Medicine and Anatomy
355. Menstruation, conception, contraception and abortion. Rome, 1st cent. A.D. (Soranus, Gynaecology 1.24, 26, 34, 36, 39, 40, 60, 61, 64. Tr. O. Temkin. G)

Soranus, a Greek from Ephesus in Asia Minor who practised in Rome, approaches his topic with more sympathy and common sense than his colleagues, and, unlike other practitioners, includes in his account of gynaecology all aspects of the female reproductive system, normal as well as abnormal.

Menstruation


(24). One has to infer approaching menstruation from the fact that at the expected time of the period it becomes trying to move and there develops heaviness of the loins, sometimes pain as well, sluggishness, continual yawning, and tension of the limbs, sometimes also a flush of the cheeks which either remains or, having been dispersed, reappears after an interval; and in some cases approaching menstruation must be inferred from the fact that the stomach is prone to nausea and it lacks appetite. Menstruation which is about to occur for the first time must be inferred from the same signs but above all from the growth of the breasts which, broadly, takes place around the fourteenth year, and from the heaviness, irritation and pubescence in the region of the lower abdomen.
(26). In women who have already menstruated often, each must be allowed to do according to her own custom. For some habitually take a rest, while others go on with moderate activities. But it is safer to rest and not to bathe especially on the first day. But in women who are about to menstruate no longer, their time for menstruation having passed, one must take care that the stoppage of the menses does not occur suddenly. For in regard to alteration, even if the body be changed for the better, all abruptness disturbs it through discomfort; for that which is unaccustomed is not tolerated, but is like some unfamiliar malaise. The methods we employ at the approach of the first menstruation must now be marshalled forth during the time when menstruation is about to cease; for that which is able to evoke the as yet absent excretion is even more able to preserve for some time menstruation which is still present. In addition, vaginal suppositories capable of softening and injections which have the [same] effect should be employed, together with all the remedies capable of rendering hardened bodies soft. But if the menstruation is too much for the strength of the patient, or again, if it is impeded by abnormal factors, then there is need for therapeutic measures which we shall elaborate in the section on 'things abnormal'.

Conception


(34). One must judge the majority from the ages of 15 to 40 to be fit for conception, if they are not mannish, compact, and oversturdy, or too flabby and very moist. Since the uterus is similar to the whole [body], it will in these cases either be unable, on account of its pronounced hardness, easily to accept the attachment of the seed, or by reason of its extreme laxity and atony [let it fall again]. Furthermore they seem fit if their uteri are neither very moist or dry, nor too lax or constricted, and if they have their catharsis regularly, not through some moisture or ichors of various kinds, but through blood and of this neither too much nor, on the other hand, extremely little. Also those in whom the orifice of the uterus is comparatively far forward and lies in a straight line (for an orifice deviated even in its natural state and lying farther back in the vagina, is less suited for the attraction and acceptance of the seed).
(36). The best time for fruitful intercourse is when menstruation is ending and abating, when urge and appetite for coitus are present, when the body is neither in want nor too congested and heavy from drunkenness and indigestion, and after the body has been rubbed down and a little food been eaten and when a pleasant state exists in every respect. (I) 'When menstruation is ending and abating,' for the time before menstruation is not suitable, the uterus already being overburdened and in an unresponsive state because of the ingress of material and incapable of carrying on two motions contrary to each other, one for the excretion of material, the other for receiving.

39. (2) In order that the offspring may not be rendered misshapen, women must be sober during coitus because in drunkenness the soul becomes the victim of strange fantasies; this furthermore, because the offspring bears some resemblance to the mother as well not only in body but in soul ...

40. (3) Together with these points it has already been stated that the best time is after a rubdown has been given and a little food been eaten. The food will give the inner turbulence an impetus towards coitus, the urge for intercourse not being diverted by appetite for food; while the rubdown will make it possible to lay hold of the injected seed more readily. For just as the rubdown naturally aids the distribution of food, it helps also in the reception and retention of the seed, yesterday's superfluities, as one may say, being unloaded, and the body thoroughly cleansed and in a sound state for its natural processes. Consequently, as the farmer sows only after having first cleansed the soil and removed any foreign material, in the same manner we too advise that insemination for the production of man should follow after the body has first been given a rubdown.

