Part 10

Unfortunately hitherto these two kinds of influence exerted by the genius epidemicus have been only too often confounded, and no adequate distinction drawn between epidemic diseases on the one hand and diseases subject to epidemic influence on the other. This has been especially so with regard to Venereal disease, the epidemic character of which curiously enough enquirers have felt bound to vindicate, as well at the beginning of the XVth. Century as here and there even at the present day. The baselessness of such an opinion is so perfectly obvious to anyone who weighs the matter with any care, that we really do not think it necessary to devote more pains now to proving the point, particularly as we propose to treat it more fully in another place. On the other hand Venereal disease _is_ subject to epidemic influence, in fact it is so perhaps to a greater extent than many other forms of sickness, as will be clearly shown in the course of our historical investigations. Accordingly the only question still wanting an answer is, how far such influence may have been effectual in Antiquity. This question of course presupposes the existence already of a number of diseases appearing in consequence of Venereal excesses; still we possess sufficient proof, as previously stated in the course of our enquiries into the influence of climate, to justify a provisional assumption of their existence for our immediate purpose. For openly admitting as we do our ignorance in relation to the influence of the genius epidemicus on sexual activity generally and on the individual activity of the genital organs in particular, and noting the problem to be one that can only be solved in the future, there is nothing else left us to investigate here but this, viz. _the influence of the genius epidemicus in reference to the forms taken and course followed by diseases occurring in consequence of Venereal excesses_.

It may be collected from later experience and observation that there are three clearly marked forms of the genius epidemicus or _epidemic condition_, that exercise a preponderating influence on affections of the genitals and Venereal disease, and condition the frequency of the occurrence of one or the other type of these, viz. _catarrhal_, conditioning blennorrhœal affections, the _exanthematic_, conditioning complaints of the cutaneous glands, and the _typhoïdal_, conditioning various forms of chancre and their malignancy.

With regard to the influence of the _genius epidemicus catarrhalis_ and _exanthematicus_, it would seem to be difficult to arrive at any definite conclusion as to what precisely this was in Asia and the South of Europe, since the Climate was _ipso facto_, as already shown, pre-eminently favourable to blennorrhœal and cutaneous affections; nevertheless the rise and spread of mentagra as well as of elephantiasis in the time of Pompey the Great does afford some indication at any rate so far as Italy is concerned. No doubt the Hippocratic writers several times mention the prevalence of skin affections at particular periods; but the expressions they employ are too general to make it possible for us to take these into special consideration in this place. However there is one passage we must make an exception of,—a passage of the greatest importance for our purpose, even though in all probability it refers to the commencement of a combined erysipelas-typhoïdal condition, to which we shall have occasion to return again later. In it Hippocrates relates how after a dry Summer with Southerly winds and frequent rain there followed a mild, wet Winter, next cold and even snow-storms succeeded in the Spring with much rain, and finally a very hot Summer again. In the Spring began inflammatory fevers and erysipelas, and[190] “in many cases aphthae and ulcerations formed in the mouth, many rheums occurred in the genitals taking the form of ulcers and abscesses on the external and internal surface of the sexual parts; also eye troubles, with discharge, obstinate, persistent and painful; also growths, which are called σῦκα (figs) on the inner and outer surface of the eye-lids, causing many to lose their sight; besides they frequently occurred on other parts liable to ulceration and particularly on the genital organs.” In this passage the expressions ἑλκώματα, φύματα, ἔξωθεν ἔσωθεν τὰ περὶ βουβῶνας (ulcers and abscesses on the external and internal surface of the sexual parts) is as a rule misunderstood by the annotators. But really ἔξωθεν (on the outside) evidently refers to ἑλκώματα (ulcers), while ἔσωθεν (on the inside) goes with φύματα (abscesses), and signifies a swelling and inflammation of a mucous gland resulting in suppuration, as may be seen from the next quoted Aphorism[191]. “Such patients as have φύματα (abscesses) in the urethra find relief, so soon as these have suppurated and broken.” That this relief (λύσις) consisted in the cessation of pain and of the retention of urine may be gathered not only from Galen’s commentary on the first passage, and from the λύεται ὁ πόνος (the suffering is relieved) in the repetition of the same Aphorism, but Hippocrates actually says so distinctly in a third passage[192].

