.). 
 
 Vaginal Plugs. — Vaginal plugs made of wool were used to 
 retain the prolapsed uterus (c. Ixvi.), and also to prevent con- 
 ception (c. xvii.). 
 
 The Mechanical Pessary. — In the chapter on prolapse of the 
 uterus (c. Ixvi.), our author says that Diodes was wont to intro- 
 duce into the vagina a pomegranate that had been peeled and 
 soaked in vinegar ; this acted by its astringency, and perhaps 
 in a mechanical way, in helping to prevent prolapse, as we 
 have already seen in the pseudo-Hippocratic work. 
 
 1. Pekitoneum and Connective Tissue. 
 
 Parametritis. — In chapter Ix. of our author's work a descrip- 
 tion is given of inflammation of the uterus, and this description 
 contains passages which evidently refer to pelvic peritonitis and 
 parametritis (^vide Metritis). 
 
 2. Diseases of the Ovaries. 
 
 Hernia of the Ovary. — There are some, amongst whom is 
 Chius, who say that there are suspensory ligaments from the 
 ovaries, and we have seen the same with our own eyes in a 
 
SORANUS. loi 
 
 woman suffering from hernia, in whom during the operation 
 the ovary prolapsed through relaxation of the vessels which 
 support and surround it, and with them the suspensory 
 ligament came down (c. iii.). 
 
 3. Affections of the Uterus. 
 
 (a) Stenosis and Rigidity of the Cervix. — These conditions 
 are mentioned in several passages by our author, and it is 
 probable that he dealt more fully with rigidity in chapter Ixi., 
 which is entitled " On Scirrhus and Indurated Uterine 
 Tumours." A fragment only of the chapter remains, but the 
 paraphrase preserved by Moschion mentions "induration of 
 the cervix." 
 
 In the first chapter on dystocia (c. Ixii.), Soranus says that 
 Diodes Carystius enumerates, as causes of dystocia, " indura- 
 tion of the uterine orifice and its consequent resistance to 
 dilatation," and in chapter xvii. stenosis is put down as a 
 possible source of danger to a woman who is pregnant. In 
 chapter xvi. the midwife is recommended to dilate the uterine 
 orifice with her finger during labour, especially in case of 
 primiparffi, in whom the uterine orifice, composed of muscle, 
 is very tense. In considering the causes of amenorrhoea, 
 Soranus says (c. xlviii.) that the uterus may perhaps be in a 
 condition of atresia, or be affected with callosities, scirrhus 
 or inflammation. Old ulceration may lead to occlusion of the 
 orifice by causing cicatrices, or the occlusion may perhaps be 
 caused by other circumstances, such as long widowhood, etc. 
 In treating these conditions, Soranus points out that any 
 membrane or caruncles about the os which are causing stenosis 
 must be removed, while the callosities and scirrhus must be 
 attacked by an emollient and metasyncritic treatment. 
 
 In speaking of the results of inflammation of the cervix, 
 
I02 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Soranus says that as we see in the case of the eyelids, which 
 after an attack of inflammation become indurated, and have 
 to be treated with acrid remedies so as to restore them, so 
 after inflammation of the cervix there persists an irregularity 
 and a hardness round the mouth of the womb, to cure which 
 it is necessary to make application of a biting (ST^^eco?) nature 
 in order to effect a change in the vitality of the tissues. If, 
 however, the condition is obstinate, then the tissues must be 
 attacked vigorously with white hellebore, and the patient must 
 bathe at the thermae (c. xlviii.)- 
 
 In speaking of a menstrual flow which comes only drop 
 by drop (c. xlviii.), our author says that if the uterine orifice 
 is too small it must be enlarged, but he does not give any 
 directions concerning the technique for dilating the cervix. 
 
 (b) Erosion and Ulceration of the Cervix. — In the chapter 
 on uterine haemorrhage (c. xlix.), Soranus mentions that an 
 erosion which succeeds an ulceration may be the cause of 
 the haemorrhage. Later on in the chapter he alludes to the 
 treatment of erosion of the cervix by means of trochischi, 
 similar to those used for diseases of the rectum. 
 
 Soranus criticises the treatment sometimes adopted by the 
 ancients of applying pessaries of such an irritating nature that 
 they attacked the uterine tissue, producing deep ulcers, which 
 healed with difficulty (c. xlviii.). Ulceration is said to cause 
 atresia of the os through the cicatrix formed by the healing of 
 the ulcer (c. xlviii.). 
 
 In chapter xvii. Soranus mentions, without describing, 
 condylomata and fissures of the mouth of the womb ; while 
 in the chapter on inflammation of the uterus (c. Ix.) he says 
 that a rugose condition of the mouth of the womb is often 
 found in those patients who have suffered from inflammation 
 situated above the cervix. 
 
SORANUS. 103 
 
 (c) Metritis, Perimetritis, Salpingitis. — Chapter Ix. deals 
 with inflammation of the uterus. Soranus opens the chapter 
 by saying that inflammation was called (p^€<yixov^ by the 
 Greeks, the term being derived from (pXeyetv (to burn), and 
 not from (pXey/j,a (mucus), as Democritus supposed. 
 
 The causes of inflammation of the uterus are attributed to 
 chills, fatigue, abortion, and to labours that have been im- 
 properly attended. Sometimes there is a general inflamma- 
 tion of the whole uterus ; at other times it is the mouth, the 
 cervix, the fundus, the superior or inferior parts, or the sides 
 of the womb. Some of the parts may be inflamed ; at other 
 times most of them may be involved. 
 
 The general symptoms are as follows : Fever, pain in the 
 affected region, pulsation of the vessels, hypogastric swelling, 
 heat and dryness of the pudendum, and tension in the gluteal 
 region ; heaviness about the loins, flanks and lower part of the 
 abdomen, and of the groins and thighs ; a feeling of cold, 
 sharp, wandering pains, and torpor of the feet and coldness of 
 the knees, with a sweating of the whole surface of the body. 
 The pulse is small and very rapid, whilst the stomach is 
 affected sympathetically, and the patient's spirits are de- 
 pressed and she becomes faint. There may be headache and 
 pain in the eyes, while the sufferer passes little urine and 
 faeces. Should the mflammation become very intense, then 
 the temperature rises still higher, and the hypogastric swelling 
 may increase ; then follow delirium, chattering of the teeth 
 and convulsive movements. 
 
 The local symptoms are these : If the mouth of the womb 
 is only partially inflamed, it closes with pain, but it is inclined 
 towards the anus, and the tension about the groins and pelvic 
 region is markedly increased. 
 
 If the mouth be not wholly but only partially inflamed, the 
 
I04 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 tension of the same region is somewhat increased, and the 
 part of the cervix affected is painful to the touch, and the 
 part also seems to project out, and to be inclined to the side 
 opposite the side on which the lesion is. If the right side (of 
 the cervix) is inflamed, it deviates to the left ; and if the left 
 side, to the right. The chief point to make out is whether 
 the most acute pain coincides in position with the inflamed 
 area, or whether it is situated on the opposite side, from 
 sympathy. Soranus says that some have maintained that, 
 while the lesion may be on one side, the inguinal and femoral 
 regions of the opposite side are painful ; while Demetrius said 
 that the area of pain corresponded to the inflamed side. 
 Soranus agrees with the opinion that, while pain is felt on 
 the same side as the lesion, it may also cause pain on the 
 opposite side, and that the spot where the pain is felt must 
 be treated. 
 
 If the whole neck of the uterus be inflamed the pains 
 become very severe, and a swelling forms behind the mouth 
 of the womb. When the right side is inflamed the leg on 
 that side becomes affected, and the groin swells ; when the 
 left side is affected the opposite side is the seat of pain, but 
 as the lowest portion of the inflamed parts rests on the first 
 part of the rectum, the passage of the faeces is difficult, and 
 they are retained ; also, there will be a desire on the patient's 
 part to go to stool, but any movement will be attended with 
 pain in the region of the lesion. Should the finger be intro- 
 duced into the rectum, a tumour will be encountered, which 
 will appear as though situated in the rectum itself. If the 
 inflammation be situated in the upper portion (of the cervix), 
 then the symptoms will be painful micturition and pain in the 
 pubic and pectineal regions. Should the whole neck of the 
 womb be affected, then all the above symptoms are present, 
 
SORANUS. 105 
 
 and on account of the greater amount of tumefaction the cervix 
 becomes more prominent in the vagina. 
 
 If the sides of the uterine cavity be inflamed, then there 
 will be pain in the flank corresponding to the lesion, and 
 the pain will be augmented if the patient bends towards the 
 opposite side. 
 
 If the inflammation be situated in the anterior and upper 
 portion of the uterus, the chief pain will be located in the 
 hypogastric region, and there will be a certain amount of 
 swelling, together with painful micturition, or even retention 
 of the urine. When the bladder is emptied, the swelling in 
 this region will be much more easily palpated. 
 
 Should the inflammation be in the posterior and inferior 
 portions of the uterine cavity, then the chief pain will be 
 in the loins, and these pains will be much increased in 
 intensity should the patient bend forward and to the side. A 
 rectal injection is not readily admitted, and we find that the 
 faeces are retained, and that the flatus does not escape ; while 
 if the finger be passed into the rectum it will encounter a 
 swelling, which differs from that met with in inflammation of 
 the rectum, inasmuch as pain does not immediately follow on 
 the introduction of the finger, but only after pressure has 
 been exerted for some little time, for the reason that the 
 tumour recedes (before the finger), thereby allowing the 
 bowel to assume its proper position, and also because the 
 tumour changes its position if the patient is placed on her 
 knees, none of these signs being encountered in inflammation 
 of the rectum. Besides these symptoms, the patient has 
 bearing-down sensations and a feeling of weight about the 
 umbilical region and towards the loins. A rugose condition 
 of the mouth of the womb is often felt in those who suffer 
 from inflammation of the region above the cervix. 
 
io6 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Soranus then proceeds to give the symptoms that denote 
 inflammation of the uterus as a whole, and endeavours to 
 draw up a differential diagnosis between inflammation in the 
 hypogastric region of the abdomen accompanied by swelling, 
 a local peritonitis unaccompanied by swelling, and inflamma- 
 tion of the whole uterus. He then brings the chapter to a 
 close with a consideration of the treatment, which is practically 
 the same as that given in chapter xlviii., where he considers 
 " retention of the menses." Among the means at his dis- 
 posal he mentions hot baths, hot drinks, counter-irritation, 
 cupping, leeches, sitz-baths, fomentations, injections of hot 
 oil and pessaries. 
 
 Chronic Metritis. — In chapter liii. our author, under the 
 heading of " The Debilitated or Atonic Uterus," gives us a 
 description of what is really chronic metritis and endo- 
 metritis. He says that the uterus may get into a debilitated 
 state as well as any other organ in the body. The periods 
 are very profuse, irregular, and often occur three or four 
 times in a month. Abortions or premature births are 
 frequent in these patients. At the menstrual period there 
 is pain in the lower part of the belly, and in the loins and 
 thighs. This condition is liable to come on after repeated 
 pregnancies, or if the uterus has been much distended whilst 
 the woman carried her children. The treatment advocated is 
 a general tonic, one with uterine injections, and the patient is 
 advised to take exercise. 
 
 Chapter Ivi. deals with an accumulation of gas in the 
 uterus. The description of the malady evidently refers to 
 cases of putrid infection and septicaemia following on par- 
 turition. Our author says that it occurs after a labour where 
 the patient gets a chill, which causes the mouth of the uterus 
 to become closed, a clot being by these means formed. After 
 
SORANUS. 107 
 
 giving various symptoms which point to peritonitis, our 
 author deals with the treatment by injections, cataplasms, 
 wet and drj^ cupping, sitz-baths, leeches, purgatives and 
 uterine injections by means of a cannula. He then writes 
 as follows : "If a blood-clot appears to be the cause of the 
 gaseous accumulation the patient should have a sitz-bath, 
 and immediately after the bath the midwife should introduce 
 her finger, which should have been well oiled, into the 
 uterine cavity, and should loosen the clot if one happens to 
 be within reach by moving it gently from the place to which 
 it is adhering, so that it may be removed without injury to 
 the parts. 
 
 Displacements of the Uterus. — The mouth and neck of the 
 womb may assume a position of version or inclination similar 
 to that assumed by crooked fingers, the position being some- 
 times to one side, sometimes to the other, sometimes forward, 
 sometimes backward, or the organ may flee upwards or fall 
 downwards. The deviation may be recognised by introducing 
 the finger into the vagina. Observation has shown that 
 lateral deviation causes pain and numbness on the side 
 corresponding to the deviation. Should the displacement be 
 forward, urination is interfered with, and there is produced a 
 tension in the pelvic region which prevents the patient holding 
 herself upright. Should the displacement be backwards, then 
 defsecation is difficult, and the patient sits with difficulty, and 
 this is especially noticeable when the uterus is inclined 
 towards the anus. 
 
 Little is said of the treatment of these conditions, the 
 chapter being somewhat mutilated, and no mention is made 
 of the mechanical pessary (c. Iv.). 
 
 Fihromyoma of the Uterus. — In chapter Iviii. Soranus gives 
 a description of the mole {fJi'V'^v, /^y^-o?), a description which 
 
io8 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 we believe applies to a fibroid tumour of the womb. We shall 
 deal with this matter fully when considering the description 
 of the mole that Oribasius has left us. 
 
 Prolapse of the Uterus and Hysterectomy. — Prolapsus 
 {irpoirTwcn'i) uteri is called a menace of inversion {eKrpoTrrj) 
 of the womb ; for it is not the case, as some think, that the 
 uterus, being freed from the parts to which it is joined, falls 
 downwards in a body, for a complete prolapsus cannot be 
 restored. Some say that the whole uterus does prolapse 
 after a blow, or some similar cause, the membranes and 
 muscles which retain it becoming ruptured or relaxed, or 
 being affected by loss of tone. Herophilus and the disciples 
 of Hippocrates say that the mouth of the womb alone 
 prolapses ; others say that the whole uterus cannot (pro- 
 lapse), for it could not regain its proper site unless the 
 prolapse were only a partial one ; and, indeed, inflammation 
 of the mouth of the womb can resemble a species of prolapse. 
 Others say that prolapse is produced through inversion, some 
 maintaining that the external coat, others that the internal 
 coat, prolapses. 
 
 Soranus then mentions some other theories about prolapse, 
 and alludes to the diagnosis of inversion. 
 
 Our author says that if we are dealing with a case of 
 complete or partial prolapsus, he does not approve of the 
 treatment adopted by Euryphon of suspending the patient 
 head downwards on a ladder for a day and a night, and of 
 keeping her recumbent after this and giving her cold ptisan 
 to drink. He holds that this suspension is intolerable to the 
 patient, while the drink causes flatulence ; he thinks that it 
 is not the right thing to fix the time for any treatment (as 
 cases vary). Again, he says that Evenor placed beef in the 
 vagina, quite regardless of the fact that the putrefaction would 
 
SORANUS. 109 
 
 bring on ulceration ; whilst Diodes, in the twelfth book of his 
 work on the " Diseases of Women," replaces the womb by 
 forcing into it air by means of a blacksmith's bellows. ^ Then 
 he introduced into the vagina a pomegranate that had been 
 peeled and soaked in vinegar. Irritation of the parts by a 
 bag of hair to cause contraction is alluded to disparagingly, 
 and fumigation is also mentioned ; he also rejects Strato's 
 treatment of filling the vagina with moistened cinders and 
 castoreum. 
 
 In the treatment of a case, our author thinks that the 
 following should be the procedure : The bowels and bladder 
 should be emptied by an enema and catheter respectively, as 
 retention of faeces and urine is common in these cases, because 
 the displaced organ presses on these parts and so narrows the 
 outlets. After this preliminary treatment the patient is placed 
 on her back, the pelvis is elevated, the thighs flexed and 
 separated. The prolapsed parts are then well smeared with 
 hot oil, and a plug of wool the size of the vaginal canal is 
 made ready by tying round it a piece of thread, after which it 
 is dipped in some medicinal substance, such as posca, or warm 
 decoction of myrtle, or mastich, etc. ; then the whole of the 
 prolapsed parts by gentle pressure are borne upwards until 
 the uterus regains its normal position, and the whole of the 
 plug is introduced into the vagina. Then a pad of wool 
 soaked in astringent wine is applied to the vulva, and the 
 abdomen is covered with sponges or wool soaked in vinegar, 
 while bandages encircle the hypogastrium, pubes and loins, 
 and the thighs are crossed one over the other. On the third 
 
 ^ Herrgott, in his translation of Soranus, has qnite misunderstood the text 
 of this passage (and of many others), as the following sentence will show : 
 "Diodes, dans son douzieme li\Te des 'Maladies des femmes,' insuflle dans la 
 matrice prolabee de la poussiere de fer des forgerons et la remet en place " 
 (p. 229). 
 
no THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 day, the plug of wool being still retained in the vagina, the 
 patient should be given a sitz-bath of warm dark astringent 
 wine, after which she should again be placed on her back, the 
 buttocks raised, and the plug carefully removed from the 
 vagina and replaced by another, and a cataplasm should then 
 be placed on the hypogastric region. Three days later the 
 bath is again given and the plug renewed, and the treatment 
 is continued until the patient has improved. 
 
 In those cases in which the uterus remains prolapsed, and 
 is much inflamed and painful, it is better to irrigate it or to 
 apply linseed-meal poultices, and after this preliminary treat- 
 ment to proceed as directed above. If the case should prove 
 very obstinate, local applications are to be persevered with, 
 and the general health is to be attended to. 
 
 Soranus brings this chapter to a close with the following 
 interesting observations. He says that if a portion of the 
 uterus becomes black through the womb having remained 
 prolapsed for a considerable period — and, indeed, it is said 
 that women may reach an extreme old age and yet have 
 a prolapsed uterus — then the remedies that are used in 
 treating serpiginous ulceration are to be employed ; and if 
 the spots do not become healed, then the dark portions are 
 to be resected, for it must be borne in mind that we have 
 indeed resected the lobe of a liver or of a lung which has 
 been gangrenous, following on prolapse of these organs. 
 
 Should the whole uterus become black, then the whole 
 must be resected, this opinion being founded not only on the 
 authority of those whom we have mentioned above, and who 
 say that it can be extirpated without danger, but also because 
 the portion that has become black is no longer an efficient 
 part, but a foreign substance, and not fit to remain. But 
 should the uterus become ulcerated from frequent prolapses, 
 
SORANUS. Ill 
 
 and adhere to the labia, as some have related, it will be 
 necessary in dealing with such a case to incise the adhesions 
 in the same way as adhesions of the intestines with the peri- 
 toneum are incised (c. Ixvi.)- 
 
 Inversion of the Uterus. — Inversion of the uterus is men- 
 tioned by our author in chapter xxii., where he remarks that 
 traction in the cord may produce inversion. 
 
 In the chapter on prolapse of the uterus (c. Ixvi.), Soranus 
 says that in a case of inversion of the whole periphery a 
 rounded tumour is found projecting like an egg, but remaining 
 within the vagina, or else protruding in front of the labia, its 
 tint being at first red, then later on white. 
 
 Diseases op the Vagina. 
 
 Atresia of the vagina is referred to in the chapter on the 
 anatomy of the female organs (c. iii., vide above) ; while 
 imperforate hymen (?) is mentioned (c. xlviii.), and directions 
 are given to incise the membrane if this forms an obstacle to 
 the escape of the menstrual fluid. 
 
 Except the above passages, Soranus hardly alludes to any 
 affections of the vagina. 
 
 Amenorrhcea. 
 
 Soranus opens chapter xlviii. of his work with the ob- 
 servation that among the diseases that ought to be sub- 
 mitted to a dietetic treatment we shall first cite retention of 
 the menses, for the reason that menstrual purgation is the 
 first function of the uterus. Menstruation accompanied by 
 pain (dysmenorrhoea) is to be distinguished from mere sup- 
 pression of the menses. Complete retention denotes the 
 cessation of the menstrual secretion from the uterus ; escape 
 of the fluid drop by drop with pain denotes an obstacle to 
 
112 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 the escape of the secreted fluid. The absence of menstruation 
 is therefore not the same thing as the retention, the latter 
 being always characterized by the absence of the flow ; while, 
 on the other hand, with the absence of the flow is not always 
 conjoined a retention, as we plainly see in the case of young 
 girls and old women and other cases. Therefore it is absurd 
 to class cases as retention of the menstrual flow when there is 
 an absence from the uterus of those fluids which should be 
 secreted there. Menstruation may fail to occur in women 
 who are formed normally, as in those who are abnormal : the 
 total number, therefore, constitutes the genus ; those in whom 
 from one cause or another the flow is hindered are the species. 
 Our author then gives a list of conditions whose chief 
 symptom is amenorrhcea. Among these we may note the 
 youthful, the aged, the pregnant, singers, and those who 
 take much exercise. Other women do not menstruate on 
 account of a diseased condition of the uterus, or of other parts 
 of the body, or of the two combined. Again, there may be 
 atresia of the uterus, callosities, scirrhus, or inflammation ; 
 while ulceration may perhaps occasion an occlusion of the 
 uterine orifice by causing cicatrices. Besides these local 
 conditions, the general state of the health may be bad, and 
 this may lead to absence of the flow, as also may fevers, 
 prolonged sickness, haemorrhage, and bleeding from the 
 stomach and the nose. 
 
 We should, in dealing with any case, inquire carefully 
 about the age of the patient, and whether she is pregnant 
 or not ; in fact, we should carefully weigh all the facts of the 
 case in order to come to a right conclusion as to the cause of 
 the retention, so that we may then set about the treatment in 
 a logical manner. 
 
 In considering the treatment, we must remember that every 
 
SORANUS. 113 
 
 case of amenorrhoea does not require treatment, for in many 
 cases the condition is quite normal. Should the flow be 
 impeded by the hymen, it will be necessary to incise that 
 membrane, and to remove any caruncles which hinder or 
 prevent the escape of the fluid. Should the occlusion (of the 
 os) be produced by callosities, fibrous masses, or an inflam- 
 matory condition, it will be necessary to diminish the in- 
 flammation by the employment of agents which soften and 
 relax the parts. Should the uterine orifice be closed or 
 deviated, it should be restored to the proper position. If our 
 patient is affected by any general condition, such as obesity, 
 fever, or any chronic or acute disease, then these conditions 
 must all be attacked. Should the menses be absent as the 
 result of general debility, then massage of the uterus is the 
 proper treatment, because it strengthens that organ. If, 
 however, we find that a certain amount of astriction and 
 stagnation {aT€\vQ)(n<;) occurs around the uterus itself, and 
 as a consequence we get the menstrual flow only commg drop 
 by drop and accompanied by pain, then we shall find m these 
 cases inguinal, lumbar and pubic pains, also pains in the 
 head, eyes, pelvis and legs, a swelling of the breasts, and an 
 aversion to food. The treatment of these cases of dysmenor- 
 rhcea our author alludes to later on. 
 
 In treating any given case we should proceed as follows : 
 "When the pains commence or when the flow is quite absent, 
 it is necessary to place the patient in a bed slightly warmed 
 and not much exposed to the light, and to keep her there in 
 quiet. Next compress gently the parts of the body in which 
 are situated the pains, for in all parts of the body on which 
 we exert pressure the internal heat diminishes, and the 
 pressure diminishes the sensation of pain. Should, however, 
 the pain not diminish, we must apply fomentation, hot com- 
 
 8 
 
114 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 presses of wool or flax, oval-shaped vessels filled with hot 
 water or bladders filled with hot oil ; or we may apply 
 cataplasms of flour heated in small bags, or sponges which 
 have been soaked in hot water and then squeezed, and covered 
 with cloths so as to prevent rapid cooling of the part. 
 Furthermore, we may apply to the pubes, hypogastrium, 
 loins and the vulva wool which is first soaked in oil and 
 then squeezed. The regions treated should be maintained 
 at an agreeable warmth by the frequent application of heat 
 and by administering hot drinks. 
 
 Besides these remedies, linseed poultices, sitz- baths, 
 pessaries and the douche may be used, and in the intervals 
 of pain the patient should be allowed to sleep. The nourish- 
 ment administered should be warm but simple. 
 
 Should, however, the pains be very intense before the third 
 day has been reached, then the patient should be bathed, after 
 which a sitz-bath may be given, followed by a vaginal injection 
 of oil. 
 
 Should the patient be weakly, instead of bleeding her we 
 may use the dry cup combined with minute punctures, so as 
 to make a superficial scarification over the region where the 
 pain is most intense ; but should the pain be on the decline, 
 then we may puncture the pubic or hypogastric regions. 
 
 Should the patient make but slow progress towards recovery, 
 we may resort to leeches, and if we want an increased effect 
 apply a dry cup over the bites. 
 
 Eectal injections of hot oil may occasionally be called for. 
 The patient having now become convalescent and the 
 menstrual flow having come and gone, we may give her a 
 more liberal diet, and, among other things, we may allow her 
 wine, exercise, general massage, together with special massage 
 to the uterus itself. With regard to this latter subject, 
 
SORANUS. 115 
 
 Soranus says that if during the time the friction is being 
 applied to the uterus with the naked hand the patient ex- 
 perience pain, then the surfaces of the body, including the 
 genital organs, should be sponged, and the friction should be 
 increased in force as the parts become used to it and less 
 tender. In addition to these means, our author directs that 
 medicated oil should be applied to the surface of the body, 
 and also to the mouth and neck of the womb. He also 
 observes that the immersion of the patient in a bath of oil has 
 a very soothing effect. 
 
 The second part of the chapter is devoted to a consideration 
 of scanty menstruation accompanied by dysmenorrhoea, and 
 our author endeavours to show an analogy between scanty 
 menstruation, which comes, as it were, only " drop by drop," 
 and retention of urine by an affected bladder, from which the 
 water comes only drop by drop. Soranus thinks that five 
 causes can be assigned to account for scanty menstruation : 
 the uterme orifice may be too narrow ; there may be a 
 diminution in the (expulsive) force (of the uterus) ; there 
 may be an oversupply of blood ; or, lastly, the fluid may be 
 in a mucous condition, or it may be thick. 
 
 Whatever may be the cause, it is the physician's duty to 
 first ascertain the cause and to correct it. Thus, for instance, 
 if the orifice of the uterus is too narrow, he must enlarge it. 
 When the cause has been found and the proper remedies 
 applied the dysmenorrhoea will disappear. As pains con- 
 stitute the chief symptom, the following treatment is recom- 
 mended to relieve them : Eest in a warm bed at the onset, 
 wrap the hands and feet in bandages, foment the belly, hypo- 
 gastrium and genital parts with warm fluids, and also place 
 on the hypogastrium and pubes pans filled with warm fluid. 
 If the pains persist, bleeding may be resorted to if the patient 
 
 8—2 
 
ii6 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 be strong ; should the pains still continue, linseed-meal 
 poultices with turpentine may be employed, or sitz-baths, 
 and at the same time the genitals should be sponged. Vaginal 
 injections may also be tried. Should the case prove obstinate, 
 we may resort to dry cupping over the belly and groins ; and 
 should this not succeed, we may try wet cupping, leeches and 
 counter-irritants. 
 
 Menoerhagia. 
 
 Soranus opens chapter xlix. with the statement that a 
 difficult labour, an abortion, an erosion that has resulted 
 from an ulceration of the cervix, a dilatation of the mouth, or 
 a rupture of any bloodvessels, may be considered in the 
 etiology of menorrhagia. He points out that haemorrhage 
 from a uterus or vagina is really dangerous, because it cannot 
 be arrested by digital pressure or by picking up the bleeding 
 vessel with the surgical hook, nor by the mere compression of 
 tampons, nor by ligatures or sutures. 
 
 In order to better determine whether the blood is coming 
 from the uterus or vagina, it is well to examine the patient 
 by means of the speculum. The treatment for menorrhagia 
 is as follows : The patient is placed in bed, the foot of which 
 is elevated, and her thighs are crossed ; cold sponges are 
 applied to the pubic region and the vulva, and a cold sitz- 
 bath may be given. If these means fail to relieve, then try a 
 vaginal douche, and if the haemorrhage still continues, then it 
 will be necessary to plug the uterus by means of a probe and 
 medicated lint ; or a small sponge may be taken, oblong in 
 shape, and introduced as far as possible into the uterus, so 
 that it may suck up the blood poured forth, and so prevent 
 clots forming, thereby helping to prevent inflammation. 
 Cupping-glasses may also be applied to the legs, groins, belly 
 
SORANUS. 117 
 
 or vulva. In other cases pessaries may be used, and when we 
 are deahng with a cervix that is eroded we may use supposi- 
 tories similar to those used for the bowel. 
 
 Leucorrhcea. 
 
 Leucorrhcea is dealt with by Soranus in chapter 1., but as it 
 contains nothing of special interest we shall not consider the 
 matter here. 
 
 Writers on Gynecology referred to by Soranus. 
 
 Alexander Philalethes. — A Greek physician, who has been 
 called by Octavius Horatianus, himself a writer on gynoecology, 
 " Alexander Amator Veri." He lived at the end of the first 
 century e.g., and was a pupil of Asclepiades. He is mentioned 
 by Galen, and in two places by Soranus (cc. xlvii., 1.). He was 
 evidently a writer on gynaecology, for Soranus says : u>i' AX'i^avhpoi 
 b <j}iXaXyid7]i sv rta irpuirw Xtyti ruv yvvaixiiuv (c. 1.). 
 
 Apollonius Mus was a follower of Herophilus, and lived in the 
 first century B.C., being a contemporary of Strabo. Soranus 
 mentions him as one of those who opposed the idea of " propriae 
 affectiones mulierum " (c. xlvii.). 
 
 Apollonius Prusieus. — Soranus alludes to this author as one 
 who advocated that when the secundines were retained, the 
 " partem prominentem esse apprehendendum atque ita extra- 
 hendum."^ Nothing is, however, known of his life or bis 
 writings. 
 
 Asclepiades. — This being the name of several physicians, the 
 particular one alluded to cannot be ascertained ; possibly the 
 right one may be Asclepiades Bithynus, who lived at Eome at 
 the beginning of the first century e.g., and to whom we have 
 already alluded. Soranus refers to him in several chapters, and 
 mentions his classification of the "flux "thus, " altera enim rubra 
 est, altera aquosa et alba" (c. 1.). He also mentions his treat- 
 ment of uterine suffocation (c. li.). 
 
 Athenio Erasistrateus is mentioned in chapter xlvii. with re- 
 ference to his views on "propriae affectiones mulierum." He 
 maintained that there were special diseases of females. 
 
 ^ Appreliendendam (?), extrahendam (?). 
 
ii8 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Ghius. — Of this writer we know nothing. Soranus mentions 
 that Chius believed that the ovary had suspensory ligaments, 
 and Soranus refers to a ease of hernia of the ovary, that he him- 
 self had seen operated on, in support of the views of Chius (c. iii.). 
 
 Cleophantus. — A Greek physician of this name lived at the 
 beginning of the third century B.C., and is quoted by Pliny and 
 Celsus. If this was the writer alluded to by Soranus in chapter 
 Ixii., he must have written on gynaecology, for Soranus refers to 
 his eleventh book " On the Diseases of "Women." 
 
 Demetrius Apameus. — This writer, as his name implies, was a 
 native of Apamea in Bithynia, and was a follower of Herophilus. 
 He lived probably in the third or second century b.c. Soranus 
 mentions him in several places, and alludes to his views con- 
 cerning pelvic pain in cases of inflammation of the uterus (c. Ix.). 
 
 Demetrius Herophileus. — This writer may be identical with the 
 previous one, or he may be the author quoted by Heraclides. 
 Soranus alludes to his views on the female flux and on difficult 
 labour (c. Ixii.). 
 
 Dio. — Of this writer nothing is known. Our author merely 
 mentions that in cases of retention of the secundines Dio had 
 resource to draughts which contained, among other ingredients, 
 sage and myrrh. 
 
 Diodes Carystius. — This writer lived in the fourth century B.C., 
 not long after the time of Hippocrates. He was in his day held 
 in high estimation. He wrote several works, which we do not 
 possess, but his famous letter to King Antigonus, " On Pre- 
 serving Health," has been handed down to us in the works of 
 Paulus. Soranus alludes to him in several places, and in 
 chapter Ixvi., which deals with prolapsus uteri, he quotes from 
 Diodes' twelfth book " On the Diseases of Women." 
 
 Evenor. — This writer may have been the Greek surgeon men- 
 tioned by Heraclides. If so, he lived in or before the third 
 century b.c. He is mentioned by Soranus as having placed 
 " carnem bubulam in pudendum muliebri " in treating prolapse of 
 the uterus (c. Ixvi.). 
 
 Euryphon Cnidius was a celebrated physician who lived in the 
 first half of the fifth century b.c, and was a contemporary of 
 Hippocrates. He is supposed by Ermerins to have been the 
 author of the spurious Hippocratic work " De Natura Muhebri." 
 Soranus alludes to his treatment of suspending women by the 
 feet to a ladder in treating prolapsus uteri (c. Ixvi.). 
 
SORANUS. 119 
 
 Hero is a writer about whom we know nothing. He is 
 mentioned by our author in reference to the conduct of a labour 
 (c. xxi.). 
 
 Herophihts. — This author was one of the most celebrated 
 practitioners of antiquity, and his name is inseparably connected 
 with anatomy. He was a native of Chalcedon, and lived in the 
 fourth or third century b.c. He is said to have vivisected 
 600 criminals, and, according to Galen, he was well acquainted 
 with the anatomy of the uterus, though he does not appear to 
 have recognised the Fallopian tubes. Soranus alludes to him 
 as the author of a work on obstetrics (c. xlvii.), and he quotes his 
 views in several places (c. Ixvi.), and he is probably indebted to 
 him for much of his chapter on " The Anatomy of the Womb " 
 (c. iii.). 
 
 Hippocrates. — The genuine works as well as the spurious works 
 on gynaecology of Hippocrates are quoted by Soranus. 
 
 Mantius was the tutor of Heraclides of Tarentum, and lived in 
 the third century b.c. Soranus quotes his practice of tying a 
 weight to the cord in order to detach the after-birth (c. xxii.). 
 
 Miltiacles Elczusius. — Soranus says that this author was among 
 those who considered that there were diseases peculiar to women 
 (c. xlvii.). 
 
 Mnaseas lived in the first century a.d. Soranus quotes his view 
 on menstruation (c. vi.). 
 
 Moschion. — Of this writer we know nothing. He is not for 
 a moment to be confused with Moschion the abbreviator of 
 Soranus. He is quoted by our author in reference to lactation 
 (c. xxxiii.). 
 
 Paris. — This writer's views are quoted on lactation. We know 
 nothing of his life. 
 
 Si7no)i Magnes was a physician of Magnesia, whose name is 
 mentioned by Herophilus, from whom Soranus takes his informa- 
 tion with regard to some facts about difficult labour (c. Ixii.). He 
 lived about the same time as Herophilus, or before him. 
 
 Sostratus. — This may have been a surgeon of Alexandria, 
 mentioned by Celsus, and who lived in the third century B.C. 
 Sprengel says that he was a lithotomist, and in a passage quoted 
 by Soranus he alludes to his manoeuvre of introducing the finger 
 into the rectum (as in the extraction of a calculus from the bladder) 
 in dealing with a case of difficult labour (c. Ixv.). 
 
 Strata Erasistrateus. — This writer was a pupil of Erasistratus 
 
I20 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 in the third century B.C. He wrote a work to explain the difficult 
 words in the writings of Hippocrates. Soranus describes his 
 method of fumigating the uterus (c. xxii.), and later on condemns 
 his treatment of filling up the vagina with moistened ashes in 
 cases of prolapse of the uterus (c. Ixvi.). 
 
 Themison. — The physician alluded to by our author was pro- 
 bably Themison the originator of the Methodici. He lived 
 probably in the first century B.C. He is said to have been the 
 first physician who made use of leeches. Soranus quotes him 
 in several passages, the most interesting being in reference to 
 hysterectomy: " Non solum enim prolabitur, sed in nonnullis 
 etiam resecatur, nee tamen resectus mortem adfert, sicuti obser- 
 vavit Themiso " (c. iii.). 
 
 Thessalus lived in Eome during the reign of Nero, a.d. 54-68. 
 He was one of the founders of the sect of the Methodici. Soranus 
 quotes his treatment of prolapse of the uterus (c. Ixvi.). 
 
CHAPTER X. 
 
 THE MEDICAL PEOFESSION IN ROME. 
 
 Before passing on to examine the works of Aretseus and 
 Galen, we shall pause for a moment to glance at the advances 
 that had been made in general medical science and the growth 
 of specialities, including gynaecology, among the Eoman people 
 at the end of the first century a.d. 
 
 Italy 600 years before the days of the Csesars consisted 
 of a number of rival States, which gradually became sub- 
 jected, and then amalgamated, to form part of the Eoman 
 Empire. The arts and sciences had slowly become cultivated, 
 and ultimately medicine had grown in favour. From super- 
 stitious rites and ceremonies, entirely in the hands of the 
 priests, it had slowly emerged under the guidance of ex- 
 patriated Greeks, and had in time come to be regarded as a 
 necessary part of the advanced civilization of the Eoman 
 people. 
 
 "We have already noticed the advent of Archagathus, 
 Asclepiades and Themison to Eome, and we have in addition 
 to note that, following on the Punic wars, Eome became the 
 centre to which every adventurer, scholar or charlatan gravi- 
 tated, in the hope that he might palm oflf his knowledge on a 
 people now ready to adopt new ideas, whether in knowledge, 
 vice, pleasure or science. Puschmann well remarks : " "When 
 
122 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 the medical art of the Greeks was transplanted to Eome, 
 medical teaching became possessed of material borrowed from 
 the rich medical literature of the Greeks, and also assumed 
 the external form which it had in Greece. The Greek doctors 
 who had migrated to Eome there acted as teachers of their 
 art, and introduced the regulations of their home. As in 
 Greece, so also in Eome : the practice of medicine was a free 
 profession, which everyone who thought he possessed the 
 necessary ability was at liberty to carry on." 
 
 To the Greeks, then, Eome owed her medicine. The Greek 
 language was studied, and the Greek medical writers were 
 widely read in order that the Eoman doctors might compete 
 successfully with the Greek emigrants. Professional medicine 
 in Eome from the first century a.d. was henceforth to be 
 Greek medicine transferred to its new home, and this Hellenic 
 influence was destined to continue for the next six centuries. 
 
 With regard to the actual practice of medicine, we find the 
 wealthy and those who were too ill to leave their beds being 
 visited by the medical man, accompanied by a troop of pupils 
 and assistants. This custom has been dealt with by Martial 
 in his epigram to Symmachus : 
 
 " I droop'd ; straight Symmachus to me does hie, 
 An hundred quacks bearing him company ; 
 An hundred frozen hands my pulse did crave ; 
 Before I had no ague, now I have." 
 
 Patients were also seen at the latreia, which were the town- 
 houses or dispensaries of the doctors. Here they were treated 
 and operated on, and here occasionally patients resided. 
 Hospitals did not, however, exist at this time, though we 
 know that buildings were erected at the temple of Asclepius 
 at Epidaurus to receive cases of sudden illness (such as 
 women in labour), lest the temple itself should be defiled by 
 the birth of the child. 
 
THE MEDICAL PROFESSION IN ROME. 123 
 
 It was during these first years of the Augustan period that 
 specialism became very common. It had become common 
 enough in Egypt ages before, but it now developed afresh, 
 because the Eoman doctors found that they were unable, 
 and perhaps unwilling, to acquire a full knowledge of every 
 branch of medicine, and so they sought to cloak their 
 ignorance by pretending to a knowledge of an individual 
 subject. This could only lead to great errors, and it soon 
 brought medicine into deserved contempt. Martial ridicules 
 this state of things in the following epigram, addressed to 
 Gallus •} 
 
 " Gallus, thou'dst have me thee attend alway, 
 To pass th' Aventine three, four times a day. 
 Cascellms remedies to the teeth applies, 
 Hyginus to all evils of the eyes ; 
 Fannius defluxions of all sorts can stay, 
 Eros the scars of branding clear away ; 
 Hermes inveterate ruptures will insure : 
 Hast thou the skill a broken State to cure 1" 
 
 We are not surprised to find that among the specialties 
 gynaecology had a prominent position, and the gynsecolo- 
 gists were called larpol yvvaiKetoc. While gynaecology was 
 practised by physicians, it is quite evident that midwives 
 frequently attended to the simpler diseases peculiar to women, 
 and in some instances they wrote treatises on gynaecology. 
 Nor could this be regarded as an innovation, for as far back 
 as the time of Hyginus we find one Agnodice, a midwife of 
 Athens, disguising herself in man's attire so that she might 
 attend lectures in medicine and the diseases of women, and 
 after a course of instruction she practised as a gynaecologist. 
 As it was contrary to the Athenian law, she was prosecuted, 
 but she was saved by the wives of some of the chief men of 
 Athens coming forward on her behalf. Besides Agnodice, we 
 
 1 Martial, Book X., 56. 
 
124 '^HE HISTORY OF ANCIENT GYNECOLOGY. 
 
 have Sotira, who wrote a work on menstruation, which is pre- 
 served in the Library of Florence ; also Lais and Elephantis, 
 who wrote on abortion and the diseases of women. Salpe, 
 a native of Lemnos, was also a writer on gynaecology ; while 
 Aspasia is mentioned by Aetius as the author of several of his 
 chapters in the work that we shall examine later on. 
 
 We have seen that Hippocrates refers to midwives practising 
 as gynecologists, while we have already given a quotation 
 from the work of Hippolytus on the same subject. 
 
 We also know that women studied medicine systematically 
 during the Eoman period, and these were called femince 
 mediae. These also doubtless enjoyed a considerable gynae- 
 cological practice. Martial alludes to them in his epigram to 
 Leda (B. XI., 71), while other writers of the period refer to 
 the medicce, occasionally in anything but complimentary 
 terms, and class them among the abortionists. Later on in 
 the fourth century Theodorus Priscianus, who wrote a treatise 
 on medicine in four books, the third book of which is devoted 
 to gynaecology, dedicated this third volume to one "Victoria, 
 the gentle servant of my art" {artis mece didce ministerium) . 
 Melanie Lepinska has recently written on the subject of 
 " Les Femmes Medecins a Eome,"^ to show that the medicce 
 are not to be confounded with the midwives. She says : 
 "Mais les recueils d'archeologie sont une veritable mine de 
 documents relatifs a I'existence des femmes me'decins k Eome. 
 Dans la capitale, en Italie, en France, dans la P^ninsule 
 iberique, les inscriptions fun^raires des medicas ont ete 
 signages. Ces collections d'inscriptions lapidaires tdmoign- 
 ent nettement que la m^decine etait exerc6e par des femmes 
 qu'il ne faut pas confondre avec les ornatrices ou avec les 
 
 1 "Les Femmes Medecins h Rome," par Mdlle. Melauie Lepinska (Le Frogrds 
 Midical, 29 Avril, 1899). 
 
THE MEDICAL PROFESSION IN ROME. 125 
 
 accoucheuses designees sur plusieurs monuments par le nom 
 d'ohstetrices. Les monuments epigraphiques sont d'une si 
 minutieuse exactitude lorsqu'ils mentionnent les professions, 
 qu'il est difficile d'admettre qu'on ait confondu la femme 
 m^decin avec I'accoucheuse." 
 
 It now only remains to us to mention some of the more 
 important operations and the instruments employed in 
 executing them, in order to have some idea of the stage to 
 which operative surgery and gynaecology had advanced at 
 this period. 
 
 The surgeons of the Alexandrian schools having had every 
 opportunity of studying anatomy, and having been familiar 
 with the positions of the organs of the body from vivisection, 
 gave the first real impulse to operative surgery. 
 
