Chapter I

If men and women, after they have reached a certain age, do not have children after cohabitation, the fault sometimes rests with both, and sometimes in only one of them. And first, it is requisite to examine the uterus of the female, that if the fault lies there it may be relieved by proper treatment. If the fault is not there, attention must be paid to some other cause of sterility. We may conclude that this organ is in a healthy state, when, like the other parts of the body, it performs its functions without pain, and is free from fatigue after the function is performed. Just as the eye is in a healthy state if it suffers no pain in seeing, and is not disordered with the exercise of its function, or unable to perform it again, so the uterus is healthy which suffers no pain, and is well able to perform its functions, whatever they may be, and after they are performed is not impotent, but is free from fatigue.

2. The uterus is said to be disordered, when, even if it performs its functions properly and without pain, it does not hinder its function by any part of itself.[229] As there is nothing to prevent an eye from seeing accurately, although all its parts are not perfect, or if there happens to be a tumour in it; so the uterus may have received no injury in this respect, if it is properly situated in the right place. In the first place, then, the healthy uterus will not be situated in this place or in that, but will always be in a similar position; but it is not difficult to decide whether it is not placed at too great a distance without suffering and pain, or whether it is devoid of sensation when touched. That these parts ought to be properly placed is evident from the following considerations, for if the uterus is not near, it will not be able to imbibe the semen, for the place from which it ought to receive it will be at too great a distance. If the uterus is near, and not able to retire further, it will be useless, for it will be always touched so as to refuse to open; but it ought to do this, and to be obedient to its function. These things ought to be thus ordered, and if they are not, the case requires attention.

3. The catamenia also should proceed correctly, that is, if the general health is good, they should last for their proper time, and not come irregularly, for when the catamenia are right, the uterus will open properly, and receive the fluids of the body whenever they are secreted; but when they make their appearance too often, or not often enough, or irregularly, while the rest of the body does not sympathise with them, and the general health is good, we must look to the uterus for the cause of their irregularity. The dullness of the uterus prevents its being opened at the proper time, so that it receives but a small portion, or rather the uterus imbibes the fluid from some inflammation of the parts. So that it shows that it requires attention, like the eyes, the bladder, the stomach, and other parts. For all the parts, when inflamed, imbibe the fluid which is secreted into each place, but not such a fluid, or in so great quantities.

4. In like manner, if the uterus secretes more than it ought to do, it exhibits an inflammatory tendency, if the secretion is regular but too abundant; but if the secretion is irregular, or more putrid than it should be in healthy subjects, the disease is then quite manifest, for it is necessary that some pain should show that all is not well. In a healthy subject, at the commencement, and the cessation of menstruation, the secretion appears white and putrid. All those subjects in whom the secretion is more putrid than in healthy persons, or is irregular, or too abundant, or deficient, should receive attention, for this it is that prevents child-bearing. But in those subjects who are only irregular, and unequal in the periods of the secretion, the disease is not the preventive of child-bearing, though it shows that the habit of the uterus is changeable, and does not always remain the same. And this affection is sufficient to prevent those persons from conception who are otherwise well disposed towards it. It is, however, hardly a disease, but an affection which may be restored without medical treatment, unless it is affected by some previous fault.

5. If the regularity and quantity of the discharge is subject to alteration, without any corresponding change in the rest of the body, which is sometimes in a more fluid, at other times in a more dry state, the uterus is not in fault, though it ought to follow the habit of the rest of the body, and receive and secrete in proportion. If the body is in a good state of health, but undergoing a change, when this takes place, and there is no need of medical treatment; but if the secretion is too small from disease, and the secretion is taken through some other source, the body suffers: and if the discharge is too great, from all the secretions of the body being turned in one direction, this does not point to disease of the uterus, but of the whole body. Whenever the catamenia coincide with the general habit of the body, it is evident that the fault does not lie with the uterus, which would perform its functions properly if the general health were correct.

6. Sometimes the uterus is weak, and sometimes strong; sometimes too fluid, and sometimes too dry; and the discharge coincides with the state of the body, it is abundant when that is full, deficient when it is less full. If the body is full of fluid, the discharge is watery; if the body is dry, it is more sanguineous; it begins with being white, like milk, and is without smell. Some are dark-coloured, and when about to cease they become white, at the last secretion. The white discharge has not the smell of putrid matter, but is more harsh and disagreeable, nor has it the smell of pus; and when this is the condition of the symptoms, there is no wearing away, but the body becomes heated. In all that are in this state, the uterus is in a healthy condition for child-bearing.