Supposing the view, still generally held even in the last Century, that regards gonorrhœa as a result of an ulcer in the urethra, to have been already adopted in Hippocrates’ time,—and inasmuch as the expression γονοῤῥοία, so far as we know, never occurs in his writings, the assumption would not only not be absurd, but such a view would really be preferable to that which makes out the discharge to be badly made semen,—we shall find in this passage an expression of the fact of the more common occurrence of gonorrhœa, the most troublesome symptom of which, viz. the pain suffered during micturition (πόνος, δυσουρία, ἰσχουρία, suffering, difficulty in micturition, retention of urine), disappears, as is well known, concurrently with the commencement of the discharge (πύου ῥαγέντος, φυμάτων ῥαγέντων,—when the pus has broken out, when the abscess has broken), or if it does not entirely disappear, is at any rate sensibly diminished. But it is not really needful to accept this as having been the ruling opinion; the facts may very well be accounted for by supposing that in virtue of the _epidemic condition_ a strongly marked tendency was set up on the part of the glandular organs to inflammatory and suppurative action, by which not merely the glands of the external skin (ἑλκώματα ἔξωθεν),—ulcerations on the outside, Moses’‏‎ יְהֹוָה צְבָאוֹת), but also those of the mucous membrane of the urethra (φύματα ἔσωθεν,—abscesses on the inside) were affected, exactly as is observed at the present day, especially in the chronic forms of gonorrhœa.

The gonorrhœa then in this case would seem to have been of a more malignant type and to have been combined with ulceration. This best agrees with the general delineation of the _epidemic condition_ as a whole, the exanthematic character of which declared itself in the fig-like growths or tumours,—the σῦκα αἰδοίοισιν (figs on the genitals). _Grimm_ (Vol. I. p. 490.) already remarks on this passage of Hippocrates: “One might be tempted in this case to regard the ulcerations of the genital parts and their consequences, the fig-like tumours, as being the first signs of disease due to incontinence. Indeed what was there to hinder an evil of the sort in those times and under a warm climate from signalizing itself,—then subsequently so far losing its malignant character that its nature was completely misunderstood? Something of the same kind actually happens under our own eyes in connection with this very disease.”

§ 33.

Still more important were the effects of these meteorological conditions on ulcers of the genitals _already in existence_. We read (loco citato p. 482.): “Even before the beginning of Spring, concurrently with the commencement of the cold time, erysipelas made frequent appearances sometimes with, sometimes without, visible cause; it showed itself highly malignant in type, and carried off many. Many again suffered from painful affections of the pharynx (anginae,—sore throats), loss of voice (affections of the wind-pipe), inflammatory fevers with delirium, aphthae in the mouth, φύματα (abscesses) in the genital organs, ophthalmias, ἄνθρακες (malignant pustules), etc.—Also many got erysipelas from external causes, at such spots as these had happened to affect them, even after the smallest injuries[193], and in all parts of the body. Above all sexagenarians suffered in this way in the head, if they were treated in the smallest degree carelessly. Even under careful and scientific treatment wide-spread phlegmonous affections frequently occurred, while the erysipelas spread to a serious extent and with great rapidity in all directions. In most of the patients so affected the metamorphosis that succeeded was to ulcerations, whilst _muscles, sinews and bones fell away to a serious degree_. But the morbid product that collected did not resemble ordinary matter (pus), but was a sort of putrid _sanies_, occurring equally in combination and by itself[194]. Such as were attacked in the head, became bald over the whole head and chin, the bones were laid bare and fell away, and such ῥεύματα (morbid discharges) as described occurred frequently, whether with or without fever. Symptoms of the kind however were more terrifying than really destructive[195], for among patients in whom these (ῥεύματα) came to maturity and resulted in suppuration, the majority were saved; on the contrary many died among those in whom the phlegmonous affections and the erysipelas disappeared, without undergoing any such metamorphosis into other forms of disease. Moreover the same thing happened to those in whose case (the morbid product) attacked some other part of the body. For with many of them the whole upper and fore arm fell away; while in some patients the disease attacked the ribs, the sole difference being whether some destruction was wrought on their anterior or posterior aspect; in others again the whole thigh or the lower leg or the whole foot was laid bare. _But the most dangerous of all was, when this or the like happened in the neighbourhood of the private parts or to the private parts themselves_, and the mischief manifested itself in the form of ulcers, and as the result of external causes. In many patients suchlike symptoms occurred during, before, as well as after the fever”[196].