 The surgeons of Eome frequently travelled to Alexandria 
 to study in the schools, especially if they desired to become 
 specialists, and there they could with ease acquire a fair 
 knowledge of anatomy. 
 
 The first real advance in surgery was made when the 
 ligature was introduced to control the haemorrhage from the 
 severed vessels during an operation, and we know that the 
 vessels had been sufficiently well studied to distinguish the 
 arteries from the veins. Celsus (B. V., c. xxvi.) is one of the 
 first writers to allude to the ligature, but he does not mention 
 the material of which it was composed. Speaking of haemor- 
 rhage from a wound, he directs that if pressure or astringents 
 fail to arrest the bleeding, then the vessels from which blood 
 is coming must be seized (vence apprehendcnda;) , and a double 
 ligature is to be passed round the vessel and tied, and an 
 incision is then to be made between the ligatures. Somewhat 
 later Heliodorus and Galen describe torsion of the small 
 vessels, after having seized them with a hook. The ligature 
 
126 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 may be said to have reached the acme of its fame in ancient 
 days when the brilHant Antyllus (350 a.d.) employed it in his 
 well-known operation for aneurysm. 
 
 The ligature being in daily use, operations that may have 
 been suggested long before this period were now attempted, 
 and accordingly we find that such extensive procedures as 
 resection of the whole humerus and removal of the inferior 
 maxilla were now carried out. 
 
 Heliodorus, a contemporary of Juvenal, appears to have 
 practised amputation by the flap method, while plastic 
 surgery was everywhere in vogue. Tracheotomy and opera- 
 tions for curing cataract were attempted with success, while 
 lithotomy and lithotrity were common operations in the hands 
 of specialists. An abscess of the liver would be opened if 
 diagnosed, and the radical cure for hernia and for stricture of 
 the urethra was not uncommon ; while specialists operated 
 on the female genital organs, removing small growths from 
 the cervix, sometimes attempting hysterectomy, and perform- 
 ing plastic operations in cases of atresia and other conditions, 
 for the speculum vaginae was in use before the year 79 a.d., in 
 which year Herculaneum and Pompeii were destroyed, for in 
 the ruins of these cities a three-bladed speculum was dis- 
 covered in the beginning of this century. In obstetrical cases, 
 when the necessity arose, the child was removed by the opera- 
 tion of embryotomy, and Caesarean section was occasionally 
 practised. 
 
 Of the instruments in use we take the following list from 
 Puschmann : Straight and curved needles, probes of various 
 kinds, hollow sounds, curved and toothed forceps, catheters 
 with a gentle S-shaped curve, several forms of clips — among 
 them some with clasps and slides — conical and spheroidal 
 cupping instruments, sharp and blunt hooks, pronged and 
 
THE MEDICAL PROFESSION IN ROME. 127 
 
 disc-shaped cauteries, knives, spatula3, lancets, bistouries, 
 rectal and vaginal specula. Of the specula, some were in 
 one piece, some in two or three. In the year 1882 one of 
 four parts was found. It was composed of two straight and 
 two S-shaped branches. 
 
 With regard to the probe, or specillum, which we shall find 
 mentioned frequently in the gynaecological works that we 
 shall examine, we may note that the specillum (/ttt/Xi;) is 
 reputed by Cicero to have been invented by the Arcadian 
 Apollo, who also was the first to bind up a wound. Seven 
 varieties are figured in the work of Professor Vulpes in one 
 plate, with ends obtuse, spoon- shaped, flat and oval, flat and 
 square, flat and divided.^ 
 
 1 Berdoe, "The Origin and Growth of the Healing Ai-t," j). 245. 
 
CHAPTEE XI. 
 
 AEET^US. 
 
 Aret^us the Cappadocian, as it is usual to style him, has by 
 his work on " Acute and Chronic Diseases " earned for him- 
 self a lasting reputation among the writers of ancient 
 medicine. English readers are fortunate in having a most 
 excellent edition of his works published by the Sydenham 
 Society, from the translation made by the learned Francis W. 
 Adams, one of the few English physicians who has earned 
 a world-wide reputation for classical knowledge. We shall 
 chiefly rely on Adams for the short account we are about to 
 give of this author. 
 
 Nothing definite can be determined respecting the age in 
 which Aretseus flourished, beyond a probable approximation to 
 the period. The fact that Galen does not mention Aretaeus 
 would imply either that Aretaeus was a contemporary or that 
 he flourished at a later period. If our author did live at a 
 later period, why do we find no reference in his works to 
 Galen, who had written at length on the same subject, and 
 who was facile princejis as a medical authority ? The probable 
 explanation, as Adams points out, is that while in the days 
 of Horace, Virgil and Ovid authors mentioned each other in 
 terms of the greatest kindness, yet in the age of Quintilian, 
 
ARET^US. 129 
 
 who lived but a short time before Galen, contemporary 
 writers did not notice one another by name. A good example 
 of this neglect is to be found in the case of Dioscorides and 
 the elder Pliny, who take not the slightest notice of each 
 other, though both handled the same subjects. Adams says : 
 ** I am clearly of opinion, from my long familiarity with the 
 works of Galen and Aret?eus, that one can decidedly detect a 
 corresponding coincidence between the literary and professional 
 views of these authors. Both had chosen Hippocrates for 
 their model, and had their minds thoroughly imbued with his 
 opinions. . . . Both display a great acquaintance with sphyg- 
 mology, and use the identical terms in describing the varied 
 conditions of the arterial pulse. Both possess a more intimate 
 knowledge of anatomy than any of the authorities on ancient 
 medicine." 
 
 Since Galen was born a.d. 131, we may take it for granted 
 that Aretseus flourished about the middle of the second 
 century of the Christian era. 
 
 He wrote on Fevers, Surgery and Pharmacy, and on 
 Acute and Chronic Diseases, the latter being the only work 
 that has come down to us. Scattered through its pages are 
 some observations on the diseases of women, and also some 
 remarks on abdominal cases. Thus, in the second book of 
 " Chronic Diseases," chapter i., we have the following inter- 
 esting passage : " This other form of dropsy is known ; small 
 and numerous bladders full of fluid are contained in the place 
 where ascites is found. But they also float in a copious fluid, 
 of which this is a proof : for if you perforate the abdomen so 
 as to evacuate! the fluid, after a small discharge of the fluid a 
 bladder within will block up the passage ; but if you push the 
 instrument farther in the discharge will be renewed. It is 
 said, however, that in certain cases such bladders have come 
 
 9 
 
I30 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 out by the bowels." This is, of course, a description of 
 hydatid cysts of the abdomen with daughter cells. 
 
 Our author also gives a description of an operation for 
 abscess of the liver. 
 
 We shall now proceed to the passages bearing on gynaecology 
 to be found in this work of Aretseus. 
 
 " Chronic Diseases," B. II., c. xi. : On Affections of 
 THE Womb, or Hysterics. 
 
 The uterus in women is benefited by purgation and par- 
 turition, but it is the common source of innumerable and bad 
 diseases : for not only is it subject to ulcers, inflammation, 
 and the fluor, but if the whole organ be suddenly carried 
 upwards it quickly causes death. . . . The chronic affections 
 are the two species of fluor ; hardness ; ulcers, part mild, 
 but part malignant ; prolapsus of the whole or of part. 
 
 Then follows a description of the red and white fluor. 
 After this the writer says : 
 
 Ulcers are formed in the womb, some broad and attended 
 with tingling, which being close together are, as it were, a 
 superficial excoriation ; pus thick, without smell, scanty. 
 These ulcers are mild ; but there are others deeper and 
 worse than these, in which the pains are slight, pus some- 
 what more abundant, much more fetid, and yet, notwith- 
 standing, these also are mild. But if they become deeper, 
 and the lips of the sores hard or rough — if there is a fetid 
 ichor and pain stronger than in the former case — the ulcer 
 corrodes the uterus ; but sometimes a piece of flesh is cast 
 off and discharged, and the sore, not coming to cicatrization, 
 either proves fatal after a long time or becomes very chronic. 
 The sore gets the appellation of phagedsena. The sores also 
 
ARET^US. 
 
 131 
 
 are dangerous if in these cases the pain gets accelerated and 
 the woman becomes uneasy. From the sore there is dis- 
 charged putrid matter, intolerable even to themselves ; it is 
 exasperated by touching and by medicines, and irritated by 
 almost any mode of treatment. The veins in the uterus are 
 swelled up with distension of the surrounding parts. To the 
 skilled it is not difficult to recognise by the touch, for it is 
 not otherwise obvious. Febrile heat, general restlessness, and 
 hardness is present, as in malignant diseases ; the ulcers, 
 being of a fatal nature, obtain also the appellation of cancers. 
 Another cancer, no ulceration anywhere, swelling hard and 
 intractable, which distends the whole uterus ; but there are 
 pains also in the other parts where it drags to it. Both these 
 carcinomatous sores are chronic and deadly, but the ulcerated 
 is worse than the unulcerated, both in smell and pains, in life 
 and in death. 
 
 Sometimes the whole uterus is protruded from its seat and 
 lodged between the woman's thighs — an incredible affliction. 
 Yet neither has the uterus not been thus seen, nor are the 
 causes which produce it such as do not occur. For the mem- 
 branes which are inserted into the flanks, being the nervous 
 (ligamentous ?) supporters of the uterus, are relaxed ; those 
 of the fundus, which are inserted into the loins, are narrow ; 
 but those at its neck, in each side to the flanks, are par- 
 ticularly nervous and broad, like the sails of a ship. All 
 these then give way if the uterus protrude outwardly, where- 
 fore the procidentia generally proves fatal : for it takes place 
 from abortion, great concussions, and laborious parturition. 
 Or if it do not prove fatal, the \vomen live for a long time, 
 seeing parts which ought not to be seen, and nursing externally 
 and fondling the womb. . . . Sometimes the mouth of the 
 womb only, as far as its neck, protrudes, and retreats 
 
 9—2 
 
132 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 inwardly, if the uterus be made to smell to a fetid fumigation, 
 and the woman also attracts it if she smells fragrant odours. 
 But by the hands of the midwife it readily returns inwards 
 when gently pressed and if anointed beforehand with the 
 emollient plaster for the wound. 
 
 B. II., c. i., is devoted to the consideration of Dropsy. The 
 writer remarks that sometimes the dropsy forms in small 
 spaces, such as the head in hydrocephalus, or in the lungs, 
 liver or spleen, or in the womb ; and, in regard to the latter, 
 if the mouth of the womb relax at all, it discharges the fluid 
 outwardly. 
 
 "Acute Diseases," B. II., c. ix. — In this chapter there are 
 some remarks on the treatment of hysterical convulsions, the 
 use of uterine injections, vaginal pessaries, the abdominal 
 binder, dry cupping over the loins, bleeding from the pubic 
 vein, the sitz-bath, and reference to some therapeutic agents. 
 
 In B. II., c. xi., of " Acute Diseases " there are some 
 remarks on so-called hysterical suffocation, in which the 
 influence of Hippocrates' teaching is plainly seen. 
 
CHAPTER XII. 
 
 GALEN. 
 
 Claudius Galenus was born at Pergamus, in Mysia, a.d. 130. 
 His father was a well-read man, and destined his son for a 
 philosopher, and from him Galen received his first instruction. 
 In his seventeenth year he began to study medicine, and 
 visited, among other places, the medical schools of Alexandria; 
 and on returning to his native city he was, at the age of 
 twenty-nine, appointed medical attendant to the School of 
 Gladiators. Five years later he visited Eome, where he met 
 with great success as a physician, though he seems to have 
 incurred the envy of his brother - practitioners. Leaving 
 Eome, he returned to his native city ; but he was soon 
 summoned back to attend the Emperor M. Aurelius, where- 
 upon he settled there, and began teaching, practising, and 
 composmg his various works. It was during this period that 
 he wrote his celebrated treatise " De Usu Partium Corporis 
 Humani," the fourteenth book of which deals with the genital 
 organs of women. 
 
 The date of Galen's death is not known for certain ; it 
 probably took place about a.d. 200. 
 
 The influence that Galen has had on medical science has 
 been greater than that exercised by any other writer. 
 Hippocrates, the father of medicine, left an undying name. 
 
134 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 and no writer is more respected for his genius; but the 
 range of his genuine works was limited. Galen, on the 
 other hand, was one of the most prolific writers that ever 
 lived. He is said to have composed at least 400 distinct 
 treatises, and, as these deal with every branch of medicme, 
 his works were for centuries the standard authorities on all 
 things medical. This influence was kept alive, when other 
 writers were forgotten, through the high estimation in which 
 Galen was held by the Arabic writers, whose compilations and 
 translations were the chief medical works of reference from 
 the seventh century up to the period of the Eenaissance, and 
 even after. Of the many treatises composed by Galen, about 
 eighty-three are admitted as genuine, nineteen are doubtful, 
 forty-five spurious. Besides these there are some eighty-five 
 which consist of commentaries, fragments, and short pieces. 
 
 Amidst this wealth of ancient learning, we look in vain for 
 additions to gynaecology. Our author has left no systematic 
 treatise on this subject ; but, as it would have been impos- 
 sible for a writer whose works are so encyclopaedic to have 
 entirely neglected this branch of medicine, we accordingly find 
 scattered throughout his various writings remarks concerning 
 the diseases peculiar to women. These, however, generally 
 display such a superficial knowledge of the subject, and are 
 so wanting in detail, that they are of little use for our present 
 history. 
 
 Among the authentic works that Galen has left us is the 
 one entitled " De Usu Partium Corporis Humani," in seven- 
 teen books ; the fourteenth book is devoted to the genital 
 organs. 
 
 This work contains little of interest from a gynaecological 
 point of view. It is really devoted to the physiology of the 
 genital organs, and Galen, like other ancient authors, sought 
 
GALEN. 135 
 
 to eetablish an analogy between the male and female parts of 
 the genital organs. 
 
 In the eleventh chapter of this work he says that the canal 
 of the uterus that receives the sperm of the male is called the 
 neck, and it opens into the vagina. The cornua are for con- 
 ducting the sperm of the female's testicles ; these horns are 
 turned towards the iliac fossae, and growing gradually attenu- 
 ated, they terminate by the extremities becoming very 
 narrow, each being attached to an ovary (/ca^' eavra Bihv/xo)) 
 situated on either side. 
 
 The work entitled "De Locis Affectis," in six books, is 
 perhaps the one which is held in highest esteem of all that 
 Galen has left us. The fifth chapter of the sixth book is 
 devoted to affections of the genital organs of woman. The 
 greater part of the chapter is taken up with the subject of 
 hysteria. 
 
 Our author seeks to explain that the various displacements 
 of the womb are due to the retention of the menses, which 
 causes a congestion of the ligaments. Should the ligaments 
 on both sides of the uterus be equally affected, then the uterus 
 may be displaced, but without any deviation ; but if one side 
 is affected more than the other, then the forces become un- 
 equal, and the tension on one side being more than on the 
 other, deviation of the uterus follows. 
 
 If the menses are suppressed we may get various results. 
 Should the patient, among other symptoms, have nausea and 
 a deranged appetite, the midwife must examine the neck of 
 the womb with her finger, and if she finds it closed, but with- 
 out being hard, then this is a sign that the patient is preg- 
 nant. When the mouth of the womb is closed, and the neck 
 is at the same time hard to the touch, this points to the 
 uterus being diseased, and the midwife must then make a 
 
136 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 careful examination, by touch, to find out towards which part 
 the uterus is inclined or displaced ; for it will be there that 
 the uterine disease will be found. 
 
 In some eases there will be pain and bearing down on the 
 affected side, the pain affecting also the hip region, while 
 the patient will limp with the leg of the affected side in 
 walking. 
 
 When the menstrual suppression lasts for some consider- 
 able time, and no flow whatever occurs, sometimes a swelling 
 will form in the flank, which is a sign to indicate inflamma- 
 tion in the deep parts. In other cases an abscess forms at 
 the inferior extremity of the flank (anal region ?), similar to 
 the abscess that forms in men in that region. Sometimes 
 the swelling described above suppurates and calls for an 
 incision (pelvic abscess after cellulitis?). Galen remarks 
 that he has known the colon to open in this region after 
 suppuration (probably he refers to cases on the left side, when 
 suppuration suj)ervenes after extraperitoneal hasmatocele, etc., 
 and the pus burrows into the rectum and on to the surface, 
 thus making a fistula). He remarks that such openings in 
 the colon heal easily, but that wounds of the uterus heal 
 slowly. 
 
 Our author then proceeds to deal with cases of menor- 
 rhagia. After giving the symptoms, he says that if the blood 
 should escape pure, as when a person is bled, we must make 
 an examination to be sure that there is no erosion of the 
 uterus present ; for it is to be observed that an erosion forms 
 sometimes on the cervix, sometimes in other situations. 
 
 The chapter ends with remarks on haemorrhage in those 
 who are pregnant. 
 
 The short account of the diseases of women in this chapter 
 is clearly derived from the works of Hippocrates (" Diseases 
 
GALEN. 137 
 
 of Women," B. L, c. i.-vii. ; "Aph.," B. V., xlvii., Ivii., 
 Ixi., etc.)- 
 
 Of the anatomical writings left us by Galen, one book, 
 ** De Uteri Dissectione," is devoted to the anatomy of the 
 uterus. Beside this work Galen wrote an anatomical work, 
 " De Anatomicis Administrationibus," in fifteen books. The 
 first nine of these have been published, but the last six are 
 not extant in the original Greek or Latin translations, though 
 there is a complete copy in Arabic in the Bodleian Library at 
 Oxford. The fifteenth book of the work is devoted to the 
 organs of generation. 
 
 Besides the passages alluded to above, which deal with 
 gynaecology, we find here and there throughout many other of 
 Galen's works short notices of remedies suitable for different 
 affections of women, such as the retention of the periods, 
 excessive flow, flux, erosion, ulceration, suffocation, cancer, 
 etc. ; vide ** De Eemed. Parab.," II., c. liii.. III., cc. xciv., 
 cxci.; "De Method. Medendi," XIV. vii. ; "De Causis 
 Sympt.," III. ii. ; " De Comp. Pharmac," IX. x. 
 
 Again, in the works of Hippocrates that Galen criticised, 
 wherever a passage occurred which dealt with gynaecology, 
 Galen wrote a short commentary. 
 
 The spurious works " De Catharticis," " De Simpl. Med.," 
 " Liber Secretorum," all contain short passages relating to 
 remedies for various diseases of women. 
 
 Among these spurious works is one devoted to gynaecology. 
 Its title is "De Gynaeceis, id est Passionibus Mulierum." 
 This work merely mentions the particular disease, and then 
 gives formulae for appropriate remedies. 
 
 Among the spurious works we have " De Anatomia Vivorum," 
 " De Anatomia Parva," " De Compagine Membrorum," all of 
 which contain short descriptions of the womb and ovaries. 
 
138 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Of Galen's work '* De Dissectione Uteri" we propose to 
 give a translation at the end of this chapter ; here we shall 
 give a resume with some remarks on various passages. 
 
 The first chapter deals with the situation of the uterus, and 
 the author remarks that the uterus reaches up towards the 
 umbilicus ; this together with a passage from the third 
 chapter, " but in woman and other animals which have a 
 womb similar to a woman's, such as the goat and the cow," 
 show us clearly that Galen had no real acquaintance with the 
 dissection of the uterus of women, but that he had relied on 
 other authors for his facts, and had drawn on his comparative 
 studies. That he had dissected animals is clear from certain 
 passages in his works, for he tells us that he had dissected 
 monkeys, an elephant, mice, birds, and fish : " Humanos 
 uteres non incidit, sed simiarum aliorumque animalium " 
 (Kuhn). 
 
 In the second chapter, after making some remarks on the 
 size of the uterus, which are, as a rule, accurate, he ends the 
 chapter by endeavouring to show that the labia are analogous 
 to the prepuce of the male. Galen followed other writers in 
 his endeavours to draw an analogy between the organs of the 
 two sexes, supposing the organs in the female to be similar 
 to those in the male, only less developed. On this theory he 
 supposes the uterus to correspond to the scrotum, and the 
 ovaries to the testicles, while the external genitals correspond 
 to the prepuce.^ 
 
 In the third chapter he deals with the form of the uterus ; 
 he describes it as " bisinuatus," and he gives a description of 
 the pampiniform plexus. 
 
 In the fourth chapter he deals with the ligaments, and 
 describes the levator ani, and he remarks that all these bands 
 
 1 "DeUsuPart.," XIV. vi. 
 
GALEN. 139 
 
 are slack, so that the uterus can be moved and changed very 
 considerably. 
 
 The arteries and veins are considered in the fifth chapter. 
 He tells us that uterine veins enter the vena cava on either 
 side ; this is an error, as we know that on the left side the 
 uterine vein enters the left renal vein. He remarks " that 
 these are four vessels which are not always in women, but 
 which occur in some cases (according to Herophilus), and, 
 after arising from those vessels which extend to the kidney, 
 enter the uterus." This arrangement of the vessels is met 
 with. Qaain says : " The spermatic artery is frequently 
 derived from the renal, occasionally from the suprarenal, 
 on one side. . . . Two spermatic arteries are not infre- 
 quently met with on one side ; both these usually arise from 
 the aorta, though sometimes one is a branch of the renal 
 artery." 
 
 Chapter vi. is devoted to a description of the tunics of the 
 womb, which is more ingenious than correct. 
 
 In the next chapter Galen remarks on the hardness of the 
 cervix, and states that under ordinary circumstances the os 
 will barely admit of a fine probe. He also makes some 
 remarks on displacement of the womb. 
 
 Chapter ix. is devoted to a description of the ovaries and 
 Fallopian tubes. He calls the ovaries opxet'i, which term 
 corresponds to testes ; he alludes to the fundus as Trvdfiijv, 
 and to the horns. He calls the Fallopian tubes the aryyela to. 
 aTTcpfiaTLKa, and describes how they commence near the 
 ovaries as dilated tubes, but on approaching the uterus they 
 become narrow. He alludes to the fact that the ancient 
 authors did not understand that these tubes opened into the 
 uterus, and he wonders that some of these writers did not 
 recognise this fact : for he says that Herophilus was an 
 
I40 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 excellent dissector, and had human subjects as well as animals 
 to dissect. 
 
 The last chapter deals with the chorion and foetal mem- 
 branes. 
 
 Summing up Galen's position with regard to gynaecology, 
 we may say that he has left us nothing original on the 
 subject, and little of interest from the works of others. It is 
 probable that his busy life did not permit him to follow up 
 the subject of gynaecology to any extent, least of all in its 
 operative details ; for it is certain that when he settled per- 
 manently in Eome he took uj) the position of a physician. 
 He says : " Aggressus vero fuissem aliquando ipse plurimum 
 experire ejus modi curationis rationem, si perpetuo in Asia 
 mansissem; sed quum Eomae plurimum agerem, civitatis 
 morem sum secutus, permissa iis, quos chirurgos vocant, 
 maxima ejus modi operum parte " (" De Meth. Med.," VI.). 
 We accordingly find throughout his works only superficial 
 remarks on gynaecological subjects, as he generally contented 
 himself with merely mentioning some of the commoner 
 complaints of women, such as suppression of the menses, 
 menorrhagia, and the flux, after which he gives a few receipts 
 for their treatment ; consequently, we find no systematic 
 treatise and no operative details of our subject. 
 
 With regard to his works on the anatomy of the uterus 
 and its appendages, his descriptions, being second-hand or 
 derived from animals, are inferior in value to the account and 
 excellent description left us by Soranus. To Galen, however, 
 must be given the credit of clearlj'- pointing out that the 
 Fallopian tubes were pervious, and that they conveyed the 
 ova to the uterus. These points Soranus entirely missed. 
 Whilst many of the ancient writers thought that the uterus 
 consisted of two cavities separated from one another by a 
 
GALEN. 141 
 
 membrane, Galen appears to have been better informed ; yet 
 he certainly imagined that the human uterus was " bicornis," 
 and he clung to the theory that the male was formed in the 
 right side, and the female in the left side, of the uterus. He 
 also made the mistake of supposing that the umbilical cord 
 had two arteries and two veins. 
 
 Galeni de Uteri Dissectione Liber. 
 
 Cap. I. : The Situation of the Uterus. — This book treats of 
 the position and size of the uterus ; of its shape ; where it 
 hangs and by what it is nourished ; with what it is connected 
 and what it touches ; what holds it together ; and what is 
 produced in the uterus, when a woman is pregnant, around 
 the chorion or membranes surrounding the foetus. The uterus 
 is placed within the peritoneum between the bladder and 
 rectum, resting on almost the whole of the latter, and reach- 
 ing far beyond the bladder towards the umbilicus, on which 
 is its fundus {7rv6/j,7]v) ; whilst towards the pudendum the 
 bladder extends beyond it (the uterus) by the length of its 
 neck. But the bladder in women is placed close to the pubes, 
 and has a shorter and a wider neck than that of the male, 
 and being placed between the bones called the bones of the 
 pubes, it connects with the vulva near its external and 
 superior limit. 
 
 After this Galen gives a description of the rectum and 
 sacrum. 
 
 Cap. II. : Size of the Uterus. — The size of the uterus is not 
 the same in all cases, for, indeed, it is much smaller after 
 giving birth to a child ; but it is larger when the woman is 
 carrying the child, and it is much smaller still in those who 
 have never conceived, and it is in proportion to their age in 
 the case of those who have not yet had the opportunity to 
 
142 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 indulge their passions. Also in those not given to venery it 
 is always smaller. 
 
 Galen then says that the fundus of the uterus is close to 
 the umbilicus, and the cervical end is eleven fingers' breadth 
 from the vulva. The chapter ends with the statement that 
 the female pudendum {rb aiSoiov) is the open space lying 
 between the pubic bones, and that the pudendum has 
 externally a cuticular process (labia) analogous to the prepuce 
 of the male. 
 
 Cap. III. : Form of the Uterus. — The form of the uterus, 
 both considered as a whole, and especially as regards its 
 fundus, is similar to that of the bladder ; but it differs from 
 that organ inasmuch that it has mammillary processes from 
 either side, which face towards the corresponding ilia. Hero- 
 philus likens these lateral processes to the curve of a semi- 
 circle ; Diodes to growing horns, and therefore called them 
 cornua, from their likeness to horns. Eudemus called them 
 *' the coils " {irXeKTavat), not mentioning whether he com- 
 pared to coils the bloodvessels, which are twisted and 
 bunched up in the locality, or the processes themselves. By 
 Praxagoras and Philotimus they are called sinus (kSXttoi), 
 whence they say that the uterus of a woman is bisinuatus, 
 whilst of animals which bear many young they say it is 
 multisinuatus. 
 
 Galen then observes that in the case of pigs and animals 
 that bear many young at a time these animals have " multos 
 sinus." He does not consider that the name sinus is a suit- 
 able one for women, for, in the first place, the uterus in pigs 
 is curved and sinuous, and, in the second place, the young are 
 conceived in the sinus. But in women, and other animals 
 which have a womb similar to a woman's, such as the goat 
 and the cow, the foetus is found in the main cavity of the 
 
GALEN. 143 
 
 uterus, not in the cornua, which are much too small for a 
 body the size of a foetus. 
 
 The remainder of the chapter contains nothing of interest 
 to us. 
 
 Cap. IV. : The Parts adjacent to the Uterus. — This chapter 
 opens with some general statements such as, " Of the parts 
 that are nearest the uterus, some merely touch it, but do not 
 coalesce with it, while other parts cannot be separated from it 
 except by dissection ;" ** that the uterus is joined to many 
 parts, and that when it is greatest it fills the iliac spaces and 
 the abdomen, while it is at the same time in contact with 
 much of the intestines." The uterus is connected with the 
 rectum and bladder by the intervening tissues of a fibrous 
 nature ; " these are," the author remarks, " mere connecting 
 links to the bladder." The uterus is also connected by certain 
 strong bands of muscles having strands of sinews. It is 
 suspended by equally large masses of tissue also from the 
 lumbar vertebrae, for processes, worthy of note, of the great 
 lumbar muscles descend on either side, and are then carried 
 to each side of the uterus, to the neck of the bladder, and to 
 the seat. All these bands are slack, so that the uterus can be 
 moved and changed very considerably. There are, besides, 
 connecting bodies which are rooted on the uterus, and which 
 partly bind it together and ramify through it ; important 
 among these are the nerves proceeding from the dorsal 
 marrow, and which partly provide the uterus and foetus with 
 nourishment and sustenance, as, for instance, the veins and 
 arteries. 
 
 The uterus is only joined and united to the bladder and to 
 the rectum at its neck, merely by membranous tissue filled 
 with bloodvessels (apT7]pi(oB€i,<;), together with some fat. It 
 can be cut away from these organs, but the coalescence is so 
 
144 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 exact that there appears to be but one and the same fleshy 
 tissue. 
 
 The testes (BlSv/jlol) and the spermatic vessels {GTrepfiariKa 
 dyyela) are closely connected with it. 
 
 The womb joins the pudendum at the termination of its 
 cervical portion. 
 
 Then follows some further remarks on its connections, but 
 these have but slight interest for us. 
 
 Cap. V. : Arteries and Veins of the Uterus. — Two veins and 
 two arteries spring from the vena cava and the large artery 
 lying over it, one of each on either side ; the vein comes from 
 the vena cava, the artery from the artery. The one brought 
 from the right goes to the right of the uterus, the other from the 
 left goes to the left of the uterus ; and before the vessel enters 
 the uterus it gives off some branches to the testes (ovaries), 
 and after this, indeed, each vessel goes to the body of the 
 uterus to ramify in it. These four vessels are placed together 
 a little below those that run to the kidneys, and the veins are 
 much larger than the arteries. But there are four other 
 vessels which are not always in women, but which occur in 
 some cases (according to Herophilus) ; these spring from the 
 vessels running to the kidneys and enter the uterus. " I have 
 not been able to find an example of this in any other animals 
 except occasionally in monkeys, but I don't doubt that 
 Herophilus may often have found these in women, for he 
 was well versed in all other matters relating to the art (of 
 medicine), and he had a very excellent knowledge of dis- 
 section, which was not derived chiefly from the lower animals, 
 as the knowledge of most anatomists is, but from the human 
 body." 
 
 This observer says that the vessels which nourish the 
 uterus are joined into the membranes, from which we have 
 
GALEN. 145 
 
 remarked that the bladder hangs ; and he noticed that the 
 membranes become thicker, harder, and rougher the more 
 frequently the uterus bears young. These facts may be 
 observed also in other animals. Moreover, there are other 
 veins and arteries which are joined to the neck of the womb 
 from either side of the uterus (uterine arteries), bemg 
 separated from that vessel which supplies the pudendum and 
 seat (internal pudic artery). 
 
 The uterus draws its nourishment from and is traversed 
 by these vessels. 
 
 Cap. VI. : The Tunics of the Uterus. — The body of the 
 uterus consists of two tunics placed contrariwise. The more 
 nervous {vevpwBia-Tepo'i) is placed externally, the more venous 
 is placed internally, and each is of such a nature that it can 
 easily stretch very much and again contract. The external is 
 simple and is single; the internal one is a double tunic, 
 whose parts are closely connected, yet do not unite and form 
 one, but only adjoin, and are held together by the adjacent 
 tunic. If, then, you wish to separate them by dissection, 
 they appear to you as two uteri placed under one and the 
 same tunic ; for you will not be able to further separate this 
 tunic into two divisions, as the uterus was in the first instance. 
 The venous tunic is rather rough on its inner surface, 
 especially at the fundus. The nervous coat which surrounds 
 this (venous one) is much thicker than the tunic of the 
 urinary bladder, and it is interwoven with many veins and 
 arteries. 
 
 Caj). VII. : Cervix Uteri. — But the neck of the uterus, being 
 muscular, consists of flesh that is hard and cartilaginous, and 
 it always becomes harder and more cartilaginous in the course 
 of time, so that in those who have conceived often or who 
 are aged it is excessively hard and cartilaginous. Herophilus 
 
 10 
 
146 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 compares its nature {ttju (fivacv) to the upper part of the 
 trachea/ and there is a foramen in the cervix through which 
 the female both menstruates and receives the seed of the 
 male, and through which, too, the foetus issues from the 
 uterus. For it is incredible how the passage varies in width 
 at the proper seasons ; this opening at any other time admits 
 the sharpened point of a probe or something slightly thicker, 
 but becomes so well closed when the woman is pregnant that 
 nothing can be admitted. When, however, the foetus is being 
 released from the wound, the cervix becomes so distended by 
 the labour pains that — a thing which is wonderful even to 
 hear — the entire living being may pass out through the open- 
 ing. The cervix does not project into the woman's vagina in 
 a straight and direct line in all cases, but it is inclined and 
 deflected sometimes to the right, sometimes to the left, some- 
 times up, sometimes down ; but as regards its anterior and 
 posterior portions, we have already said that it is much the 
 same in all cases. 
 
 Cap. VIII. deals with the increase and decrease in the 
 thickness of the tunics of the womb, but contains nothing of 
 interest for us. 
 
 Cap. IX. : Testes et Vasa Seminaria Foeminarum.. — The 
 ovaries (opx^fi, testes) of the female are placed by the sides 
 of the uterus, one being on each side of the fundus {irvdixriv) 
 close to the horns. They are of smaller size than the testes 
 of the male, from which they differ both in shape and com- 
 position : for the ovaries are flat, whilst the testes are rounded 
 and oblong ; and the ovaries appear to be made up of glands, 
 the testes of soft flesh. Each is covered by a separate skin 
 membrane, which in the male is called the dartos. The 
 testes of women do not possess as well a reddish-coloured 
 
 ^ Soranus, c. iii. 
 
GALEN. 147 
 
 bag, or scrotum. There are besides arteries and veins running 
 to the ovaries, one to each, branching from those vessels 
 which go to the uterus. These vessels, indeed, intermingle 
 with one another before they enter the ovaries, and they are 
 twisted in coil shape (in the same way as they are in the 
 male), so that if you cut the coil the single cut would display 
 many openings, not because you have cut many vessels, but 
 the one vessel often. 
 
 The seminal tubes (dyyela to, cr7rep/j,aTiKd) which run from 
 the ovaries are seen to contain seed in a similar way to the 
 tubes in the male; these tubes, which are wide near the 
 ovaries and possess a cavity that can be seen a little distance 
 from the ovaries, become narrowed and appear as though 
 they were not hollow, while at the cornua, where they are 
 joined into the uterus, they again become dilated. Neither 
 Aristotle, Herophilus, nor Euryphon was aware of these con- 
 nections {ijji(f>va€t<i). ** These writers I merely mention in the 
 present instance, not because they alone were ignorant of the 
 fact, but because, though they were excellent dissectors, yet 
 they did not observe this. For it is hardly to be wondered 
 at that Diodes, Praxagoras, Philotimus, and almost all the 
 ancient writers, were ignorant of this fact, as they were of 
 most others in connection with the body, since they had but 
 a rough and imperfect knowledge of dissection ; for this 
 reason I think I need not take any notice of them. As 
 regards the first-mentioned, I don't know what to say ; I do 
 not dare to condemn them when their investigations in all 
 other matters have been so accurate ; at the same time, the 
 seminal vessels are not so small as to escape anyone's notice." 
 These writers, indeed, described in detail those vessels which 
 enter the neck of the bladder, mentioning that they enter the 
 same region as in man, and that these vessels have glands, 
 
 10—2 
 
148 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 and also that they extend from the testes and run close 
 beside the uterus; but of the vessels going to the cornua 
 they said nothing, yet these, indeed, enter the uterus by 
 openings not less evident than those of the vessels entering 
 the neck of the bladder, and they are seen to contain seed in 
 the cavities. 
 
 Cap. X. deals with the chorion and other matters con- 
 nected with the foetus. 
 
CHAPTER XIII. 
 
 THE BYZANTINE PEKIOD.— THE STATE OF MEDICINE 
 AFTER THE DEATH OF GALEN. 
 
 We have in a former chapter briefly sketched the state of 
 medical science in the opening years of the Christian era. 
 
 We saw the people of Italy, as a scattered and divided race, 
 rise to a proud eminence and become the ruling nation of the 
 East, and under Augustus throw out inducements to intellec- 
 tual Greece that resulted in the migration of those who firmly 
 established Greek medicine in the Koman capital. 
 
 After the death of Augustus (a.d. 14) Eome was governed 
 by a succession of Emperors differing widely in character and 
 mind. One has only to compare the character and deeds of 
 Tiberius,^ a monster of perfidy ; of Caligula, who passed his 
 life in debauchery ; of the wanton and cowardly Nero, with 
 the acts and works of Titus, " the love and delight of the 
 human race "; of the soldierly Trajan ; of the accomplished 
 Hadrian ; of Marcus Aurelius, the patron of science and 
 philosophy, to see under what diverse rulers the people of 
 Rome lived and fought. Now, at one time we see every 
 encouragement given to science and medicine, while at another 
 the mere upholding of harmless philosophical tenets might 
 mean disaster. Caracalla, the parricide and fratricide, when 
 
 * Theodorua Gadareus said of Tiberius, irriXbv Hi/xaTt. ir€(pvpa/j.^vov. 
 
I50 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 visiting Alexandria gave the city up to plunder, turned the 
 professors from their seats of learning, and put to death the 
 upholders of the Aristotelian philosophy. 
 
 During the first 200 years of this era, Pliny, Celsus, 
 Dioscorides, Soranus, Cselius Aurelianus, Aertseus and Galen 
 lived and wrote ; and while the Koman power was at its 
 zenith during the Augustan period, yet slowly and inevi- 
 tably the power of Eome had begun to decline ; and though 
 the works of Galen represent the highest point to which 
 medical science attained in ancient times, yet after his death 
 (a.d. 200) we have a fall so abrupt that we may say, without 
 exaggeration, that the works that we encounter for the next 
 thousand years are but the shadows of those written by Galen 
 and his predecessors, and show in their language, as in their 
 subject-matter, the rapid decline of intellectual vigour and 
 original research. 
 
 The overthrow of the Eoman State was brought about by 
 the continued profligacy, cruelty and incapacity of the throne ; 
 by attacks of foes gradually increasing in strength from with- 
 out; while within there existed the corruption of officials, 
 the conduct of an overbearing soldiery, the abandonment of 
 family ties, and the increase of vice and crime among all 
 classes. Added to this, the military power at last reigned 
 supreme, and appointed or deposed their Emperors at will. 
 To medical science and art this military power was a fatal 
 opponent. 
 
 In tracing the future history of medicine after the death of 
 Galen, we must leave Italy : for though the schools at Eome, 
 as in the case of Alexandria and Athens, still survived the 
 political disasters of the State, Eome itself was doomed to fall 
 into the hands of the barbarians, after it had been abandoned 
 as the capital of the Eoman Empire, in favour of the newly- 
 
THE BYZANTINE PERIOD. 151 
 
 created Byzantium, where science and learning was destined 
 to lead a sickly existence for a thousand years. 
 
 Constantinople was called after its founder Constantine, 
 who, after crossing the Cottian Alps, defeated Maxentius and 
 captured Eome (a.d. 312). This gave him the mastery of 
 the Western world. Licinius, on the other hand, having 
 defeated Galerius, became master of the East. But Constan- 
 tine, after a considerable interval, determined to oust his 
 rival, and having defeated him (a.d. 323), he now became 
 sole ruler of the empire, and as Eome was but a nominal 
 capital, Constantine determined on making Byzantium the 
 capital of the empire (a.d. 328). 
 
 By making Constantinople the residence of the Emperors, 
 the centre of the empire was removed from the Latin world 
 to the Greek ; and although Latin continued to be the official 
 language for several centuries, the influence of Greek civiliza- 
 tion soon obtained such an ascendancy over the Latin that, 
 while the Roman Empire perished by the barbarians in the 
 West, it was changed into a Greek empire by the Greeks in 
 the East. 
 
 Though medicine had now returned to its original cradle, it 
 had never ceased to be cultivated in the minor cities of 
 Greece, as well as in Alexandria, during the Roman supremacy 
 in Italy. But a new influence had now come into life since 
 the seat of learning had been moved from Athens to Rome, 
 and this new power was destined to exert an influence, not 
 altogether favourable, on the advancement of medicine as a 
 science. Christianity had come into being, and, though at 
 first adopted only by the poor, the wretched, and the power- 
 less, it had gradually grown until it numbered in its ranks 
 the rich and powerful, and culminated in having as its chief 
 convert the autocrat of the empire, Constantine. The 
 
152 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Christians, at first persecuted and scorned, in time found 
 themselves in such a position that they were able to turn on 
 those who had oppressed them, and gradually becoming the 
 controllers of all that related to the physical and social welfare 
 of the people, they used their powerful influence to check 
 original research and cramp science in every possible way. 
 The attitude that they assumed at a later period towards the 
 physical science was similar to the position they took up 
 towards medicine during the third and fourth centuries, for 
 the great practical doctrines which were presented to men's 
 minds, and the serious tasks, of the regulation of the will 
 and affections, which religion impressed upon them, made 
 inquiries of mere curiosity seem to be a reprehensible mis- 
 application of human powers ; and many of the fathers of the 
 Church revived, in a still more peremptory form, the opinion 
 of Socrates, that the only valuable philosophy is that which 
 teaches us our moral duties and religious hopes.^ 
 
 The Church believed in the preternatural, and was there- 
 fore the antagonist to science in all its branches ; but though 
 opposed to scientific medicine, it did not disdain to endeavour 
 to create a system of faith-healing, in which miracles, prayers, 
 charms and amulets occupied the foreground. Little wonder 
 is it that men ceased to devote years to the study of a science 
 when they saw themselves successfully supplanted by religious 
 orders who were content to invoke the supernatural to aid 
 them, when the most superficial knowledge of the works of 
 Hippocrates or Galen would have enabled them to work 
 effectual cures. 
 
 "With the growth of Christianity paganism became extinct, 
 and with it the temples of Asclepius. But the Christians 
 were not content with suppressing the former customs, and 
 
 ^ Whewell, "History of the Inductive Sciences," vol. i., p. 252. 
 
THE BYZANTINE PERIOD. 153 
 
 now instituted in their place a Christian form of incubation, 
 not dissimilar to the pagan one. Thus, sufferers came to the 
 churches and implored the preservation of their health, or the 
 cure of their infirmities, the fruitfulness of barren women, or 
 the safety and happiness of their children.^ The priests 
 encouraged the patients to pass the night in the churches, 
 where after dreaming they related their visions, and as in 
 former days gave the priests a clue to the treatment. The 
 fortunate patients donated casts and figures of the diseased 
 parts, and thus a fresh supply of donaria accumulated. 
 
 Science stood in direct opposition to Christian dogma when 
 it made the manifestations of Nature, as, for example, the 
 human body — which the Christian held as impure and worth- 
 less, if not despicable — the subject-matter of its study.^ 
 Medicine in all its branches therefore suffered, but no branch 
 more than anatomy, for the Christians forbade human dis- 
 section, and even if the student dissected animals he risked 
 being taken for a magician. 
 
 Freind, who has studied this period with great diligence, 
 quotes, as an example of the servility of the authors, that he 
 found but one instance of the slightest deviation from the 
 descriptive anatomy of Galen ; the exception referred to occurs 
 in the description of the salivary glands. 
 
 We have dealt with the gloomy side of the Christians' 
 influence on medicine ; the redeeming point is revealed when 
 we consider that to them we owe the establishment of the first 
 hospitals for the sick and the first asylums for the poor and 
 aged. 
 
 Whilst traces of establishments for the poor and sick can 
 be found in the history of the Hindus, and the Spaniards 
 found hospitals in Mexico after the discovery of America, and 
 
 ^ Gibbon, op. cit., c. xxviii. ^ Puschmann, op. cit., p. 136. 
 
