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The internal cause is either instrumental or material; in the womb or in the blood. In the womb, it may be in various ways; by humours, and abscesses and ulcers, by the narrowness of the veins and passages, or by the adipose membrane in fat bodies, pressing on the neck of the matrix, but then they must have hernia, zirthilis, for in men the membrane does not reach so low; by too much cold or heat, the one vitiating the action, and the other consuming the matter through the wrong formation of the uterine parts; by the neck of the womb being turned aside, and sometimes, though rarely, by a membrane or excrescence of the flesh growing at the mouth or neck of the womb. The blood may be in fault in two ways, in quantity and in quality; in quantity, when it is so consumed that no surplus is left over, as in viragoes or virile women, who, through their heat and natural strength, consume it all in their last nourishment; as Hippocrates writes of Prethusa, for when her husband praised her overmuch, her courses were suppressed, her voice changed and she got a beard with a manly face. But I think, rather that these must be Gynophagi, or woman-eaters, rather than women-breeders, because they consume one of the principles of generation, which gives a being to the world, viz., the menstruous blood. The blood may likewise be lost, and the courses checked by nosebleeding, by bleeding piles, by dysentery, commonly called the bloody flux, by many other discharges, and by chronic diseases. Secondly, the matter may be vitiated in quality, and if it be sanguineous, sluggish, bilious or melancholy, and any of these will cause an obstruction in the veins.
Signs which manifest the disease are pains in the head, neck, back and loins; weariness of the whole body (but especially of the hips and legs, because the womb is near those parts); palpitation of the heart. The following are particular signs:—If the suppression arises from a cold, the woman becomes heavy, sluggish, pale and has a slow pulse; Venus' combats are neglected, the urine is thick, the blood becomes watery and great in quantity, and the bowels become constipated. If it arises from heat, the signs are just the opposite. If the retention be natural and arises from conception, this may be known by drinking hydromel, i.e., water and honey, after supper, before going to bed, by the effect which it has; for if after taking it, she feels a heating pain about the navel and the lower parts of the abdomen, it is a sign that she has conceived, and that the suppression is natural.
The whole body is affected by any disorder of the womb, and especially the heart, the liver and the brain, and there is a singular sympathy between the womb and those three organs. Firstly, the womb communicates with the heart by the mediation of those arteries which come from the aorta. Hence, when menstruation is suppressed, fainting, swooning, a very low pulse, and shortness of breath will ensue. Secondly, it communicates with the liver by the veins derived from the hollow vein. Obstructions, jaundice, dropsy, induration of the spleen will follow. Thirdly, it communicates with the brain by the nerves and membranes of the back; hence arise epilepsy, madness, fits of melancholy, pains in the back of the head, unaccountable fears and inability to speak. I may, therefore, well agree with Hippocrates that if menstruation be suppressed, many dangerous diseases will follow.
In the cure of this, and of all the other following cases, I shall observe the following order:—The cures will be taken from surgical, pharmaceutical and diuretical means. The suppression has a plethoric effect, and must be removed by the evacuation; therefore we begin with bleeding. In the middle of the menstrual period, open the liver vein, and two days before, open the saphena in both feet; if the repletion is not very great apply cupping glasses to the legs and thighs, although there may be no hope of removing the suppression. As in some women, the cotyledones are so closed up that nothing but copulation will open them, yet it will be well to relieve the woman as much as possible by opening the hemoroid veins by applying a leech. After bleeding let the place be prepared and made flexible with syrup of stychas, calamint, betony, hyssop, mugwort, horehound, fumitary, maidenhair. Bathe the parts with camomiles, pennyroyal, savias, bay-leaves, juniper-berries, rue, marjoram, feverfew. Take a handful each of nep, maidenhair, succory and betony leaves and make a decoction, and take three ounces of it, syrup of maidenhair, mugwort and succory, half an ounce of each. After she comes out of her bath, let her drink it off. Purge with Pill agaric, fleybany, corb, feriae. In this case, Galen recommends pilulae of caberica coloquintida; for, as they are good for purging the bad humours, so also they open the passages of the womb, and strengthen it by their aromatic qualities.
If the stomach be over-loaded, let her take an emetic, yet such a one as may work both ways, lest if it only works upwards, it should check the humours too much. Take two drachms of trochisks of agaric, infuse this in two ounces of oxymel in which dissolve one scruple and a half of electuary dissarum, and half an ounce of benedic laxit. Take this as a purge.
After the humour has been got rid of, proceed to more suitable and stronger remedies. Take a drachm and a half of trochisk of myrrh; ten grains of musk with the juice of smallage; make twelve pills and take six every morning, or after supper, on going to bed. Take half an ounce of cinnamon, two drachms each of smirutium, or rogos, valerin aristolochia; two scruples each of astrumone root and saffron; two drachms of spec. diambia; four scruples of trochisk of myrrh; two scruples tartari vitriolari; make half into a powder; make lozenges with mugwort water and sugar, and take one drachm of them every morning; or mix a drachm of the powder with one drachm of sugar, and take it in white wine. Take two drachms each of prepared steel and spec. hair; one scruple each of borax and spec. of myrrh, with savine juice; make it up into eighty-eight lozenges and take three every other day before dinner. Take one scruple of castor, half a drachm of wild carrot seed with syrup of mugwort, and make four pills, take them in the morning fasting, for three days following, before the usual time of purging. Take five drachms each of agaric, aristolochia, and juice of horehound; six drachma each of rhubarb, spikenard, aniseed, guidanum, asafoetida, mallow-root, gentian, of the three peppers and of liquorice: make an electuary with honey, and take three drachms for a dose. For phlegmatic constitutions nothing can be better than the decoction of guaiacum wood with a little disclaim, taken fasting in the morning, for twelve days consecutively, without producing sweating.
Treat the lower parts of the body to suffumigating, pessaries, ointments and injections; for fumigating use cinnamon, nutmeg, the berries of the bay tree, mugwort, galbanum, molanthium, amber, etc. Make pessaries of figs and the bruised leaves of dog's mercury, rolled up in lint, and if a stronger one is required, make one of myrrh, opopanax, ammoniac, galbanum, sagepanum, mithridate, agaric, coloquintida, tec. Make injections of a decoction of origane mugwort, dog's mercury, betony, and eggs; inject into the womb with a female syringe. Take half an ounce each of oil of almonds, lilies, capers, camomiles; two drachms each of laudanum and oil of myrrh; make a salve with wax, with which anoint the place; make injections of fenugreek, camomiles, melilot, dill, marjoram, pennyroyal, feverfew, juniper berries and calamint; but if the suppression arises from a lack of matter, then the courses ought not to be brought on until the spirits be raised and the amount of blood increased; or if it arises from affections of the womb itself, as dropsy or inflammation, then particular care must be used; but I will not lay stress on this here, but will mention the remedies in their order.