Contraception


60. A contraceptive differs from an abortive, for the first does not let conception take place, while the latter destroys what has been conceived ... And an expulsive some people say is synonymous with an abortive; others, however, say that there is a difference because an expulsive does not mean drugs but shaking and leaping ... For this reason they say that Hippocrates, although prohibiting abortives, yet in his book 'On the Nature of the Child' employs leaping with the heels to the buttocks for the sake of expulsion.[1] But a controversy has arisen. For one party banishes abortives, citing the testimony of Hippocrates who says: 'I will give to no one an abortive'; moreover, because it is the specific task of medicine to guard and preserve what has been engendered by nature. The other party prescribes abortives, but with discrimination, that is, they do not prescribe them when a person wishes to destroy the embryo because of adultery or out of consideration for youthful beauty; but only to prevent subsequent danger in parturition if the uterus is small and not capable of accommodating the complete development, or if the uterus at its orifice has knobbly swelling and fissures, or if some similar difficulty is involved. And they say the same about contraceptives as well, and we too agree with them. And since it is safer to prevent conception from taking place than to destroy the foetus, we shall now first discourse upon such prevention.
61. For if it is much more advantageous not to conceive than to destroy the embryo, one must consequently beware of having sexual intercourse at those periods which we said were suitable for conception. And during the sexual act, at the critical moment of coitus when the man is about to discharge the seed, the woman must hold her breath and draw herself away a little, so that the seed may not be hurled too deep into the cavity of the uterus. And getting up immediately and squatting down, she should induce sneezing and carefully wipe the vagina all round; she might even drink something cold. It also aids in preventing conception to smear the orifice of the uterus all over before with old olive oil or honey or cedar resin or juice of the balsam tree, alone or together with white lead; or with a moist cerate containing myrtle oil and white lead; or before the act with moist alum, or with galbanum together with wine; or to put a lock of fine wool into the orifice of the uterus; or, before sexual relations to use vaginal suppositories which have the power to contract and to condense. For such of these things as are styptic, clogging and cooling cause the orifice of the uterus to shut before the time of coitus and do not let the seed pass into its fundus. [Such, however, as are hot] and irritating not only do not allow the seed of the man to remain in the cavity of the uterus, but draw forth as well another fluid from it.

62. And we shall make specific mention of some. Pine bark, tanning sumach, equal quantities of each, rub with wine and apply in due measure before coitus after wool has been wrapped around; and after two or three hours she may remove it and have intercourse. Another: Of Cimolian earth, root of panax, equal quantities, rub with water separately and together, and when sticky apply in like manner. Or: Grind the inside of fresh pomegranate peel with water, and apply. Or: Grind two parts of pomegranate peel and one part of oak galls, form small suppositories and insert after the cessation of menstruation. Or: Moist alum, the inside of pomegranate rind, mix with water, and apply with wool. Or: Of unripe oak galls, of the inside of pomegranate peel, of ginger, of each 2 drachms, mould it with wine to the size of vetch peas and dry indoors and give before coitus, to be applied as a vaginal suppository. Or: Grind the flesh of dried figs and apply together with natron. Or: Apply pomegranate peel with an equal amount of gum and an equal amount of oil of roses. Then one should always follow with a drink of honey water. But one should beware of things which are very pungent, because of the ulcerations arising from them. And we use all these things after the end of menstruation ...

Abortion


64. In order that the embryo be separated, the woman should have [more violent exercise], walking about energetically and being shaken by means of draught animals; she should also leap energetically and carry things which are heavy beyond her strength. She should use diuretic decoctions which also have the power to bring on menstruation, and empty and purge the abdomen with relatively pungent clysters; sometimes using warm and sweet olive oil as injections, sometimes anointing the whole body thoroughly therewith and rubbing it vigorously, especially around the pubes, the abdomen, and the loins, bathing daily in sweet water which is not too hot, lingering in the baths and drinking first a little wine and living on pungent food. If this is without effect, one must also treat locally by having her sit in a bath of a decoction of linseed, fenugreek, mallow, marsh mallow, and wormwood. She must also use poultices of the same substances and have injections of old oil, alone or together with rue juice or maybe with honey, or of iris oil, or of absinthium together with honey, or of panax balm or else of spelt together with rue and honey, or of Syrian unguent. And if the situation remains the same she must no longer apply the common poultices, but those made of meal of lupines together with ox bile and absinthium, [and she must use] plasters of a similar kind.
65. For a woman who intends to have an abortion, it is necessary for two or even three days beforehand to take protracted baths, little food and to use softening vaginal suppositories; also to abstain from wine; then to be bled and a relatively great quantity taken away. For the dictum of Hippocrates in the Aphorisms, even if not true in a case of constriction, is yet true of a healthy woman: 'A pregnant woman if bled, miscarries.' For just as sweat, urine or faeces are excreted if the parts containing these substances slacken very much, so the foetus falls out after the uterus dilates. Following the venesection one must shake her by means of draught animals (for now the shaking is more effective on the parts which previously have been relaxed) and one must use softening vaginal suppositories. But if a woman reacts unfavourably to venesection and is languid, one must first relax the parts by means of hip-baths, full baths, softening vaginal suppositories, by keeping her on water and limited food, and by means of aperients and the application of a softening clyster; afterwards one must apply an abortive vaginal suppository. Of the latter one should choose those which are not too pungent, that they may not cause too great a sympathetic reaction and heat. And of the more gentle ones there exist for instance: Of myrtle, wallflower seed, bitter lupines equal quantities, by means of water, mould troches the size of a bean. Or: Of rue leaves 3 drachms, of myrtle 2 drachms and the same of sweet bay, mix with wine in the same way, and give her a drink. Another vaginal suppository which produces abortion with relatively little danger: Of wallflower, cardamom, brimstone, absinthium, myrrh, equal quantities, mould with water. And she who intends to apply these things should be bathed beforehand or made to relax by hip-baths; and if after some time she brings forth nothing, she should again be relaxed by hip-baths and for the second time a suppository should be applied. In addition, many different things have been mentioned by others; one must, however, beware of things that are too powerful and of separating the embryo by means of something sharp-edged, for danger arises that some of the adjacent parts be wounded. After the abortion one must treat as for inflammation.

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Notes:

See above, number 341.