154 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 we have seen that at the latreia patients were sometimes 
 taken in and cared for, yet the Christian influence was the 
 chief one in the estabUshment of hospitals, which were 
 supported by contributions from charitable people. 
 
 At the close of the fourth century, Fabiola is credited with 
 founding the first Christian infirmary at Eome, and her 
 example was soon followed by others, such as St. Basil, who 
 established a large charity at Csesarea, while at Edessa 
 Bishop Eabboula built a hospital which was exclusively for 
 women. 
 
 Foundling hospitals came into existence first at Treves, 
 then at Angers and Milan. 
 
 The impetus to original research having been checked, the 
 authors we are now about to deal with are to be looked on as 
 mere compilers. As Heeren^ has observed, compilation after 
 the encyclopaedic method is the usual concomitant of declining 
 literature, and our three authors, Oribasius, Aetius, and 
 Paulus iEgineta, illustrate well this rule: they have copied 
 what was valuable, but they have given us little that was 
 original. On the other hand, we cannot but admire the 
 industry of those patient writers when we consider the 
 immense labour involved in their compilations. Oribasius 
 (a.d. 360) at the instance of Julian compiled his work, which 
 consisted originally of seventy-two volumes. If we glance for 
 a moment at the method of composing and making a book in 
 those remote days, we shall perhaps better appreciate the 
 enormous labour involved in these mere compilations. 
 
 The skin of the goat or calf tanned soft, and dyed yellow or 
 red, was a favourite material for writing on among ancient 
 
 ^ Hallam, "Introduction to the Literature of Europe," c. i. 
 
THE BYZANTINE PERIOD. 155 
 
 authors.^ These skins were often joined one to another until 
 they reached 100 feet in length ; this constituted a roll 
 or volume. Parchment, so called from first being made at 
 Pergamus, was in great demand, but was costly. The 
 papyrus formed the chief article on which to write, but we 
 frequently find interleaved with every four sheets of the 
 papyrus a sheet of parchment, so as to give the whole 
 stability. Probably for clinical purposes the tablets of wax 
 written on by a style, or the leaves of trees, may have been 
 used, and the writer then copied his notes on to some more 
 convenient material for preservation ; while in special cases 
 the priest, the physician, or the patient had the history 
 carved on stones and placed in the temple. These records, we 
 have seen, were used by Hippocrates in compiling some of his 
 works ; our three authors, however, probably made but slight 
 use of them. 
 
 Beside stone tablets, wooden tables were engraved with 
 important matters, such as laws, and were termed codices. 
 
 The inner bark of the linden or teil-tree was much in 
 demand ; it was the liher of the Eomans, and the Biblos of the 
 Greeks. 
 
 The instruments used in writing varied with the material 
 chosen by the author for his manuscript. For waxen or 
 leaden tablets a needle, called the style, was employed ; this 
 was often made of iron. For writing with ink a calamus, 
 formed from a reed of the Nile, was much in use ; the calamus 
 was sometimes, however, made of silver. The quill also was 
 used in very ancient times. 
 
 The ink was made either from the dark fluid obtained from 
 the cuttle-fish, or else made from the finest soots, or the coal 
 
 ^ Isaac Taylor, "History of the Transmission of Ancient Books to Modern 
 Times." London, 1859. 
 
156 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 of ivory or wood, mixed with gum and diluted with acids ; 
 these inks often kept their pristine blackness for centuries 
 after. The titles of the chapters were sometimes written in 
 coloured inks. 
 
 After writing several sheets, authors folded three or four 
 together and had them stitched separately, and then connected 
 them with similar sheets already stitched ; when sufficient 
 were connected the whole was covered by linen, silk, or 
 leather. 
 
 The above will serve to show what a formidable task an 
 author had before him in ancient times when he sat down to 
 write a book ; let the reader consider what Galen's task was, 
 of whom it is stated that the *' number of his distinct 
 treatises cannot have been less than 500. "^ Most difficult 
 and expensive must it have been to have acquired a sufficient 
 number of books to have entitled one to have been considered 
 the owner of a library, yet such was the wonderful avidity of 
 the Greeks for learning and advancement, that a book, having 
 once been pronounced worthy of study, was rapidly copied 
 and recopied, until there were sufficient copies to be sent even 
 to the furthest Greek colonies. 
 
 The accumulation of books to form public libraries often 
 occupied the minds of potentates, and it is related of one 
 of the Ptolemies that he refused to supply the famished 
 Athenians with wheat until they had presented him with the 
 original manuscripts of iEschylus, Sophocles, and Euripides. 
 This demand for celebrated authors led to forgeries, and this 
 accounts for the large number of spurious works that have 
 been handed down to us as having been written by Hippo- 
 crates and Galen. 
 
 Pisistratus was one of the first to collect the works of the 
 
 ^ Greenhill : "Galen " (Smith's " Dictionary of Mythology"). 
 
THE BYZANTINE PERIOD. 157 
 
 learned, whilst among the cherished spoils of war the books 
 found in the libraries of the conquered cities were often most 
 carefully removed and sent back to the capital. Thus, Sylla 
 brought from Athens the famous library of Apellicon, in 
 which were the works of Aristotle and Theophrastus, that 
 were hardly known before in Italy.^ 
 
 Among the libraries that have been famous we may 
 recall those of Crassus, Ciesar, Cicero,^ and Lucullus; the 
 Alexandrian, founded by Ptolemy, contained 700,000 books, 
 and the library of Attalus, King of Pergamus, had 200,000 ; 
 lastly, the library founded at Constantinople by Constantino 
 continued to be added to for a thousand years, until the fall 
 of that city, 1453.^ It is not improbable that it was in this 
 latter library that Oribasius and Aetius compiled their works, 
 though, as they both had studied at Alexandria, they may 
 have returned to that city to consult in its archives copies of 
 works not to be seen elsewhere. 
 
 1 Plutarch, " Life of Sylla. " 
 
 - Cicero purchased many of his works from Atticus, who had a family of 
 learned slaves, and these he employed to copy from the manuscripts of the 
 various libraries in Athens. In one of Cicero's n-orks we find the following letter 
 to Atticus : "Take care that you do not part with your library to any man, how 
 eager soever he may be to buy it, for I am setting apart all my little rents to 
 purchase that relief for my old age " (Middleton, "Life of Cicero," vol. i., p. 152). 
 
 ^ In the library at Cairo the manuscripts of astronomy and medicine amounted 
 to 6,500 (Gibbon, op. cit., c. lii. ). 
 
CHAPTER XIV. 
 
 OKIBASIUS. 
 
 Oribasius {'Opei^d(no<;, or 'Opi^dcrLos:) was born at Pergamus, 
 the birthplace of Galen, about 325 a.d. He was well educated, 
 and studied under Zeno. Having become acquainted with 
 Julian whilst that Prince was kept in confinement in Asia 
 Minor, a lifelong friendship sprang up between them, only to 
 end with the death of the Emperor. Our author, having 
 thrown in his lot with Julian after he was raised to the rank 
 of Caesar, accompanied his patron into Gaul. During this 
 expedition Julian commanded him to make an epitome of the 
 writings of Galen, and Oribasius executed the task so well that 
 Julian requested him to make the work more complete, by 
 adding from other authors what was already wanting in his 
 first essay. This work Oribasius accomplished after Julian 
 became Emperor (a.d. 361), and so vast was the undertaking 
 that the results were contained in seventy books, under the 
 title of (Tvvaycoyal laTpiKai, or " Collecta Medicinalia." 
 
 Eunapius, the intimate friend of Oribasius, has written his 
 life, and we find, from that work, that after Julian had been 
 appointed Emperor he created Oribasius Quaestor of Con- 
 stantinople. 
 
 After the death of his patron, Oribasius was exiled by 
 Julian's successors, Valentinian and Valens, to some nation 
 
ORIBASIUS. 159 
 
 among the "barbarians." Here our author showed his 
 knowledge of medicine to great advantage, and in time was 
 held in high esteem among his new patients ; and after a 
 period he married a woman of good family with ample 
 fortune, by whom he had four children ; and it was to one 
 of these, his son Eustathius, that he addressed his 
 " Synopsis " (%vvo-^L<i), which is an abridgment of his first 
 great compilation. The date of our author's death is 
 unknown, but it is conjectured that it was at the beginning 
 of the fifth century, since he was still alive in 395 a.d., when 
 Eunapius inserted the account of his life in his *' Vitse Philo- 
 sophorum et Sophistarum." 
 
 We shall now proceed to notice the three works that 
 Oribasius has left us. 
 
 The first and most important is the "Collecta Medicinalia." 
 This is not an original work, but a compilation, and one that 
 mainly aims at giving an epitome of Galen's works, together 
 with extracts from other authors, the resulting work being a 
 vast encyclopaedia, after the style of Pliny's compilation, and 
 embraces medicine, hygiene, therapeutics, and surgery. 
 
 The plan followed by Oribasius was not merely to take a 
 chapter in its entirety from the author that he was dealing with, 
 but, rather, to cut out a passage from one part and another 
 from another, and then piece them together with extracts 
 from Galen, Hippocrates, Soranus, Eufus and Antyllus, But 
 frequently he is not content with a piecemeal chapter formed 
 on the above lines, so he abstracts a section on the subject from 
 some other author, whose views are frequently at complete 
 variance with the opinions expressed in the other chapter. 
 This method is a gain to us, but it must have been very dis- 
 concerting to those who consulted our author's works in his 
 own time. 
 
i6o THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 His second work, the " Synopsis," was written for his son 
 Eustathius, and was probably composed some thirty years 
 after the first. It consists of nine books, and is a compendium 
 of the " Collecta," and was intended to serve as a vade- 
 mecum for those who could not consult more detailed works. 
 The author also tells us, in the preface, that he does not make 
 mention of such subjects as surgery, anatomy, machines, 
 luxations, and fractures, because these are all difficult to deal 
 with, and are outside the scope of this vade-mecum, which 
 is meant to be a merely elementary treatise on hygiene and 
 therapeutics. 
 
 In this work he uses his predecessors' views, taking Galen 
 still as his chief authority ; but on the whole he is more 
 concise, and less confusing, than in the " Collecta "; as he is 
 content to give one view of the subject, and not several at 
 variance with one another. 
 
 His third work is entitled Eviropia-Ta, or " De Facile 
 Parabilibus." While the former works were written for 
 medical men, this last work was compiled for those who had 
 not specially studied medicine, and who perchance might wish 
 to consult a medical work in an emergency. 
 
 This work is dedicated to Eunapius, his friend and 
 biographer, and was probably written between 390 and 
 400 A.D. It is chiefly made up of extracts from the 
 ** Synopsis," and also in a less degree from the " Collecta." 
 
 It is divided into four books, and it gives the directions for 
 the first aid to those who are sick, and who may be far from 
 any medical man. It describes also the symptoms of the 
 various diseases, enumerates the principal medicinal remedies 
 applicable to each case, gives lists of remedies used in medi- 
 cine, and also indicates their effects. On the whole it is a 
 clear little manual, and often to the point. 
 
ORIBASIUS i6i 
 
 The works of Oribasius are of great importance, not from 
 their originality, but because they have preserved extracts 
 from authors whose works have perished for ever. But this 
 is not their only recommendation ; they have, by preserving 
 so many extracts from such an author as Galen, become in 
 themselves a reference for the text of this writer, as well as 
 for others whose works we have only in a mutilated condition. 
 Lastly, these works are of great importance, inasmuch as 
 they throw a side-light on such subjects as the baths, 
 epidemic diseases, the treatment of fevers, etc. — subjects not 
 treated so fully by any other author of antiquity whose works 
 we possess. 
 
 Of the various editions of Oribasius that have been 
 published we shall take notice of one only — the last, and at 
 the same time the best and most complete. 
 
 This edition was published between 1851 and 1876, in 
 six volumes, at Paris, under the following circumstances : 
 Daremberg, the well-known author on ancient medicine, con- 
 ceived the idea of examining the manuscripts of the best- 
 known Greek and Latin authors in the various European 
 libraries, and, after collating the various texts, publishing a 
 complete edition of each author. This stupendous task was 
 begun, and in part carried out, under the patronage of the 
 French Government, and one of the results of his labours 
 was this edition of the works of Oribasius.^ His coadjutor in 
 this task was Bussemaker of Amsterdam. 
 
 This edition of Oribasius consists of six volumes, each 
 containing some 800 pages. 
 
 The first four volumes were published under the joint 
 supervision of the authors ; but neither lived to see the 
 
 ^ " (Euvres d'Oribasius, texte grec, en grande parti nedit," etc. Bussemaker 
 et Baremberg. Paris, 1851-1878. 
 
 11 
 
i62 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 fifth and sixth volumes brought out ; that task was left to 
 Molinier, who used his predecessors' notes to complete their 
 work. 
 
 ^t StL ^ SLL ^ 
 
 We propose now to examine the works of Oribasius, and 
 to pick out any passages that refer to the diseases of women. 
 
 In these volumes Daremberg and Bussemaker have gone 
 to infinite trouble to show from what source almost every 
 passage in our author's writings has been derived ; and these 
 lists prove beyond all doubt that Oribasius has nothing 
 original to say on the subject of gynascology. 
 
 Taking the first volume, we find that it contains the first 
 six books, and deals with Dietetics and Exercise, and under 
 the latter heading we have massage dealt with at great 
 length. 
 
 The second volume contains Books VII. to X., XIV., XV. 
 and a fragment of XVI. It deals with such subjects as 
 bleeding, purging, the use of the enema, hygiene, baths, 
 fumigation, pessaries, vaginal injections, and the administra- 
 tion of medicine. From these subjects we cull the following : 
 
 B. VIII. xxiv. : Eectal injections of milk are recommended 
 in cases of inflammation of the bladder or of the uterus. 
 
 B. VIII. xxxi. : The uterus has a certain affinity in suffering 
 with the colon; it is natural, therefore, to suppose that, in 
 case of inflammation of the uterus, injections into the colon 
 will have a soothing effect. Oil and a decoction of linseed- 
 meal are recommended for such injections. 
 
 B. VIII. xxxvii., xxxviii. : In these chapters is given an 
 interesting account of the position to be occupied by a patient 
 during the administration of an enema. The various causes 
 that prevent the fluid from being successfully injected are 
 dealt with. 
 
ORIBASIUS. 163 
 
 B. IX. xxiv.-lv. : These chapters deal with cataplasms, and 
 in several places such applications are mentioned as being 
 useful in gynaecological cases. 
 
 B. X. i.-viii. : These chapters deal with the use of baths, 
 and our author quotes Antyllus as his authority for recom- 
 mending mineral springs for women who are irregular at the 
 periods, and for those who are subject to abortions (c. iii.). 
 
 B. X. xix. : Fumigation of the genital organs is described. 
 The chapter is extracted from Antyllus, who recommends 
 fumigation for prolapse of the uterus. After mentioning the 
 various substances to be placed in the vessel he says : "A 
 cover of wood, pierced in the centre, is placed on the vessel, 
 where it is fixed by means of potter's clay, or by a paste of 
 flour. Into the opening in the lid a pipe is fixed, very exactly, 
 so that no air can enter the vessel. To the extremity of the 
 pipe (that is, projecting from the vessel) a small tube of lead 
 is carefully fixed. The woman is placed on an accouchement 
 chair (eVl Blfppov /maKOTiKov), which has an opening in the 
 centre. Under the chair a small flame is placed, and over 
 this flame the fumigating vessel is adjusted, and the pipe is 
 introduced into the hole in the chair, after which the leaden 
 pipe, which reaches beyond the opening in the chair, is 
 passed by the patient into her vaginal orifice. The vessel 
 being heated, the fumes pass up the pipes and fumigate the 
 parts. 
 
 B. X. xxii. : A few observations are recorded here on the 
 action of astringents on the uterus. 
 
 B. X. XXV. : On Pessaries — from Antyllus. This chapter 
 has been extracted by Paul, and we shall give it in reviewing 
 that writer's works. 
 
 B. X. xxvi. : On Injections — from Antyllus. Instruments 
 are specially formed for uterine injections, but into the cavity 
 
 11—2 
 
i64 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 that is situated anterior to the uterus (vagina) one may make 
 injections by means of a small bladder {4>uaapLov) ; the sub- 
 stances that are injected into the uterus and vagina are, how- 
 ever, the same. 
 
 An injection may soften, restrain, cool, heat, expel gas, and 
 ease pain, all these effects depending on the ingredients used. 
 
 B. XIV. Ixiii. : This chapter contains some remarks from 
 Galen on the means to be employed for increasing the flow of 
 milk, or for increasing the menstrual flow. The view is held 
 that the same substances that will excite the secretion of milk 
 will also increase the periods, since the blood contained in the 
 veins is the source common to both. The author observes 
 that there are veins which are common to both the breasts 
 and the uterus, and that if the blood is carried more to one of 
 the parts than to the other, the part deprived of the blood 
 becomes, for the time, devoid of secretion. 
 
 B. XIV. Ixv. : Many receipts are given here for pessaries, 
 which are intended to provoke the menstrual flow. 
 
 Vol. III. contains part of Book XXI., which deals with 
 physiology and pathology; part of Book XXII., which deals 
 with the physiology of generation; extracts from other books- 
 whose proper numbering is doubtful, and which deal with 
 hygiene ; Books XXIV., XXV., and XLV. 
 
 B. XXIV. is of great interest to us, for it contains the well- 
 known chapter from Soranus on the anatomy of the uterus, 
 and it was by means of this chapter that Dietz recognised the 
 long-lost work of Soranus that we have already noticed. 
 
 B. XXII. ii. : Here is given Galen's account of the sperm. 
 The following passage is of interest, as it exhibits the fact that 
 Galen understood the functions of the Fallopian tubes, and it 
 is also an example of what we have referred to above — i.e., 
 that Oribasius gives in one chapter the views of one author on 
 
ORIBASIUS. 165 
 
 a subject, and in the next chapter gives views entirely at 
 variance with these. In short, Galen here points out that the 
 Fallopian tubes convey the sperm from the ovaries to the 
 uterus, while Soranus did not even recognise the tubes, and 
 supposed that the ovaries discharged their products into the 
 bladder. The extract is as follows : " The epididymes of 
 females are not manifest, because the testicles (ovaries) and 
 the sperm vessels (tubes) are equally small ; indeed, the 
 testicles, which are much smaller than in the male, are 
 situated in the (lower region of the) abdomen by the side of 
 the fundus of the uterus, one on each side, and they receive 
 twisted vessels similar to those that exist in the male. . . . The 
 female ejaculates her sperm into the uterus, and it is warm 
 but less abundant than in the male. In consequence the 
 vessel that takes its rise in the testicle implants itself in the 
 horn of the uterus, and is full of sperm, and pours through 
 the horns of the uterus, by means of a narrow orifice, a similar 
 fluid into the cavity of the uterus." 
 
 The above quotation, while showing that Galen had hit upon 
 the function of the Fallopian tubes, at the same time shows 
 that he did not, of course, recognise that the "ovum" was 
 the body that was transmitted, but mistook the normal 
 secretion^ (?) of the tube for the sperm of the female, and 
 imagined that this had been secreted by the ovaries. 
 
 B. XXII. vi. : Concerning the Mole. In this chapter 
 Oribasius gives an account of what he terms the mole. He 
 says that after con<^a*ion the size of the uterus increases, 
 and that the woman appears to be pregnant. But when the 
 time of delivery comes there is no labour ; still, the size (of the 
 belly) does not diminish, but it remains in the distended con- 
 
 ^ The probable fimction of the Fallopian glands is to provide an albuminous 
 fluid for the ovum as it traverses the Fallopian tube (Bland Sutton, " Diseases of 
 Ovaries and Fallopian Tubes," p. 234). 
 
i66 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 dition for a space of from three to four years, until the patient 
 is seized with diarrhoea, and she is delivered of a mass of 
 flesh, which is called a mole. In some cases the above con- 
 dition remains until the patient is advanced in years, and 
 may even persist up to the time of her death. Later on in 
 this chapter Oribasius remarks that the mole in some cases 
 may become so hard that we cannot cut it with an axe. 
 
 In a note^ to the above passage, Daremberg and Busse- 
 maker say: *'En lisant ce chapitre, ainsi que les endroits 
 paralleles de Soranus, d'Aetius et d'Actuarius, que nous avons 
 cites dans la * Table des chapitres,' on se convaincre facile- 
 ment que, sous le nom de mole, les anciens decrivent, non 
 I'affection qui porte encore ce nom, mais la grossesse extra- 
 uterine." 
 
 We do not agree with this opinion ; a careful study of the 
 descriptions of the mole in Soranus, Aetius, and Paul con- 
 vinces us that the ancients referred to two separate con- 
 ditions, viz., myoma of the uterus and the fleshy mole, as we 
 understand the term nowadays. In our opinion, the above 
 description will apply to a fibroid of the uterus, the hard 
 body, which Daremberg would consider a lithopsedion, being 
 in our opinion a calculus of the uterus, due to the degenera- 
 tion of the fibroid, a condition referred to both by Hippocrates 
 and Aetius. Adams, in his commentary on Paul's description 
 of the mole, considers that Paul is dealing with a fibroid. 
 
 B. XXII. iii. : Concerning the Fcetus of Seven Months, from 
 Galen. After making some lengthy remarks on the cervix 
 uteri, the writer says that hardness of the cervix is a symptom 
 of three different conditions : dryness, inflammation, and 
 scirrhus of the womb. Later on in the chapter he supports 
 
 1 Vol. III., p. 692. 
 
ORIBASIUS. 167 
 
 the idea that the male child is carried on the right side, and 
 the female child on the left side, of the uterus. 
 
 The regime for woman is dealt with in an elaborate manner 
 in chapters iv. and v. in the collection of chapters from books 
 whose numbers are uncertain. 
 
 B. XXIV. deals with anatomy, and c. xxix. deals with the 
 uterus, the chapter being composed of extracts from Galen's 
 work on the dissection of the uterus. 
 
 B. XXIV. xxxi., xxxii. : These chapters also deal with the 
 anatomy of the uterus and vulva, and are there alluded to as 
 having been extracted from Soranus. 
 
 The fourth volume contains Book XLV, which deals with 
 tumours; Books XL VI., XL VII., XL VIII., XLIX., which 
 deal with fractures and dislocations ; Book L., on affections 
 of the genitals ; Book LL, on ulcers ; finally there is a 
 collection of chapters from books whose numbers are not 
 ascertained. 
 
 B. XLV. xii. : On the Thymus. The thymus {dvixo<) is an 
 ulcer covered by tissue that is rugged and friable. It often 
 occurs about the seat and about the genital parts, as well as 
 at other parts of the body. It may be benign or malignant, 
 and when malignant, if it be cut out, it will return, so that it 
 is necessary in operating on it to have resource to the cautery, 
 and even then it may be incurable. Thymus that takes the 
 form of carcinoma is grave. Sometimes in its growth the 
 genital organs of the female are invaded, the invasion taking 
 place from the thymus growing at the seat. 
 
 In B. L., c. viii., the same disease is described as affecting 
 the male organs of generation. 
 
 Among the books whose numbers are not definitely 
 ascertained we have a few chapters dealing with gynaecological 
 subjects. 
 
i68 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 C. cxxxviii. : Menstrual Purgation. This chapter gives 
 some details about the time of the first onset of the menses, 
 and when they usually cease. Sitz-baths are mentioned in 
 the treatment of dysmenorrhcea, and myrrh is recommended 
 for amenorrhoea. 
 
 C. cxxxix. : Remedies which expel the Fcetus. The author 
 states that the same pessaries that are used to provoke the 
 periods also expel the foetus. 
 
 C. cxl. : On Pica. 
 
 C. cxli. : On Deliverance. This chapter deals with reten- 
 tion of the placenta, and directions are given for extracting it 
 with the hand introduced into the uterus. 
 
 C. cxlii. : Retention of the Menses. Directions are given 
 for the treatment of amenorrhoea by pessaries, baths, and 
 medicines. 
 
 C. cxliii. : On Menorrhagia. This chapter is the only 
 attempt at anything like systematic treatment of a gynaeco- 
 logical subject that occurs in the " Collecta." 
 
 The author opens the chapter by stating the circumstances 
 under which we get an increased loss of blood. His treat- 
 ment for menorrhagia consists in bandaging the limbs, the 
 application of affusions to the genital parts by means of 
 cloths or of warm sponges; he warns, as does Aetius, 
 against chilling the parts. He recommends the applica- 
 tion, to the uterus, of the cinders of a new sponge that has 
 been soaked in tar, also pessaries of wool in the form of 
 a ball or made in the shape of a finger. Injections by 
 means of a small syringe or of an instrument specially de- 
 signed for that object should be tried. Lastly, a small 
 strip of lint may be applied to the mouth of the womb 
 
 by means of a sound, or a sponge shaped like a tent may 
 be used. 
 
ORIBASIUS. 169 
 
 C. exliv. : The flux is considered, and general treatment by 
 exercise, massage, and baths is recommended. 
 
 C. exlv. : Inflammation and Deviation of the Uterus. This 
 chapter deals with inflammation of the womb, the portion 
 concerning deviation being lost. The subject is treated in a 
 way similar to that found in Aetius. 
 
 Vol. V. contains the " Synopsis " and " Euphorista." 
 
 " Synopsis," B. VIII., c. xli. : Kemedies against the Diseases 
 of Women. This chapter deals with uterine suffocation. Eue 
 mixed with honey, and applied by means of wool to the 
 rectum, is one remedy. We mention it in order to show that 
 the pessary of wool was used both for the front and the back 
 passage. 
 
 C. xlii. : Excessive Uterine Purgation. This is a condensa- 
 tion of the chapter in the " Collecta " (Vol. IV., c. cxliii.). 
 
 C. xliii. : Treatment of Sterile Women. The general and 
 the local treatment of these cases is considered. Massage, 
 fumigation, fomentations, the douche, and pessaries, are all 
 recommended, the last-named being of use when the mouth 
 of the womb is gaping or when it is too contracted. 
 
 C. xlv. : Uterine Suffocation, from Philumenus. 
 
 Cc. xlvi., xlvii. : Flux. 
 
 C. xlviii. : Inflammation of the Uterus. A short chapter 
 on treatment. 
 
 C. xlix. : Abscess of the Uterus. A few lines, the last 
 sentence being that it is necessary to know that an abscess of 
 the uterus may rupture at the orifice of the womb, into the 
 bladder, but more often into the rectum. 
 
 C. 1. : Ulcer of the Uterus. The treatment alone is dealt 
 with, sitz-baths, embrocations, cataplasms, and pessaries 
 being recommended. 
 
 C. li. : Carcinoma of the Uterus. The author remarks that 
 
I70 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 the affection is incurable, but that we should alleviate the 
 pains by means of opium pessaries. 
 
 C. Hi. : Fissures of the Womb. Pessaries and sitz-baths 
 are to be used in the treatment of these. 
 
 C. liii. : Shrinking (of the Neck) of the Uterus. The orifice 
 of the womb may be the seat of a process of shrinking, 
 following on an ulcer of the anterior portion, or of an 
 inflammation which ends in scirrhus. Sitz-baths, vapour- 
 baths, and fumigations are the treatment. 
 
 C. liv. : On the Uterus filled with Gas. 
 
 C. Iv. : Prolapse of the Uterus. A short description is 
 given of the method of restoring the prolapsed uterus by 
 placing the patient on her back, elevating the pelvis, pressing 
 the uterus upwards, and then placing in the vagina a ball of 
 wool with a string attached to it. Sponges are applied to the 
 pubes, and cupping-glasses to the region of the umbilicus. 
 
 " Euphorista," B. IV., c. cxii. : How to provoke the Menses. 
 
 C. cxiii. : Flux. 
 
 C. cxiv. : Eemedies against Inflammation, Ulceration, and 
 Pruritus of the Vulva and Vagina, and against Prolapse of 
 the Uterus. This chapter contains a few receipts for the 
 various affections enumerated. 
 
 It will be seen from the above review that the works of 
 Oribasius contain few facts of any importance on the subject 
 of gynaecology, the books dealing with this subject and 
 obstetrics being probably, as Siebold suggests, among those 
 that we have lost. 
 
CHAPTER XV. 
 
 MOSCHION. 
 
 It is customary to associate the name of Moschion with that 
 of Soranus, not because these writers were contemporaries — in 
 reality some centuries separated them — but because the irony 
 of fate has shown that Moschion, an author who was lauded 
 and studied while Soranus lay forgotten and lost, is but the 
 abbreviator and translator of the earlier Soranus. The true 
 relation of Moschion's work to that of Soranus has been only 
 clearly understood during recent years, and it is interesting 
 to follow out the history of the various editions of the minor 
 work until we come to the time when, Soranus being dis- 
 entombed, his copier is deposed. Among those who have 
 published editions of Moschion, or who have written con- 
 cerning him, may be mentioned the following : Gesner, Wolf, 
 Bauhien, Spach, Dewez, Siebold, Haeser, Ermerins, Wagner, 
 Daremberg, Eose, Herrgott, Barbour. Of these writers, 
 Herrgott in his notes to Siebold's work, and in his own edition 
 of Soranus and Moschion, and Dewez in the preface to his 
 edition of Moschion, give us an outline of the steps that led 
 to the ultimate elucidation of the matter. 
 
 Towards the middle of the sixteenth century Gesner of 
 Zurich found a Greek manuscript in the library of Augsburg. 
 He copied it, and compared it with a Latin translation of the 
 
172 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 same author in the possession of Guarinus. Wolf, his friend 
 and successor, published the work after Gesner's death, add- 
 ing to it the much-mutilated preface of Moschion found in the 
 Latin version of Guarinus, but not in the Greek one. This 
 preface, strange to say, did not contain any mention of 
 Soranus, and so the original author from whom the work 
 had been copied was not surmised. This work, with another 
 dealing with diseases of women, comprised a portion of the 
 gynaecological encyclopaedia published by Gaspard Wolf at 
 Basle in 1566, under the title of " Gynaeciorum, libri 
 graecorum, arabrum et latinorum." This collection, aug- 
 mented by Bauhien in 1586, and again by Spach in 1597, 
 was published respectively at Basle and Strasburg. 
 
 No new discovery was made with regard to Moschion, and 
 it was not until 1793 that Dewez published his edition from 
 a Greek manuscript preserved in the library at Vienna. His 
 edition is before us now. It opens with a lengthy preface in 
 Latin, and this is followed by the Greek text of the manu- 
 script, and then is given Dewez 's version of the text in Latin, 
 the whole concluding with copious notes and the spurious 
 chapters that Dewez objects to in the edition of Gesner. 
 
 In the preface Dewez points out the difficulties that Gesner 
 had to overcome on account of the mutilated condition of the 
 manuscript, and he then passes on to examine the statement 
 made by Le Clerc, who tried to prove that Moschion was a 
 contemporary of the Emperor Nero, because Moschion states 
 in one of his works that he had given a medicated pessary to 
 Julia Agrippina, who soon after this treatment was enabled to 
 become pregnant, and brought forth a son, Diogenianus : 
 "Misi autem Dominae Juliae Agrippinae illius (Pessi) usum, 
 quae hucusque sterilis desideratissimum filium Diogenianum 
 habet." The objection to this theory is that Julia Agrippina's 
 
MOSCHION. 173 
 
 son was first called L. Domitius Abenobarbus, and tlien, after 
 Agrippina's marriage witb ber uncle Claudius, ber son was 
 called Nero Claudius Csesar Drusus Germanicus : we bave no 
 autbority for tbe statement tbat Nero was ever called Dio- 
 genianus, and tberefore Le Clerc's tbeory tbrows no ligbt on 
 tbe subject ; on tbe contrary, as Dewez remarks, if Moschion 
 bad lived in tbe days of Nero, bow could be quote Soranus, 
 wbo lived in tbe time of Trajan and Hadrian ? Now, it is to 
 be noticed tbat tbe quotation containing tbe name Soranus, 
 referred to by Dewez, occurs not in tbe preface of any manu- 
 script tbat Dewez bad, but in tbe penultimate cbapter of tbe 
 work : ** Et bae quidem sunt causse difficilis partus, quas ego 
 Moscbion et cfetera antiquitas statuere decrevimus, Soranus 
 vero alias adjicit causas." Dewez later on says : " Moscbion, 
 as is sbown in tbe preface to my manuscript, wrote tbe book 
 for tbe use of Latin matrons and midwives wbo were ignorant 
 of Greek idioms ; bence be wrote it in Latin, and not in 
 Greek. It is not unlikely tbat tbe Latin work perisbed, and 
 tbat tbe Greek rendering, wbicb was written at a mucb later 
 date, alone remained. Tnus, tbe Greek work is a recent one, 
 but still one of antiquity, and may date from about tbe time 
 of Cselius Aurelianus. 
 
 Tbe next step in tbe elucidation was tbe discovery of the 
 work of Soranus by Dietz, and its subsequent publication by 
 Lobeck in 1838, and by Ermerins in 1869. Tbese works 
 allowed a comparison to be made between Soranus and 
 Moscbion, and tbe final judgment was pronounced when in 
 1882 Rose, at Leipsic, publisbed bis work, from a manuscript 
 work of tbe tbirteentb century, under tbe title of " Sorani 
 Gynseciorum vetus translatio latina nunc primum edita cum 
 additis grseci textus reliquiis a Dietzio repertis atque ad ipsum 
 codicem parisiensem nunc recognitis." 
 
174 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Eose had several manuscripts to help him, and he had not 
 only the preface that Dewez possessed, but a still more perfect 
 one in which the following significant sentence occurred : 
 " Placuit mihi hsec quoque gyaxcia, in latinum vertere ser- 
 monem, licet etiam maximam partem triacontados ad integrum 
 tenorem secutus Soranum transtulerim." 
 
 Eose by ample reference indicates where each chapter in 
 Moschion's work had been taken from Soranus. 
 
 After Eose, Herrgott in 1895 published his edition of 
 Soranus in French, dovetailing each chapter of Moschion 
 with the chapter in Soranus from which it had been 
 derived. 
 
 Thus, after centuries we find Moschion falling from his high 
 place as an original author, and taking up the lowly rank of 
 translator and abbreviator of another man's work. 
 
 Barbour, in a short account of our author's work, gives his 
 views in the following extract: "It will be evident that this 
 work of Moschion is based on the teaching of Soranus, though 
 when Moschion lived and what the exact relation of the two 
 books to each other is lies wrapped in obscurity. 
 
 " Moschion admits in his preface that his book is not an 
 original, but a translation from a Greek text for the use of 
 ' Latin matrons and obstetricians unskilled in the Greek 
 tongue.' This original Latin Moschion is lost. The Greek 
 version, which we have in the College of Physicians' Library 
 (Edinburgh), is considered by Weber (quoted by Ermerins) to 
 have been produced in the sixth century at Constantinople ; 
 and the extant Latin version is, according to the same 
 authority, a still more recent production of the Greek one.^ 
 Further, it is held by Weber and Ermerins that even the 
 
 ^ " My (Weber's) own ojanion is that tlie Latin fcetus was a product of the 
 Schola Salernitana, to which we owe many translations of that kind," — Baebouk. 
 
MOSCHION. 175 
 
 original Moschion is not based directly on Soranus, but on a 
 work on diseases of women written in the fourth century by 
 Cjelius Aurelianus, who in his turn drew from Soranus.^ If 
 this view is correct, we must place Moschion somewhere 
 during the fourth century, or between it and the sixth. 
 These various editions of Moschion show that the book was 
 widely used, and hence that the valuable work of Soranus on 
 gynaecology and obstetrics was during these centuries not 
 altogether lost. . . . 
 
 " It is interesting to follow the history of this book through 
 its various stages in the hght of these different editions, and 
 we would suggest that the first Latin version, for the use of 
 Latin- speaking matrons and midwives, was produced before 
 the fall of the Western Empire in the fifth century ; its 
 Greek sister just fits in with the development of the Eastern 
 or Greek- speaking Empire at Constantinople in the sixth 
 century; and the version in barbarous Latin points to a 
 later period, when learning was beginning to make way again 
 in Western Europe.'"^ 
 
 With regard to Moschion's name, it may originally have 
 been Mose, and this would have been pronounced Mosche ; 
 the Greek form would then become Moaxicov, and the Latin 
 Muscio. 
 
 Finally, it is to be noted that the name Moschion occurs in 
 the works of Pliny, Soranus, Galen, Aetius and other authors, 
 
 ^ " Moschion sua non ex ipso Sorano hausisse videtnr, sed ex alio eoqne Latino 
 scriptore, qui Sorani sane scripto usus librum de mulieruni morbis composuit. Is 
 fortasse erat Crelius Aurelianus, medicus seculi, ut videtur, quarti post Christum, 
 qui niuliebrium passionum libros scripsit. Soranum s^pius commemorat eiusque 
 libros, ut constat; in Latinum transtulit ; seholse mcthodicffi addictus est et multa 
 habet, quae cum Moschione concordent." — Ermerins, Soranus, p. xvii. 
 
 Emierins, in a note to the above quotation from Weber, says: "Probabilis 
 tamen mihi est Weberi conjectura Moschioneni e Cselii Latinis Graeca sua in 
 brevius redegisse " (McKay). 
 
 * Barbour, Edinhurgh MedicalJournal, vol. xxxiv., p, 331. 
 
176 THE HISTORY OF ANCIENT GYNECOLOGY, 
 
 all of whom lived prior to the date at which our author is 
 supposed to have flourished, i.e., the fifth or sixth century a.d. 
 
 ***** 
 
 We shall now proceed to briefly notice this small work of 
 Moschion. 
 
 The book is in the form of a catechism with 152 questions 
 and answers, and it was, to the Eoman midwives, what 
 Saunders' Question-Compends are to the American student 
 of the present day. The first question asked is, " Quid est 
 obstetrix?" then follows a short description explaining the 
 author's view. The second question is, "By how many 
 names is the uterus called?" Then the author replies that 
 the uterus is called by three different names, and explains the 
 origin of these various terms. 
 
 In order to show how absolutely certain it is that Moschion 
 took his materials either directly from Soranus or at second 
 hand from Caelius Aurelianus, whose works have been shown 
 to be little more than Latin translations from Soranus, we 
 shall give a chapter from Soranus, and after that the cor- 
 responding chapter from Moschion. 
 
 Soranus. 
 
 Cap. XX.: What are the signs by which an approaching 
 normal labour may be recognised ? 
 
 In order that the necessary preparations may be made for 
 the accouchement, it is indispensable to know the premonitory 
 signs of a labour occurring at the seventh month or the tenth 
 month. The signs are as follows : A feeling of weight in the 
 lower region of the abdomen and in the hypogastric region, 
 together with the sensation of heat in the genital parts, the 
 groin, and the loins, with niggling pains in the lower segment 
 of the uterus. The uterus descends so much into the vagina 
 
MOSCHION. 177 
 
 that the exploring finger of the midwife reaches it without 
 difficulty. The uterine orifice is soft and swollen, open 
 and moist, and in proportion to the progress of the labour the 
 region about the haunches and the epigastrium becomes 
 less prominent ; but, on the other hand, the loins and the 
 pubic region become swollen, and the patient passes her 
 water frequently. A viscous secretion is discharged from 
 the genital parts, sometimes tinged with blood, which is 
 derived from the vessels of the chorion which have ruptured. 
 Should a vaginal examination be made, the exploring finger 
 will encounter a rounded tumour, which resembles an egg ; 
 one distinguishes this from a case of inflammation, in which 
 the examination is followed by pain, and the orifice is tender 
 and dry. 
 
 MOSCHION. 
 
 Cay. XLIV. : What are the signs of approaching labour ? 
 
 At the seventh month and tenth month a pregnant woman 
 has pain and a sense of heat, not only in the region of her 
 kidneys, but also in her inguinal and lumbar regions. The 
 uterus comes to be lower in its position ; its orifice becomes 
 opened and the parts moist. On the approach of the labour 
 the upper regions of the abdomen become less full, while the 
 lower parts become fuller above the groins. There is frequent 
 micturition, and the exploring finger introduced into the 
 vagina feels a body similar to an egg, in the orifice of the 
 uterus, and this body grows gradually larger, and at times 
 there is a show of blood. 
 
 Caj). XLV. : How are the pains that accompany inflamma- 
 tion to be distinguished from those of labour ? 
 
 With the pains which accompany inflammation, the uterine 
 orifice is closed and dry. 
 
 12 
 
178 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 On p. 4 of Dewez's edition of Moschion is a picture of the 
 uterus. Had this drawing been a part of the original manu- 
 script, it would certainly have been the oldest representation 
 of the uterus that we possess. It, however, has no great 
 antiquity, and, as Haeser and Barbour have pointed out, it is 
 an interpolation from Vesalius (1514 to 1564). 
 
CHAPTER XVI. 
 
 ' AETIUS. 
 
 Aetius ('AeT409) was born at Amida, a city of Mesopotamia. 
 The exact time at which he lived has not been determined. 
 Cornarius in his edition of some of the books of Aetius, 
 published in 1533, confused our author with Aetius the 
 Atheist, known generally as Aetius Antiocheni, who was born 
 about A.D. 300. Our author quotes St. Cyril, Patriarch of 
 Alexandria, who died a.d. 444, in the following words : 
 " Posca concoctione valde commoda, Cyrilli Archiepiscopi " 
 (Tetrab. III. i. xxiv.). He also quotes Petrus Archiater ; 
 " Aliud quod preparat Petrus Archiathros, et ipsi bonum 
 testimonium praebet " (Tetrab. II. i. x.), an author who lived 
 in the middle of the sixth century. On the other hand, 
 Aetius is quoted by Alexander Trallianus (526 to 605) ; so that 
 we may fix his period as the middle of the sixth century, as 
 Haeser has done. Castelanus, however, who wrote in 1618, 
 placed him after Paul : '* Galenum contractum, Oribasium 
 explicatum, Paulum ampliatum." This, however, is an error. 
 From passages in his works we know that he studied at 
 Alexandria : " iXdiov aKevaaia o eaKevacra (paravi) iv 'AXe^- 
 avhpeia " ; and it is not improbable that it was at Alexandria, 
 with all its wealth of books, that he made some of his 
 compilations. 
 
 12—2 
 
i8o THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Of his life we know little. He resided at Constantinople, 
 and gained the title of " Comes obsequii," or chief officer in 
 attendance on the Emperor, probably Justinian I. (527 to 
 565) ; this title appears on several of the manuscripts of his 
 works. He was the first writer to mention such Eastern 
 drugs as cloves and camphor, and he was the first important 
 Christian Greek author on medicine, whose works we possess, 
 who has left us examples of the spells and charms in use in 
 his day. Thus, of a patient who has a bone in his throat, he 
 says that the bone may be extracted by forceps, or a piece of 
 raw meat with a string on it may be given to him, and he is 
 directed to swallow it, and then immediately it is to be drawn 
 up again ; or the following may be said : '' Egredere os, si 
 tamen os, aut festuca, aut quicquid tandem existit : Quemad- 
 modum Jesus Christus ex sepulchro Lazarum eduxit, et 
 quemadmodum lonum ex ceto ; " then the patient was taken 
 by the throat, and the following said : " Blasius martyr et 
 servus Christi dicit, aut aseende aut descende." 
 
 The work that Aetius has left us is entitled " /3i/3X,ta 
 'larpiKa eKKaiheKa,'' and deals with medicine and surgery in 
 sixteen books. It is a valuable work, not because of any 
 great originality about it, for it is a mere compilation, the 
 author using his own experience to guide him when accept- 
 ing another's statement ; but it is valuable, nevertheless, 
 because it represents the state of medicine at the time at 
 which he wrote, a time when original work had ceased, and 
 each author was content to slavishly copy from his prede- 
 cessors ; and it is valuable because it has preserved to us 
 passages from authors such as Philumenus, Leonides, and 
 Aspasia, whose works we do not possess. With regard to 
 gynaecology and obstetrics the writings are of the greatest 
 interest, and give us in several places a better view of the 
 
AETIUS. i8i 
 
 advanced state of these sciences than can be obtained from 
 other authors. 
 
