Aretaeus, De causis et signis acutorum morborum (lib. 2)
Francis Adams LL.D., Ed.

CHAPTER XI. ON AFFECTIONS OF THE WOMB, OR HYSTERICS.

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 fatal diseases of an acute nature connected therewith have been described elsewhere: but the chronic affections are, the two species of fluor; hardness; ulcers, part mild, but part malignant; prolapsus of the whole, or of part.

The fluor, then, is either of a red or white colour; its appearance indicates this. It is the red if it consist of bright red blood, and the varieties thereof; or livid, or black and thin, or thick and coagulated, like a thrombus; or white, like water; or a bright ochre colour, like bile: in thickness like a thinnish or thin and fetid ichor. The white flux (or fluor albus) is like pus, and the true form like white whey; but a clot of blood frequently runs off with the pus. But there is an infinite variety of forms of it, as regards more or less quantity. Its periods sometimes agree with those of the menstrual purgation, but it does not continue the regular time as before; there is not much blood, but it flows during many days; the interval is for a few days, but is quite free from discharge. Another variety as to the period: the first purgation is at the regular time, but it occurs two or three times during each month. Another variety: a continual flux; small, indeed, every day, but by no means small during the whole month; for the uterus never closes its mouth, labouring under relaxation, so as to permit the flow of the fluid: but if it neither intermits nor diminishes, they die of hemorrhage. The symptoms are, the woman's colour in accordance with those of the discharge; sleepless, loathes food, anxious, relaxed, especially in the red flux, and subject to pains; the discharge fetid in both varieties, but to a greater and less extent at different times; for the white is worse if the putrefaction be unusually great; and sometimes the red, if the erosion be exacerbated. In a word, the black is the worst of all; the livid next; the pale, the

white, and the purulent, are more protracted, indeed, but less dangerous. Of these the pale is worse indeed, but much better when mixed with the customary discharge. Now the customary discharge is red in all its varieties. But, indeed, the red are worse in old women; but the white are not at all so to the young; but even to them that which is customary is less troublesome. Another white fluor: the menstrual discharge white, acrid, and attended with an agreeable pruritus; along with which the discharge of a white thick fluid, like semen, is provoked. This species we call female gonorrhœa. It is a refrigeration of the womb, which therefore becomes incapable of retaining its fluids; hence, also, the blood changes to a white colour, for it has not the purple colour of fire. The stomach, also, is subject to the affection, and vomits phlegm; and also the bowels are similarly affected in diarrhœa.

Ulcers, too, 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 somewhat more abundant, much more fetid, and yet, notwithstanding, 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 small piece of flesh is cast off and discharged, and this sore not coming to cicatrization, either proves fatal after a long time, or becomes very chronic. This sore gets the appellation of phagedæna. The sores also are dangerous if in these cases the pain gets exacerbated, and the woman becomes uneasy. From the sore there is discharged a 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 untractable, which distends the whole uterus; but there are pains also in the other parts which 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 has protruded from its seat, and lodged on 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 membranes which are inserted into the flanks, being the nervous (ligamentous?) supporters of the uterus, are relaxed; those at the fundus, which are inserted into the loins, are narrow; but those at its neck, on each side to the flanks, are particularly nervous and broad, like the sails of a ship. All these, then, give way if the uterus protrude outwardly, wherefore this procidentia generally proves fatal; for it takes place from abortion, great concussions, and laborious parturition. Or if it do not prove fatal, the women live for a long time, seeing parts which ought not to be seen, and nursing externally and fondling the womb. It would appear that, of the double membrane of the womb, the internal lining coat is sometimes torn from the contiguous one, for there are two transverse plates of the coat; this, then, is thrown off with the flux, and in abortion and laborious parturition, when it adheres to the placenta. For if it be forcibly pulled, the coat of the uterus being stretched, ..... But if the woman do not die, it is either restored to its seat, or but a small part appears externally, for the woman conceals it with her thighs. Sometimes the mouth of the womb only, as far as the neck, protrudes, and retreats inwardly if the uterus be made to smell to a fetid fumigation; and the

woman also attracts it if she smells to fragrant odours. But by the hands of the midwife it readily returns inwards when gently pressed, and if anointed beforehand with the emollient plasters for the womb.