 The only work of Aetius that we now possess is divided up 
 into four Tetrabibli, each of which is again divided into four 
 sermones (\070t). This arrangement is the work of some 
 modern editor, for Aetius himself refers to his own works 
 according to the numerical series. 
 
 The book that is devoted to gynaecology and obstetrics is 
 the last, or sixteenth, of the series, and we shall presently 
 proceed to examine its contents. 
 
 Of the various editions of Aetius that have been published, 
 the Aldme, brought out at Venice in 1534, consisted of the 
 first eight books in Greek. It is to be regretted that the 
 remaining eight books, with one exception, have not been 
 published in that language, for it is only by consulting the 
 original version of our author that we can hope to clear up 
 many of the passages which at present the Latin versions 
 leave in obscurity. Daremberg in his edition of Eufus (1879) 
 published the full Greek text of the eleventh book, which 
 deals with diseases of the kidney and bladder. 
 
 In 1533 Janus Cornarius published six of the books in 
 Latin, i.e., from the eighth to the thirteenth inclusive; while 
 Montanus completed the work by publishing the remaining 
 ten books in 1535 at Basle. Justus published a complete 
 Latin translation in 1834 at Venice ; while in 1542 Cornarius 
 published a Latin translation of the whole work, which has 
 gone through several editions, the last probably being that in 
 Stephen's " Medicse Artis Principes," Paris, 1567. The edition 
 before us is that of Cornarius, 1549. 
 
 Besides these editions of our author, various chapters have 
 been published from his works from time to time. Among 
 the writers in this connection we shall but mention Orosius 
 
i82 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 (1540), Horn (1654), Habenstreit (1757), Weigel (1791), 
 Magnus Tengstrom (1817), Mustoxydes and Schinas (1816). 
 Daremberg, as we have already mentioned, has pubHshed 
 the eleventh book in Greek, in order to show how much 
 Aetius was dependent on Rufus for his facts for that par- 
 ticular book. 
 
 Maughs^ has given several extracts from the sixteenth book 
 in an article published in an American journal. As there has 
 been no edition of the books of Aetius since 1567, and since 
 the notices of our author found in the histories of medicine 
 (with the exception of Freind and Siebold's) are all very scant, 
 even the usually full Haeser dismissing our author in a page 
 and a half — since this is the case, we propose to give a 
 resume of the whole of the sixteenth book, and then to give 
 a translation of its most important chapters dealing with 
 gynaecology. 
 
 We shall first give a list of the chapters, and we shall give 
 the names of the authors from whom we believe Aetius 
 derived the materials for each chapter in question. That 
 Aetius was indebted to Soranus for a large amount of his 
 work will become very evident to anyone who will carefully 
 study the works of these two authors. Aetius frequently 
 acknowledges his indebtedness to Soranus, but, on the other 
 hand, he as frequently does not. 
 
 In the edition of the works of Soranus edited by Dietz 
 many chapters were published which Ermerins later on 
 showed were mere interpolations from the works of Aetius, 
 and he struck them out of his edition of Soranus ; but even 
 with these chapters taken away from Soranus Aetius remains 
 largely in his debt : " Summatim tamen non dubitandum, 
 quin Aetius plura e nostro Sorano desumpserit."^ 
 
 1 Maughs, Jotcr. Am. Med. Assoc, vol. ii., p. 225, 1884. 
 ^ Ermerins, loc. ciL, xiii. 
 
AETIUS. 183 
 
 In the following list the chapters marked thus (*) are those 
 which were published in Dietz's edition of Soranus, but were 
 rejected by Ermerins : 
 
 CAP. 
 
 i. De uteri situ, etc. (Galen : De dissectione vulvge, cc. i.-ix.) 
 ii. QuaB intra pregnantis uterum nascuntur. (Galen : De dis- 
 sectione vulvse, c. X.) 
 iii. De secundse generatione. (Galen : De dissectione vulvee, c. x.) 
 iv. Menstruae mulierum purgationis ratio. (Soranus, c. iv.) 
 V. Notae futurae virginum purgationis. (Soranus, c. v.) 
 vi. Quando semen appareat. 
 
 vii.* Fcecundarum mulierum dinotio. (Soranus, c. ix.) 
 viii. Quomodo cognoscantur quae conceperunt. (Soranus, c. xii.) 
 ix. Notse foetus masculi ac foeminae. (Soranus, c. xiii. ; Hippo- 
 crates : Sterility ; Littre, Vol. VIII., p. 417.) 
 x.* De pica. (Galen : De causa sympt., I. vii. ; Soranus, c. xv.) 
 xi. De tumoribus pedum in praegnantibus. (Soranus Dietzii, 
 
 c. 24.) 
 xii.* Cura praegnantibus adhibenda. (Aspasise ; Soranus, c. xiv.) 
 xiii. Notae pai'tus secundima natm:am futuri. (Soranus, c. xx.) 
 xiv. Parientibus facienda. (Soranus, c. xxi.) 
 XV.* Cura circa aegre parientes adhibenda. (Aspasise ; Hippocrates : 
 
 Aphor., V. xUx.) 
 xvi Quomodo opem ferre oportet his quae non tuto concipiunt. 
 
 (Soranus, c. xvii.) 
 xvii. Pessi sterUitatem inducentes. (Soranus, c. xvii.) 
 xviii.* Foetum corrumpentia. (Aspasiae ; Soranus, c. xvii. ; Hippo- 
 crates : Aphor., V. xxxi.) 
 xix. Signa futurum abortum praecedentia. (Soranus, c. xviii. ; 
 Hlippocrates : Aphor., VI. xxxvii.) 
 XX. Quomodo abrupti foetus ejectioniopitulemm-. (Soranus Dietzii, 
 
 C. XXV.) 
 
 xxi. De his quae bimestres aut trimestres foetus abortiunt. (Hippo- 
 crates : Littre, IV. 549, VII. 337.) 
 xxii, Pariendi difficultatis causae. (Soranus, cc. Ixii., Ixiv.) 
 xxiii.* De foetus extraetione, et exectione. (Philumeni ; Soranus, 
 
 c. Isv. 
 xxiv.* De secundae eductione. (Philumeni ; Soranus, c. xxii.) ? 
 XXV.* Cura post foetus exectionem. (Aspasiae.) 
 xxvl. Causae sterilitatis ; curatio. 
 xxvii. Frigidoris uteri signa, ac curatio. 
 xxviii. Calidoris uteri signa, ac curatio. 
 xxix. Humidioris uteri curatio. 
 XXX. Siccioris uteri curatio. 
 
1 84 THE HISTORY OF ANCIENT GYNAECOLOGY, 
 
 CAP. 
 
 xxxi. 
 
 sxxii. 
 xxxiii, 
 xxxiv. 
 
 XXXV. 
 
 xxxvi. 
 xxxvii.* 
 xxxviii.* 
 
 xxxix. 
 xl* 
 xU. 
 xlii. 
 xliii.* 
 
 xliv. 
 
 xlv.* 
 xlvi. 
 xlvii. 
 xlviii. 
 
 xlix. 
 
 li* 
 
 m. 
 
 liii. 
 
 liv. 
 
 Iv. 
 Ivi. 
 
 Ivii. 
 
 Iviii. 
 
 lix. 
 Ix. 
 
 Ixi. 
 
 Diversarum affectionum, ob quas mulieres non concipiunt, 
 
 curatio. 
 Potiones, pessi, et siafi&tus ad conceptionem. 
 De lactis defectu. (Soranus Dietzii, c. Ixvi.) 
 Ne lac in mammis coeat in grumos. 
 De coagulate in mammis lacte. 
 De vitiato lacte mammas Isedente. 
 
 Ad mammas inflammatas. (Philumeni ; Soranus Dietzii, c. Iv.) 
 Ad induratas mammarum inflammationes. (Philumeni ; Soranus 
 
 Dietzii, c. Iv.) 
 De mammarum abseessu. (Soranus Dietzii, c. Ivi.) 
 De mammarum fistulis. (Leonidae ; Soranus Dietzii, c. Ivii.) 
 De mammarum nomis. 
 
 De exedentibus mammarum ulceribus. (Soranus Dietzii, c. Iviii.) 
 De cancris mammarum. (Archigenis et Leonidae ; Soranus 
 
 Dietzii, cc. lix., Ix.) 
 Qui cancri ciiratu facUes, et qui difficiles. (Soranus Dietzii, 
 
 c. Ix.) 
 Cancri chirurgia. (Leonidae ; Soranus Dietzii, c. Ixi.) 
 Cancri curatio post amputationem et inustionem. 
 Cancrorum curatio citra chirurgiam. (Soranus Dietzii, c. Ixii.) 
 Canceratorum tumorum non ulceratorum curatio. (Soranus 
 
 Dietzii, c. Ixiii.) 
 Cancri ulcerati curatio. (Soranus Dietzii, c. Ixiv.) 
 De mammis induratis. (Leonidae ; Soranus Dietzii, c. Ixv.) 
 De menstruis suppressis. (Rufi et Aspasiae.) 
 Mulieribus quae non purgantur accidentia. (Galen : De locis 
 
 affectis, VI. v.) 
 Curatio earum quae ob nimiam caliditatem non purgantur. 
 
 (Soranus Dietzii, c. xcv.) 
 Frigidae temperaturae dinotio, ac curatio. (Soranus Dietzii, 
 
 c. xcvi.) 
 Pessi menses educentes. (Soranus Dietzii, c. xcvii.) 
 Curatio earum quae prae pinguedine non concipiunt. (Soranus 
 
 Dietzii, c. xcviii.) 
 Curatio earum quae ob plenitudinem non purgantur. (Soranus 
 
 Dietzii, c. ci.) 
 Curatio earum quae ob maciem non purgantur. (Soranus 
 
 Dietzii, c. xcix.) 
 Curatio earum quae ob vitiatos humores non purgantur. 
 
 (Soranus Dietzii, c. c.) 
 Curatio earum quibus sanguis ad nares, vel sedem defertur. 
 
 (Soranus Dietzii, c. ciii.) 
 Curatio earum que ob nimium ocium non purgantur. (Soranus 
 Dietzii, c. cii.) 
 
AETIUS. i8s 
 
 CAP. 
 
 Ixii. Curatio eainm qute ob aliquam uteri affectionem non purgantur. 
 
 (Soranus Dietzii, c. civ.) 
 Ixiii. De mensium stillicidio. (Soranus, c. xlviii.) 
 Ixiv. De nimia mensium purgatione. (Soranus Dietzii, c. ev.) 
 Ixv.* De fluxu muliebri. (Arcliigenis.) 
 Ixvi. Curatio rubri uteri fluxus. (Archigenis ?) 
 Ixvii. Albi fluxus curatio. (Archigenis ?) 
 Ixviii. De uteri strangulatione. (Soranus, c. li. ; Galen: De locis 
 
 affectis, VI. v.) 
 Ixix. Pessi ad uteri strangulationem idonei. (Soranus Dietzii, 
 
 c. cxi.) 
 Ixx.* Unctiones ad uteri suffocationem. (Philagrii ; Soranus Dietzii, 
 
 c. cxii.) 
 Ixxi.* Varia auxilia ad uteri strangulationem. (Philagrii ; Soranus 
 
 Dietzii, c. cxiii.) 
 Ixxii.* De seminis fluxu. (Soranus, c. lii.) 
 Ixxiii.* De uteri debilitate. (Soranus, c. hii.) 
 Ixxiv.* De furore uterino. (Soranus, c. ?) 
 Ixxv.* De uteri resolutione. (Soranus, c. liv.) 
 Ixxvi.* De uteri prolapsu. (Soranus, c. Ixvi.) 
 Ixxvii.* De reclinatione, aversione, ac recursu uteri. (Aspasise ; Galen ; 
 
 Soranus, c. Iv.) 
 Ixxviii. De uteri inflatione. (Soranus, c. Ivi.) 
 Ixxix. De uteri hydrope. (Soranus Dietzii, c. cxx.) 
 Ixxx. De mola uteri. (Soranus, c. Iviii.) 
 Ixxxi.* De tumore uteri laxo. (Soranus, c. Ivii.) 
 Ixxxii.* De Satyriasi. (Soranus, c. lix.) 
 
 Ixxxiii.* De uteri inflammatione. (Philumeni ; Soranus, c. Ix.) 
 Ixxxiv."^'- De uteri in scirrhi tumorem indurato. (Soranus, c. Ixi.) 
 Ixxxv.* De uteri abscessu. (Archigenis.) 
 Ixxxvi. Abscessus oris uteri chirurgia. (Archigenis ?) 
 Ixxxvii. Abscessus uteri inter intestina, et peritonaeum membranam, 
 
 ruptio curatio. 
 Ixxxviii.* De uteri exulceratione. (Archigenis.) 
 Ixxxix. Ulcerum uteri carbunculosorum curatio. 
 xc* Ad sordida uteri ulcera. (Archigenis). 
 xci. Ad humor em a muliebri pudendo profluentem. 
 xcii.* Ad uteri nomas. (Aspasite.) 
 xciii.* Quse ad cicatricem ducunt. (Asclepiadse.) 
 xci v.* De cancris uteri. (Archigenis.) 
 xcv. De uteri obturatione. 
 
 xcvi. De utero non perforate. (Celsus, VII. xxviii.) 
 xcvii.* De hsemorrhoidibus uteri. (Aspasise.) 
 xcviii. De calculo uteri. 
 xcix. De calculo vesicae muliebris. 
 
i86 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 CAP. 
 
 c* De hernia aquosa mulierum. (Aspasiae.) 
 ci. De hernia inguinis muHerum. (Aspasiae ?) 
 cii.* De hernia varicosa. (Aspasiae.) 
 ciii. De nymphae sectione. 
 civ. De Cauda, 
 cv.* De thymis. (Philumeni.) 
 cvi.* De condylomatis. (Aspasiae.) 
 cvii. De rimis, ac fissuris uteri, 
 cviii. De tuberculis uteri miliaribus. 
 cix. De scabris uteri pustuhs. 
 ex. De alarum pudendi muliebris abscessu. 
 cxi. Ad umbilicum prolapsum. 
 cxii. Ad rugas ventris. 
 cxiii.-cxxiii. Preparation of remedies. 
 
 C. i. : "De uteri situ, magnitudine, ac forma." This 
 chapter is a paraphrase of the first nine chapters of Galen's 
 work " De dissectione vulvae." He falls into the same error 
 as Galen with regard to the size of the uterus, but he gives 
 an excellent description of the Fallopian tubes, and makes the 
 remark that during sexual intercourse the uterus draws the 
 seed from the ovary. 
 
 Cc. ii., iii. : " Quae intra pregnantis uterum nascuntur ; De 
 secundse generatione." These chapters are paraphrases from 
 the tenth chapter of Galen's work on the dissection of the 
 uterus. He concludes the third chapter with the remark : 
 "At si quis diligentius speculari hsec voluerit, capram aut 
 vaccam, vel cervam dissecare poterit, ossa pubis removendo, 
 et cutem apte resecando." 
 
 C. iv. : " Menstruae mulierum purgationis ratio." The 
 author deals with the menstrual flow, the usual age at which 
 it sets in, its quantity and duration. The chapter is derived 
 from Soranus, c. iv. 
 
 C. V. : " Notse futuras virginum purgationis." The signs 
 and symptoms of an approaching menstrual period are given 
 from Soranus, c. v. 
 
AETIUS. 187 
 
 C. vi. : ** Quando semen appareat, et conceptus tempus 
 adveniat." This chapter eontams but a few lines, the 
 substance being that the semen is provided at the fourteenth 
 year. This chapter does not correspond to any in Soranus, 
 the nearest approach being the remark in c. iv., *' that 
 menstruation shows itself about the fourteenth year, at the 
 same time that the signs of puberty and the swelling of the 
 breasts are apparent." 
 
 C. vii. : " Foecundarum mulierum dinotio." Aetius 
 acknowledges Soranus as the author of this chapter (Soranus, 
 c. ix.). 
 
 C. viii. : '* Quomodo cognoscantur quae conceperunt." Here 
 are enumerated the signs of pregnancy. This chapter is taken 
 from the latter part of Soranus, c. xii. 
 
 C. ix. : " Notes foetus masculi ac foeminae." This chapter 
 is taken from Soranus, c. xiii., both authors quoting Hippo- 
 crates (Littre, VIH., p. 417), who said that a good colour, 
 quickness in movement, and swelling of the right breast, 
 denoted that a woman had conceived a male child. 
 
 C. X. : " Depica." Aetius acknowledges Galen (" De causa 
 sympt.," I. vii.) as the author of this chapter, but both 
 authors are indebted to Soranus, c. xv. Our author derives 
 the name of the disease from the bird pica («tcrcra), or from 
 ivy {kltto'^), which entwines itself round various objects ; so 
 also do the appetites in these women fasten on a variety of 
 peculiar articles of diet. He gives the symptoms and treat- 
 ment very fully. 
 
 C. xi. : " De tumoribus pedum in prsegnantibus." This 
 chapter corresponds to c. xxiv., Soranus Dietzii, and consists 
 of but a few lines, which tell how to make up certain prepara- 
 tions for treating swelling of the feet in the pregnant. 
 
 C. xii. : " Cura prsegnantibus adhibenda." Aetius acknow- 
 
1 88 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 ledges Aspasia as the authoress ; the whole chapter, however, 
 corresponds to the first part of Soranus, c. xiv. The advice 
 to the pregnant is excellent, warning them against lifting 
 heavy weights, violent exercises, severe clysters, etc. 
 
 C. xiii. : *' Notse partus secundum naturam futuri." A 
 short chapter derived from Soranus, c. xx., and dealing with 
 the signs of an approaching labour. 
 
 C. xiv. : " Parientibus facienda." This chapter consists of 
 few lines, and merely deals with the management of the 
 breath in labour. It appears to us to be derived from 
 Soranus, c. xxi. 
 
 C. XV. : " Cura circa segre parientes adhibenda." Our 
 author acknowledges Aspasia as the authoress. It is a short 
 chapter, and deals with some aspects of a difficult labour. 
 After the labour, if the after-birth remain, the author warns 
 against extracting it by force, but recommends (without 
 acknowledgment) the advice given by Hippocrates (" Aphor.," 
 v., xlix.), to apply a sternutatory, and shut the mouth and 
 nostrils and hold the breath. 
 
 C. xvi. : " Quomodo opem ferre oportet his qu£e non tuto 
 concipiunt." The first part of this chapter enumerates the 
 various causes why it is dangerous for some women to 
 conceive, and Aetius is indebted to Soranus, c. xvii., for much 
 of his material. He remarks " that to prevent conception 
 the mouth of the womb may be smeared with various 
 substances, such as honey or opobalsam." 
 
 C. xvii.: "Pessi sterilitatem inducentes." This chapter is 
 devoted to receipts for pessaries for producing sterility, some 
 of which are taken from Soranus, c. xvii. 
 
 C. xviii. : " Foetum corrumpentia." Aetius acknowledges 
 Aspasia as the authoress. Many of the passages correspond 
 to Soranus, c. xvii., yet it is to be remarked that, although 
 
AETIUS. 189 
 
 Soranus quotes so many authors, he does not mention 
 Aspasia. The sentences corresponding to those of Soranus, 
 therefore, in this and other chapters have probably been 
 interpolated by Aetius into Aspasia's original account, if, 
 indeed, she lived anterior to Soranus, as also have the 
 quotations from Hippocrates. In this chapter he quotes 
 Hippocrates : " Sanguis enim a muliere pregnante evacuatus 
 abortum facit " ("Aphor.," V. xxxi.). Soranus also quotes 
 Hippocrates to this effect. Aetius says that the corruption of 
 the foetus is dangerous, especially if the woman is robust and 
 healthy. He thinks that the second and fourth months are 
 to be avoided, while the third month should be chosen if we 
 wish the patient to abort, and this is to be brought about by 
 sitz-baths, external applications, bleeding, and pessaries made 
 of iris, galbanum, turpentine, etc. 
 
 C. xix. : " Signa futurum abortum prsecedentia." Aetius 
 has taken this chapter almost word for word without acknow- 
 ledgment from Soranus, c. xviii. The signs relied on are : 
 first a discharge of aqueous fluid, rapidly becoming san- 
 guineous ; then are passed clots and pieces of membrane ; the 
 patient has pains in the loins, pelvis, lower part of the abdomen, 
 groins, head, eyes, and articulations ; feeling of chilliness about 
 the body, sometimes fever and shivering, sometimes epileptiform 
 spasms. Hippocrates is quoted as saying that when the abortion 
 is spontaneous it produces less fulness of the breasts. Soranus 
 then quotes Diodes, that a feeling of coldness is experienced 
 in the thighs, but though Aetius gives the quotation he does 
 not mention Diodes. The passage mentioned by our author 
 from Hippocrates occurs in the "Aphorisms " (VI. xxxvii.) : "In 
 a pregnant woman, if the breasts suddenly lose their fulness she 
 has a miscarriage." 
 
 C. XX. : " Quomodo abrupti foetus ejectioni opitulemur." 
 
I90 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 If the foetus be retained in the neck of the uterus, the whole 
 body (but especially the parts in the neighbourhood of the 
 uterus) is to be bathed with oil of Cyprus, and the patient is 
 to be made to sneeze. If the uterus is closed through inflam- 
 mation we introduce dry sponge ; at first the pieces are small, 
 and then larger ; these are shaped like a pessary, and are to 
 be smeared with medicinal substances. Should the secundines 
 be alone retained, they are not to be extracted with force, but 
 the cord may be tied to the patient's leg. He postpones 
 further directions until a later chapter (c. xxiv.). This 
 chapter corresponds to c. xxv., Soranus Dietzii. 
 
 C. xxi. ; " De his quae bimestris aut trimestris foetus abor- 
 tiunt." Aetius is indebted to Hippocrates for this chapter 
 (Littre, IV. 549, VII. 337). The author supposes that the 
 excess of humour determines the abortion, and the treatment 
 aims at drawing off this excess by administering drugs and 
 applying pessaries. 
 
 C. xxii. : " Pariendi difficultatis causae." Most of this 
 chapter has been taken from Soranus (cc. Ixii., Ixiv.), and, 
 being lengthy, it would be useless to give a short extract. The 
 chapters, as we have had occasion to observe in dealing with 
 Soranus, are among the most excellent that we have received 
 from the ancients on obstetrics. 
 
 C. xxiii. : " De foetus extractione, ac exectione." Aetius 
 acknowledges Philumenus as the author of this chapter, but 
 the substance of the chapter is to be found in Soranus, c. Ixv. 
 
 C. xxiv. : " De secundfe eductione." This is from Philu- 
 menus, but many of the passages correspond to Soranus, 
 c. xxii. Aetius advises the introduction of the left hand into 
 the womb, but warns that direct traction may cause prolapse 
 (Soranus says inversion) of the womb. He gives directions 
 for dilating the os with the finger. 
 
AETIUS. 191 
 
 C. XXV. : " Cura post foetus extractionem." From Aspasia. 
 This is made up chiefly of receipts. 
 
 C. xxvi. : " Causae sterilitatis ; curatio." Aetius enumerates 
 a long list of afifections of the womb which cause sterility, 
 and among them he says, " aut quod vasa ejus clausa sunt et 
 obstructa, aut per cicatricem inductam excsecata " ; the vasa 
 referred to might possibly be the Fallopian tubes. 
 
 Cc. xxvii.-xxx. These four chapters deal with sterility 
 from the frigid, warm, the humid, and the dry womb. The 
 descriptions appear to refer to various conditions of metritis 
 and endometritis, and the chapters are chiefly made up of 
 receipts. Fumigation by a reed is referred to in the treatment 
 of the frigid womb. 
 
 C. xxxi. : "Diversarum affectionum, ob quas mulieres non 
 concipiunt, curatio." Flatus in the womb is given by our 
 author as a cause of sterility. In another place he says that 
 if the OS uteri is too open astringents are to be used, and if 
 the uterus is displaced it should be corrected by the 
 sound. 
 
 C. xxxii. : " Potiones, pessi, suffitus ad conceptionem." 
 This is devoted to numerous receipts for pessaries, etc., to 
 enable the patient to conceive. 
 
 Cc. xxxiii.-xxxvi. These chapters deal with the milk in 
 the breast, and the pathological conditions produced by it ; 
 c. xxxiii. is similar to c. Ixvi., Soranus Dietzii. 
 
 C. xxxvii. : *' Ad mammas inflammatas." Aetius acknow- 
 ledges Philumenus as the author of this and the next chapter, 
 " Ad induratas mammarum inflammationes " (Soranus Dietzii, 
 c. Iv.) ; these chapters are mainly composed of receipts. 
 
 C. xxxix. : " De mammarum abscessu." In cases where 
 the breast has to be incised for abscess, the author directs 
 that an incision may be made into it with safety, but the 
 
192 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 nipple must not be cut, as that would interfere with its future 
 use (Soranus Dietzii, c. Ivi.)- 
 
 C. xl. : " De mammarum fistulis." This is from Leonides. 
 The author explains that a fistula may result from the rupture of 
 an abscess. The chapter corresponds to c. Ivii., Soranus Dietzii. 
 
 Cc. xli., xlii. These chapters deal with noma and phage- 
 daenic ulcers of the breast ; the writer explains how the latter 
 differ from cancerous ulcers. C. xlii. corresponds to c. Iviii., 
 Soranus Dietzii. 
 
 C. xliii. : "De cancris mammarum." This is taken from 
 Archigenes and Leonides. The author classes cancer of the 
 breast under two headings — those with ulceration and those 
 without. In the breast it consists of a large tumour, unequal 
 and resistant to pressure, having extensive roots and ac- 
 companied by varicose veins. There is pain, and at times 
 malignant phlegmon in the axillae. It is generally incurable. 
 The application of poppy-heads to relieve the pain is recom- 
 mended (Soranus Dietzii, cc. lix., Ix.). 
 
 C. xliv. : ** Qui cancri curatu faciles, et qui difficiles." 
 The author mentions the cancers which he thinks are able 
 to be cured, and those which he considers incurable. The 
 chapter corresponds to Soranus Dietzii, c. Ix. 
 
 C. xlv. : " Cancri chirurgia." This is from Leonides. The 
 operation of incision of the breast is here well described, the 
 cautery being used to stop haemorrhage and to destroy the 
 disease (Soranus Dietzii, c. Ixi.). 
 
 Cc. xlvi.-xlix. These .chapters deal with the treatment of 
 the case after an operation on the breast, and the treatment 
 of cases of cancer with and without ulceration. Cc. xlvii.- 
 xlix. correspond to cc. Ixii.-lxiv., Soranus Dietzii. 
 
 C. 1.: "De mammis induratis." This is from Leonides, 
 and corresponds to Soranus Dietzii, c. Ixv. 
 
 J 
 
AETIUS. 193 
 
 Cc. li.-lxii. : The author deals at considerable length in 
 these chapters with the various causes, and the treatment, of 
 amenorrhcea {vide post, amenorrhoea) . Aetius acknowledges 
 Eufus and Aspasia as the authors of chapter li. 
 
 C. Ixiii. : " De mensium stillicidio." This chapter is 
 derived from the second part of Soranus, c. xlviii. ; it deals 
 with cases of scanty and painful menstruation, and contains 
 nothing but what can be found in Soranus. 
 
 C. Ixiv. : "De nimia mensium purgatione." Aetius 
 enumerates various causes which lead to the loss of much 
 blood from the genital organs ; among them may be men- 
 tioned a labour, or an abortion, or an erosion. The symptoms 
 that follow excessive loss are pallor, sometimes a rise in 
 temperature, loss of appetite, and the digestion is affected, 
 while sometimes oedema of the feet may be present. He 
 advises that legs should be bandaged, but objects to the appli- 
 cation of sponges soaked in posca, lest the uterus or bladder 
 should be chilled ; in this he differs from Soranus. This 
 chapter is c. cv. of Soranus Dietzii. 
 
 Cc. Ixv.-lxvii. : " De fluxu muliebri." These chapters deal 
 with the red and white flux, and are probably all derived from 
 Archigenes, who is acknowledged as the author of the first of 
 them. 
 
 Cc. Ixviii.-lxix. : " De uteri strangulatione." Aetius does 
 not acknowledge the author from whom these chapters are 
 derived, but it is evident that he took most of his material 
 from Galen (" De locis affectis," VI. v.), who in turn was much 
 indebted to Soranus, c. li. 
 
 Cc. Ixx., Ixxi. : " Unctiones ad uteri suffocationem,." and 
 " Varia auxilia ad uteri strangulationem." These two chapters 
 are from Philagrius, and correspond to Soranus Dietzii, 
 cc. cxii., cxiii. 
 
 13 
 
194 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Cc. Ixxii.-lxxvi. These chapters are all taken from Soranus, 
 and Aetius acknowledges his authority. Chapter Ixxiv., 
 entitled "De furore uterino," though stated to be from 
 Soranus, does not correspond to any of the chapters that have 
 come down to us in the works of that author. Ermerins 
 says : " Apparet caput Sorani nomen apud Aetium inscriptum 
 ferro quod ab auctore nostro non est relictum." The other 
 chapters deal with prolapse of the womb, fluxus seminis, and 
 the debilitated uterus. 
 
 C. Ixxvii. : De reclinatio, aversione, ac recursu uteri." 
 Aetius acknowledges Aspasia as his authority for this chapter, 
 but many of the passages are similar to those in the fifth 
 chapter of the sixth book of Galen's " De locis affectis." It 
 deals with the various displacements of the womb, and men- 
 tions the knee-elbow position, as well as rectal examinations 
 and the use of the sound in rectifying the neck of the uterus. 
 
 C. Ixxviii. : " De uteri inflatione." This chapter is a para- 
 phrase of Soranus, c. Ivi. It deals with septic endometritis 
 and metritis. Soranus directs that the midwife should intro- 
 duce her finger into the uterus if she thinks that clots are the 
 cause of the trouble. The translator of Aetius uses the follow- 
 ing words : " Obstetrix digitum illitum in pudendi sinum 
 immittat." 
 
 C. Ixxix. : " De uteri hydrope." The author says that 
 when the menses have been suppressed for some time, and 
 the patient has not become pregnant, the uterus becomes 
 filled with humour, and small bladder-like bodies are developed 
 in the fluid. With this the abdomen becomes swollen, and 
 the patient has a slow walk, and breathes with difficulty. 
 The above description evidently alludes to hydatidiform 
 degeneration of the chorion. (Soranus Dietzii, c. cxx.) 
 
 C. Ixxx. : " De mola uteri." The mola referred to here is a 
 
AETIUS. 195 
 
 fibroid tumour of the uterus, and the description is taken 
 
 from Soranus, c. Iviii. 
 
 C. Ixxxi. : " De tumore uteri laxo." In this short chapter 
 
 an oedematous condition of the uterus is described ; it is taken 
 
 from Soranus, c. Ivii. 
 
 C. Ixxxii. : "De Satyriasi." This chapter deals with a 
 
 perverted sexual feeling brought about by pruritus of the 
 
 genitals. From Soranus, c. lix. 
 
 C. Ixxxiii. : " De uteri inflammatione." Aetius attributes 
 
 this chapter to Philumenus ; it nevertheless contains much 
 
 that is in Soranus, c. Ix. ; we shall give a re'sume of it in 
 
 dealing with metritis {vide post) . 
 
 C. Ixxxiv. : "De utero in scirrhi tumorem indurato." 
 
 Aetius acknowledges Soranus as his authority. On referring to 
 Soranus we find that chapter Ixi. of that author has the same 
 title, but, being a mere fragment, we cannot compare the two 
 chapters. The extract given by Moschion does not bear much 
 resemblance to the subject-matter of the chapter in Aetius. 
 It appears to us that the description given by Aetius is meant 
 to apply to myoma of the uterus, for he says : ** Scleroma is 
 a form of scirrhus, and is chiefly found in the cervical region, 
 where it causes a certain amount of swelling with a little pain. 
 Scleroma may also occupy the fundus of the uterus as a 
 tumour." 
 
 C. Ixxxv. : " De uteri abscessu." This chapter, with the 
 next, *' Abscessus oris uteri chirurgia," are from Archigenes ; 
 Aetius acknowledges the former, but not the latter. The 
 description given of the opening of an abscess in the broad 
 ligament is one of the most interesting in the work before us, 
 as we have vividly brought before us the technique, the 
 instruments, the position of the patient, and the after-treat- 
 ment. The writer describes the abscess as though it were a 
 
 13—2 
 
196 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 uterine abscess, but this does not affect his description of the 
 technique of the operation. 
 
 C. Ixxxvii. : " Abscessus uteri inter intestina, at peritonseum 
 membranam rupti curatio." This chapter deals with a 
 pelvic abscess which points to the groin, and directions are 
 given for opening it in that situation by the knife, unless it 
 be a suppurating hsematocele, when the cautery is recom- 
 mended. 
 
 Cc. Ixxxviii.-xc. : " De uteri exulceratione." These chapters 
 are from Archigenes. The author points out that there are 
 various causes for ulceration of the cervix, such as an eroding 
 flux, injury from acrid medication, from the bursting of an 
 abscess, from difficult labour, extraction of the foetus, and 
 other causes. He describes the discharges in such cases, and 
 directs that the seat of the ulceration should be examined 
 by the speculum, and that the treatment should be by pes- 
 saries, and for the pain poppy-heads. He ends the chapter 
 by giving directions for treating ulceration of the labia. 
 
 C. xcii. : " Ad uteri nomas." From Aspasia. 
 
 C. xciii. : " Quse ad cicatricem ducunt." From Asclepiades. 
 
 C. xciv. : " De cancris uteri." From Archigenes. The 
 author divides the cancers of the uterus into ulcerative and 
 non-ulcerative cancers. Various receipts are given for local 
 treatment, but no operative measures are described. In a 
 later chapter, in dealing with haemorrhoids (polypi uteri), 
 Aetius warns the reader against touching such growths if 
 they are malignant in character. 
 
 C. xcv. : " De uteri obturatione." This chapter is probably 
 the one of greatest interest in the whole work, on account of 
 the excellent description given by our author of the use of 
 sets of sponge tents for dilating the cervix. 
 
 C. xcvi. : "De utero non perforato." This chapter is 
 
AETIUS. 197 
 
 largely derived from Celsus (VII. xxviii.), though it gives some- 
 what fuller details. Aetius recommends that the speculum be 
 used so as to keep the newly-formed canal open, and with this 
 end he also recommends the introduction of a pipe made of 
 tin. 
 
 C. xcvii. : " De haemorrhoidibus uteri." This chapter is 
 from Aspasia. The haemorrhoids are said by our author to 
 occur at the mouth of the womb or in the pudendum. They 
 are probably polypi, and Aetius recommends that they should 
 be examined by the speculum. 
 
 C. xcviii. ** De calculo uteri." Aetius says that occasion- 
 ally a calculus may be formed in the uterus. He describes a 
 bimanual manipulation, one finger in the rectum and the 
 other hand on the abdomen, in order to expel the stone. ^ 
 
 C. xcix. " De calculo vesicae muliebris." The directions 
 given for the incision in case of stone are as follows : " Tunc 
 paululum supra pudendi alas, quo loco calculus occurrit sec- 
 tionem facito." Neither the directions given by Aetius, " supra 
 pudendi alas," nor those by Celsus, " sub ima sinisteriore 
 era," make the exact place for the incision very clear. 
 
 Cc. c.-cii. : "De hernia." From Aspasia. 
 
 C. ciii. : "De nymphse sectione." The operation here 
 described refers to amputation of the enlarged clitoris ; 
 nympha and clitoris were used as synonymous terms. 
 
 C. civ. "De Cauda." The cauda here referred to was no 
 doubt a polypus projecting into the vagina. It may occa- 
 
 ^ Calculus of the uterus is here referred to ; many cases have been reported in 
 recent years, and Everett has collected thirty-three. The calculi represent in 
 most cases the calcareous degeneration of utero-myomata, and while degeneration 
 is rare in polypi, it is not unknown, and these latter are those in which the 
 calculus is most likely to be expelled. Recently Doran stated at the Obstetrical 
 Society of London ("Trans. Obstet. Society of London," vol. xl., p. 225, 1899) 
 that a myoma of the uterus was apt to calcify if its vascular supply were for 
 long obstructed. 
 
igS THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 sionally have been a hypertrophy of the cervix, but the author 
 would hardly have dismissed the treatment so shortly if the 
 latter had been meant, as amputation in case of hypertrophy 
 of the cervix would have constituted a fairly grave operation, 
 on account of the hgemorrhage. 
 
 Cc. cv.-cxxiii. : The remaining chapters deal with small 
 growths about the mouth of the womb, as well as clefts and 
 fissures in that region. The descriptions, however, of the 
 affections are not always sufficiently full to enable one to 
 discern the real nature of the disease mentioned. The final 
 chapters of the work consist of receipts for various ointments 
 and applications. 
 
CHAPTER XVII. 
 
 AETIUS (Continued). 
 
 Physical Examination of the Pelvic Organs. 
 
 Palpation, percussion, and inspection are frequently alluded 
 to. In the chapter "De uteri infiatione " (c. Ixxviii.) the 
 following occurs : " Ad digitorum pulsationem sonus tympani 
 redditur." Percussion and palpation are both well described 
 in the diagnosis of a fibroid (mola) from ascites and 
 pregnancy (c. Ixxx.). 
 
 Vaginal Examination. 
 
 In dealing with a case of pelvic abscess (c. Ixxxvi.), the 
 author gives us a most excellent and minute account of the 
 method to be adopted in making the vaginal examination with 
 the speculum. Many other passages show the reliance placed 
 on the vaginal examination for diagnostic purposes ; thus, we 
 find that (c. Ixxxiii.) in inflammation of the uterus, if a vaginal 
 examination be made and the finger be placed in the os, it 
 will be found hard and closed, hot and retracted, especially if 
 the inflammation is in the cervical portion of the uterus. 
 Again, the direction in which the uterus is inclined may 
 be told by the introduction of the finger into the vagina 
 (c. Ixxvii.). 
 
 Both hands were used in some cases ; the patient being 
 placed in position, two fingers of the left hand were inserted 
 
200 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 into the vagina, while the right hand compressed the bladder 
 from above (c. xcix.). 
 
 Eectal Examination. 
 
 In the case of calculus of the womb the finger of the left 
 hand is inserted into the rectum, while the right hand is 
 placed on the abdomen (c. xcviii.). In treating a case of 
 retroflexion the midwife should introduce her finger into the 
 rectum and push the uterus forward (c. Ixxvii.). 
 
 Position of the Patient. 
 
 A passage in chapter Ixxxvi. shows us the great antiquity of 
 the lithotomy position as regards gynaecological operations {vide 
 post, cellulitis). In another chapter the knee-elbow position is 
 referred to thus : In cases of retroflexion the faeces are not 
 passed, nor can a clyster be admitted — " nisi genibus innitatur 
 segra " (c. Ixxvii.). 
 
 In treating lateral displacement of the womb the patient 
 should be placed on the side opposite to the displacement 
 (c. Ixxvii.). 
 
 In the after-treatment of imperforate vagina the patient is 
 kept on her back with a pillow between her legs until the 
 cicatrix is formed (c. xcvi.). In treating prolapse of the 
 womb the patient is placed on her back, and the buttocks 
 raised (c. Ixxvi.). 
 
 Therapeutic Agents. 
 
 Speculum. — The best description of the method of using the 
 speculum which has been handed down to us is to be found 
 in chapter Ixxxvi. {vide post, cellulitis). 
 
 In diagnosing haemorrhoids (polypi ?) of the uterus 
 (c. xcvii.), Aetius says : ** Melius tamen per dioptram depre- 
 henduntur." 
 
 I 
 I 
 
AETIUS. 20I 
 
 Sound. — A uterus that is distorted must be straightened 
 and corrected either by the finger or the sound (c. xxxi.). In 
 cases of retroflexion the midwife with her sound, which is 
 directed by her finger, should straighten the neck of the 
 womb (c. Ixxvii.)- 
 
 In operating on imperforation of the upper part of the 
 vagina, the sound should be introduced into the cervical part 
 of the uterus as a precaution, and to serve as a guide 
 (c. xevi.)- 
 
 In using the speculum, the operator is advised "per specillum 
 sinus muliebris profunditatem demetiatur," so that he will 
 know how far to introduce the instrument, and thus avoid 
 pressing on the tender uterus (c. Ixxxvi.). 
 
 Volsella. — The volsella is mentioned in the operation for 
 imperforate hymen (c. xcvi.), and in dealing with haemorrhoids 
 of the uterus (c. xcvii.). 
 
 Dilators. — The graduated dilators mentioned by Hippocrates 
 are not alluded to by Aetius. In dilating the cervix he used 
 the sponge tents (c. xcv.), and in some vaginal operations 
 rolls of lint (c. xcvi.) and a tube of tin were used ; while by 
 the introduction of the speculum the newly-formed canal was 
 kept dilated in case of imperforate vagina (c. xcvi.). Digital 
 dilatation of the os is mentioned (c. xxiii.). 
 
 Catheters. — The catheter for drawing off the urine is 
 mentioned in several chapters (c. Ixxvi.) ; it is also used as 
 a sound in cases of difficult labour: "Quod si vero calculus 
 affuerit, eum extra vesicae collum per catheterempropellemus" 
 (c. xxii.). 
 
 Vaginal and Rectal Injections. — These injections are men- 
 tioned in many places (cc. Ixxvi., Ixxxiii., xcviii.) ; after 
 rupture of an abscess into the rectum or into the vagina we 
 must inject pomegranate or rose oil, and if the pus is offensive 
 
202 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 inject astringents (c. Ixxxv.)- The injection may sometimes 
 be given by an ear syringe (per auricularem — c. Ixxxvi.). 
 
 The sitz-bath (c. Ixxxv.) ; fumigations (cc. xxvii., Ixxxv.) ; 
 fomentations externally (cc. Ixxxiii., Ixxxv.), and by means of 
 a sponge in the vagina (c. Ixxxv.), or to the prolapsed womb 
 (c. Ixxvi.) ; counter-irritation (c. Ixxvi.) ; cautery for haemor- 
 rhage (c. xlv.) ; cataplasms containing linseed, fenugreek, and 
 turpentine (c. Ixxxv.) ; bleeding (c. Ixxxv.) and cupping 
 (c. Ixxxiii.) ; massage (c. Ixxxiii.) ; pessaries for the vagina and 
 rectum — all these subjects are dealt with by Aetius. 
 
 Tents. — In the chapter " De uteri obturatione " (c. xcv.), 
 we have the first mention of the sponge tent being used for 
 the purpose of dilating the cervix ; the passage is as follows : 
 ** But if we find that the parts are soft to the touch, we should 
 introduce dried sponge, to which is attached a piece of thread, 
 in order that the narrow part of the canal may be dilated ; and 
 if the sponge slip out, we should place a larger piece in the 
 uterus, and for this reason it behoves us to have several 
 different sizes ready " (c. xcv.). 
 
 Vaginal Plugs. — Plugs made of wool, and soaked in wine 
 and various astringents, are mentioned by Aetius (c. Ixxvi.). 
 
 The mechanical pessary is not mentioned by our author. 
 
 Anatomy (c. i.). 
 
 Aetius in the first place mentions the names applied to the 
 uterus, such as metra, matrix, hystera, and then gives the 
 various origins of these terms. He next deals with the situa- 
 tion of the uterus, giving what is obviously a paraphrase of 
 Galen's description. He follows Galen in his mistake con- 
 cerning the length of the womb, and says that the fundus 
 extends far beyond the bladder, reaching up to near the 
 umbilicus. He remarks that the fundus is similar in shape 
 
AETIUS. 203 
 
 to the bladder, but it differs from that organ in having nipple- 
 like projections, called cornua, produced from either side and 
 facing towards the loins. 
 
 The horns, he says, at first run upwards, then downwards, 
 and become gradually narrower, so as to resemble veins. 
 These narrowed portions of the horns with sinuous curves 
 reach to the ovaries (testes), which are placed by the side of 
 the uterus, one ovary on either side of the fundus close to the 
 cornua, and through these sinuous curves of the cornua the 
 uterus draws the semen from the ovaries during coitus. 
 
 The ovaries are not round or oblong and covered by a 
 delicate fleshy membrane, as in the male, but they are small, 
 flat, and glandular, and are covered by a delicate membrane. 
 He then deals with the ligaments of the uterus and its blood- 
 supply. He says that two veins and two arteries come from 
 the vena cava and aorta. These four vessels are distributed 
 to the uterus, but before entering it they give off branches to 
 the ovaries, and it is from these vessels that the menstrual 
 blood comes. Other vessels are also distributed to the uterus, 
 and give branches to the ovaries and cervix. Aetius then 
 proceeds to give Galen's descriptions of the tunics of the 
 womb, mentioning the cartilaginous feel of the cervix, and 
 recording the fact that a sound cannot enter the os at times, 
 and that it is closed up when the woman is pregnant. He 
 mentions the vagina as the sinus or pudendum, and gives its 
 length as the width of six fingers, remarking that it is soft 
 and delicate in a young woman, but that child-bearing and 
 the escape of the periods made it indurated. He also draws 
 attention to the variation in thickness of the walls of the 
 uterus. 
 
 In chapter ciii. Aetius describes the appearance and situa- 
 tion of the clitoris. 
 
204 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 1. Peeitoneum and Connective Tissue. 
 
 Parametritis and Pelvic Abscess. — The title of chapter Ixxxv. 
 is " De uteri abscessu," and this Aetius has taken from 
 Archigenes; the description in reality refers to a case of 
 pelvic suppuration. The author opens this chapter by saying 
 that a uterme abscess results from preceding inflammation, 
 as is the rule in other parts of the body. Therefore, in the 
 first place the usual signs of inflammation are apparent, and 
 at about the time that the suppuration begins the pains 
 increase, and we have fevers and rigors chiefly towards 
 evening ; the swelling then increases, and the pains become 
 more acute. Sometimes there is retention of urine, some- 
 times the faeces are not passed — sometimes both. The exact 
 part affected will be indicated by localized pain, and if this 
 pain cannot be shaken off, then we must resort to measures 
 which aid suppuration, such as poultices containing linseed- 
 meal, fenugreek, turpentine, etc., which are applied to the 
 lower portion of the abdomen and to the lumbar regions. 
 Besides this, we should assiduously foment the vagina with a 
 sponge, and conduct into it vapours by means of a reed which 
 is inserted into the perforated cover of a jar. Sitz-baths 
 should be frequently taken ; the fluid composing the bath 
 should have drawing properties. Should, however, the pains 
 continue to increase, we must add to the poultices boiled or 
 bruised poppy-heads. Aetius then gives other remedies, some 
 being applied in the form of pessaries. 
 
 Should the abscess burst into the bladder, and we see pus 
 in the urine, we should then give the patient milk to drink 
 and administer cucumber seeds. If the abscess bursts into 
 the rectum, we should inject into the bowel a decoction made 
 from the rind of the pomegranate. If the abscess rupture 
 
AETIUS. 205 
 
 into the vagina, and the pus be laudable, inject rose oil, etc. ; 
 but if the pus be offensive, the astringent injections must be 
 used ; if the discharge be very fcetid, the vagina is to be 
 washed out with mead. 
 
 In chapter Ixxxvi. our author gives the directions for 
 operating on " abscessus oris uteri." If the abscess be 
 situated about the mouth of the womb, we must not be too 
 prompt in having resource to incision, but wait until the 
 disease is matured and the inflammation has increased to its 
 utmost, and the parts pressing on the pus are thinned. The 
 woman is placed supine on a seat, with her legs drawn up on 
 her abdomen, and her thighs separated from one another. 
 Let her arms also be brought down under her legs, and 
 secured by proper ligatures passing over her neck. The 
 patient being placed before a clear light, the operator sits on 
 her right side, and he is then to make an examination with a 
 speculum proportionate to her age. The depth of the vagina 
 is to be measured with a sound, lest the stalk of the speculum 
 be too long, and so the uterus would be pressed against it. 
 And if it is found that the stalk of the speculum is longer 
 than the vagina, folded compresses should be placed on the 
 labia or sides of the pudendum, so that the speculum may be 
 placed firmly on them. The stem should be introduced, 
 having the screw at the upper part ; and the speculum is to 
 be held by the surgeon, but the screw is to be turned by the 
 assistant, so that, the blades of the stem being separated, the 
 vagina may be distended. If when the abscess is exposed it 
 be found soft, then its apex is to be divided with the scalpel or 
 sharpened probe ; and after the pus has been evacuated, a 
 very soft tent soaked in rose-oil is placed in the incision, or, 
 rather, away from the opening, in the vagina of the patient, 
 so as not to produce compression. 
 
2o6 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 The author then goes on to say that, besides the above 
 treatment, the vulva and loins should have applied to them 
 unwashed or clean wool that has been dipped in oil, and that 
 on the third day the patient should have a sitz-bath, followed 
 by the introduction of a tent. If the part is cleansed with 
 difficulty, an injection of the decoction of iris may be thrown 
 up with an ear- syringe. 
 
 The author ends the chapter with the remark that if the 
 abscess should be within the mouth of the uterus we must 
 not operate. 
 
 The subject of pelvic suppuration is continued in 
 chapter Ixxxvii. The author says, when an abscess bursts 
 between the intestine and the peritoneal membrane, and 
 surrounds the uterus and bowel, the swelling that forms 
 chiefly surrounds these parts and indicates what has happened. 
 If the abscess ruptures into the uterine cavity, relief from 
 pain is experienced, and the os uteri becomes soft to the 
 touch. The pus should be encouraged to reach the surface, 
 and after the skin has become sufficiently thinned an opening 
 should be made with a probe in the most prominent part of 
 the swelling, from which part we may hope to obtain the 
 more perfect evacuation. If the swelling be due to an out- 
 pouring of blood (pelvic hsematocele), instead of the sharp 
 probe or the scalpel we should apply the cautery to the 
 summit of the swelling, and by this means evacuate the pus. 
 After opening the abscess, the wound should be attended to, 
 and should be bathed with honey-water, and should be 
 fomented with a sponge twice during the day and once at 
 night. Sitz-baths and injections are also to be used. 
 
AETIUS. 207 
 
 2. Affections of the Uterus. 
 
 Stenosis and Rigidity of the Cervix. — Obstructions round 
 the mouth or the neck of the womb arise either from 
 advanced ulceration or from inflammatory hardening, by 
 which means the parts become so narrow that the semen 
 cannot gain an entrance to the womb, or if it does enter it is 
 not retained, because the uterus cannot contract, on account 
 of the callous condition. Sometimes semen is admitted, and 
 a foetus is developed within the too narrow os. The concep- 
 tion leads to the patient's death, for the child cannot be born 
 on account of the narrowness of the canal. 
 
 Hip-baths and pessaries are to be first tried. But when we 
 find that the parts are soft to the touch we should introduce 
 pieces of dried sponge, to which are attached pieces of thread, 
 in order that they may dilate the narrow portion of the canal ; 
 and if they should slip out, then we should place larger ones 
 in, and for this reason it behoves us to have several different 
 sizes ready. After this we should smear the following 
 preparation on the sponge tents before inserting them : red 
 Bulphuret of arsenic, dry alum, yellow sulphuret of arsenic 
 (these to be rubbed up with honey). 
 
 If we perceive that dilating by the sponge tent has not been 
 sufficient, and that inflammation has been induced, then we 
 should smear on the tents the following preparation : iris, 
 goose-grease, turpentine, frankincense, etc. When the inflam- 
 mation has subsided and the place is sufficiently well opened, 
 we may cover a tent with cerate prepared from rose-oil and 
 goose-grease ; and these tents are to be used continually in 
 order to cause a cicatrix, so that the place may become 
 gradually firm (c. xcv.). 
 
 In chapter xvi. Aetius says that, on account of the narrow- 
 
2o8 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 ness of the cervix in some women, parturition may be fraught 
 with danger ; while in chapter xxvi. he says that a woman 
 may be sterile on account of the mouth of the womb being 
 closed from cicatrization. In chapter li. Aetius says that 
 after an abortion we may get ulceration of the os, which then 
 leads on to cicatrization, after which we may get obstruction. 
 
 Laceration and Erosion of the Cervix. — Fissures round the 
 mouth of the womb are caused by difficult parturition on 
 account of the size of the child's head ; they may also be 
 found in the pudendum, there caused by the escape of 
 irritating humours. At first they escape notice, while the 
 pains from the labour are quite recent ; but afterwards they 
 become slightly felt by the patient, for both after a manual 
 examination and after coitus pain is produced, and they bleed 
 from the friction. They are discovered when the vagina is 
 dilated (by the speculum), for fissures form round the circle 
 of the OS uteri. 
 
 In the treatment Aetius says all surgical aid and medicines 
 of an irritating nature are to be avoided, for such induce 
 inflammation and convulsive movements. He recommends 
 hip-baths and pessaries. After the ulcers are cicatrized we 
 may use calamine (c. cvii.). When fissures become chronic 
 they may become converted into condylomata. 
 
 Condylomata are reddish projections. The rugae that are 
 encountered round the os uteri, whilst inflamed, rise up and 
 become indurated, and sometimes a swelling and thickening 
 results. Particularly during the menstrual period are condy- 
 lomata produced, and after parturition they rise up and can 
 be recognised by touch. Pessaries and astringents are recom- 
 mended for the treatment (c. cvi.). 
 
 Aetius says that an erosion may be the cause of monor- 
 rhagia (c. Ixv.). 
 
AETIUS. 209 
 
 Ulceration of the iiterus is dealt with in chapter Ixxxviii. 
 Aetius, quoting Archigenes, says that ulceration of the uterus 
 is often due to an eroding flux, to injuries from acrid medica- 
 tions, from the bursting of an abscess, from difficult labour, 
 after abstraction of the foetus, or from the latter becoming 
 corrupted. The patient experiences shooting pains in the 
 parts affected, while, if the ulcer is foul, fetid and sanious 
 discharges may be produced, and reflex symptoms, such as 
 pains in the head, eyes and hands. The ulcer thus indicated 
 may be discovered by the speculum ; but if situated out of 
 view the diagnosis is made from the nature of the dis- 
 charge. 
 
 The treatment is by sitz-baths, injections and pessaries, 
 and a decoction of poppy-heads is recommended when the 
 pains are severe. 
 
 In chapters Ixxxix., xc, carbuncular and sordid ulcers of 
 the uterus are alluded to on the authority of Archigenes ; 
 while in chapter xcii. " nomse et ulcera depascentia " are 
 mentioned from the works of Aspasia. 
 
 Cancer of the Uterus (e.xciv.). — Of the cancerous tumours of 
 the uterus, some ulcerate, and some do not, as in cancer of 
 the breast. When there is no ulceration, the tumour found 
 round the os uteri is hard and resistant to the touch, uneven, 
 prominent, feculent in colour, red or livid ; sharp pains are 
 felt in the groins, belly, vulva, and loins, and these are in- 
 creased by manual examination and by various medications. 
 
 Should the cancer be an ulcerated one, in addition to the 
 pain, hardness, and swelling, we find ulcers spreading and 
 irregular, and for the most part foul, prominent, and white in 
 colour ; some, however, appear feculent, livid, red and bloody. 
 
 The discharge that comes from cancers is always thin, 
 watery, black or reddish-yellow, with a strong odour. Occa- 
 
 14 
 
2IO THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 sionally we have haemorrhage, and the other signs which 
 indicate inflammation of the uterus. The complaint, as 
 Hippocrates said, is incurable, but may be relieved by baths of 
 fenugreek and mallow, and by cataplasms of a similar kind. 
 Various remedies are then given by Aetius (who has extracted 
 his chapter from Archigenes) to alleviate pain and for haemor- 
 rhage. No mention is made of operative treatment ; in fact, 
 in chapter cv. the writer warns the reader against surgical 
 interference in case of malignant thymus, on account of the 
 danger of hgemorrhage. Aetius also advises that malignant 
 polypi be left alone (c. xcvii.). 
 
 Metritis (c. Ixxxiii.). — Inflammation of the uterus, our 
 author says (taking Philumenus as his authority), may arise 
 from many causes, such as injury, suppression of the menses, 
 abortion, ulceration, too frequent coitus, long walks, cold, etc. 
 Sharp pains in the lower part of the abdomen and loins point 
 to the trouble, and if a vaginal examination be made, the os 
 will be found hard and closed, hot and retracted, especially 
 if the inflammation happens to be round the os or in the 
 cervical portion of the uterus. 
 
 The symptoms of inflammation of the uterus will vary with 
 the position of the inflammation ; thus, displacements may 
 occur following on inflammation of the uterine cavity or 
 fundus, while stoppage of the bowels and pains in the spine 
 would point to inflammation of the posterior aspect of the 
 womb ; difficulty in passing water, or passing it drop by drop, 
 points to the anterior wall being the seat of the trouble, and if 
 the inflammation affects the lateral aspect of the uterus the 
 groins become swollen, and the legs are incommoded and are 
 moved with an effort. 
 
 The treatment is then given at great length. 
 
 Eest in a warm, quiet place, no movement of the legs, 
 
AETIUS. 211 
 
 massage and fomentations to the feet and hands. The bowels 
 are emptied by enemata. Warm water and ptisan are given 
 as drinks. Bleeding may be practised, and the diet is re- 
 stricted. Counter-irritation, embrocations, pessaries, baths, 
 may all be employed in some cases, while in other cases 
 cupping-glasses and scarification in the lumbar region may 
 be resorted to. Pessaries and vaginal injections are also to be 
 used. 
 
 Aetius gives in chapter Ixxviii., under the heading of " De 
 uteri inflatione," a condensed account of chapter Ivi. from 
 Soranus, wherein septic metritis and endometritis are de- 
 scribed. 
 
 In chapters xxvii.-xxx. Aetius deals with the cold, warm, 
 humid, and dry womb, and his descriptions appear to apply 
 to some forms of chronic metritis and endometritis, and the 
 same remarks apply to chapters Ixv.-lxvii., where the various 
 fluxes are considered ; while chapter Ixxiii, which is entitled 
 " De uteri debilitate " (extracted from Soranus), also refers to 
 chronic metritis. Our author has nothing new to tell us in 
 dealing with this subject, and advocates injections, fumigations, 
 pessaries, sitz-baths, etc. 
 
 Displacement of the Uterus. — Aetius gives us Aspasia's 
 views on this subject in chapter Ixxvii., which is entitled " De 
 reclinatione, aversione, ac recursu uteri." If the menses are 
 suppressed, the veins and arteries that come to the uterus 
 become overloaded, for the blood comes to the mouth of the 
 vessels and it is unable to enter the uterine walls ; either 
 because the fluid is too thick, and, being driven against 
 the mouth of the vessels, becomes clotted ; or because the 
 mouths of the vessels become closed and the blood cannot 
 pass, and the vessels thereupon becoming filled with humour, 
 the appendages surrounding the uterus become swollen, and 
 
 14—2 
 
212 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 through this distension the uterus is drawn backwards. 
 Should this be equal on both sides, the forces tending to create 
 a reclinatio, a revulsio, and a recursus are equalized (and 
 nothing results). But if the traction is greater on one side 
 than the other, the displacement will occur on that side on 
 which we get the vessels most distended with blood, and the 
 author thinks that the liver is the governing influence on the 
 right side, while the spleen rules the left. In whatever way 
 the uterus is inclined, the finger can tell by touch, and the 
 following signs are also diagnostic : If it is obliquely inclined 
 there is tension in the femoral region of that side, pain, cold- 
 ness, torpor, etc. ; if it is inclined backwards or downwards 
 there is torpor, and difficulty in moving the legs, etc. ; defseca- 
 tion is prevented, nor can enemata be administered — ** nisi 
 genibus innitatur segra " ; flatus is retained, and there is pain 
 in the seat, especially if the displacement is a retroflexion *'si 
 versus anum reclinatio contigerit." 
 
 If the displacement is towards the pubes, we get pain in 
 the lower part of the abdomen, and sometimes suppression of 
 the urine. 
 
 In the treatment our author directs that, if the case be one 
 of retroflexion, the midwife in the first place is to introduce 
 her finger into the patient's rectum and push the uterus 
 forward. She is then to make a pessary, 3 inches in length, 
 composed of galbanum and cerate, and to attach a string to it 
 so that it may easily be withdrawn; this pessary is to be 
 introduced into the anus. A plug of wool may be used in a 
 similar manner. On the following day some tepid oil should 
 be injected into the uterus and bowels. 
 
 If the traction on the uterus has caused it to assume an 
 oblique position (lateral displacement?), we must first use 
 fomentations, and then the midwife with the sound, which is 
 
AETIUS. 213 
 
 guided by her finger, should straighten the neck of the uterus, 
 while the patient should be placed on the opposite side to the 
 direction of the displacement. 
 
 Should we get retention of urine at any time during the 
 treatment, we must draw the water off with a catheter. 
 
 In chapter Ixxxiii., in speaking of inflammation of the 
 uterus, Aetius remarks that inflammation of the upper 
 portion may cause displacement of the os and cervix by 
 dragging the uterus inwards towards the inflammation. 
 
 Prolapse of the Uterus ; Hysterectomy. — Aetius has in 
 chapter Ixxvi. given us a resume of the sixty- sixth chapter of 
 Soranus. He adds nothing of importance, and ends his 
 account with the following : " It is reported that when the 
 whole uterus has been putrid, it has sometimes been removed, 
 and the woman has, nevertheless, gone on living." 
 
 Fihromyoma, Polypus^and Calculus of the Uterus (c. Ixxx,). — 
 The mole is a hard tumour of the uterus, which forms some- 
 times after inflammation, sometimes after an ulcer in which 
 there has been an overgrowth of tissue. The name "mole " 
 has been given to such tumours because the sufferers from the 
 affection move with difficulty and slowness. With such a 
 tumour we get retraction of the parts above, emaciation, pale- 
 ness, and loss of appetite. At first there may be a suspicion 
 of conception, for the menses are suppressed and the breasts 
 swollen, and there are stomach troubles, pain in the loins, and 
 a prominent belly ; in time, however, the true nature of the 
 affection is perceived, for with the mole we get pains in the 
 abdomen, and we do not have the movements of the child, as 
 in pregnant women. Aetius says that occasionally we may 
 think we are dealing with a case of dropsy, but we distinguish 
 the mole from that affection by its hardness and by the 
 absence of the fluid wave on palpation, and of the tympanitic 
 
214 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 sound on percussion. In some cases, however, dropsy may 
 supervene. Sometimes fleshy bodies the size of a walnut are 
 expelled from the front passage ; this may occur once in a 
 month, or once in two or three months. Aetius says that 
 some men have given up the disease as incurable, but others 
 are confident that if taken early something may be done ; in 
 any case, we should use our best endeavours for our patient. 
 In the treatment he recommends emollient applications, such 
 as baths, pessaries, fumigations, and, later on, dropaces and 
 sinapisms (c. Ixxx.). 
 
 In chapter civ., under the heading " De cauda," we have 
 the following : In some women a fleshy body springs from the 
 mouth of the womb, and fills up the woman's vagina. It may 
 even project beyond the vulva like a tail, hence its name. In 
 treating this, Aetius directs that the body should be seized by 
 the forceps and resected at its base. The cauda here referred 
 to is probably a large polypus, though the description might 
 also refer to a pediculated fibroid, or to hypertrophy of the 
 vaginal portion of the cervix ; neither of the latter would, 
 however, be removed with such ease as the short description 
 of the operation would imply. Adams thinks that the cauda 
 was a cauliflower excrescence (Paul, VI. 70). 
 
 In chapter xcvii. Aetius deals with haemorrhoides uteri, 
 which, as Adams remarks, are probably polypi of the uterus. 
 Our author, quoting Aspasia, says that haemorrhoids are met 
 with at the mouth or in the neck of the womb, in the womb 
 itself, and occasionally in the vagina. Their presence can be 
 diagnosed by touch, but better still by the use of the speculum. 
 Besides making the patient sterile, they also cause a feeling 
 of weight in the loins during the menstrual period. Those 
 that are varicose or malignant should be left alone, but we 
 may treat the other varieties as we treat piles in the seat. 
 
AETIUS. 215 
 
 Those which are hard may be cut out at once, but those that 
 bleed much should have an incision made all round the base, 
 and should then be pulled up by the volsella, and a ligature 
 passed round them ; and after a little they may be resected, 
 then treated with astringent remedies. 
 
 Uterhie Calculus, — In chapter xcviii. Aetius says that occa- 
 sionally a calculus may be formed in the uterus. If we wish 
 to get rid of this, we must have the bowels emptied and the 
 uterus irrigfited, and the patient is then to be placed in the 
 supine position with her thighs apart. After this, insert two 
 fingers of the left hand into the rectum, and place the right 
 hand on the abdomen and depress the belly ; the combined 
 pressure of the hand above and of the fingers inserted into the 
 rectum will enable us to expel the calculus. If the stone be 
 imbedded in the cervix, or if it adheres to the mouth of the 
 womb, we must expose the parts by means of the speculum, 
 and resect the body with the scalpel ; in the after-treatment 
 we apiDly astringents. 
 
 3. Affections of the Vagina and Vulva. 
 
 Atresia Vagince et Atresia Hymenalis (c. xcvi.). — Some 
 women have from birth an imperforate uterus, and such cases 
 are classed under three headings. In some the obstruction, 
 composed of membrane or flesh, is situated at the alte or labia 
 pudendi ; in others it is in the vagina ; while in others it is at 
 the mouth of the womb itself. In those cases in which the 
 obstruction involves the labia pudendi, we must place the 
 patient in the supine position with the legs flexed and 
 abducted. We then proceed to dissect out the membrane 
 with a probelike instrument until the pudendum assumes its 
 normal dimensions; after this we insert into the wound a 
 
2i6 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 roll of lint and fix it securely, and apply such remedies as will 
 aid the cure by causing suppuration. Later on rose cerate 
 may be applied by means of lint. If, however, after making 
 one incision we find the alse pudendi closely united by fleshy 
 processes, we must cut the skin on both sides, and then 
 dilate the parts by rolls of lint, following the same line of 
 treatment as given above. During the treatment the patient 
 rests in the supine position, with a pillow between her legs 
 until cicatrization is complete. If the external orifice of the 
 pudendum is patent, we may find the vagina obstructed by 
 a fleshy development, and the result is that but a narrow 
 foramen is found. The patient is placed in the same position 
 for the operation, and a sound is then introduced into the 
 cervical canal of the uterus as a guide, lest we in error make 
 the section too high up. We then dissect by means of a broad 
 speculum below the locality marked by the sound, until the 
 passage appears of normal form. Holding the dissected 
 portion then by means of a volsella, we cut out a figure, 
 quadrangular in shape. Standing the patient upright, the 
 fluid which has collected in the uterus is by this manoeuvre 
 allowed to escape ; and after this has been done sufficiently, 
 we again place the woman on her back in her former position, 
 and push into the incision a tent soaked in wine and oil, 
 taking the precaution of attaching to the tent a thread, so 
 that it may be easily withdrawn. The parts having been 
 properly bound, we enjoin quiet. During the subsequent 
 days the parts are well irrigated with hydromel, and rolls of 
 lint are introduced into the vagina, after they have been 
 treated with drugs which encourage suppuration. When a 
 cicatrix has been produced, a tube made of tin is introduced, 
 and allowed to remain until the parts are firm. Should the 
 parts, however, become again united, and the os uteri be once 
 
AETIUS. 217 
 
 again closed, introduce dry sponge (tents) until such time as 
 the cicatrix becomes hard. 
 
 If, however, the membrane obstructs the os uteri, after the 
 patient is placed in the proper position, the vagina is distended 
 by the speculum, and the membrane, having been seized by 
 means of a volsella, is extended, and then twisted round and 
 round so that it becomes all gathered together, after which it 
 is resected by a broad speculum and astringents are applied ; 
 then a roll of lint is introduced with a thread attached. 
 
 The speculum should be frequently introduced, so as to 
 prevent the cavity being filled with granulation tissue ; and 
 sponge tents are also to be used until the lips of the wound 
 shall have become hardened. The tube of tin is also to be 
 introduced into the canal. 
 
 Thymus Pudendi (c. cv.). {Papillomata ?) — The thymus is 
 found sometimes in the labia, sometimes in the vagina, or on 
 the mouth of the womb. It is an uneven excrescence, similar 
 to the clusters of thymus in appearance. In some cases it is 
 harmless ; in other cases it is a malignant growth, red, and 
 bloodstained, especially after coitus or after walking exercise. 
 The growths may resemble a ripe blackberry, and can be 
 diagnosed by inspection sometimes without any instrumental 
 aid ; but at other times the speculum must be used to see 
 them. 
 
 The treatment laid down is to excise the growth, but Philu- 
 menus, from whom Aetius takes the chapter, thinks that if 
 the thymus be malignant it should not be excised, for fear of 
 the great haemorrhage that follows the operation. If we do 
 excise, he warns us against wounding the uterus itself, an 
 accident which may easily be avoided if the thymus be 
 resected close to the volsella. 
 
 Miliary Tubercles (c. cviii.). {Ovida Nabothii and Granular 
 
2i8 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 Vagijiitis T) — Sometimes millet-like eminences arise in the 
 neck or at the mouth of the womb, or in the pudendum itself. 
 These can be diagnosed by touch, or with more certainty by 
 the speculum. Where these growths are irritated by coitus, 
 they may become a hindrance to the menstrual flow and to 
 conception. 
 
 The treatment is by pessaries impregnated by an astringent, 
 such as alum. 
 
 Eczema {?). — In chapter cix., under the heading *'De 
 scabris uteri pustulis," Aetijis says : ** Scaly pustules are 
 wont to arise on the pudendum and mouth of the womb. 
 These undergo furfuraceous desquamation, and a pruritus 
 results ; the patients are much relieved by the application of 
 warm water." He also recommends medicated sitz-baths. 
 
 Abscess (Bartholinian ?) (c. ex.). — If an abscess should 
 occur in the alx or labia pudendi, and should point towards 
 the seat, it should not be opened : for incisions in this region, 
 which is full of wrinkles, are apt to lead to the formation of a 
 fistula. If, however, the abscess tends towards the meatus 
 urinarius, it may be incised with safety. 
 
 Menorrhagia and Metrorrhagia (c. lxiv.). 
 
 Immoderate discharges of blood may take place after labour 
 or after abortions, the vessels being dilated and ruptured or 
 having their mouths open. An erosion may give rise to a 
 haemorrhage. The symptoms that are observed after haemor- 
 rhage are pallor, sometimes fever, sometimes not ; the appetite 
 and digestion are poor ; oedema of the foot and body may be 
 present. 
 
 In the treatment Aetius directs that the extremities should 
 have ligatures placed round them, and the armpits and groins 
 should be bandaged. The patient should be given posca to 
 
AETIUS. 219 
 
 drink, but this must not be cold; while to the parts we should 
 apply much wool squeezed out of wine, rose-oil, or quince-oil, 
 or the oil of myrtle. 
 
 Aetius says that he does not agree with those who place 
 sponges that have been squeezed out of cold posca on the 
 uterus, because they prove injurious to the uterus by chilling 
 it. He agrees with injections and astringent remedies, these 
 latter to be placed in the vagina in the form of pessaries ; he 
 also approves of the application of cupping-glasses to the 
 breasts. 
 
 Amenoeehoea. 
 
 Aetius deals with the above subject very fully in twelve 
 chapters (li.-lxii.). In chapter li., quoting Eufus and Aspasia 
 as his authorities, our author says that naturally or un- 
 naturally some women have no menstrual periods. 
 
 Amenorrhcea would be considered a natural condition if the 
 woman had neither disease of the womb nor of any part of 
 her body. Menstruation does not occur before the fourteenth 
 year, and not after the fiftieth. The barren and the pregnant, 
 singers and dancers, do not menstruate ; in the case of the 
 latter the exercise consumes the superfluous blood. Women 
 of a warm temperament, country women, and those who take 
 much exercise, lose but little. Lean and fat women seldom 
 conceive (and if fat women do their offspring is puny), and 
 as a rule they lose little blood, for fat women have too little 
 blood in their veins, as it is consumed in forming fat. Those 
 women who lose blood from the nose, or vomit it from the 
 chest, or who have lost much from having been bled, have 
 suppression of the menses. Disease, profuse perspiring, 
 vomiting, purging, cutaneous eruptions, callosities, cicatrices, 
 and diseases of the uterus, may all be factors in amenorrhcea. 
 
220 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Leucoekhcea. 
 
 In chapter Ixv. Aetius quotes Archigenes on the flux, and 
 in the following chapter gives full directions for the treatment 
 of the red and white flux (cc. Ixvi., Ixvii.). When the dis- 
 charge is red he begins with venesection, and the application 
 to the parts of sponges soaked in astringents. 
 
 If the flux is white he recommends exercise, friction, gesta- 
 tion, and astringents. 
 
 In chapter Ixxii. he deals with fluxus seminis. 
 
 Dysmbnoeehcea. 
 
 In chapter Ixiii. Aetius gives a paraphrase of the second 
 part of chapter xlviii. from Soranus {vide ante) ; he, however, 
 adds nothing of interest. 
 
 Excision of the Nympha (Clitoeis) (c. cm.). 
 
 The nympha (clitoris) is a muscular or skinlike body 
 situated above the commissures of the labia, and just where 
 the meatus urinarius is. In some cases the clitoris is so large 
 that it presents a shameful deformity, so that when irritated 
 by the contact of the patient's garments the woman is excited 
 to venery. 
 
 The Egyptian custom is to amputate before it grows large, 
 chiefly about the time when the girl is marriageable. The 
 operation is thus performed : The girl is placed leaning back 
 in a chair, and the attendant, a strong adult, seated close to 
 her, places his arms under the popliteal region of the patient, 
 BO as to have control of her legs and the rest of her body. 
 Then the surgeon, standing in front of the assistant, seizes the 
 clitoris with a large pair of forceps and pulls it out, holding 
 the forceps with his left hand, while with the right hand he 
 resects the body close to the teeth of the forceps. It is 
 
AETIUS. 221 
 
 necessary to mark well the araount we intend to remove, so as 
 not to take the clitoris away by its very roots, but only to 
 remove the superfluous part. It should therefore be resected 
 close to the teeth of the forceps, since the body that we are 
 dealing with is skinlike in consistence and can be drawn out 
 very far, and unless this point is carefully observed the 
 section may easily be carried beyond the proper region, and 
 a shrinking of the part follows, which the Greeks have termed 
 rhoeas. 
 
 The after-treatment consists in applying a sponge squeezed 
 out of wine or cold water, followed by appropriate dressings. 
 
 Calculus of the Female Bladder (c. xcix.). 
 Calculus does not occur very frequently in the female's 
 bladder, because the water passage is wide and straight. 
 Should we have to extract a stone, we proceed as follows : The 
 woman is placed on her back, with her hips sloping down 
 and her legs bent back. Two fingers of the left hand are now 
 introduced into her vagina, while at the same time the right 
 hand presses on the bladder from above. Then push the 
 stone towards the neck of the bladder, and force it so that it 
 will advance beyond the sphincter muscle of the neck of the 
 bladder. Then make the incision a little above the labia 
 ("paululum supra pudendi alas ") at the place where the calculus 
 is situated, and then extract the stone by means of a pair of 
 forceps. After a dressing of frankincense, place on the belly 
 and loins lint which has been soaked in warm oil, and fix it 
 by bandages. Later on apply ointments which will help 
 cicatrization of the wound. 
 
 Writers on Gynecology referred to by Aetius. 
 
 Archigenes was a Greek physician who was born at Apamea, and prac- 
 tised at Eome about 100 a.d., during the reign of Trajan. He was con- 
 nected with the sect of the Eclectici, and is several times mentioned by 
 
222 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 Juvenal (VI. 236 ; XIII. 98 ; XIV. 252). He wrote a treatise on the 
 Pulse, and Galen wrote a commentary on it. He also attempted the 
 classification of fevers, and was the first to treat dysentery with opium. 
 
 Ascle]piades. — Vide gynaecologists mentioned by Soranus. 
 
 Asjpasia we have already mentioned. 
 
 Leonides of Alexandria lived probably at the end of the second or the 
 begmning of the third century (Haeser), because he quotes Galen, and is 
 quoted by C^elius Aurelianus. He was a surgeon, and operated on stru- 
 mous glands, and amputated by the flap operation. He also operated on 
 hernia and fistula. Of his writings nothing remains but fragments pre- 
 served by Aetius and Paul. 
 
 Philumenus. — The date at which Philumenus lived is unknown. Haeser 
 and Siebold place him about 50 to 80 a.d., while Greenhill remarks that 
 it can only be said that he lived in or before the fourth century a.d. He 
 is quoted by Oribasius, Alexander Trallianus, and Ehazes, as well as 
 by Aetius. 
 
 Philagrms was a Greek writer who lived about 280 a.d. Suidas says 
 that he wrote as many as seventy volumes, but only a few fragments 
 remain for us, and these are preserved in the works of Oribasius and 
 Aetius. 
 
CHAPTEE XVIII. 
 
 PAULUS ^GINETA. 
 
 Paulus ^gineta (IlauXo? Kl^ivt^Tr]^) is so called from his 
 birthplace having been in the island of ^gina. We know 
 nothing of his life except that he visited Alexandria ; he 
 mentions the fact in the fourth book of his works, in treating 
 on fistula, in these words : *' Another remedy which I received 
 in Alexandria " (B. IV., c. xlix.). The time when he lived is 
 determined from the following data : Paul quotes Alexander 
 Trallianus and Aetius, therefore he lived posterior to both these 
 writers ; Aetius mentions St. Cyril, Archbishop of Alexandria, 
 whose death is ascertained, from ecclesiastical history, to have 
 happened at the middle of the fifth century ; Aetius also notes 
 a medicine recommended by Petrus Archiater, physician to 
 Theodoric, who was posterior to St. Cyril. Aetius did not 
 flourish earlier than the end of the fifth century ; Alexander 
 Trallianus is mentioned by Agathias, who set about writing 
 his history about the beginning of the reign of Justin the 
 Younger, a.d. 565. In spite of the above facts, modern 
 authors differ widely in regard to the century in which Paul 
 lived. Adams says Vossius is wholly undecided ; Moreau and 
 Le Clerc place him in the fourth century; Van der Linden 
 and Conringues in the fifth ; but Freind, Albertus Fabricius, 
 Hutchinson, Sprengel, and most of the later writers on the 
 
224 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 ancient history of medicine, bring him down as low as the 
 seventh century. Adams, Haeser, Milward, and Siebold place 
 him at the end of the sixth or the beginning of the seventh 
 century. 
 
 The works of Paul are compilations, but they are the 
 compilations of a learned physician, a skilful surgeon, and a 
 man well versed in gynaecology. He drew his material from 
 all available sources ; particularly is he indebted to Galen, 
 Oribasius, Aetius, and Alexander Trallianus, though he seldom 
 acknowledges the authorities from whom he derives his facts. 
 
 Suidas states that he wrote several medicinal works, but 
 the principal one only has come down to us, and is commonly 
 called "De Ee Medica Libri Septem." 
 
 Paul has in the preface to this work given us a summary of 
 each book. 
 
 In the first book he gives us some information on the 
 complaints of pregnant women (B. I., c. i.), while in the third 
 book we find that the diseases of women are dealt with from 
 chapter Ix. to chapter Ixxvi. Again, in the sixth book 
 chapters Ixx.-lxxv. are devoted to some of the surgical opera- 
 tions performed on the female parts. Besides the work that 
 has come down to us, Paul is said to have written a book on 
 gynaecology ; and Freind remarks that he appears to be the 
 first instance of a professional man-midwife, and he draws 
 attention to the fact that the first chapter in his extant work 
 is on the complaints of pregnant women. He certainly was 
 held in great respect by the Arabian midwives, as the follow- 
 ing passage from Abul-Pharagius will show : *' E medicis 
 autem, qui hoc tempore floruerunt, fuit Paulus iEgineta 
 medicus suo temporis Celebris : insigniter autem peritus fuit 
 in mulierum morbis, multumque illis curae impendit. Con- 
 venire ipsum solebant obstetrices, et eum de rebus quae 
 
PAULUS ^G I NET A. 225 
 
 mulieribns post partum acciderent, consulere, quibus re- 
 spondere dignabantur, et quid facerent iis de quibus qusesierant 
 indicare ; eum Ab-Kawabeli (obstetricium) appellarunt. Scrip- 
 sit librum de medicina in novem distinctum tractatus, quern 
 transtulit Honain Ebn Isaak ; et librum de affectibus 
 mulierum."^ Whilst Paul's work " De Ee Medica Libri 
 Septem " is one of the most valuable compilations in ancient 
 medicine that has come down to us, the passages which deal 
 with the diseases of women tell us nothing but what can be 
 found in his predecessors' works. Siebold, after dealing with 
 Paul's contribution to midwifery, then refers to him as a 
 writer on gyn?ecology, and bestows on him more praise than 
 is warranted, for Siebold appears either to forget, or not to 
 recognise, how absolutely Paul depends on Aetius, Archigenes, 
 Soranus, and others, for his information ; and consequently, 
 while we praise Paul for selecting what is judicious, we are 
 not in a position to say, as Siebold has, " that a glance at the 
 chapters in which he treats the diseases of the uterus shows 
 by the doctrines enunciated that the author had a large 
 experience in gynaecology." Had we, indeed, not possessed 
 the originals from which these passages have been compiled, 
 this praise would have been meagre ; but having the originals, 
 we are compelled to place Paul in the rank of judicious 
 compilers. Furthermore, he appears to have derived his 
 material from Aetius rather than Soranus, inasmuch as he is 
 generally content to give a very short account of the actual 
 disease, then to relate a few causes, and finally to proceed to 
 give long lists of receipts for the cure. The method resembles 
 closely the one adopted by Aetius, while Soranus, a man truly 
 versed in his work, gives a full definition, history, causes, 
 
 1 Gregor., " Abul-Pharajio, arable, edit, et latin, conversa ab Ed. Pocockio," 
 Oxon., 1672, p. 114. 
 
 15 
 
226 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 symptoms, and treatment, not merely lists of receipts. In 
 fact, a careful study of many ancient works will show that 
 those who were content to be merely compilers adopted the 
 plan, seen often in the chapters of Paul and Aetius, of giving 
 a short description of the disease, and then proceeding imme- 
 diately to enumerate the drugs useful for its cure, neglecting 
 entirely to trace its cause or to paint its symptoms. 
 
 Paul's most original work is to be found in the sixth book 
 of his treatise, which deals with surgery. In his descriptions 
 of operations we frequently j&nd him differmg from former 
 writers, such as Hippocrates, Galen, and Leonides, and we 
 often have much fuller details of the surgical treatment of 
 cases than are to be found in the surgical works of Celsus. 
 Among other chapters, he has given us that excellent one 
 found in Aetius (XVI., Ixxxv., Ixxxvi.), who has taken it from 
 Archigenes, " On Abscess of the Womb," also the one on 
 imperforate pudendum from Aetius and Celsus, and the 
 chapter on extirpation of the clitoris from Aetius. 
 
 We may sum up Paul's position in ancient times by 
 quoting from Adams. " All the medical authors of the 
 distinguished Arabian period quote his opinions in almost 
 every page of their works, and never fail to recognise him as 
 one of the most eminent of their Grecian masters." 
 
 Of the editions of his works that have been published, the 
 best and most scholarly is that by Adams : *' The Seven 
 Books of Paulus ^gineta. Translated from the Greek, with a 
 commentary embracing a complete view of the knowledge 
 possessed by the Greeks, Romans, and Arabians on all 
 subjects connected with medicme and surgery." This work, 
 which is a masterpiece of learning, was published by the 
 Sydenham Society in three volumes, London, 1844 to 1847. 
 We shall use it throughout in quoting from Paul. 
 
PAULUS ^GINETA. 227 
 
 The Greek text has been twice published, Venet., 1528, and 
 Basil, 1538, while there have been numerous Latin transla- 
 tions published at different periods. 
 
 On Pessaries, from Antyllus. — Pessaries are applied to the 
 womb. There are three different kinds of them ; for some 
 are emollient, some astringent, and some are anastomotive ; 
 i.e., they open the mouths of vessels. We use the emollient 
 in inflammation of the womb, in ulceration and coldness of it, 
 in ascension upwards, eversion and inflation thereof. They 
 are prepared from Tuscan wax, the oil of privet and of lilies, 
 the fat of geese and of fowls, unsalted butter, burnt resin, 
 stags' marrow, and fenugreek and the like. The anastomo- 
 tive, or those which open the mouths of vessels, are used 
 when we wish to recall the menstrual purgation that has been 
 stopped, or to correct the state of the womb when it is shut 
 up or contracted. These are prepared from honey, mugwort, 
 dittany, the juice of cabbage, liquorice, the juice of horehound, 
 rue, scammony, or the like. The astringent are used in cases 
 the reverse of those for which the anastomotive are applied ; 
 for they restrain the female discharge, contract the womb 
 when it is open, and impel it upwards when prolapsed. The 
 pessary is made of the thickness of bath sordes, and a little 
 thicker ; and then some wool, like a narrow tent, is to be 
 doubled and dipped in the medicine, and applied to the 
 mouth of the womb, having a long thread attached to it to 
 draw down the pessary readily when it is thought proper 
 (B. VII., c. xxiv.). 
 
 On Trochischi, or Troches. — Trochischi are so named from 
 their form. There are three different kinds of them. For 
 some of them are to be swallowed, some injected, and some 
 rubbed in. Paul gives receipts for several to be used for the 
 pudendum (VII. xii.). 
 
 15—2 
 
228 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 Anatomy. — We have no description of the womb left us by 
 Paul, nor any mention of the ovaries or Fallopian tubes. 
 
 Cellulitis. — Under the heading of "Abscess of the Uterus" 
 (III. Ixv.), Paul gives us an abridged account from Aetius 
 (XVI. Ixxxv.) of pelvic suppuration. Later on (VI., Ixxiii.) 
 he gives us the directions of Archigenes for operating in such 
 cases (Aetius, XVI. Ixxxvi.). 
 
 Phimus in the Uterus. — Phimus takes place about the 
 mouth of the womb, either in consequence of ulceration or of 
 inflammation terminating in scirrhus. Emollient hip-baths 
 of oil and water, cataplasms, pessaries, vapour baths, fumiga- 
 tion with aromatics, are all recommended. The author says 
 that phimus may be dissolved by a pessary of the sordes of 
 unwashed wool, nitre, and turpentine resin, being simply an 
 obstruction of the mouth of the womb (III. Ixxiii.). 
 
 In dealing with cases of sterility, our author says that when 
 the mouth of the uterus is shut up, it must be opened by 
 injections of aromatics and by using fomentations. Fumiga- 
 tions of the womb may be applied either by sitting on a 
 proper chair, and receiving the vapours which arise, or by 
 injections of hot water in which sage, mugwort, rue, cumin, 
 pennyroyal, sweet flag, and the aromatic seeds, have been 
 boiled (III. Ixxiv.). 
 
 Imperforate Pudendum and Phhmis. — Paul gives (VI. Ixxii.) 
 the operation described by both Aetius (XVI. xcvi.) and 
 Celsus (VII. xxviii.). 
 
 Laceration of the Cervix. — When the mouth of the womb 
 gapes, the diet, fomentations, and medicines should be of a 
 desiccant nature and astringent (III. Ixxiv.). 
 
 Ulceration of the Womb. — Paul says that the uterus is often 
 lacerated from difficult labour and other causes, and the ulcer 
 may be detected by the dioptra, but if deep seated by the 
 
PAULUS ^GINETA. 229 
 
 discharges. He then gives a description of the discharges, 
 which, he says, vary according to whether the ulcer is 
 inflamed, foul, spreading, or clean (III. Ixvi.). 
 
 His description is taken from Aetius (XVI. Ixxxviii.), who 
 acknowledges his indebtedness to Archigenes, Aspasia, and 
 Asclepiades. 
 
 Inflammation of the Uterus, and Change of its Position. — 
 Paul gives a very similar account to that of Aetius. He 
 enumerates a number of causes and general symptoms, and 
 then proceeds to the symptoms for inflammation of the 
 posterior and anterior portions of the uterus, and lastly for 
 the mouth of the womb. His treatment is by embrocations, 
 cataplasms, hip-baths, and pessaries. He finishes the chapter 
 with the followmg : " When there is derangement of the 
 position of the uterus, it is to be treated like inflammation 
 during the violence of the attack ; but during the remission or 
 decline emollients are to be applied, and when the complaint 
 is protracted alteratives are to be used." Our author does 
 not give here or elsewhere any description of the displace- 
 ments of the uterus (III. Ixiv.). 
 
 In the chapter on "Inflammation of the Womb" (III. Ixx.), 
 taken from Aetius, our author mentions that the midwife 
 should introduce her finger, well oiled, into the womb, and 
 gently extract, if possible, the thrombus lying in the womb by 
 breaking it down (III. Ixx.). 
 
 Fibroid of the Uterus.— J] ndev the heading of " The Mole " 
 (III. Ixix.), Paul gives from Aetius a description of a fibroid 
 tumour. He says : " The mole, too, is a scirrhous tumour, 
 forming sometimes at the mouth and sometimes in the body 
 of the womb, conveying to the touch the sensation of stone, 
 and being attended with retraction of the parts above, and 
 emaciation, paleness, loss of appetite, retention of the menses, 
 
230 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 and swelling of the breasts, so as in certain cases to raise 
 suspicions at first of a conception ; but in process of time the 
 true nature of the complaint is developed. Sometimes it 
 raises suspicions of dropsy, from which it is to be distinguished 
 by the hardness of the swelling, and from there being no 
 sound of water when tapped by the fingers, as in case of 
 dropsy. In certain cases, however, the disease actually 
 terminates in dropsy, which for the most part proves 
 incurable. In some cases it also brings on a discharge of 
 blood." Our author recommends rest. He ends the chapter 
 thus : " Some call by the name of mole an unorganized mass 
 of flesh which forms on the coats of the womb, and is 
 delivered like the foetus." 
 
 In the previous chapter he deals with scirrhus and scleroma 
 of the uterus in the same way as Aetius does (XVI. Ixxxiv.). 
 
 Cancer of the Uterus (III. Ixvii.). — Our author has 
 borrowed from Aetius (XVI. xciv.), who is indebted to 
 Archigenes. 
 
 Prolapsus Uteri (III., Ixxii.). — Paul takes his account from 
 Aetius (XVI. Ixxvi.), who borrows from Soranus (Ixvi.). 
 
 Fissures, Condylomata, Hcsmorrhoids, Thymi of the Uterus. — 
 The descriptions of these various diseases is taken from 
 Aetius. Our author remarks on the operative treatment: 
 *' Such excrescences in women, when brought into view and 
 exposed, are to be seized with a forceps and cut out with the 
 point of a half-spatula ; for the most distinguished surgeons 
 do not approve of ligatures in these cases." 
 
 Extirpation of the Nympha and Cauda Pudendi. — Paul again 
 borrows from Aetius (XVI. ciii.) , but adds nothing new. 
 
 Menstrual Discharge. — The age at which the period begins 
 is put down by our author as the fourteenth year ; a few have 
 it earlier, in the thirteenth or twelfth ; and not a few are later 
 
PA UL US ^GINETA . 231 
 
 than the fourteenth year. The duration is two, three, seven, 
 or in some cases twelve, days. They cease about the fiftieth 
 year ; a few have them till the sixtieth ; while in some they 
 begin to disappear about the thirty-fifth year, particularly 
 with such who are fat. If the period does not come on, the 
 sitz-bath is recommended. 
 
 There is a short chapter abstracted from Oribasius on 
 " Emmenagogues " (I. xlvii.). It points out that decoctions 
 of certain substances promote the flow, and that suppositories 
 may do the same. 
 
 Retention of the Menses. — Paul points out that the menses 
 may be suppressed from various causes, and if the discharge 
 is suppressed owing to primary affection of the internal parts, 
 then we must first direct our attention to the cure of the part 
 originally affected, and afterwards think of the uterus. In 
 discussing the treatment he speaks of a pessary of carded 
 wool, rounded to the shape of the finger, and impregnated 
 with the medicines (III. Ixi.). 
 
 On Immoderate Menstruation and Uterine HcB7norrhage. — 
 The account given here is very similar to that given by 
 Aetius. Paul favours the application of a sponge, soaked in 
 wine or liquid pitch, to the pudendum, but, as stated above, 
 Aetius condemns this. An example of a pessary recom- 
 mended by Paul may be given : Of fissile alum, of the inner 
 part of galls, of the juice of acacia, of manna, of each 4 drachms ; 
 the yolks of four roasted eggs ; these powders are rubbed with 
 the juice of plantain and mixed. In using it the pessary 
 of wool is impregnated with it, dipped into rose - oil, and 
 applied. 
 
 Paul also recommends dry-cupping by large instruments 
 applied frequently under the nipples to act by revulsion 
 (III. Ixii.). 
 
232 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 We now propose to give a few observations from Paul on 
 wounds of the peritoneum, and his description of gastrorrhaphy, 
 in order that a comparison may be made between the method 
 of closing the abdominal wound in these early times and the 
 method adopted by us of the present day after performing an 
 abdominal section : 
 
 B. VI. Hi. : How wounds of the peritoneum are to be healed 
 is next to be considered. If, then, the wound is small, so 
 that the prolapsed intestine, being distended with air, cannot 
 be returned to its place, it will be necessary either to evacuate 
 the flatus or enlarge the wound. The former measure is the 
 better, provided one can accomplish it. But how may this be 
 most probably done ? By removing the cause which occasions 
 the inflation of the intestines. But what is this ? Congela- 
 tion of the surrounding air, so that the cure is to be performed 
 by heating. Wherefore, having soaked a soft sponge in hot 
 water, and then squeezed it out, foment the intestine there- 
 with. In the meantime let hot austere wine be prepared, for 
 it is more heating than water, and communicates strength to 
 the intestines. If after having had recourse to all these 
 things the intestines remain inflated, we must divide as much 
 of the peritoneum as the prolapsed intestine requires. The 
 straight instrument called the syringotoma, used for operating 
 upon fistulse, is very proper for this incision. A recumbent 
 position of the patient is the best when the wound is in the 
 lower part ; and when in the right side he may be on the left, 
 and when the left side he may be on the right, and this is 
 common both to great and small wounds. But the replace- 
 ment of the intestine into its proper place when the wound is 
 large requires a skilful assistant. For he must take hold of 
 the wound internally with his hands, and contract and com- 
 
/ ■ 
 
 PAULUS ^GINETA. 233 
 
 press it a little, so as to expose always a small portion to the 
 sewer, and also must compress moderately what is sewed until 
 the whole is sewed. 
 
 What is the most proper mode of performing the operation 
 called gastrorrhaphy we must next explain. Since the ab- 
 domen must be united with the peritoneum, we have to begin 
 by passing a needle through the skin from without inwards ; 
 but when it has transfixed the skin and the whole rectus muscle, 
 passing by the adjacent peritoneum, we must push the needle 
 from within through the other part of the peritoneum, and so 
 hence from within outwards through the rest of the abdomen ; 
 and when it has passed out we must push the needle again 
 from without inwards through the part of the abdomen, and 
 passing by the adjacent portion of the peritoneum, and begin- 
 ning again from the opposite side of this membrane, perforate 
 it from within outwards, and at the same time all the other 
 parts of the abdomen ; then beginning again from this, sew 
 it with the opposite membrane, and afterwards transmit it 
 from the neighbouring skin outwards, and do this repeatedly 
 until the whole wound be sewed up. The space between 
 sutures required to keep the under parts together must be 
 very small, but the interval between those required to keep 
 the skin from falling asunder need not be so small. Excess 
 in either respect must be avoided, and a medium chosen 
 between the two extremes. And a medium is likewise to be 
 observed as to the consistence of the thread ; for that which 
 is too hard hurts the soft skin, and what is too soft is first 
 broken. In the same manner, passing the needle too near 
 the lips of the wound occasions often a rupture of the re- 
 mainder, which is too narrow. But if too much be taken, 
 much of the skin remains ununited. These observations 
 apply to the treatment of all ulcers, but are more especially 
 
234 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 to be observed in gastrorrhaphy ; and, as aforesaid, we must 
 act, forming a conjecture as to the adhesion of the peritoneum 
 with the abdomen, from the circumstance that the latter, being 
 membraneous, seldom adheres ; or, as some do, by bringing 
 together the parts of the same kind — that is to say, peri- 
 toneum to peritoneum and abdomen to abdomen ; or it may 
 be done thus : In the same manner as above we must pass a 
 needle from the side of the abdomen nearest us, from without 
 inwards, and through it above ; then, passing both lips of the 
 peritoneum, one must again turn the needle from without 
 inwards, through both lips of the peritoneum, and, again 
 turning it from within outwards, pass it through the opposite 
 part of the abdomen. This mode differs from the common 
 and vulgar one, inasmuch as the needle is passed through the 
 four lips at one perforation, and exactly conceals the peri- 
 toneum within the abdomen. In order that no vital part may 
 be affected sympathetically, some tender wool is to be dipped 
 in moderately hot oil, and the whole space between the groins 
 and armpits wrapped in it. It will be better also to evacuate 
 the bowels by a clyster of warm oil. But if any of the intes- 
 tines be wounded, dark austere wine in a tepid state should 
 be injected, more especially if it be perforated quite through. 
 
 The large intestines are easily cured, but the smaller ones 
 with difficulty ; and the jejunum is utterly incurable, from the 
 multitude of its convolutions and the magnitude of its vessels, 
 and owing to its coat being thin and nervous ; besides, it 
 receives all the bile in an undiluted state, and is nearest to 
 the liver. The under and fleshy parts of the stomach we 
 may attempt to cure, for we may succeed, not only because 
 these parts are thicker, but because curative medicines are 
 more readily applied to them, owing to the situation. The 
 parts, however, about the mouth of the stomach and oeso- 
 
PA UL US ^GINETA . 235 
 
 phagus are affected by the medicine only in passing down, 
 and the exquisite sensibility of the mouth of the stomach is 
 an obstacle to the cure of wounds of it. When from a rupture 
 of the peritoneum the omentum is prolapsed, and either 
 becomes livid or black, the part anterior to the black portion 
 may be included in a ligature, for fear of haemorrhage, and 
 the part behind the ligature is to be cut off, and the extremi- 
 ties of the ligature allowed to hang from the under part of 
 the sewed wound of the abdomen, in order that they may 
 readily escape when cast off by suppuration of the wound. 
 
CHAPTER XIX. 
 
 THE AEABIAN WEITEKS. 
 
 Paulus iEGiNBTA was the last of the eminent Greek authors 
 on medicine ; for although Constantinople was not conquered 
 by the Turks until 1453, we nevertheless find no medical 
 writer connected with that city worthy of mention after Paul's 
 death, except perhaps Actuarius, who lived there as Court 
 physician 1000 a.d., and in whose works we find a few 
 references to the diseases of women. 
 
 Already during the latter years of Paul's life the cloud of 
 war was rising in the East. Mahomet having inspired his 
 followers with the ambition of conquest, we behold a people, 
 hitherto fairly isolated from all other nations, suddenly issuing 
 from their native land and capturing province after province. 
 During the Caliphate of Omar II., the Arabs, led on by the 
 victorious Amrou, captured Alexandria, and, after losing it for 
 a short period, finally took possession of it, and in 646 not 
 only expelled the professors from their seats of learning, 
 but pillaged the city and burnt the great library of 
 700,000 volumes. 
 
 Though the greater number of the works were destroyed, 
 yet the Arabians may have allowed some of the medical works 
 to be rescued, for they, as Freind remarks (though Siebold 
 thinks the conclusion is overstrained), were not more adverse 
 
THE ARABIAN WRITERS. 237 
 
 to good health than other nations, and so they may have 
 allowed some of the chief medical works to be rescued, know- 
 ing that they were the guides which were to serve to teach 
 their own physicians when these same works had been 
 translated. Certainly it would appear that many works were 
 conveyed to Greece and Italy, rescued from those destined to 
 feed the fires of the city baths. In later days we find a some- 
 what similar instance of the preservation of works before and 
 after the capture of Constantinople by the Turks, when the 
 Greek medical writings were conveyed to Italy, and, after 
 being translated into Latin, formed a valuable foundation for 
 the revival of learning during the fifteenth century. 
 
 But even before the capture of Alexandria, Syriac transla- 
 tions of many of the Greek medical writers had been made 
 at Alexandria, and after the city was captured these books 
 became more disseminated among the Arabs, and later on 
 were translated into Arabic (687 a.d.). 
 
 The Caliphs now became the patrons of learning, and 
 Bagdad, founded by the Caliph Al Manzor (762), remained 
 the imperial seat of his posterity during a reign of 500 years, 
 and soon became one of the principal seats of learning in the 
 East. Thither came those who saw in the luxury and 
 progress of the new capital an opening where they might 
 exercise their calling, and Gibbon tells us that in the city 
 800 physicians were licensed to exercise their lucrative pro- 
 fession. Here Honain, a physician of the Nestorian sect, 
 with his disciples, became during the ninth century the chief 
 of a school or manufacture of translations, and here many of 
 the works of the classical authors were translated into the 
 Arabic language.^ 
 
 Those who would follow the future of gynaecology from the 
 
 ^ Gibbon, loc. cit,, c. lii. 
 
238 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 death of Paul onwards must study the works written, com- 
 piled, and translated by the physicians who flourished at 
 Bagdad in the East and Cordova in the West. We may say, 
 however, at the outset, that the perusal of their works will 
 not repay the trouble, because no new facts of importance 
 were added to previous knowledge, since the Ai*abs were 
 content to copy from the Greeks whatever related to gynae- 
 cology, because they could have but a very limited experience 
 in this branch of medicine, inasmuch as the religious laws of 
 the people forbade a man to examine the genital organs of a 
 woman, in consequence of which gynaecology and obstetrics 
 were left in the hands of women, who not only did the minor 
 operations, but even performed embryotomy and lithotomy. 
 
 The Arabian authors whose works contain reference to 
 gynaecology are the following : 
 
 Serapion, who was born in Syria, has left us two works 
 in Syriac. He lived at the commencement of the ninth 
 century. 
 
 Rhazes (882 a.d.) resided at Bagdad, and is famous for his 
 work on small-pox. 
 
 Ali Ahhas, also of Bagdad, lived during the latter part of 
 the tenth century. 
 
 Avicenna, born 980 a.d., was a resident of Bagdad. He 
 was the Galen of the East, and left a huge work entitled 
 " The Canon," which was largely used by the Arabians during 
 the twelfth century. 
 
 In Spain, where the Arabs had penetrated about the year 
 711, medicine was cultivated, and Cordova became the Bagdad 
 of the West. Among the writers of Spain who have left us 
 some passages on gynaecology are Avenzoar, of the thirteenth 
 century ; Averroes, born in 1126 ; and Albucasis, who lived 
 at the end of the eleventh century (died 1106). 
 
THE ARABIAN WRITERS. 239 
 
 With the termination of the Moorish rule and the estabhsh- 
 ment of the Inquisition by Ferdinand, the pursuit of science 
 in Spain was brought to an end, just, in fact, at that period 
 when the new Hght of learning was beginning to illuminate 
 Europe — a light which continued to increase in brightness and 
 splendour from century to century, until we have come to bask 
 in the splendour of its rays. 
 
PART II. 
 (Being a Resume of Part I.) 
 
 CHAPTER XX. 
 
 eEsumE of the anatomy of the female genital 
 
 OEGANS. 
 
 Uterus. 
 
 We shall first note the various terms used by our authors for 
 designating the womb. 
 
 Soranus (c. iii.) tells us that the womb was called Mrpa, 
 varepa, and SeX^y9 : firjTpa because it is mother {firix'qp) of 
 the fcetus born from it, or because it makes those having it 
 mothers ; and, according to some, because it has a measured 
 period {fierpov 'x^povov) for menstruation and bringing-forth ; 
 varepa}- because it exhibits its functions late (va-repov), or 
 because it occupies the lowest part of the female intestines ; 
 8€\(pv<; because it brings forth brothers (aSeX^ot). 
 
 Galen, in referring to the womb, frequently used the term 
 varipai, because his conception of the womb had been derived 
 from the bicornuate uterus of the lower animals ; /mjrpac was 
 
 ^ Liddell and Scott say that if varepa is from varepos, the last or lowest part of 
 the female intestines, it cannot be connected with the Latin uterus, which is 
 prohably akin to 'ivrepa ; but more probably it is akin to uterus, and not to 
 liffT-e/sos. The Sanscrit term for uterus is udara. 
 
ANATOMY OF THE FEMALE GENITAL ORGANS. 241 
 
 used in a similar manner. Another form of SeX^y? was 
 77 8eX(pva, and Eufus points out that SeA,<^y9 was a term used 
 for the womb in one of the Hippocratic treatises (S., 222). 
 
 Celsus (IV. i.), in his short description of the womb, refers 
 to it as " vulva " ;^ thus, "Vulva autem in virginibus quidem 
 admodum exigua est." 
 
 Position and Size of the Uterus. — Soranus describes the 
 uterus from the dissection of a cadaver in the horizontal 
 position, and says that it lies between the bladder and rectum, 
 and rests on the latter, but beneath the former, either in 
 whole or in part, according to change in its size. He remarks 
 that in infants it is smaller than the bladder, but in virgins at 
 puberty it reaches to the same height as the bladder, while 
 in those more advanced in years and in married persons, 
 especially multiparse, it is even larger, so that it extends to 
 where the colon stops. During pregnancy it is much larger, 
 while after delivery it contracts, but still remains larger than 
 before pregnancy. Eufus does not deal with either the position 
 or the size of the uterus. 
 
 Aetius follows Galen, and the latter says that the uterus is 
 placed within the peritoneum between the bladder and rectum, 
 resting on almost the whole of the latter, and reaching far 
 beyond the bladder towards the umbilicus : "qui parte fundus 
 ipsius est." He says that the womb varies in size, being 
 smaller in those who have not conceived, while it is much 
 larger in those who are pregnant. Galen remarks that the 
 cervix is eleven finger-breadths {7^ inches) from the vulva, 
 while Soranus says that the os uteri is more distant from the 
 labia in some than in others, according to the age, and that in 
 adults the distance is generally from 3| to 4 inches. 
 
 ^ Vulva is probably derived from volvo, and may therefore be written voha, 
 ■which signifies a ^\Tappe^ or seed-covering. Others have derived it from valva, 
 or valvce, folding- doors, which is also derived from volvo, 
 
 16 
 
242 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Celsus says that the uterus in girls is small, but in women, 
 except when they are pregnant, it is not much larger than a 
 body that may be embraced by the hand (IV. i.). 
 
 It will be seen from the above passages that Soranus and 
 Celsus had accurate notions concerning the size of the uterus, 
 but that Galen and Aetius held the erroneous view that the 
 unimpregnated uterus was so large that the fundus reached 
 up close to the umbilicus. The writer of the Hippocratic 
 treatise on the "Diseases of Women" (ii. 133) appears to have 
 had an accurate idea of the length of the uterus, for he directs 
 that in dilating the uterus the dilators are to be introduced 
 for a distance of four finger-breadths (2*8 inches). 
 
 We may next inquire if our authors knew the normal 
 position of the uterus. Soranus says that after delivery the 
 uterus becomes contracted, but retains a larger size than 
 before pregnancy. Under these circumstances it is larger 
 than the bladder, and does not lie under it (the cadaver being 
 in the horizontal position). Behind, the fundus of the uterus 
 lies higher than the fundus of the bladder, being under the 
 umbilicus, so that the cavity of the bladder lies upon the neck 
 of the uterus, and its fundus upon the cavity of the latter. 
 
 The above description is fairly accurate, and it was most 
 probably derived from the works of the Alexandrian ana- 
 tomists, among whom was Herophilus, who had dissected the 
 female organs of generation, as Galen expressly informs us 
 (" De Uteri Dissect.," c. ix.). If, however, we take the 
 descriptions of Galen and Aetius, we shall see that if these 
 descriptions are meant to refer to the unimpregnated uterus, 
 then they had no idea of the size, nor of the normal 
 position of the fundus, of the unimpregnated womb, as both 
 these writers state that the fundus reaches up to near the 
 umbilicus. 
 
ANATOMY OF THE FEMALE GENITAL ORGANS. 243 
 
 Again, if we turn to our authors' descriptions of the various 
 displacements of the uterus, we find that they were able to 
 recognise a retroflexion of the uterus, and Aetius gives 
 excellent directions for restoring the uterus to its proper 
 position ; while, on the other hand, we see that the bimanual 
 examination could not have been practised to ascertain the 
 normal position, else we should not have had such statements 
 as Aretseus gives us, ** that the uterus may be moved up in a 
 direct line to below the cartilage of the thorax, and also 
 obliquely to the right or to the left, either to the liver or 
 spleen" ("Acute Diseases," II. xi.). Lastly, we are con- 
 vinced that many of the displacements of the uterus that were 
 described were guessed at from the position and direction of 
 the cervix, not from the position of the fundus, though their 
 constant use of the sound may have told them much. In 
 conclusion, we may therefore say that, while the Alexandrian 
 anatomists had probably accurately described the normal 
 position of the uterus, among gynaecologists the position of 
 the fundus was not always accurately ascertained, inasmuch 
 as the bimanual examination was not practised, and the sound 
 was not systematically used to ascertain the direction of the 
 fundus of the uterus, many of the malpositions being guessed 
 at merely from the position and direction of the cervix. 
 
 Shajye of the litems. — Soranus says that the shape of the 
 uterus is not convoluted, as in the brutes, but more like a 
 cupping-glass {aiKva = a gourd). For, beginning from the 
 rounded and broad end of the fundus, it contracts sensibly to 
 the narrow mouth. The first, and projecting, part of it is 
 called aTofiLov (mouth = os uteri) ; next comes the Tpdxn\.o<i 
 (neck = cervix), then the avxnv (narrow neck = isthmus) ; these 
 last two together form the Kav\6<i (stem). Where it broadens 
 out beyond the constriction of the neck, we have first the 
 
 16—2 
 
244 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 MfxoL (shoulders), then the irXevpd (ribs, sides), last of all the 
 'jrvOixrjv (fundus), beneath which is the )8ao-i9 (base). 
 
 Galen says that the form of the uterus, both considered as 
 a whole and especially as regards the fundus {irvO^rjv), is 
 similar to that of the bladder ; but it differs from that organ 
 inasmuch as it has mammillary processes growing from either 
 side. In another passage, however, Galen shows that he did 
 not know the true shape of the human uterus, for he says : 
 " But in women and other animals which have a womb similar 
 to a woman's, such as the goat and cow," etc. 
 
 Os Uteri. — Eufus gives us similar terms to Soranus for the 
 various parts of the uterus, and remarks that Hippocrates 
 named the mouth of the womb afxtpiSeov, from the resemblance 
 to the circles of iron on the plough ; while Soranus says that 
 the size of the os uteri varies, and is in most cases normally 
 as large as the outer end of the auditory meatus ;; while Galen 
 remarks that it admits the sharpened point of a probe or 
 something slightly thicker. 
 
 Soranus and Galen describe the cervix, the former mention- 
 ing that its texture is soft and fleshy in virgins, but in those 
 who have borne it becomes more callous ; both these authors 
 quote Herophilus in likening the cervix in this condition to 
 the end of the bronchus. 
 
 Structure, Ligaments, and Blood-swp'ply . — Soranus says that 
 the whole uterus is as far as possible fibrous {vevpdohr^si), but 
 not composed of fibres alone, but also of veins, arteries, and 
 flesh. 
 
 Galen gives an elaborate description of the tissues of the 
 uterus, dividing them into an external and internal tunic, the 
 latter being a double tunic and capable of being dissected into 
 two layers. 
 
 Soranus and Galen both give excellent descriptions of the 
 
ANATOMY OF THE FEMALE GENITAL ORGANS. 245 
 
 ligaments of the uterus, and Soranus remarks that when these 
 ligaments are shortened by inflammation the uterus is dragged 
 on, and lies to one side. 
 
 Soranus describes the blood- supply to the ovaries and 
 uterus as being derived from the renal artery on both sides, 
 and he says that the ovarian veins open into the renal veins 
 on each side {vide Kelly, " Operative Gynaecology," Fig. 27). 
 
 Galen, however, is more accurate in stating that the arteries 
 in question come from the aorta, but he is inaccurate in say- 
 ing that the ovarian veins open into the vena cava on either 
 side. He alludes to vessels which correspond to those 
 described by Soranus, for he says : '* There are four other 
 vessels which are not always in women, but which occur in 
 some cases (according to Herophilus) ;^ these spring from the 
 vessels running to the kidneys, and enter the uterus." 
 
 Fallopian Tubes and Ovaries. — Soranus says that the ovaries 
 {Uhvixo<i, double, twin, testicle, ovary) grow out from the 
 sides near the isthmus, about opposite to the middle of the 
 uterus. In shape they are, unlike the male organs, long and 
 somewhat flat, and are round and broad at the base. The 
 spermatic vessel from the uterus is carried out of each ovary, 
 and, being placed along the sides of the uterus as far as 
 the bladder, enters into the neck of the latter. Whence it 
 appears that the seed of the female, inasmuch as it is poured 
 out, does not play a part in the production of life. He further 
 remarks that there are suspensory ligaments of the ovaries, 
 for he had seen them in a case of operation for hernia, in 
 which, during the operation, the ovary had prolapsed. 
 
 ^ The fact that Soranus studied in Alexandria, and quotes Herophilus with 
 regard to the cervix being like the end of the bronchus ; that he gives the blood- 
 supply to the uterus as coming from vessels which arc unusual, and which Galen 
 shows Avere the discovery of Herophilus ; and, lastly, the fact that the Fallopian 
 tubes are not mentioned by Soranus, and were missed by Herophilus, are all 
 evidences that Soranus used the work of Herophilus or of one of his followers in 
 compiling his account of the uterus. 
 
246 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Galen gives an excellent description of the ovaries, and 
 remarks on the coils of vessels, that run to the ovaries. 
 Galen then describes the Fallopian tubes. He says that the 
 seminal tubes which run from the ovaries are seen to contain 
 seed, in a similar way to the tubes in the male ; these tubes, 
 which are wide near the ovaries, and possess a cavity that can 
 be seen, a little distance from the ovaries become narrowed, 
 and appear as though they were hollow ; while at the cornua, 
 where they are joined into the uterus, they again become 
 dilated. Neither Herophilus nor Euryphon nor Aristotle was 
 aware of these connections.^ 
 
 Eufus says that Herophilus was of the opinion that females 
 had no varicose vessels (Fallopian tubes), but Eufus says that 
 he himself had seen the uterus of a sheep, and from either 
 side, springing from the testes (ovaries), there were (Fallopian) 
 tubes which opened into the cavity of the uterus, and from 
 these tubes mucous fluid escaped when they were pressed, so 
 that it is a strong presumption that there are spermatic vessels 
 of the varicose species. 
 
 Aetius says that the horns of the uterus first run upwards, 
 then downwards, and become gradually narrower, so that the 
 distant portions resemble veins. These narrowed portions of 
 
 ^ It is interesting to compare the descriptions that our authors have left us of 
 the Fallopian tubes with the description of the tubes by Fallopius : 
 
 "That slender and narrow seminal duct rises, fibrous and pale, from the horn 
 of the uterus itself; becomes, when it has gone a little bit away, appreciably 
 broader, and curls like a branch (capreolus) until it comes near the end ; then, 
 losing tlie hornlike curl, and becoming very broad, has a distinct extremity which 
 appears fibrous and fleshy through its red colour, and its end is torn and ragged 
 like the fringe of well-worn garments, and it has a wide orifice, which lies always 
 closed through the ends of the fringe falling together ; and if these be carefully 
 separated and opened out, they resemble the orifice of a brass trumpet. "Where- 
 fore, since the seminal duct from its beginning to its end has a likeness to the 
 bent parts {aqoreoli) of this classic instrument, separate or attached, therefore it 
 has been called by me the ^Ueri hd>a. These are present not only in the human 
 body, but also in the sheeii, cows, and all other animals which I have dissected " 
 (Barbour, loc. cit., p. 454). 
 
ANATOMY OF THE FEMALE GENITAL ORGANS. 247 
 
 the horns with sinuous curves reach to the ovaries, which are 
 placed by the side of the uterus, and through these sinuous 
 curves of the cornua the uterus draws the semen from the 
 ovaries during coitus. 
 
 From the above descriptions, it is abundantly clear that 
 Eufus, Galen, and Aetius were acquainted with Fallopian 
 tubes, while Herophilus and Soranus did not know of their 
 existence. Furthermore, these authors understood that these 
 tubes were the means of communication between the ovaries 
 and the uterus, and they considered the normal secretion of 
 the Fallopian tubes the substance secreted by the ovaries ; 
 for Eufus says that when these tubes were pressed fluid 
 escaped, so that it was a strong presumption that they were 
 spermatic vessels of the same kind as the vas deferens in the 
 male ; and Galen, in his work on the Sperm, says that the 
 Fallopian tubes can be observed to be filled with sperm 
 (fieaTov 8e (pdiverai, (iTrepixaTO'i) , and in another place ('* De 
 Usu Partium," XIV. xi.) he remarks that there exists a great 
 resemblance between the sperm of the testicles of the female 
 and the fluid contained in the glandular bodies (prostate) of 
 the male. In short, these writers supposed that the mucus 
 of the Fallopian tubes was the secretion from the ovaries. 
 How could they by any possible means guess at a truth which 
 De Graaf, Hoorne, Swammerdam and Malpighi failed to 
 ascertain, and which only became a possible discovery when 
 the microscope had been brought to sufficient perfection to 
 enable Baer (1836) to clear up the mystery by discovering the 
 ovum ? 
 
 Round Ligaments. — Both Eufus and Galen mention the 
 round ligaments, the latter supposing that they poured into 
 the uterus a fluid analogous to the prostatic fluid of the male.^ 
 
 ^ Daremberg, " CEuvres de Galien," torn, ii,, p, 118, 
 
248 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Vagina and External Genitals. 
 
 Soranus says that the female pudenda (to jwaLKelov alSolov) 
 are also called koXtto^; jvvaiKelo<;, by which term he means to 
 designate the vagina, the wall of which he says is fibrous and 
 rounded, like intestine, and more roomy at the inner, and 
 narrower at the outer, end. It is attached internally to the 
 cervix uteri, externally to the labia. He says that the length 
 of the vagina in the adult is 4 inches, and he gives many 
 reasons to prove that no thin partition membrane exists 
 which barricades the vagina, ** by which he appears to 
 combat some view that the hymen was always imperforate" 
 (Barbour). 
 
 Soranus then remarks that the parts outside are called 
 Trrepvycofiaja (wings = labia majora), forming as it were the 
 lips of the vagina, and that these end above in the vv/j,(pi] 
 (clitoris), and that below the clitoris there is a fleshy pro- 
 minence called the urethra, while the rough fold is the %et\o9 
 (lip = labium minus) . 
 
 Galen refers to the vagina as the 'ywauKelo'i koXtto^ (" De 
 Uteri Dissect.," c. vii.). In another passage he says that to 
 alholov TO yvvacKetov is the open space lying between the pubic 
 bones, and has a cuticular process externally, analogous to 
 the prepuce of males. This description appears to apply to 
 the vagina, for in several passages in another of his works 
 (" De Usu Partium," Lib. XIV.) the same terms are used to 
 express the vagina, thus : 6 <yap tol ronv vcnepcov avxv^ • . • 
 t<? TO <yvvaiK€LOv al^olov rekevra (XIV. iii.). 
 
 Eufus says that the cavity leading up to the cervix is the 
 yvvaiK€io<; «oX.7ro9, while the parts that can be seen from the 
 outside are embraced by the term alSotov. He calls the 
 clitoris the vvfi^t] (the myrtleberry), and the cleft in the 
 
 i 
 
ANATOMY OF THE FEMALE GENITAL ORGANS. 249 
 
 mid-line of the genitals he calls the axio-f^a, while the mons 
 veneris is the Krei^, or comb. What Soranus called irrepv- 
 ydofiara (labia majora) he explains were less commonly called 
 fivpTox^iXa. 
 
 Celsus in his description of the female parts alludes to the 
 vagina as the canal : " quem canalem vocant " (IV. i.). 
 
 Among the Egyptians a distinction was drawn between the 
 uterus, the vagma, and the external genitals, for we have 
 three distinct words used in the Papyrus Ebers to express 
 those different parts. Thus, on p. 170 the uterus is evidently 
 alluded to, as prolapse of the womb is referred to, and the 
 term " met-ret " is used. On p. 174 the vagina is referred to, 
 and the term *' sed " is used ; while in other passages the 
 general term " at " is used, and is translated by Joachim by 
 the word " vulva," which may be taken in a broad sense to 
 mean uterus, vagina, or the external organs of generation, or 
 merely the latter, as the term usually signifies nowadays.^ 
 
 ^ Besides the terms used by our authors, we find many other words in use by 
 classical wiiters to denote the uterus, vagina and vulva. 
 
 A. Terms which signify " Wovib." 
 
 Alvus: "Cum prsegnans Dionysium alvo contiueret" (Cicero, "De Div.," 
 
 I. XX.). This word is probably connected with vulva and the Sanscrit ulva, a 
 cavity or womb. 
 
 Arvum: "Muliebria arva" (Lucret., IV. 1101); "genitale arvum" (Virgil). 
 
 Bulga : Lucilius, Sat., Lib. VI. (b.c. 103). 
 
 Fovea: TertuUianus. 
 
 Loci, Loca: "Cum in locis semen insederit " (Cicero, "De Nat. Deorum," 
 
 II. li.) ; also in Celsus, II. viii. : " Qu£e locis laborat, aut difficulter partum 
 edit, sternutamento levatur." 
 
 Matrix: " Matricis dolor" (Vegetius, " De Re Veterinaria "). 
 
 UUr: Csecilius Statins (b.c. 168). 
 
 Uterus: Plautus, " Truculentus, " I. ii. 97. 
 
 Utriculus: Plinius Secundus, Hist. Nat., XI. xxxvii. 84. 
 
 VerUer : "Homines in ventre necandos conducit" (Juvenal, VI. 595-6), 
 
 ''Eiroti<}>ah.ov : This word signifies the boss of a shield, but it is used by 
 Parthenius (B.C. 63) to denote the womb. 
 
 Ta<7Tj)p, ur]diis : Both these words signify the belly, and are used by Homer to 
 denote the womb. 
 
250 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 In the Jewish Talmud the uterus is called the sleeping- 
 chamber ; the cervix uteri the porch ; the seed-vessels the 
 storeroom ; the vagina the outer house ; the hymen the 
 virginity; the labia majora the hinges; the labia minora the 
 doors ; the clitoris the key. 
 
 Tovri : That which is begotten. Hippocrates, however, used the word to 
 signify the womb, according to Rufus. 
 
 K6X7ros : This word denotes the bosom, waist, and womb. Sorauus says that 
 the whole receptacle of the womb is called the kijtos (cav^ini), ydarpa {venter), 
 and /c^Xttos {simis). Galen also, in speaking of the bicornuate uterus, says that 
 each horn is called by Praxagoras and Philotimus the /c6\7ros, and hence the 
 womb of woman is BLkoXttos (bisinuatus). Later on, in describing the vagina, 
 Soranus calls it KdXiros, and nowadays we derive such words as "colpitis" and 
 " colporrhaphy " from ndXiros, meaning thereby disease of, or operations on, the 
 vagina and not the uterus. 
 
 2iTo/xaxos : Galen uses this term to express the mouth of the womb. The term 
 " womb " itself is from the Anglo-Saxon wamb, the belly or womb. 
 
 B. Terms that signify " Vagina." 
 
 Cunmos: " Inter se geminos audes committere cunnos" (Martial, I. 91). 
 
 Vagina : This word does not occur in Celsus, who used the term canalis for 
 the;front passage. It appears to have been applied to the front passage, if we 
 may judge from a line in the " Pseudolus " of Plautus, Act IV. vii. 
 
 Concha: Plautus, "Rudens," Act. III. iii. 
 
 Sinus : " Tangitur et tacto concipit ilia sinu " (Ovid), 
 
 Tubus : Martial, XI. ixii. 6. 
 
 C. Terms that signify ^' Vulva." 
 
 Crista: Juvenal, VI. 421. 
 
 Sulcus: Virgil, "Georgic," III. 136. 
 
 Muliebria: All the organs of generation (Tacitus, " Annales," XIV. Ix.). 
 
 Navis and Saltus are applied by Plautus to the pudendum. 
 
 Hortulus cupidinis. 
 
 Porcus: Varro, "De Re Rustica," II. iv. 10. 
 
 Pudendum : The part about which one should be ashamed. 
 
 Specus : Auctor Priapeiorum. 
 
 'AfitpiKUvaris : Eustathius. 
 
 'Eo-xdpa : Eustathius. 
 
 KiktOos, Kvcrds : Aristophanes. 
 
 Xolpos : Aristophanes. 
 
 nXtxaSes : Perineum (Rufus). 
 
 K^TTos : Organs of generation, but according to Diogenes Laertius equals pubes. 
 
 AAra : Groin or pudenda. 
 
CHAPTER XXL 
 
 EESUME OF PHYSICAL EXAMINATIONS OF THE 
 PELVIC ORGANS. 
 
 Inspection, Palpation, and Percussion. 
 
 These methods of examination were commonly used by the 
 ancients. Hippocrates, Soranus, and Aetius refer to them in 
 many places in dealing with gynaecological cases ; thus, the 
 latter points out how the mola (myoma uteri?) may be 
 differentiated from ascites and pregnancy by palpation and 
 percussion (c. Ixxx.). The liver and spleen are described as 
 being palpated in one of the Hippocratic works. 
 
 Vaginal Examinations. 
 
 These examinations were made by the medical men,^ the 
 specialists in gyngecology, by the midwife, by female practi- 
 tioners, and by the patient herself. The examination was 
 made either with the finger or the speculum. In the Ebers 
 Papyrus we have the first mention of vaginal examinations in 
 dealing with obstruction for disease on one side of the cervix, 
 and in the treatment of prolapsus uteri. Soranus mentions 
 the specialists in gynaecology who were called in by the 
 midwives in difficult cases: "Dicimus quosdam esse mulierum 
 medicos, quia affectiones mulierum sanant ; et homines solent 
 
 ^ Vaginal examinations are frequently mentioned in the Talmud, and were 
 made by the Rabbins. 
 
252 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 obstetrices ad morbos vocare, quando mulieres proprium quid 
 patiuntur et quodillis cum viris baud commune sit " (c. xlvii.). 
 Tbese men no doubt performed the more difficult operations, 
 for it was not until the Arabian period that men ceased to 
 examine and operate on the female genital parts. The midwives 
 frequently examined the vagina and cervix, as we see from 
 many passages in Hippocrates (N. 0. W., 40^), and Soranus 
 specially mentions that the index-finger of the left hand was 
 used, and that the nail was to be evenly pared (c. xxi.), so as 
 not to lacerate the organs (c. i.). The medicae, or female 
 practitioners, no doubt made examinations, for in the 
 " Hippolytus " the Nurse tells Phaedra that if her disorder is 
 one that cannot be revealed to men, then there are women 
 who understand such matters. Lastly, there are numerous 
 passages in Hippocrates that show that the patient was 
 accustomed to examine her os and cervix (D. 0. W., ii. 133), 
 while passages in Soranus show us that females were 
 accustomed to smear substances on their own cervices to 
 prevent conception (c. xvii.). 
 
 The bimanual examination does not seem to have been used 
 for diagnostic purposes ; it was, however, used in cases of 
 stone in the bladder (Aetius, c. xcix.), when two fingers of the 
 left hand were introduced into the vagina and the right hand 
 compressed the bladder from above. It was also used in case 
 of calculus of the uterus, two fingers of one hand being passed 
 into the rectum, while the other hand was employed to press 
 from above (Aetius, c. xcviii.). 
 
 1 D. 0. W. = " Diseases of Women"; S. = " Sterility " ; N. 0. W. = "On the 
 Female Nature. " 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 253 
 
 Eectal Examination. 
 
 This was resorted to, as shown by Soranus (c. Ix.), in the 
 differential diagnosis of inflammation of the rectum from 
 peri-uterine inflammation ; while Aetius directs, in a case of 
 retroflexion of the uterus, that the midwife should introduce 
 her finger into the rectum and push the uterus forward 
 (c. Ixxvii.). 
 
 The rectal speculum was used by the Hindus, and Hippo- 
 crates (" Fistulse," c. iii.) refers to it in dealing with cases of 
 rectal disease ; while the rectal bougie was also used by the 
 Hindus to dilate the rectum in cases of stricture (Wise, 
 "Hindu System of Medicine," p. 387). 
 
 Galen in his " Linguarum Explanatio," in defining 
 KaTOTTTrip, says that it was the instrument for dilating the 
 seat. 
 
 Position of the Patient. 
 
 Aetius, in a passage from Archigenes, thus describes the 
 position of the patient during an examination with the 
 speculum : The woman is placed supine on a seat, with her 
 legs drawn up on her abdomen, and her thighs separated from 
 one another. Let her arms also be brought down under her 
 legs, and secured by proper ligatures passing over her neck. 
 The patient being placed before a clear light, the operator sits 
 on her right side, and he is then to make an examination with 
 a speculum proportionate to her age. The depth of the 
 vagina is to be measured with a sound, lest the stalk of the 
 speculum be too long, and so the uterus would be pressed 
 against it. And if it is found that the stalk of the speculum 
 is longer than the vagina, folded compresses should be placed 
 on the labia or sides of the pudendum, so that the speculum 
 may be placed firmly on them. The stem should be intro- 
 
254 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 duced having the screw at the upper part, and the speculum 
 is to be held by the surgeon ; but the screw is to be turned 
 by the assistant, so that the blades of the stem being sepa- 
 rated the vagina may be distended (c. Ixxxvi.). 
 
 This passage shows the antiquity of the ** lithotomy 
 position " in gynaecology ; this position, however, was used 
 by the Hindus in rectal operations, showing still further its 
 antiquity (Wise, p. 386). 
 
 During treatment the patient was sometimes placed on 
 her back, with her feet elevated and her thighs separated 
 (D. 0. W., 144), or crossed, the one over the other (Soranus, 
 c. xlix.). In other cases she lay on her side ; thus, in treat- 
 ing a case of displacement of the uterus, soon after labour, 
 " the woman will lie on the hip opposite to the displacement " 
 (Aetius, c. Ixxvii. ; N. 0. Y7., 25). In other cases the foot of 
 the bed was raised (D. 0. W., 149 ; Soranus, c. xlix.), or the 
 buttocks were raised (Aetius, c. Ixxvi.) ; while in case of 
 prolapse the body of the patient was fixed to a ladder, and 
 she was then placed head downwards, so that succussion could 
 be practised (N. 0. W., 5) ; Soranus did not, however, approve 
 of this position. In some cases of dystocia the patient was 
 placed on her knees (Soranus, Ixiv.) ; while Soranus, in deal- 
 ing with a case which he supposes to be (peri-) uterine 
 inflammation, but which was more probably a prolapsed 
 ovary, says that the tumour may be felt by a rectal examina- 
 tion, but that it will alter its position if the patient be placed 
 in the knee-elbow position (c. Ix.). Aetius also alludes to the 
 knee-elbow position in dealing with retroflexion of the uterus, 
 for he says that the faeces are not passed, nor can a clyster be 
 administered : ** nisi genibus innitatur regra " (c. Ixxvii.). 
 
 Eufus, in dealing with diseases of the bladder, also alludes 
 to this position (''Diseases of Kidneys and Bladder," c. xi.). 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 255 
 
 In the after-treatment of imperforate vagina, the patient 
 was kept on her back, and a pillow was placed between her 
 legs (Aetius, c. xcvi.)- Oribasius alludes to the position to 
 be occupied by a patient in having a clyster administered 
 (" Collecta," B. VIII. xxxvii., xxxviii.). 
 
 Of the positions enumerated above, the inverted one 
 mentioned by Hippocrates and Soranus, in the treatment of 
 prolapsus uteri, has more than a passing interest, when we 
 see in it the first dawning of the Trendelenburg position, so 
 much in use among gynaecologists of the present day. Hippo- 
 crates in his work on " Articulations " has given us a full 
 and minute description of the above position. He says that 
 leather cushions are first placed on a ladder and secured 
 there, and the patient is then placed on the cushions and 
 secured by cords passing round the ankles and above and 
 below the knees and at the nates ; the arms are fastened 
 along the sides of the body. After this the ladder is hoisted 
 up to the gable end of a house, and succussion practised 
 (c. xliii.).^ 
 
 This inverted position was used by Ambrose Pare in 
 reducing some forms of hernia3 ; while Jean Scultet in his 
 work "L'Arcenal de Chirurgie " (1675) used the position in 
 operating on herniae, and gives figures of the patient lying on 
 a board head downwards. He says : " Premierement, apres 
 avoir implore le secours du Ciel, le patient, suffisamment 
 echauffe dans le bain, sera place a la renverse sur une lingue 
 ais, couverte d'un linge en quatre doubles, et fermement 
 appuye sur la table et sur un banc en sorte que les pieds 
 soient en haut et la teste en bas."^ 
 
 ^ Adams, in his edition of the "Genuine Works of Hippocrates," gives a 
 plate from Vidus Vidius showing this apparatus for succussion. 
 
 2 Desposses, ''La. imsitiou decline." Eevuede Gynecologic (Fozzi), T. III. iv. 737. 
 
256 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Therapeutic Agents. 
 Instruments used in Examination and Operations. 
 
 Speculum. — Wise, in his descriptions of the surgical instru- 
 ments used by the Hindus, says that " Naru-juntra consist of 
 twenty varieties of tubular instruments, of different sizes and 
 shape, according to their intended use, including cannulae, 
 catheters, syringes, etc. They are used for removing extrane- 
 ous substances from deep-seated canals, as the intestines, 
 urethra, etc. ; for examining deep-seated parts ; for the 
 application of other instruments," etc. (Wise, p. 168). 
 
 Soranus says that in case of haemorrhage from the vulva 
 we can distinguish the place from which the blood is proceed- 
 ing more accurately by using the speculum (c. xlix.). Soranus 
 wrote about 100 a.d., but we know that the rectal speculum 
 was in use before this time, as Hippocrates mentions it in 
 treating of fistula in ano, for he says : " And having examined 
 the ulcerated part of the rectum with a speculum," etc. (c. iii.). 
 The vaginal speculum was also in use, for in the ruins of 
 Pompeii^ a speculum with two branches and a travelling yoke 
 for them driven by a screw has been discovered, and one with 
 four blades has quite recently been unearthed. 
 
 Galen in his ** Linguarum Explanatio " says, in referring to 
 KaTcoTTTrjp,^ that it was the instrument to dilate the seat, while 
 hiannpa^ was the instrument by which he dilated and viewed 
 the female genitals. Aetius gives us the best description of 
 the manner in which the speculum was introduced, taking his 
 account from Archigenes ; this we have already given above 
 {vide "Position of the Patient"). Paul also mentions the 
 speculum, but after this writer's time the speculum was but 
 
 ^ Destroyed 79 a.d. " KarowTrip ; KarairTi^p, ^ bibTrrpa, 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 257 
 
 little used, for during the Arabian period men were not 
 allowed to examine the female parts. 
 
 The speculum, however, was not forgotten in the Middle 
 Ages, and Franco (1586), Pard (1592), and Scultet (1666), 
 each described the speculum. On p. 788 of Vol. II. of the 
 " (Euvres d'Ambroise Pare," edited by Malgaigne, we find a 
 three-bladed speculum figured, and the text says : "On 
 pourra mettre le speculum matricis, a fin de voir plus aise- 
 ment." Astruc in 1761, in describing a vaginal examination, 
 says that the finger may be used, but if that is not sufficient 
 a speculum uteri may be used. In the eighth edition of 
 Heister's " Surgery," published in 1768, we find the bivalve 
 speculum figured, and the description to the plate says : 
 " Fig. 15 is a speculum ani, or instrument to dilate and 
 inspect the anus and vagina in disorders of these parts." In 
 short, as Thomas^ has said, " it was described by successive 
 writers up to the nineteenth century in language as distinct 
 as words could make it, and yet not only they who read, but 
 they who wrote it, did not comprehend its meaning or appre- 
 ciate its significance." 
 
 It remained for Eecamier to regenerate this instrument, and 
 he first used it in 1801 ; but it was not till 1818 that he 
 brought it before the profession and pointed out its true 
 significance as an instrument for the gynaecologist. His 
 recent biographer^ says : " Les speculums usites parmi les 
 chirurgiens, jusqu a Ee'camier, n'ont reellement aucun rapport 
 avec I'instrument qu'il a imagine. 
 
 " Eecamier se servit d'abord d'un tube d'etain, a parois 
 reflechissantes, dont il augmenta peu a peu le calibre et 
 modifia progressivement la forme. 
 
 ^ Thomas, "Diseases of Women," p. 24. 
 
 ^ "Recamier et ses Contemporains," Paul Thiaire, Paris, 1899, p. 145. 
 
 17 
 
258 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 " Ce fut, au debut, line simple canule du volume d'un doigt 
 at de quatre a cinq ponces de long, a travers laquelle il 
 pratiquait des pansements sur le col uterin, et sur les parois 
 vaginales (1801). Peu a peu, il augmenta son calibre, disposa, 
 en bee de flute, I'extremite uterine, evasa son extr6mit^ 
 externe en forme d'entonnoir (1818). ... II le brisa alors 
 et adopta deux demi-cylindres destines a s'ecarter et k agrandir 
 considerablement le champ de I'investigation." 
 
 Chrobak^ sums up the various kinds of specula thus : The 
 old speculum of Segalas constitutes the link between the 
 tubular and the many-bladed instrument, since it consisted of 
 two halves of a cylinder united by a transverse bar. The 
 oldest specula were multibladed. The speculum of Paulus of 
 ^gina consisted of two blades; those of Albucasis, Pare, 
 Scultetus, and that from Pompeii, of three blades ; later 
 Scultetus, Heister, Lisfranc, Jobert, Eicord, Boivin, E^camier, 
 devised two-bladed ; Paracelsus, Mauriceau, Busch, Hatin, 
 Weiss, Charriere, three-bladed ; Charriere, Segalas, Eiques, 
 Scanzoni, four-bladed ; Beaumont a five-bladed, and Magonty 
 a six-bladed." 
 
 Sound. — The sounds mentioned by our authors in use for 
 gynaecological cases were made of wood or metal. 
 
 Hippocrates directs the patient to use a sound of lead to 
 open the uterine orifice before a fumigation was administered 
 (D. 0. W., i. 11). The leaden sound is also mentioned by 
 him as being used to straighten or rectify a displaced uterus, 
 and pine-wood sounds were used for the same purpose. 
 Aetius in a case of retroflexion says that the midwife with her 
 sound, which is directed by her finger, should straighten the 
 neck of the womb (c. Ixxvii.). 
 
 ^ Clirobak, "Die Untersuchung cler weiblichen Genitatien und allgemeine 
 gyntikologische Therapie. " 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 259 
 
 The sound was also used to measure the length of the 
 vagina : " per specillum sinus muliebris profunditatem 
 demetiatur " (Aetius, c. Ixxxvi.). It served as a guide when 
 operating on imperforate vagina, being introduced into the 
 canal as a precaution (Aetius, c. xcvi.) ; and Soranus, Aetius 
 and Oribasius each describes its use for plugging the uterus in 
 cases of menorrhagia. 
 
 With regard to the uterine sound, there has been much 
 discussion as to how much credit Sir James Simpson should 
 have accorded to him, in connection with the instrument 
 which universally bears his name. 
 
 Simpson was an authority on antiquities, and he was fully 
 alive to what had been written by his predecessors on the 
 subject of the sound, and he accordingly maintained that, 
 while the introduction of a probe or sound into the os and 
 cavity of the uterus was mentioned in the Hippocratic writings, 
 and also in Avicenna and in some Arabian authors, a uterine 
 probe or bougie is alluded to, and Hilken, Cooke, and other 
 writers in the sixteenth and seventeenth centuries had spoken 
 of it ; yet, nevertheless, all those authors had implied that the 
 sound had been introduced into the cervix of the uterus more 
 as a means of treatment — and particularly for the mechanical 
 dilatation of a contracted or strictured os — than as a means of 
 physical diagnosis.^ 
 
 Simpson, in fact, was led to introduce the uterine sound 
 because he considered that the physical examination, as 
 hitherto practised, seldom enabled us to ascertain accurately 
 the organic condition of more than the cervix and lower part 
 of the body of the uterus. " To meet these difficulties in 
 uterine diagnosis, I have for some time past been in the habit 
 
 ^ Simpson, "Obstetric Memoirs and Contributions," Priestly and Storer, 
 vol. i., p. 93. 
 
 17—2 
 
26o THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 of using a metallic uterine sound or bougie of nearly the size 
 and shape of a small male catheter, which, when introduced, 
 as it can easily be done, into the interior of the uterus, and 
 manipulated there in different ways, has proved to me of 
 great service in rendering the diagnosis of the diseases in 
 question, and more particularly those of the fundus, body, 
 and cavity of the organs, parts usually considered beyond 
 the reach of examination, much more accurate and precise 
 than can be effected by any other means with which I am 
 acquainted."^ 
 
 That the sound had been used for the exploration and 
 measurement of the uterus by others before the days of 
 Simpson he did not attempt to deny, for it was well ascer- 
 tained that Wierus in 1637 had used a sound for exploring the 
 uterus, and the authors that Simpson quotes in his memoir, 
 viz., Hilken and Cooke, had both referred to the sound of 
 Wierus. Furthermore, in 1771 it was employed by Levret 
 for measuring the length of the uterus in hypertrophy of the 
 cervix, and subsequently as an aid in diagnosis by Chambon, 
 Vigoroux, and Desormoux.^ 
 
 The result of the examination of the many passages in our 
 authors' works, in which the use of the sound is mentioned, 
 compels us to agree with Simpson's contention that the 
 ancients used the sound to rectify the uterus, ascertain the 
 patency of the cervix, or to measure the vagina : but they 
 cannot be said to have used it to accurately ascertain the 
 length of the uterus in different affections, nor to have used 
 it, except in some very simple cases, to aid them in their 
 diagnosis. 
 
 It may now be permitted to us to inquire if the sounds used 
 by the ancients bore any resemblance to the sounds used by 
 
 ^ Simi^soii, loc. cit., p, 43. ^ Thomas, loc. cit., p. 24. 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 261 
 
 US in the present day. The Greek word /ji'qXr) is usually- 
 translated by the Latin equivalent specillum (derived from 
 specio, to look at), and is reputed by Cicero to have been 
 invented by the Arcadian Apollo. After examining the 
 various passages in many authors, one is led to the conclusion 
 that firfKr) and specillum were terms applied to a considerable 
 variety of instruments, ranging from sharp-pointed probes 
 to flat bistoury-like instruments used for cutting purposes. 
 We shall now quote various passages to bear out this con- 
 tention. 
 
 Galen, " De Dissectione Uteri," c. vii. : In speaking of the 
 size of the os uteri, Galen says at times it will admit a 
 sharpened specillum : " Qui quum reliquo toto tempore 
 specilli {/xT]Xr)<i) acuminatum capitulum vel paulo crassius 
 aliquid admittat." 
 
 Celsus, V. xxviii. 5 : Here we see its use as an exploring 
 probe : " Ante omnia autem demitti specillum in fistulam 
 convenit, ut quo tendat, et quam alte perveniat, scire pos- 
 simus." 
 
 VII. iv. 4 : Here as a guide : " In has demisso specillo ad 
 ultimum ejus caput incidi cutis debet." 
 
 Soranus, c. xlix. : Here we see the specillum used for 
 plugging the uterus with wool in case of haemorrhage : Sia 
 BaKTvXov, ^rj fjbijXvi TTapevnOefievov tu> crro/xari, t?}9 vcnepm. 
 
 Aetius, c. Ixxvi. : The use of the uterine specillum in 
 correcting malposition of the uterus is shown here : " Si vero 
 in obliquam retractio inclinat . . . obstetrix specillo cum digito 
 subimmisso, uteri collum dirigat." 
 
 C. Ixxvi. : Here we see it used as a measure for the vagina : 
 " Per specillum sinus muliebris profunditatem dimetiatur." 
 
 C. xcvi. : This passage shows the specillum in use as a 
 flat knife : " Atque ita infra signatum per stylum locum 
 
262 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 dissecabimus per specillum latum." Galen (" Linguarum 
 Explanatio ") says, in reference to fjbrjXy TrXareir], a flat 
 specillum similar to a (nrddr] (spatula). 
 
 Galen, "De Semine," II. i. : Mention is made of the 
 " specilla ad formam spathse facta." 
 
 Aetius, c. Ixxxvii. : This passage shows that the specillum, 
 though it might serve as a knife, was not the same as a 
 scalpel : " At si sanguis eruptionis tumor est, pro specillo sive 
 scalpello, cauterium eminentiori loco adhibebimus at ita pus 
 educemus." 
 
 Celsus, V. xxviii. 3 : Here we see the specillum used for 
 applying remedies to affected parts : " Quidquid autem 
 inspergitur averso specillo infundi debet." The " averso " 
 would probably refer to the back of the specillum. 
 
 VI. vii. 5 : Here we have mention of a special specillum for 
 the ear : " Ubi vero vermes orti sunt, si juxta sunt, pro- 
 trahendi oriculario specillo sunt." Mention is also made of a 
 specillum for operations on the eyes, " asperato specillo " 
 (Celsus, VI. vi. 27) ; and Pliny (VII. liv.) relates a tragic 
 instance in connection with the use of the specillum in an eye 
 case, for, in giving instances of sudden death, he says : ** What 
 is more singular than all, C. Julius the physician, while he 
 was applying with his specillum some ointment to the eye of 
 a patient, fell dead." 
 
 Paul, VI. 78. Here we have mention of a double- 
 headed specillum, for in treating of fistula in ano Paul says 
 that " Hippocrates directs us to pass a raw thread consisting 
 of fine pieces through the fistula by means of a probe having 
 a perforation, or a double-headed specillum." 
 
 The above quotations will show that the term " specillum " 
 was applied to a great variety of instruments, and this con- 
 clusion is supported when we examine the catalogue of the 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 263 
 
 instruments found at Pompeii,^ in which we find seven 
 varieties of the speeillum figured, with obtuse, spoon-shaped, 
 flat and oval, flat and square, and flat and divided, ends. 
 
 In concluding, we may give from Adams (Paul, Vol. II., 
 p. 273) the following account, from Fabricius, of the speeil- 
 lum : "II nous sufiit s9auvoir que specilliLin (qui est le mot 
 latin de Celse) est un instrument long et rond, de cuivre, 
 d'argent, ou de plomb, auquel on sonde les fistules, ayant un 
 de ses bouts plus large, et I'autre plus etroit, en vulgaire 
 Italien stilo " (" (Euv. Chir.," IL). 
 
 Later on Adams gives Harduin's account of the speeillum : 
 ** Quid sit speeillum Varro explicat (Lib. V., *De Lingua 
 Lat.') : Quo oculos inungiiimus quihus specimus (hoc est, 
 aspicimus), speeillum est. Graecis fiijXrj dicitur. Aetius, 
 Serm. viii. 14 : Cum specillo instrwnento, quod melam Grceci 
 appellant. Instrumentum parvum ac teres, quo utuntur ad 
 vulnerum aut fistularum viam aut profunditatem pernoscen- 
 dam. Une sonde de chirurgien." If the Koirdpiov, however, 
 was the same as the /zj^'Xt? or the speeillum, it was evidently 
 used for cutting with as for cutting upon (Adams, Paul, 
 Vol. IL, p. 402). 
 
 Uterine and Vaginal Dilators. — Dilators made of wood, lead, 
 and tin are mentioned by Hippocrates (D. 0. W., ii. 133; 
 S., 217). 
 
 The method adopted in dilating the cervix by the author of 
 the Hippocratic treatise in the " Diseases of Women " was 
 briefly as follows : The patient first received fumigations for 
 five or six days, until the cervix was thought to be in a suitable 
 condition. After the fumigations, dilators {roov irpoaOeroov) 
 made of pieces of very greasy pine-wood were introduced into 
 
 ^ Vulpes, ' ' Illustrazione di tulli gli Strumenti chirurgici scavali in Ercolano e 
 in Pompei," Napoli, 1847. 
 
264 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 the cervix. There were six of these, and each was six finger- 
 breadths in length ; they ended in a point, and each suc- 
 ceeding rod was a little longer than the preceding one, the 
 largest being the size of the index-finger and of the shape of 
 a finger, being smaller at one extremity than at the other. 
 Before being introduced they were smeared with oil. At first 
 the point was introduced gradually by turning the dilator 
 round and pushing it at the same time, the rod being intro- 
 duced for a distance of four finger-breadths (2'8 inches). 
 After the first rod had been introduced it had to be withdrawn 
 and replaced by a larger one. During the after-treatment a 
 leaden pipe filled with mutton-fat was kept in the uterus 
 during the night-time, while in the day-time one of the pine 
 rods was used. 
 
 None of our other authors allude to this method of dilating 
 the uterus, although Soranus says that if the cervix is too 
 small it must be dilated, but he does not give the method to 
 be adopted. He refers to the finger as a dilator in obstetrical 
 cases (cc. xvi., xxi.). 
 
 Aetius, quoting Archigenes, gives us an excellent account 
 of the use of sponge tents in dilating the cervix. He says : 
 " When we find that the parts are soft to the touch we should 
 introduce pieces of dried sponge, to which are attached pieces 
 of thread, in order that they may dilate the narrow portion of 
 the canal ; and if they should slip out, then we should place 
 larger ones in, and for this reason it behoves us to have 
 several different sizes ready " (c. xcv.). Pliny (XXXI. xlvii.) 
 says the softest kind of sponges are those employed for tents 
 (pcniciUi) . 
 
 Hippocrates describes another method for gradual dilatation 
 of the cervix by means of tents made of raw flax. There 
 were three of these tents — the first small, the second larger, 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 265 
 
 and the third as large as the little finger, and the length was 
 four finger-breadths. They were rubbed with goose-grease, 
 and introduced after an aromatic fumigation had been 
 administered, and were used in cases of induration of the 
 cervix and stenosis of the os (D. 0. W., ii. 157). 
 
 With regard to uterine dilatation by means of instruments 
 whose blades are separated after introduction (and which were 
 first recommended by Busch, in modern times, for obstetrical 
 purposes), we find no mention of such in our author's works ; 
 and it is not, in fact, until we come to the works of Albucasius, 
 of the twelfth century, that we find these instruments 
 described as being used for dilating the cervix in obstetrical 
 cases.^ In some vaginal operations rolls of lint (Aetius, 
 c. xcvi.), or a tube of tin, was used to keep up the dilatation of 
 the passage after a plastic operation for imperforate vagina ; 
 and the same end was achieved by the frequent introduction 
 of the speculum. 
 
 "We see from the above descriptions of uterine and vaginal 
 dilatation that the ancients were familiar with the two methods 
 most frequently employed by ourselves, viz., the rapid dilata- 
 tion by means of graduated bougies, and the slower dilata- 
 tion by means of tents. Thus, the steel sounds of Macintosh 
 and Peaslee were represented among the ancients by their 
 leaden sounds, while the graduated bougies of Hegar bear 
 an extraordinary resemblance to the graduated conical pine 
 rods of Hippocrates. Their sponge tents with string attached 
 differed in no respect from those of Simpson, while the flax 
 balls may be said to have been the forerunners of Vulliet's 
 slower method of dilating by means of gauze. 
 
 Sir James Simpson is generally credited with the first 
 
 1 A figrire of the vertigo Albucasis, with which the womb was dilated, will be 
 found on p. 208 of Professor Glaister's Life of Smellie (1894). 
 
266 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 introduction of sponge tents for gynaecological purposes, but 
 in the light of the above passages from Aetius and Archi- 
 genes Simpson's claim must be reduced to the reintroduction 
 " of a means of safely opening up the cavity of the cervix and 
 body of the uterus, to such an extent as might enable us to 
 introduce a finger into the uterine cavity, for the purpose of 
 diagnosis and operation,"^ the means being the placing of 
 sponge tents in the os and cavity of the uterus. 
 
 Simpson was fully aware that sponge tents had been used 
 before his day for dilating the cervix, for he quotes from the 
 work of Henry Van Eoonhuyse (1672), who wrote that "in 
 some women this neck (of the womb) is so hardened, tapering 
 out, and sunk down . . . that he was forced to enlarge it by 
 means of the radix gentiana, medulla sambuci, or even by a 
 prepared and dried sponge, having been first moistened in 
 melted white wax, and squeezed in a press to make of it con- 
 venient pessaries, according to the exigency of the case, by 
 which the neck of the womb can be disclosed and widened."^ 
 This description was afterwards copied without acknowledg- 
 ment by an English WTiter named Cook, and published in a 
 work called " The Marrow of Chirurgery." 
 
 Before Henry Van Eoonhuyse published his work,^ Roderic 
 de Castro, of Portugal, published a work,* in which he 
 advocated the dilatation of the cervical cavity by expansile 
 substances, such as the roots of gentian, aristolochia, bryonia, 
 and cyclamen. 
 
 Dilatation by means of straight metallic sounds of different, 
 degrees of thickness was introduced in the first quarter of this 
 century by Macintosh, a teacher in Edinburgh, for the treat- 
 
 ^ Simpson, loc. cit., vol. i., p. 125. 
 
 2 Simpson, "Clinical Lectures on the Diseases of Women," 1872, p. 247. 
 
 ' "Geneesen heelkonstige aanmerkingeu," Amstei'dam, 1672. 
 
 * "Dc universa muliebrium medicina," Hamburg, 1603. 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 267 
 
 ment of cases of dysmenorrhcea due to a contracted cervix ; 
 while for the purpose of rapid forcible dilatation of the cervix 
 expanding instruments have been devised by Osiander, Carus, 
 Aveling, Busch, Mende, Leblanc, Hunter, Nott, Atlee, 
 Priestly, Ellinger, Miller, Wilson, Schultze, Ball, and others.^ 
 
 Uterine Injections. — All our authors after Hippocrates 
 mention the use of uterine injections. 
 
 Hippocrates gives us a very minute account of the uterine 
 cannula in use, and the method to be adopted in making the 
 injections. The end of the tube will be polished like a sound, 
 and made of silver ; a perforation will be at the side, having 
 beyond it the small tip of the catheter. There will also be 
 other perforations, which will be placed at equal distances on 
 each side of the catheter throughout its length ; these holes 
 will not be large, but narrow. The extremity of the injection- 
 pipe will be round, all the rest hollow. To the pipe will be 
 attached a bladder (of a sow) which has been first well scraped. 
 Then place the milk of a mare in the bladder, first taking the 
 precaution to close the holes in the injection-pipe with a linen 
 rag. Having filled the bladder with milk, it is then to be 
 tied so as to close it, and the injection-pipe having been 
 placed in the uterus (the rag first being removed), the bladder 
 is pressed and the uterus is washed out (D. 0. W., c. 80). 
 
 Beside these uterine injections, the uterus was treated by 
 infusions {eyx^'^'^^)' which, according to Littr^, appear to 
 have differed from the injections {Kkvafxo'^) in consistence. It 
 appears to us that these infusions were really poured into 
 the vagina, the patient being in a position which prevented 
 the escape of the fluid from the vagina for some time, and 
 by this means some of the fluid would enter the uterus 
 (D. 0. W., i. 78). 
 
 ^ Chrobak, loc. ciL, c. xii. 
 
268 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 Vaginal Injections. — In the Ebers Papyrus we have mention 
 of peppermint -water being used for vaginal injections. Among 
 the Hindus vaginal injections were made by means of the 
 bladders of cattle, or of leather bags, while in almost every 
 page of our authors, after Hippocrates, we have vaginal 
 injections alluded to. These injections were, no doubt, made 
 by means of bags formed from animals' bladders, or from 
 leather, while Aetius says that the injections were sometimes 
 given by an ear-syringe — "per auricularem " (c. Ixxxvi.). 
 Many receipts are scattered throughout these works for 
 these injections, which consisted of emollients such as rose- 
 oil, or of astringents such as pomegranate, and many other 
 substances. 
 
 Rectal Injections. — Enemata originated with the Egyptians, 
 and Chabas draws attention to the fact that out of 170 medical 
 receipts in the Papyrus Brugsch twenty-eight are for enemata. 
 Enemata are frequently mentioned in the Hindu medical 
 works, and all medical authors refer to them. Oribasius in 
 the " Collecta " has left us a very full account of rectal injec- 
 tions (B. Vin. xxiv.-xxxviii.), and, among other things, gives 
 us a chapter on nutrient enemata, which, however, were 
 known to and used by the Hindus. 
 
 Daremberg and Bussemaker make the following interesting 
 remarks on the chapters from Oribasius : " Pour donner les 
 clysteres, les anciens n'avaient pas de veritables seringues, 
 c'est-a-dire des pompes, mais des outres termine'es par una 
 canule, semblables a ces poires de caoutchouc dont on se sert 
 pour les injections dans le vessie et qui, sauf la matiere, sont, 
 comme on le voit, renouvelees des Grecs. II parait, aussi, 
 par une figure que I'un de nous, M. Daremberg, a trouvee 
 k Dresde, sur un tres beau manuscrit de Galien, que I'outre 
 etait remplac^e quelquefois par un entonnoir a long tube 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 269 
 
 dans lequel on versait de haut de liquide. Ainsi le clysoir 
 serait aussi renouvele des Grecs. II semble que la canule 
 des clystcres (car ce mot serait a de'signer le lavement ou 
 I'instrument destine k le donner) etait tres large, car 
 Mnesithe dit qu'il faut toujours avoir soin de presser sur 
 la partie vide de I'outre ; autrement le liquid d^k injecte 
 pourrait retomber dans I'outre a travers la canule " (Vol. II., 
 p. 838). 
 
 Catheters. — Among the Hindus injections were made into 
 the bladder by means of a tube four finger-breadths in length, 
 and havmg an opening capable of allowing the passage of a 
 small pea. The tube was smeared with oil, and then intro- 
 duced, and the injection was made by means of the bladder 
 of a buffalo or a pig. These catheters were made of gold, 
 silver, copper, iron, hard wood or ivory. 
 
 Soranus tells us that in a case of dystocia, if there be a 
 stone in the bladder, it should be pushed up towards the 
 fundus of the bladder with a catheter (c. Ixiv.). 
 
 Celsus says that the catheter should be made of copper, 
 and for the female that it should be from 6 to 9 inches long. 
 He remarks that the female passage is shorter than the male, 
 and is discovered by a sort of mammary protuberance above 
 the vagina (VII. xxvi.). 
 
 Adams remarks that "the ancients seemed to have fancied 
 that it was necessary to fill up the internal cavity of the 
 catheter with wool, or some such substance, in order to 
 produce a vacuum when drawn out, believing that the 
 catheter in this case acted upon the principle of the siphon" 
 (Paul, VI. 59). 
 
 Sitz-baths, Vapour-hatks, Baths of Oil, the Thermce. — Baths 
 are frequently mentioned by all our authors, and prescribed 
 in many gynaecological cases. Soranus advises women to 
 
270 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 abstain from baths during the period, especially on the first 
 day (c. v.). 
 
 The sitz-hatli is very frequently mentioned, and was 
 evidently held in high esteem. Hippocrates, in speaking of 
 aphthae of the genitals, says : *' If strangury supervene, a sitz- 
 bath of the decoction of roses, or of briars, of myrtle or of 
 olive tree, or of sage, is to be immediately given " (D. 0. W., 
 ii. 210). 
 
 Baths of oil are mentioned by Soranus as being agreeable, 
 " multum etiam juvat in oleum immersio " (c. xlviii.) ; whilst 
 Oribasius gives a lengthy account of these and many other 
 kinds of baths (" Collecta," X. xxxvii.). 
 
 The thermce were in great demand in the treatment of all 
 chronic affections, and Soranus frequently recommends them 
 in the treatment of the diseases of women. Oribasius, quot- 
 ing Antyllus, advises women prone to abort to take a course 
 of baths at the thermae (" Collecta," X. iii.). 
 
 Fumigation of Uterus and Vagina. — Fumigations were 
 extensively employed in all classes of uterine and vaginal 
 diseases, and the myth that the uterus was like an animal, 
 and was attracted by sweet- smelling vapours, whilst it 
 retreated from disagreeable odours, is to be found in the 
 works of Hippocrates, the pseudo-Hippocratic works on 
 gynaecology, in the pages of Alexander Aphrodisiensis, Plato, 
 Aretaeus, and others. The technique of a fumigation is 
 differently described by our various authors. In the pseudo- 
 Hippocratic work on the diseases of women (ii. 133), we 
 have the following details of the process : A vessel holding 
 4 gallons was taken, and a lid with an aperture in it was 
 closely fitted to the vessel with clay. Through the aperture 
 a tube or a reed was passed into a vessel in which was 
 placed the medicinal substances to be used in the fumigation. 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS, 271 
 
 A hole, 2 feet deep, was dug in the floor, and wood was burnt 
 in the hole until the sides became very hot, whereupon the 
 larger pieces of wood were removed and the glowing charcoal 
 left behind. The vessel was then placed in this excavation, 
 and the heat caused the vapour of the medicated substances 
 to pass along the pipe or reed, which was placed either in 
 the vagina or the uterus. Care had to be taken that the 
 vapour was not too hot, else the patient's parts would 
 have been burnt. During the fumigation the patient was 
 directed to examine her own cervix to ascertain its con- 
 dition. 
 
 Soranus says, in describing the various lines of treatment 
 adopted by others in cases of retention of the secundines, 
 " that Strato, pupil of Erasistratus, used to place in a small 
 vessel of silver or bronze (which closed with a cover made of 
 tin) the following herbs . . . and having adjusted a small 
 tube to the vessel the mouth of the tube was placed in the 
 vagina, and the vessel was then gently heated." Soranus 
 remarks ** that this treatment may result in the vagina being 
 severely burnt " (c. xxii.). 
 
 Oribasius, quoting from Antyllus, gives us yet a different 
 account of the method of conducting a fumigation. He says 
 "that a cover of wood, pierced in the centre, is placed on a 
 vessel, whereon it is fixed by means of potter's clay or by a 
 paste of flour. Into the opening a pipe is fixed, and the 
 vessel is placed beneath an obstetrical chair, in the seat of 
 which is an opening, through which a leaden pipe is passed 
 and connected with the tube of the fumigating vessel. The 
 pipe is passed into the vaginal orifice, and the vessel being 
 heated the fumigation is made (" Collecta," X. xix.). 
 
 After reading the three methods above described, one is led 
 to inquire for the ideas which prompted this form of treat- 
 
272 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 ment, and we find that even the Ebers Papyrus and also the 
 Hindu medical works mention that fumigation was employed in 
 treating gynaecological cases. The ancients probably thought 
 that the active properties of the aromatics used in the process 
 of fumigation would be liberated, and would act much more 
 effectually in the form of a warm vapour than if these bodies 
 were merely applied in the form of injections or pessaries. 
 They even thought that the vapour had the power of penetrat- 
 ing the tissues, for Hippocrates in one of his Aphorisms says : 
 " If a woman do not conceive, and wish to ascertain whether 
 she can conceive, having wrapped her in blankets, fumigate 
 below, and if it appear that the scent passes through the body 
 to the nostrils and mouth, know that of herself she is not 
 unfruitful" (V. 59). 
 
 Among the aromatics most frequently employed may be 
 mentioned frankincense, spikenard, cassia, and storax; while 
 the fumes of wax and hot charcoal are mentioned in the 
 Papyrus Ebers. 
 
 The various passages in our authors show us that the 
 fumigation was used to cleanse the part, to promote the 
 menstrual flow, to reduce inflammation of the uterus or 
 vagina, and to soften the cervix and prepare it before it 
 was dilated ; in short, it was a kind of panacea, and had to 
 form part of the treatment in nearly all affections of the 
 genitals. 
 
 The practice of fumigating the vagina and uterus was con- 
 tinued during the Middle Ages, and we find in A. Pare's works 
 a figure and a full description of an apparatus for fumigating 
 the womb (Vol. II., p. 758) ; and Heister also mentions this 
 subject. Fumigation of the genitals in modern times has not 
 been much practised, and, with the exception of treating 
 venereal sores and growths with the fumes of mercury, it is 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 273 
 
 almost unheard of nowadaj^s. Quite recently Pincus^ has 
 attempted to revive it, in a modified form, for the treatment 
 of metrorrhagia, subinvolution, haemorrhage from myoma of 
 the uterus, and for endometritis, his method being to 
 introduce heated vapour into the uterine cavity by means of 
 a special cannula, which is connected by a rubber pipe with a 
 steam generator, the endometrium being acted on in some 
 cases by direct contact with the vapour, and in others by 
 contact with the heated uterine cannula. 
 
 Fomentations. — Fomentations were used by the Hindus in 
 treating gynaecological cases, while all later authors refer to 
 them frequently. Soranus says that fomentations were 
 applied by means of flax, wool, or sponges; the latter, after 
 being dipped in warm oil or hot water, were squeezed, and 
 then, on being applied, were covered by cloths (c. xlviii.). 
 
 The vulva was frequently fomented by means of warm 
 sponges, by which means affusions were also applied 
 (Oribasius, " Collecta," IX. xxiii.). 
 
 Dry heat was applied by means of oval-shaped vessels 
 filled with hot water, and by means of bladders filled with 
 hot oil, as Soranus tells us in treating amenorrhcea (c. xlviii.). 
 Hippocrates, in dealing with regimen in acute diseases, has 
 left us an excellent account of fomentations. He says : "Of 
 hot applications the most powerful is hot water in a bottle or 
 bladder, or in a brazen vessel, or in an earthen one ; but one 
 must first apply something soft to the side, to prevent pain. 
 A soft large sponge, squeezed out of hot water and applied, 
 forms a good application ; but it should be covered up above, 
 for thus the heat will remain the longer, and at the same 
 
 ' Pincus, " Weiteres iiber Vaporisation und Vapokautei'isation :" " Instrumen- 
 tarium, Tcclinik, Indikationen " (Centrabl. f. Gyndk., 1898, No. 10). Brothers, 
 "Experiences with Intra-uterine Vaporization" {Amcr. Journ. of Ohstct., 
 October, 1899). 
 
 18 
 
274 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 time the vapour will be prevented from being carried up to 
 the patient's breath, unless when this is thought of use, for 
 sometimes it is the case." He further mentions that barley 
 and tares may be infused and sewed in bladders and applied, 
 or bran may be used, while salts or toasted millet in woollen 
 bags make good dry fomentations (Adams, Vol. I., p. 288). 
 
 Celsus also refers to the hot-water bottles used by the 
 Eomans. He says : " Quin etiam calido oleo replentur 
 utriculi ; et in vasa fictilia, a similitudine quas lenticulas 
 vocant, aqua conjicitur " (B. II. xvii.). 
 
 Cataplasms. — Cataplasms were largely employed by the 
 ancients, and Oribasius has left us over twenty chapters 
 devoted to them ("Collecta," IX. xxiv.-lv.). 
 
 The linseed poultice is referred to by Hippocrates thus : 
 "If on account of a watery flux from the uterus the lower 
 portion of the abdomen is painful, then a good cataplasm 
 should be made for the abdomen by mixing honey with linseed- 
 meal (D. 0. W., ii. 198). 
 
 Embrocations were also frequently employed, but, according 
 to Antyllus, they had less effect than cataplasms ; but they 
 were to be resorted to in those cases where cataplasms could 
 not be employed (Oribasius, IX. xxii.). 
 
 Anointing the body with oleaginous substances in case of 
 pain, and in treating gynecological cases, is referred to by 
 Hippocrates (D. 0. W., ii. 210). 
 
 Leeches ; Bleeding ; Cupping. — These three therapeutic 
 agents were held in high repute among the ancients, and all 
 our authors mention them in connection with the treatment 
 of gynaecological cases. Thus, Hippocrates (D. 0. W., ii. 100) 
 advises the application of a dry cup to the regions below the 
 breasts in case of metrorrhagia, and between the breasts to 
 stop the menses ("Aphor.," V. 50); though Paul (VI. xli.) 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 275 
 
 warns us not to apply the cupping instrument near the 
 breasts, " for sometimes they fall into it. and, swelling 
 greatly, render the removal difficult." Hippocrates also lays 
 stress on the application of a cup to the haunch (eVt rb 
 Icrxlov) after reducing a prolapsed womb (N. 0. W., 5), 
 while Paul recommends that a cup be also applied to the 
 navel; and Soranus mentions both bleeding and cupping in 
 treating cases of retention of the menses (c. xlviii.). 
 
 Hippocrates is the first of the classical writers to mention 
 bleeding, but we find that leeching, bleeding, and cupping 
 were practised by the Hindus (Wise, pp. 173-178), while 
 cupping-horns have been found in the Egyptian tombs. 
 
 The method adopted by the Hindus m cupping was to use 
 a horn, the larger extremity being applied over the scarified 
 part while the air was sucked out at a small hole in the 
 pointed extremity of the horn. In other cases a hollow gourd 
 was prepared by making a hole in it, and then placing a piece 
 of burning rag in it. 
 
 Celsus (H. ii.) mentions two kinds of cupping instruments, 
 one made of horn, and one of copper,^ while Oribasius 
 ("Collecta," VII. xv.) mentions one made of glass; Paul 
 (VI. 41) likewise mentions glass cups, but remarks that those 
 made of copper have a more powerful attraction, as being 
 able to endure a stronger fire, whereas those of glass are apt 
 to break. Antyllus tells us that the cupping vessels made of 
 silver ought not to be used, as they become too hot, and burn 
 the patient (Oribasius, VII. xvi.). 
 
 In some cases the cup was applied and the spot dry-cupped, 
 the vacuum being caused by a piece of lighted cloth placed 
 in the vessel. If, however, the dry-cupping was not sufficient, 
 
 ^ Vulpes, in his illustrations of the surgical instruments found at Pompeii, has 
 figured some of the bronze cupping vessels (PI. VI., Figs. 4, 5). 
 
 18—2 
 
276 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 then the spot cupped was scarified and the cup again applied 
 (Paul, VI. xli.). 
 
 Cautery. — The cautery is referred to by Hippocrates in the 
 treatment of pelvic abscess which points at the pubes. H»^ 
 directs that it should be here opened by the cautery. Aetius, 
 in dealing with the same subject, says that if the swelling is 
 ,due to an outpouring of blood (pelvic haematocele?), instead 
 ,of the sharp probe or the scalpel, we should apply the cautery 
 to the summit of the swelling, and by this means evacuate 
 the pus (c. Ixxxvii.). Aetius also gives us an excellent de- 
 scription of the use of the cautery, in incision of the breast, 
 for stopping the haemorrhage and eradicating the disease 
 i(c. xlv.), while Aretpeus directs us to open abscesses of the 
 liver with the cautery. Oribasius, in dealing with thymus of 
 the genital organs, says that when it is malignant, if it be cut 
 -out it will return, so that it is necessary in operating on it to 
 have recourse to the cautery (" Collecta," XLV. xii.). 
 
 The cautery was used by Hindu surgeons, as the following 
 passage will show: "Fire can sometimes be employed, when 
 neither the knife nor escharotics can be used, as it is the 
 strongest of all escharotics. It is applied in different ways, 
 sometimes by means of long pepper, goat's dung, the tooth of 
 a cow, an arrow-point, long, circular, or hook- shaped iron 
 probes " (Wise, p. 180). 
 
 Hippocrates says those diseases which medicines do not 
 cure, iron (the knife ?) cures ; those which iron cannot cure, 
 fire cures ; and those which fire cannot cure are to be reckoned 
 wholly incurable (" Aphorisms " VII. 87). 
 
 The cautery iron is described by Hippocrates in his book 
 on " Hemorrhoids," c. ii. He says : " I recommend seven or 
 eight small pieces of iron to be prepared, a fathom in size, in 
 thickness like a thick specillum, and bent at the extremity, 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 277 
 
 and a broad piece should be on the extremity, Hke a small 
 obulus." 
 
 The cautery knife is mentioned by Galen (" Isagogue," 
 c. xix.). Thus, in describing the operation of excision of 
 the breast, Galen says that it may be performed by a razor 
 heated in the fire. 
 
 Besides using the actual cautery, potential cauterization 
 was practised, and among the substances used for the purpose 
 \Yas arsenic. 
 
 Massage. — Massage is mentioned by Soranus in several 
 places in connection with the treatment of gynaecological 
 cases. Thus, in retention of the menses, he says thaty 
 when the patient is beginning to regain her health and ia 
 taking exercise she should be treated by " frictionibus totius 
 corporis et partium circa uterum. Quodsi tamen in uteri 
 frictione in ipsis locis facta attactus manus nudae contusionem 
 adferat," etc. In another place he says that if menstruation 
 is absent, and this be due to disease of other parts of the 
 body, then " etiam ipsi uteri loco curam adhibere frictione et 
 iis, quae consolidare possunt" (c. xlviii.). He also refers ta 
 the employment of a skilled rubber (xwy i^ireipwv uXetirrcbi^) i<y 
 aid us in treating a case of amenorrhoea. 
 
 These passages show us that not only was massage of the 
 whole body resorted to in gynaecological cases, but that special 
 massage of the uterus was in vogue. 
 
 The employment of massage in the treatment of disease, 
 and for relieving pain and fatigue, must be regarded as a 
 universal practice, whose origin is of high antiquity ; for the 
 Chinese manuscript Kong-Fau, which is dated 3000 B.C., 
 seems to have contained detailed accounts of massage, while 
 among the Persians, under the title of siirchinia, among the 
 Greeks and Eomans mider the terms avuTpty^a and frictio. 
 
2 78 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 we must class all those friction movements now included 
 under the term " massage,"^ a word which, according to 
 Piorry, is derived from ixda-aeiv = to rub, but according to 
 Savary is from the Arabic word mass, to press softly. 
 
 In the Hindu system of medicine we find shampooing^ and 
 rubbing both used, in order that the members may remain 
 healthy, and that the skin may be kept in good condition 
 (Wise, p. 98). Even among uncivilized races massage is 
 practised, and Captain Cook tells us that the natives of 
 Otaheite practise massage for the relief of muscular fatigue, 
 using percussion, kneading, and friction. 
 
 Massage among the Greeks had its origin in the fact that 
 it came in time to be part of the system of training undertaken 
 by those who contested in the gymnastics of the Olympian 
 games. In the days of Homer those who engaged in the 
 wrestling contests were dressed in the ijerizoma, but without 
 their bodies being oiled. Later on the girdle was discon- 
 tinued, and oil was rubbed into the body ; according to 
 Thucydides, the Lacedaemonians were the first to adopt the 
 plan. There, accordingly, sprang up a class of rubbers, 
 called among the Greeks aliptse {aXeiirTai), whose office it 
 was to anoint the body of the competitors in the contests, the 
 object of this anointing being to prevent excessive perspiration. 
 The body was not, however, merely anointed, but the oil was 
 well rubbed in ; and as these alipt^e in time became experts, 
 they also became advisers as to exercise and mode of life, and 
 they, as well as the Eoman aliptae (who were slaves), massaged 
 in private houses, and it is one of these aliptae that Soranus 
 recommends us to employ in treating a case of amenorrhoea. 
 
 The iatraliptae, according to Pliny (H. N., XXIX. ii.), were 
 
 ^ Bnsch, "General Orthopn^dics, Gymnastics, and Massage." 
 
 " The term "shampoo " is dtiived from the Hindoo chanqma, to press. 
 
 I 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 279 
 
 at first only the slaves of physicians, but they afterwards took 
 rank as physicians, and devoted themselves to curing diseases 
 by anointing and massage. Those that flourished at Rome 
 do not seem to have enjoyed a good moral reputation,^ for 
 Seneca declares that he would rather thrust his hand into the 
 fire than have it massaged by any of them, male or female. 
 Hippocrates, in his work " De Articulis," says that the 
 physician should understand massage, while Celsus tells 
 us that Asclepiades (128 to 56 b.c.) wrote much about it, 
 and claimed a considerable amount of originality for his 
 work ; but Celsus claims that Hippocrates had, before As- 
 clepiades, clearly laid down the indications for the employ- 
 ment of friction in the words " qui dixit, frictione si vehemens 
 sit, durari corpus, si levis molliri ; si multa minui ; si modica 
 impleri." Galen, Oribasius, Aetius, and Paul have all left 
 us much on the subject of general massage, while from the 
 passages in Soranus we see that Brandt, in our present time, 
 cannot claim to have been the first who massaged the 
 uterus. 
 
 Pessary. — The Papyrus Ebers shows us that both the 
 pessary and the suppository were used by the Egyptians 
 in gynaecological cases. Thus, in treating the axat disease, 
 directions are given for preparing jaspis with honey and 
 coUyrium, which were to be smeared on lint, and this was 
 then introduced into the vagina, and left there for four days. 
 We also find the pessary mentioned in the medical works of 
 the Hindus. Hippocrates gives us many receipts for pessaries, 
 and classifies them as emollient, astringent, and purgative. 
 The first of these varieties reduced inflammation round the 
 womb and softened the cervix ; the second class restrained 
 discharges from the female genital organs ; the last group 
 
 ^ "Callidus et crist* digitos impressit aliptes" (Juvenal, Sat. VI.). 
 
28o THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 cleared the uterus of pathological discharges and of the 
 products of conception, and also aided the menstrual flow. 
 Pessaries were frequently used by the ancients in their en- 
 deavours to produce abortions, and these generally contained 
 powerful drugs, such as cantharides, elaterium, andcolocynth. 
 Hippocrates in his " Oath " forbids the use of such pessaries. 
 The word " pessary " is derived from ireaao^, a small stone, 
 the Latin equivalent being j-jessits or pessum. The term used 
 by Hippocrates is Trpocrderov, the verbal adjective of TrpoarLOrj/xi^ 
 and signifies added, filled, or adaj)ted to. 
 
 Celsus, in speaking of the use of pessaries, says, " Sed alia 
 quoque utilia sunt, ut ea qure ffeminas subjiciuntur -weaaov^ 
 Grseci vocant " (V. xxi.). 
 
 The pessary being the chief means employed in treating 
 the diseases of the womb and vagina, we have reference made 
 to it by all our authors. In order to prepare a pessary, a 
 piece of lint was rolled into the form of a finger, and a string 
 was attached to this, in order to maintain it in shape, and to 
 enable it to be withdrawn from the cavity into which it had 
 been introduced. Before being inserted the pessary was 
 covered with the liquid or the ointment that the practitioner 
 wished to apply to the diseased part. In other cases, pieces 
 of sponge or balls of wool were soaked in medicated substances 
 and applied in the form of a ball or tent. Some pessaries 
 were shaped like a penis, and were called TrpiaTrtcr/co? ; Paul 
 alludes to one in describing the operation for imperforate 
 pudendum (VI. Ixxii.). 
 
 Not only were pessaries placed in the vagina, but they 
 were also inserted into the uterus and into the rectum 
 (D. 0. W., ii. 133). 
 
 Before inserting a pessary, the patient generally bathed 
 herself, then a fumigation was administered, and after that 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 281 
 
 the pessary was inserted. After its withdrawal the patient 
 again bathed herself, or had a sitz-bath (D. 0. W., ii. 163). 
 
 Among our authors on gynaecology, the writer of the 
 Hippocratic work on the " Diseases of Women " and Aetius 
 have left us very many formulae for the different varieties of 
 pessaries ; while Oribasius, who mentions the opium pessary 
 ("Synopsis," IX. li. : Trea-aol Sia o-rrlov aK€va^6/jL6voi) has given 
 us much information on the same subject, his material having 
 been derived from Antyllus, and to this latter authority Paul 
 is indebted for his chapter on pessaries. 
 
 Adams says that Myrepsus is the most copious writer on 
 the subject, for he describes the preparation of forty-five 
 different sorts of pessaries. 
 
 Suppository. — The word " suppository " is derived from 
 supponere = io place under. The Greek term ^d\avo<i corre- 
 sponds with the Latin word glans, for when the suppository 
 was made it resembled an acorn in shape. 
 
 The suppository differed from the pessary inasmuch as the 
 medicated substances were not usually applied by means of 
 lint or wool, but were rolled into an acorn-shaped body, and 
 then introduced into the uterus or vagina. In some passages, 
 however, in Hippocrates we find that the balanos consisted 
 of wool saturated with various ingredients (D. 0. W., ii. 177). 
 
 Trochisks. — Celsus says, " pastillique quos TpoxicrKov<; 
 Graeci vocant." The trochisks, or troches, according to Galen, 
 derived their name from their spherical shape. Paul says 
 that there were three different kinds of troches, for some of 
 them had to be swallowed, some injected, and some rubbed m. 
 They were in some cases somewhat similar to suppositories, 
 but were flat in shape. They were used for treating diseases 
 of the rectum, but Soranus refers to their use for the vagina 
 in cases of erosion of the cervix : " Quodsi insuper erosio adsit, 
 
282 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 etiam remedio nigro cum charta ex aceto, vel trochisco 
 {jpoxia-Kw) aliquo eorum qui adversus intestinorum difficul- 
 tatem praescribuntur, uti debemus " (c. xlix.). Oribaeius gives 
 us also an example of the trochisk used for gynaecological 
 purposes, " trochiscus ad fluxum sanguinis mulierum " 
 C' Synopsis," III. ci.). 
 
 We see from the foregoing that pessaries, suppositories, 
 and trochisks were among the most ancient therapeutic 
 means of treating diseases of the uterus and vagina, and if 
 we turn to the Arabian authors, or to a medieval one such as 
 Pare (Vol. II., p. 774), or even to a more recent one, such as 
 Heister, we shall find the suppository and pessary in constant 
 use in gynaecology. 
 
 In our own times the suppository was reintroduced into 
 gynaecological practice by Sir James Simpson, and for years 
 he was in the habit of applying a variety of substances to the 
 vagina in the form of medicated suppositories. These were 
 not made like the ancient pessaries, with wool or lint for a 
 foundation, but were composed of the drug used, compounded 
 in the form of an ointment, and brought to a requisite degree 
 of consistence with one or two drachms of yellow wax to the 
 ounce of ointment ; about an ounce of the different ointments 
 made four pessaries.^ 
 
 That the method pursued by the ancients of applying these 
 remedies to the vagina in the form of pessaries was an 
 excellent one, no one will dispute, and we think that it is 
 much to be regretted that the custom is not more widely 
 followed nowadays : for the glycerine plug, to which is 
 occasionally added a few drops of ichthyol or a little iodo- 
 form, is but a poor representative of a neglected but most 
 excellent therapeutic measure. 
 
 ^ Simpson's Obstetrical "Works, vol. i., p. 99. 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 283 
 
 Uterine, Vafjiual, and Ilcctal Plugs. — Our authors made 
 frequent mention of a variety of plugs to be used for the 
 uterus, vagina, or rectum; thus, PHny says: " Pam's wool 
 washed in cold water and steeped in oil is used for female 
 complaints, and to allay inflammation of the uterus. Greasy 
 wool used as a pessary brings away the dead foetus and 
 arrests uterine discharges," In treating some complaints of 
 women the Hindus introduce a piece of cloth soaked in oil into 
 the vagina. 
 
 Soranus, Aetius, Oribasius, and Paul direct that a ball of 
 wool tied round with a string should be pushed into the 
 vagina after reducing a prolapsed womb. 
 
 The uterus was frequently plugged, Soranus says, in dealing 
 with a case of menorrhagia, that some " lana mollis digito vel 
 specillo inducatur uteri osculo " ; and if this is not sufficient, 
 then we proceed thus : " Quod si fiat, parvam spongiam 
 oblongam itidem madefactam quam maxime fieri potest in 
 profundum immittere oportet, ut excretus sanguis recipiatur 
 neque in grumos conversus consensum faciat et inflamma- 
 tiones " (c. xlviii.). 
 
 Aetius directs us to use a rectal plug after reducing a 
 retroflexion of the uterus (c. Ixxvii.), and Oribasius refers to 
 the use of pieces of lint for the rectum. 
 
 In the Hippocratic work on " Fistulas," a tent is described 
 as being pushed into the rectum. " When it [the tent?] has 
 been pushed inwards, introduce a ball of horn into the rectum 
 and leave it there ; and when the patient wants to go to stool, 
 let it be taken out and again replaced, and let this practice be 
 continued for five days " (Adams, vol. ii., p. 817). 
 
 Intra-utenne and Vaginal Pessaries. — The first mention 
 that we have of an intra-uterine pessary occurs in the Hippo- 
 cratic work on the " Diseases of Women " (ii. 183). After 
 
284 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 dilating the cervix, a hollow lead sound was taken and filled 
 with ground mutton-fat, and introduced into the uterus, where 
 it kept up the dilatation. 
 
 In speaking of prolapse of the womb, the author of the 
 treatise just mentioned directs us after reducing the prolapsus 
 to take a pomegranate and split it into two halves, and intro- 
 duce one of these halves into the vagina. 
 
 Soranus, in writing on the same subject, says that Diodes 
 was wont to introduce into the vagina a pomegranate that had 
 been peeled and soaked in vinegar. Both these bodies, no 
 doubt, acted in a mechanical way, as well as through their 
 astringent properties. 
 
 A large ball of wool is mentioned by Soranus, Aetius, 
 Oribasius, and Paul, to be used after reducing a prolapsed 
 uterus. This was inserted into the vagina, and aided in pre- 
 venting prolapse during the treatment. Sponges were also 
 introduced into the vagina, and Albucasis used an animal's 
 bladder as a pessary. 
 
 Chrobak, in sketching the history of the modern pessary, 
 says that '* the first reference to the instruments in use 
 to-day dates from the time of Ambroise Pare " (1573). This 
 is quite correct ; but, nevertheless, we shall show that the 
 solid pessary was in use long before the time of Pare. 
 
 Malgaigne,^ in his introduction to the works of Pare, thus 
 refers to a solid pessary used by Mathieu de Gardi, also called 
 De Farrare, who died in 1472 : " Une grande dame de la 
 Bourgogne avait une chute de matrice ; Mathieu lui conseilla 
 un pessaire en cire assez solide, de la forme d'un penis, et 
 qu'on entourerait de laine trempee dans des liquers astrin- 
 gentes." 
 
 In the works of Pare (p. 3G9, vol. i.) we have a figure of an 
 
 Op. cit., Vol. I., p. xcv. 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 285 
 
 intra-uterine pessary given, with the following description : 
 " Instrument d'or ou d'argent pour mettre en la matrice, en 
 forme de pessaire," etc. On p. 742, vol. ii., Pare gives two 
 figures : the one represents an oval pessary, the other a round 
 one, and Malgaigne notes that Pare had already figured the 
 oval one in 1564. 
 
 It is unlikely that Pare was the inventor of these pessaries, 
 for Piousset (the writer on Cesarean section^) in 1581 points 
 out that a woman that he visited in 1579 had been wearing a 
 cork pessary for forty years, and that it had been placed in 
 her vagina in 1539. He also, in another passage of this 
 work, speaking of pessaries, says : " Item, les vns le font 
 rond, les autres en ouale, les autres triangle ou quadrangle 
 inequilateral; a angles obtus ; les vns en forme de coeur 
 applatie ; quelques vns de rondeur oblongue et tronquee ; les 
 vns rond en plat, pertuise au milieu, ou non." Bauhin, who 
 translated Eousset's work into Latin in 1582, says, in an 
 appendix, that the German women were accustomed to use an 
 empty walnut, covered with wax and shaped to resemble a 
 fowl's egg, for a pessary in case of prolapse of the womb. 
 Jean Bauhin (a brother of the translator of Piousset) was the 
 first to conceive the idea of supporting the uterus by means of 
 a pessary with a stem. 
 
 Heister gives in his work several engravings of pessaries, 
 •oval, quadrangular, and triangular in shape. He describes 
 *'each of them as being perforated in the middle, and formed 
 out of cork or wood waxed over, or else of silver or gold." At 
 another place he describes an " elastic pessary of steel wire 
 turned into a conical worm." 
 
 Ligatures, and Methods of arresting Hamoi'rhage. — The 
 
 ^ "Traite Nouveau de I'Hysterotomotokie, ou Enfantement Cesarien," etc., 
 Paris, 1581. 
 
286 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 arrest of hsemorrhage, up to the times of Celsus and Galen, 
 appears to have chiefly been by cold compresses, styptics, 
 or the cautery. Celsus shows us very clearly that the liga- 
 ture was in use in his day (V. xxvi.), but he also mentions 
 that patients who were subjected to amputation often died from 
 haemorrhage and fainting during the course of the operation : 
 " Saepe in ipso opere, vel profusione sanguinis, vel anima; 
 defectione moriuntur." 
 
 Vulpes, in commenting on the instruments preserved at 
 Pompeii, says that among them is a forceps for removing 
 pieces of bone from the surface of the brain in case of fracture 
 of the skull, and he thinks it may have been used for taking 
 up an artery. He also thinks that the Greeks were able to tie 
 an artery for haemorrhage, and he bases his opinion on an in- 
 scription dug up at Athens, and from a treatise by Archigenes 
 (a.d. 100) existing in the Lauretian Library at Florence, 
 wherein it is said that " the vessels carrying (blood) towards 
 the incision must be tied or sewn up." 
 
 Soranus remarks that haemorrhage from the uterus is 
 difficult to deal with, because we cannot arrest it : " neque 
 laqueorum constrictione, neque suturis uti licet " (c. xlix.). 
 He also mentions that the uterus had been extirpated when 
 it had become prolapsed, but he does not give any details as 
 to how the haemorrhage was controlled, though he mentions 
 the fact that the operation was successful, and that some of 
 the patients lived to an advanced age. 
 
 Galen, Eufus, Aetius, and Oribasius all mention that 
 torsion of the vessels was employed to arrest haemorrhage, 
 and Galen refers to the cautery knife. 
 
 The materials in use for ligatures were strings of flax 
 and hemp. Galen alludes to sutures made of wool, and Paul 
 mentions woollen sutures for stitching wounds of the eyelids. 
 
PHYSICAL EXAMINATIONS OF PELVIC ORGANS. 287 
 
 Animal sutures and ligatures are usually regarded as quite 
 a modern idea ; but although Dr. Mc Sweeney introduced silk- 
 worm gut, and Dr. Young proposed catgut in 1813, and 
 Dr. Physick of Philadelphia in 1814 brought forward chamois 
 leather as a material for ligatures, nevertheless we find that 
 sutures of animal tissues were spoken of by Pihazes as early 
 as 900 A.D., and were used for stitching up wounds of the 
 abdomen. These sutures were made of the strings of the 
 lute ("corda liuttai vel cithare"), while Albucasis alludes to 
 the stitching of a wound in the bowels with a fine thread 
 made of the twisted intestines of an animal : " Filo subtile, 
 quod abstersum est ex intestino animalis annexo." 
 
 Catgut^ itself is of extreme antiquity, as we find that the 
 strings of the Egyptian harps were of catgut, while the 
 strings of the old Greek harps in the time of Homer were 
 formed of the twisted intestines of sheep.^ As Simpson 
 remarks, the word " cord," as applied to the strings of the 
 harp, etc., is itself, in fact, sufficiently indicative of the 
 material of the strings, as originally the term x°P^V simply 
 signified intestines. 
 
 Metallic threads were used by the Greeks, but not for 
 sutures or ligatures. 
 
 1 "Catgut " is corrupted from "gut cord." 
 
 2 Simpson, " Acupressure," p. 492. 
 
CHAPTER XXII. 
 
 EESUMfi OF THE DISEASES OF WOMEN. 
 
 Peritoneum and Connective Tissue. 
 
 Parametritis and Pelvic Abscess. — Hippocrates, Soranus, 
 Aetius, and Paulus have each left us descriptions of pelvic 
 inflammation and pelvic abscess, whose origin, in their minds, 
 was always intimately connected with the womb. Thus, Hippo- 
 crates tells us that after suppression of the menstrual fluid 
 for nine months the retained blood becomes purulent, and it 
 may then be evacuated by way of the vagina, or it may travel 
 towards the groin and form a swelling there (D. 0. W., i. 2). 
 Soranus (c. Ix.) gives us many of the facts that make up a 
 good clinical picture of a patient with cellulitis, and he attri- 
 butes the symptoms to inflammation of particular regions of 
 the womb. Aetius, quoting Archigenes, under the heading of 
 Uterine Abscess, has given us an excellent description of a 
 pelvic abscess, and tells us in minute details the steps to be 
 adopted in opening such an abscess by way of the vagina 
 (cc. Ixxxv., Ixxxvi.) ; while Hippocrates evidently refers to a 
 pelvic abscess when, in one of his Aphorisms (V. 47), he says : 
 " If the portion of the uterus seated near the hip- joint sup- 
 purate, it gets into a state requiring to be treated with tents." 
 Galen (*'De Loc. Aff.," VI. v.) remarks that after suppres- 
 sion of the menses a tumour forms in the flank, and this, he 
 
RESUME OF THE DISEASES OF WOMEN. 289 
 
 says, is a sign that indicates inflammation of the deep parts ; 
 while Aetius draws our attention to a case of suppurating 
 hfematocele (c. Ixxxvii.), and Hippocrates mentions the open- 
 ing of a ha^matocele before it suppurates as a dangerous 
 practice (D. 0. W., i. 2). 
 
 In considering the various passages which deal with para- 
 metritis in our authors' works, we are not incHned to think 
 that the ancients understood the true role played by the folds 
 of the broad ligament in these cases. They evidently supposed 
 that in cases of uterine inflammation the tumour formed by 
 the side of the uterus was due to the swelling of the wall of 
 the uterus, and that when a pelvic abscess occurred it was 
 really an abscess of the uterus itself.^ Their clinical observa- 
 tion that these swellings by the side of the uterus occurred 
 when the womb was inflamed was quite correct, but they 
 could hardly have been expected to have understood that 
 these swellings, which to all appearances were part and parcel 
 of the uterus itself, were in reality in the tissues adjoining 
 the uterus ;^ and yet in some cases the swelling was recognised 
 as being separate from the uterine wall, for Soranus differ- 
 entiates between what he calls inflammation of the hypo- 
 gastrium, inflammation of the uterus, and inflammation of 
 the peritoneum ; and he points out that in inflammation of 
 the uterus a tumour exists which moves with the uterus when 
 the latter is displaced, but that in inflammation of the hypo- 
 
 ^ Bennet : "The ancients do not appear, however, to have had a correct idea 
 of the origin and nature of these abscesses, which they describe as abscesses of 
 the uterus. They evidently thouglit that the uterus itself was the seat of 
 inflammation, and consequently the source whence the pus came" ("Practical 
 Ti-eatise on Inflaniniation of the Uterus," p. 239). 
 
 ^ Duncan: "Dr. Bennet believes that intiammation and abscess in the pelvis 
 have generally been confounded by ancients and moderns with acute metritis and 
 iliac abscess. According to my views, the confounding of diseases by these 
 ancients and moderns is nearer the truth than tlie separation of them by most 
 authors of our day " ("Perimetritis and Parametritis," p. 35). 
 
 19 
 
290 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 gastrium, although a tumour also exists, yet it does not move 
 when the uterus changes its position. 
 
 Again, we know that the sudden arrest of menstruation is a 
 frequent cause of pelvic haematocele, inasmuch as an undue 
 pressure is put upon the thin-walled veins contained between 
 the folds of the broad ligament, a rupture takes place, and the 
 blood is poured forth into the cavity ;^ but the ancients 
 appeared to have considered that a suppression of the menses 
 led to an accumulation of blood in the womb, and this in 
 time led to the suppressed blood finding its way by some 
 means from the uterus to the surface about the groin, the 
 menstrual fluid either being in the form of blood or of blood 
 and pus. Hippocrates shows us clearly that he considered that 
 the suppression of the menstrual fluid would give rise to a 
 swelling by the side of the uterus ; but if after a time the 
 womb changed its position and the menstrual flow took place 
 from the mouth of the womb, then the swelling by the side 
 of the uterus would disappear, inasmuch as the fluid com- 
 prising it would find its way into the uterus : Kadiajarat to 
 e^earrjKO^ Kara ttju XuTrdprjv, SiahcSoi <yap e? ra? jitjTpa^ 
 
 (D. 0. W., i. 2). 
 
 Affections of the Fallopian Tubes and Ovaries. 
 
 Soranus says, in dealing with inflammation in the posterior 
 and interior portions of the uterus, that, if a finger be passed 
 into the rectum, it will encounter a swelling, which differs 
 from that met with in inflammation of the rectum, inasmuch 
 as pain does not immediately follow on the introduction of 
 the finger, but only after pressure has been exerted for some 
 little time, for the reason that the tumour recedes (before the 
 finger), thereby allowing the bowel to assume its proper 
 
 ^ Lawsou Tait, " Diseases of Women and Abdominal Surgery," p. 228. 
 
RESUME OF THE DISEASES OF WOMEN. 291 
 
 position, and also because the tumour changes its proper 
 position if the patient be placed on her knees. This descrip- 
 tion must refer to an inflamed tube or to a prolapsed tube and 
 ovary, not to a parametritis (c. Ix.). 
 
 Again, Soranus refers to a case of hernia of the ovary, 
 which he himself saw during a herniotomy (c. iii.). 
 
 Herrgott has suggested that a passage in Soranus (c. xii.) 
 may refer to ectopic pregnancy, and Daremberg thinks that 
 the descriptions of the mole found in some of our authors are 
 really pictures of ectopic pregnancy; be this as it may, 
 Albucasis has certainly left us a description of ectopic preg- 
 nancy about which there are no doubts, for he observed parts 
 of a fcetus escaping through the abdominal wall by suppura- 
 tion.^ 
 
 With regard to operations on the ovaries, we feel sure that,, 
 since paracentesis abdominis was an operation very fre- 
 quently performed by the ancients for dropsy (Paul, VI. 1.),. 
 it is more than probable that ovarian cysts were frequently 
 tapped, either deliberately or in mistake for dropsy ; and we- 
 support this contention by alluding to a case mentioned by 
 Ai-etffius,^ where he describes the tapping of an abdominal' 
 hydatid and the escape of the daughter cysts by the trocar. 
 That the ovaries were sometimes removed as a deliberate 
 operation appears at first sight improbable,^ yet we have the= 
 statement by Athenteus, in his " Denosophists," that Xanthus- 
 relates that " Adramyttes, the King of the Lydians, was the- 
 first man who ever castrated women, and used female eunuchs 
 instead of male eunuchs." That it was possible for the 
 ancients to do abdominal sections successfully we need not 
 
 ^ "De Cliirurgia," cura J. Channiiig, Oxoii., 1778. 
 
 2 "Chronic Diseases," B. II., c. i. 
 
 3 Baas states that the Hindus removed the ovaries iu wonieu to restrain theit" 
 lust. 
 
 19—2 
 
292 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 doubt, especially after reading the description by Fellin of a 
 case of the Caesarean operation performed in Central Africa 
 in modern times in which the temperature during the after- 
 treatment never rose above 101° F., nor the pulse beat faster 
 than 108, while on the eleventh day the wound was com- 
 pletely healed and the woman as well as usual. If such an 
 operation could be performed by these uncivilized people, and 
 if ovariotomy can be successfully carried out by some of the 
 native tribes of Australia, then there is nothing improbable in 
 the statement made in the Hindu works on medicine, that 
 abdominal section was practised for intestinal obstruction ; 
 that the Alexandrian surgeons operated on the liver ; that 
 Csesarean sections were successfully undertaken by the 
 Romans and the Jews ; and that Praxagoras advised incision 
 into the gut to allow the faeces to escape in cases of volvus or 
 intussusception. 
 
 Affections of the Uterus. 
 
 (a) Stenosis and Rigidity of the Cervix. — Hippocrates, 
 Soranus, and Aetius deal at some length with these con- 
 ditions, and in the treatment Hippocrates gives us some 
 excellent descriptions of the technique to be followed when 
 dilating the cervix by graduated pine rods (D. 0. W., ii. 133), 
 and in other cases by leaden sounds (D. 0. W., i. 13 ; 
 Sterility, 217), or by tents of raw flax (D. 0. W., ii. 157). 
 
 Aetius in dealing with the same subject gives us from 
 Archigenes a full account of the use of sets of sponge tents 
 (c. xcv.). 
 
 (b) Laceration f Erosion, and Ulceration of the Cervix. — 
 Hippocrates says that if the mouth of the womb gapes in a 
 manner contrary to nature, the menstrual periods become 
 more abundant and viscid, they come on more frequently 
 
RESUME OF THE DISEASES OF WOMEN. 293 
 
 than normal, and the patient suffers from pain in the lower 
 part of the abdomen and in the loins. The treatment should 
 be by pessaries and astringents (D. 0. W., ii. 166). 
 
 Soranus says (c. xlix.) that an erosion which succeeds an 
 ulceration may be the cause of menorrhagia ; and later on he 
 alludes to the treatment of erosion of the cervix by means of 
 trochisks. He also mentions that pessaries of an irritating 
 kind may cause deep ulcers in the cervix, which heal with 
 difficulty (c. xlviii.) ; and he remarks that ulceration may 
 cause atresia of the os, through the formation of cicatrices 
 after the healing of the ulcers (c. xlviii.). 
 
 Aetius tells us that fissures round the mouth of the womb 
 are caused by difficult labours, on account of the size of the 
 child's head, and that these fissures are discovered by 
 examination of the patient by means of the speculum. In 
 the treatment, be it noticed that Aetius says that all surgical 
 interference, and medicines of an irritating nature, are to be 
 avoided, for such induce inflammation (c. cvii.). 
 
 In other chapters Aetius mentions, from the words of 
 Archigenes, " carbuncular and sordid" ulcers of the cervix, 
 also " nomfe et ulcera despascentia " of the uterus. 
 
 (c) Metritis. — The descriptions given us, by the author of 
 the Hippocratic works on gynaecology, of inflammation of 
 the uterus refer to both acute and chronic metritis, and the 
 clinical pictures that he draws are most excellent and accurate 
 (D. 0. W., ii. 169-171). 
 
 This author has also given us an excellent account of septic 
 endometritis following on an abortion, and he treats such a 
 case by uterine injections (D. 0. W., i. 63). 
 
 Soranus (c. Ix.) has given us a most elaborate account of 
 the various symptoms and signs which are to be found 
 following inflammation of the various regions of the uterus 
 
294 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 and cervix. His descriptions embrace a consideration of 
 parametritis and pelvic abscess. Aetius also deals at length 
 with the same subjects. 
 
 Displacements of the Uterus. — Hippocrates mentions in 
 various chapters (D. 0. W., ii. 137-142) displacements of 
 the uterus to the right, to the left, to the front, and towards 
 the seat. No directions are given to instruct us how these 
 various displacements are to be diagnosed by physical examina- 
 tion. Besides these displacements, the imaginary ones, such 
 as the fleeing of the womb up to the heart and liver, are also 
 described (D. 0. W., i. 7). 
 
 The chapter in Soranus that deals with displacements is 
 unfortunately mutilated, but in the description of the anatomy 
 of the uterus he remarks that the ligaments of the uterus are 
 shortened by inflammation, and that this organ is then 
 dragged upon and lies to the side; while if the ligaments 
 through any cause shall become weakened and relaxed, then 
 the uterus falls down (c. iii.). 
 
 Aetius has left us an excellent account of anteversion, 
 retroversion, and lateral displacement of the uterus, and all 
 the supposed symptoms that accompany each of these con- 
 ditions, together with some remarks on the treatment of such 
 •cases by the knee- elbow position and by the use of the sound 
 (c. Ixxvii.). 
 
 Prolajjse of the Uterus and Hysterectomy. — Prolapse of the 
 womb is referred to in the Papyrus Ebers, in the Hindu 
 System of Medicine, and by Hippocrates, Soranus, Aretaeus, 
 Oribasius, Aetius, and Paulus. 
 
 Soranus gives us an historical review of the various opinions 
 held with regard to prolapse, and taking his views and the 
 views of other authors, the generally received idea appears to 
 have been that prolapse was due to the stretching, rupture, 
 
RESUME OF THE DISEASES OF WOMEN. 295 
 
 or relaxation of the muscles and membranes that normally 
 kept the womb in its position. 
 
 With regard to treatment, the Ebers Papyrus refers to 
 fumigation and local medication to be applied to the prolapsed 
 organ until it was brought into a fit condition to be restored. 
 Hippocrates (D. 0. W., 144) and Soranus (c. Ixvi.) give us 
 very full accounts of the treatment. The bowels and bladder 
 were first emptied, and the patient placed on her back, her 
 pelvis elevated, and the prolapsed parts smeared with hot oil. 
 Pressure was then applied to, and an endeavour made to 
 replace, the prolapsed organ, and if the manoeuvre was 
 successful a large plug of wool, soaked in astringent sub- 
 stances, was inserted into the vagina, and the patient re- 
 mained at rest for three days, after which the plug was 
 changed. 
 
 In addition to the above, Hippocrates recommends succus- 
 sion. This was practised after the patient had been bandaged 
 to a ladder-like framework, the patient being left in an 
 inverted position for hours. In some cases he recommends 
 incision to be made into the side of the uterus ('?), the object 
 of which is not clearly defined. 
 
 Both Hippocrates and Soranus mention the use of a 
 pomegranate in case of prolapse, the fruit being introduced 
 into the vagina to serve, not only as a mechanical pessary, 
 but also as an astringent body. 
 
 Soranus (c. Ixvi., c. iii.) and Aetius (c. Ixxvi.) both refer 
 to vaginal hysterectomy in cases of prolapsed wombs which 
 either could not be restored or which had become gangrenous ; 
 and they state that the patients had lived to a good old age 
 after some of the operations. The method pursued in the 
 extirpation is not even hinted at, but probably the cautery 
 was used. 
 
296 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 The Talmudic writers also mention that the spleen and 
 the uterus may be excised without the death of the animal 
 resulting. 
 
 Cancer of the Utcms. — Hippocrates (D. 0. W., 159) tells us 
 that when cancer of the womb is well advanced it is incurable. 
 Aetius (c. xciv.) gives us a lengthy account of the different 
 forms of cancer that attack the uterus, but he does not 
 mention operative treatment ; on the contrary, he warns the 
 surgeon against interference in a case of malignant thymus 
 (c. cv.) and malignant polypus of the womb (c. xcvii.), but 
 Oribasius advises the use of the cautery in case of malignant 
 thymus (" Collecta," XII. xlv.). 
 
 Inversion of the Uterus. — Inversion is mentioned by Soranus, 
 who remarks that traction on the cord may produce it (cc. xxii., 
 Ixvi.). 
 
 Fihroid Tumours, Polypus, and Calcidus of the Uterus. — Under 
 the title of " Mole," Soranus, Oribasius, Aetius, and Paulus 
 describe what is to our minds a fibroid tumour of the womb, 
 though Daremberg and Bussemaker think that the descriptions 
 refer to ectopic pregnancy. 
 
 In the differential diagnosis of this tumour our authors point 
 out how it may be distinguished by palpation from dropsy, 
 and by percussion from tympanites. 
 
 Aetius, under the title of " Cauda," gives us an account 
 (c. civ.) of a fleshy body that springs from the mouth of the 
 womb and fills the vagina, or may even project beyond the 
 vulva like a tail. The body is probably a polypus or a 
 hypertrophied cervix (vaginal portion), though Adams suggests 
 that it may have been a cauliflower excrescence. The treat- 
 ment recommended was incision, the growth being drawn 
 down by a volsella, a ligature passed round it, and the part 
 excised. 
 
RESUME OF THE DISEASES OF WOMEN. 297 
 
 Calculus of the uterus is mentioned by Hippocrates and 
 Aetius (c. xcviii.), this condition probably being one of cal- 
 careous degeneration of a fibroid tumour of the womb. Aetius 
 describes how such a body may be forcibly expelled from the 
 uterus, and points out that if it be embedded in the cervix, or 
 if it be adherent to the mouth of the womb, we must introduce 
 a speculum into the vagina and resect the body with a scalpel. 
 
 Affections of the Vagina and Vulva. 
 
 Soranus mentions atresia of the vagina (c. iii.), and says 
 that if a membrane (hymen?) obstructs the passage, and 
 prevents the escape of the menstrual fluid, then it should be 
 incised. 
 
 Celsus and Aetius have given us a long and excellent 
 account of atresia vaginae, and full directions for operating on 
 such cases and for keeping the new passage patent. 
 
 Thymus Pudendi. — Aetius (c. cv.) described thymus of 
 the genital organs ; Oribasius also refers to the same growth. 
 From their descriptions, the growths appear to have been 
 papillomata. 
 
 Aetius says that the thymus should be incised if it be a 
 simple growth ; but should it be malignant, Aetius, who 
 follows Philumenus, advises that it should not be touched, for 
 fear of great haemorrhage. Oribasius advises that the malig- 
 nant thymus should be treated by the cautery (XII. xlv.). 
 
 Tubercles. — The description which Aetius has left of these 
 small bodies causes us to think that he was referring to the 
 ovula Nabothii and to granular vaginitis (c. cviii.). He 
 describes them as small millet-like excrescences which arise 
 in the neck, or at the mouth, of the womb, or in the pudendum 
 itself. He treats them by astringent pessaries. 
 
 Eczema (?). — In chapter cix., under the heading "De 
 
298 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 scabris uteri pustulis," Aetius describes what we take to be 
 an eczematous condition of the pudendum accompanied by 
 pruritus, for which he recommends sitz-baths. 
 
 It is more than probable that Agrippina suffered from an 
 eczema of the genitals, and the excessive irritation of the 
 parts drove both Messalina and herself to seek relief from 
 coitus among the brothels of Eome. 
 
 Abscess {Bartholinian ?) . — Aetius says that if an abscess 
 should occur in the alse or labia pudendi, and should point 
 towards the seat, it should not be opened, for incisions in this 
 region, which is full of wrinkles, are apt to lead to the 
 formation of a fistula. If, however, the abscess points 
 towards the meatus urinarius, it may be incised (c. ex.). 
 
 Ambnorrh(Ea, Menorrhagia, Metrorrhagia, Leucorrhcea, 
 and Dysmenorrhcea, are dealt with by our authors, and the 
 chapter on amenorrhcea by Soranus is one of the most 
 excellent in his work. 
 
 Hjematombtra, Pyometra, and Hydrometra, are dealt with 
 by Hippocrates in several different chapters (D. 0. W., ii. 178). 
 
 Excision of the Clitoris. 
 
 Under the heading of " Excision of the Nympha," Aetius 
 describes how the clitoris was removed. Having seized it 
 with a pair of forceps, it was pulled forward and resected 
 close to the teeth of the forceps (c. ciii.). 
 
 G0N0RRH(EA. 
 
 The period at which gonorrhoea first attacked the human 
 race is not known, but since we recognise what an enormous 
 factor this affection is in the etiology of the diseases of 
 women, it is necessary to examine those passages in ancient 
 writers which apparently refer to the disease ; for if gonor- 
 
RESUME OF THE DISEASES OF WOMEN. 299 
 
 rhoea did exist — and we believe it did — the women in the past 
 must for certain have suffered all those complications, such as 
 tubal disease and acute metritis, with which we are familiar 
 at the present day, as the result of this disease. 
 
 Moses, in the jBfteenth chapter of Leviticus, says : " When 
 any man hath a running issue out of his flesh, because of his 
 issue he is unclean" (verse 2). The Septuagint version 
 renders liazzah, the man with the issue, by 6 yovoppv7]<;, the 
 man with a gonorrhoea ; but the objection that has been 
 urged against considering the " issue " referred to as a 
 gonorrhoea is found in verse 13, where it is stated : " When 
 he that hath an issue is cleansed of his issue, then he 
 shall number to himself seven days for his cleansing." It is 
 urged that the interpretation of the verse is that eight days 
 after infection he was clean, therefore that the affection could 
 not have been gonorrhoea. This interpretation, however, is 
 not correct, as may be seen by considering verse 28, when, in 
 dealing with females at the time of the menstrual flow, the 
 law was : " But if she be cleansed of her issue, then she shall 
 number to herself seven days, and after she shall be clean " ; 
 and so we think is verse 13 to be interpreted : that when he 
 that hath an issue is cleansed of his issue, then (after being 
 quite cured) he shall number to himself seven days for his 
 cleansing. 
 
 With regard to the term jovoppoia, we find that this term 
 was used by Eufus, Aetius, and Paulus to express a condition 
 of spermatorrhoea, not of gonorrhoea as we now understand 
 the term; and Galen says (" De Locis Affect.," VI. vi.) that 
 gonorrhoea is an involuntary excretion of sperm, and is 
 derived from jov7], seed, and peco, to run.^ But Moses does 
 
 ^ The word "clap," so often used for gonorrhoea, is, according to Sevediaur, 
 derived from "clapiers," which were public shops kept by prostitutes. 
 
300 THE HISTORY OF ANCIENT GYNAECOLOGY. 
 
 not mean that the issue mentioned in verse 2 is sperma- 
 torrhoea, because that affection is mentioned in verse 16, 
 and verse 32 says : *' This is the law of him that hath an 
 issue, and of him whose seed goeth from him, and is defiled 
 therewith." 
 
 In Deuteronomy (xxiv. 1) it is stated that if a man should 
 marry a woman, " and it come to pass that she find no favour 
 in his eyes, because he hath found some uncleanness in her, 
 then let him write her a bill of divorcement." 
 
 Herodotus says (" Clio," i. 105) that the Scythians in an 
 expedition came to Ascalon, a city of Syria, and that some of 
 them pillaged the temple of Venus Urania. However, the 
 goddess inflicted on the Scythians and all their posterity a 
 female disease, and those affected by it were called ot 'Ei^apee?. 
 Of the nature of this affection we have no particulars.^ 
 
 Celsus (VI. xviii.) gives us an account of balanitis and 
 phimosis, which he says are due to ulcers under the prepuce, 
 or in the glans, or in the urethra,^ and from them we may 
 have a purulent discharge. Besides these affections of the 
 penis, he also describes the simple, phagedenic, serpiginous 
 and gangrenous (venereal ?^) ulcers, but he nowhere mentions 
 that these diseases are due to sexual intercourse. He also 
 mentions inflammation of the testicle, which arises apart 
 from any external violence. 
 
 ^ Bumstead and Taylor translate this passage thus : ' ' Sent upon them and 
 their posterity the woman's disease, which is characterized by a running from the 
 penis." Tliis latter part is, however, a pure invention, the words used by 
 Herodotus being merely drfKeiav vovffov. 
 
 - Till about the year 1753, it was generally supposed that the matter from the 
 urethra, in cases of gonorrhcea, arose from an abscess in the passage (Cooiier's 
 "Surj^ical Dictionary," art. "Gonorrhcea"). 
 
 a ]}y "venereal " one implies that these ali'ections were directly or indirectly due 
 to sexual intercourse. Tlie term was first so used by Bethencourt of Rouen, in 
 ir)27. It is, however, to l)e noted that Celsus does not say that any of these 
 afl'ections were due to sexual intercourse. 
 
RESUME OF THE DISEASES OF WOMEN. 301 
 
 Juvenal makes an allusion to what appears to have been 
 a venereal disease, and Martial,^ in his "Epigrams," hints at 
 the same thing. Still, it is strange that neither Greek nor 
 Roman authors give us clear descriptions of these diseases, 
 the explanation probably being that these diseases were not 
 generally alluded to, and Celsus, before he refers to the 
 subject, apologizes for mentioning diseases " qute invitissimus 
 quisque alteri ostendit." 
 
 Women who could not have intercourse, either on account 
 of the menses or on account of disease of the genitals, were 
 termed ancunulentce, and these prayed to Juno Fluonia, and 
 were accustomed to use the aster atticus. The plant is men- 
 tioned by Pliny ("Hist. Nat.," XXVII. xix.) as being a 
 sovereign remedy for diseases of the groin. The Greeks 
 termed it ^ov^coviov, while the Eomans called it buhoniam, 
 and the word came to be applied to the disease for which it 
 was given, whether in the case of females or males ; this is 
 the origin of our term " bubo." The Eomans said of a female 
 who communicated a disease to a man, "H^c te imbubinat."^ 
 
 Eoman doctors declined to treat secret diseases, and there- 
 fore the rich were tended by their own slave doctors, while 
 the poor were driven into seclusion — a custom, in fact, that 
 prevailed among the children of Israel, who " were to put out 
 of the camp every leper, and every one that hath an issue " 
 (Num. V. 2).^ 
 
 But it is probable that, though the Eoman doctors may 
 have declined to attend to venereal diseases, the arcJdatri, 
 who acted somewhat after the fashion of the dispensary 
 
 ^ " Partem gulosam solvit indecens morbus " (XI. 61). 
 
 ^ Scaliger, quoted by Sanger, "History of Prostitution," p. 85, 
 
 ' "In 1497 James IV. of Scotland, in consequence of the frightful prevalence 
 
 of the venereal disease in Edinburgh, issued the celebrated proclamation 
 
 banishing the infected from the city." — Acton. 
 
302 THE HISTORY OF ANCIENT GYNECOLOGY. 
 
 surgeons of the present day, treated those diseases embraced 
 under the generic term "morbus indecens," inasmuch as they 
 were bound to treat the poor gratuitously, though they 
 might charge the rich. At subsequent periods this disease 
 (gonorrhcea), and in many instances its compHcations of 
 swelled testicle and cystitis, were described with more or 
 less detail by Mesue (904) ; by Ali Abbas, one of the Persian 
 Magi (980); by Ehazes (852); by Albucasis, and others.^ 
 
 ^ Since writing the resume on gonorrhoea -we have been able to consult the 
 Jerusalem Talmud, and the frequent references therein to gonorrhoea confirm us 
 in the opinion that this disease played an important role in the etiology of the 
 diseases of women in ancient times. 
 
 THE END. 
 
 Sailliire, Tindall and Cox, 20 tt- 21, King William Street, Strand, London. 
 
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