_Galen_, who has left us a Commentary on this passage (Vol. XVII. A.) mentions in the first place that aphthae, φύματα (abscesses) of the genitals, etc. specifically possessed (p. 661.) nothing of κακοηθεία (malignity), but only when as in this case they occurred in conjunction with a putrid general condition. “The putrid character easily arises even without a pestilential general condition, if the parts are attacked by phlegmonous affections or erysipelas, and spreads likewise over the neighbouring parts lying uppermost; hence it is we are compelled after cutting away the decayed tissues to cauterize the place. It is no wonder then, when such a condition has arisen that upper and fore-arm, thigh and lower leg, ribs and head are attacked, if the private parts suffer above all others.—So far the author has discussed those affections of a kind akin to erysipelas which associate themselves with ulcerations or other comparatively insignificant external cause; in what follows he speaks of such attacks as occurred without any such occasioning cause”[197].

Now if we examine these statements, so far as they are of immediate interest in view of our object, we may unhesitatingly conclude from them, that in Hippocrates’ time a large number of patients suffered from ulcers of the genitals. These it seems under the influence of the prevailing typhoïdal conditions were assailed by inflammation of an erysipelas-like type, rapidly passing over into humid gangrene, which latter destroyed the parts attacked, readily extended its ravages, and eventually killed the patient. This is an observation which _Galen_ likewise had frequent occasion to make (so probably under the head of Influence of the Climate of Asia, pp. 318, 326, 329.), without any exactly definite typhoïdal conditions having been prevalent[198], and even saw himself under these circumstances very generally constrained, in order to put a stop to the spread of the mortification, _to amputate the gangrenous tissue, and afterwards cauterize the wound_. What was the origin of these ulcers of the genitals is indeed not stated; but it is certain they were not invariably conditioned by the prevailing _genius epidemicus_. Besides, since Hippocrates several times mentions them without giving the cause that produced them, it is a more likely conjecture to suppose that this cause was one universally familiar (it consisted in an act of unclean intercourse with women), than to assume it to have been _absolutely unknown_ to physicians generally[199].

Again the result of this investigation is of still more especial interest in so far as it enables us to properly appreciate Thucydides’ notice of the so-called _Plague of Athens_.[200] This has been discussed by very many writers, and has given occasion to the most widely different explanations. He relates as follows: “For the disease which at first had its stronghold in the head, beginning from above downwards traversed by degrees the whole body; and even supposing a patient to have escaped the worst, yet a seizure of the extremities put its mark upon him. For it attacked the genitals and the extremities of the hands and feet; and many escaped death, but with the loss of these parts.” Even more clearly does the poet _Lucretius_[201] paint the disease, when he says:

Profluvium porro qui tetri sanguinis acre Exierat; tamen in nervos huic morbus et artus Ibat et _in partes genitales corporis ipsas_, Et graviter partim metuentes limina leti _Vivebant ferro privati virili_.

(Then too if any one had escaped the acrid discharge of noisome blood, the disease would yet pass into his sinews and joints and onward even _into the sexual organs of the body_; and some from excessive dread of the gates of death _would live bereaved of these parts by the knife_. Munro’s translation).

Though we really are concerned only with the last words of Thucydides, so far as they relate to the genitals, yet what precedes has given occasion to such extraordinary interpretations that we feel bound to devote some attention to this as well. The whole passage proved itself an especial _stone of stumbling_ to those writers who endeavoured to identify the Athenian plague with _scarlet-fever_, as _Malfatti_ did, or with _small-pox_, like _Scuderi_ and _Kraus_. In fact this is why the last named says as he does[202]: “The loss of the private parts and the extremities (στερισκόμενοι τούτων,—being deprived of these, with the loss of these) would certainly seem to point merely to the loss of the _free use_ of these parts, in consequence of ulcerations, swellings of the joints, lesions and contractions, for the entire members are not likely to have been destroyed by mortification or amputated by the surgeon? Indeed it is only in deference to the verses of Lucretius that the latter opinion has become the one generally held; but even Ancient commentators[203] have felt that the Roman poet may very possibly have mistaken Thucydides’ meaning. Moreover I feel myself disposed to agree with them particularly on this ground, that the mortification of the whole of any of the greater limbs, though it _has_ been observed in pestilential fevers, in _Typhus contagiosus putridus_ (putrid infectious Typhus) amongst others, yet makes a comparatively rare symptom of the disease, and at the same time so dangerous a one that it can hardly be, as Thucydides alleges it was, that many (πολλοὶ) after such a serious affection escaped death, while on the contrary some (εἰσὶ δ’ οἵ) only did so with the loss of the eyes.” Any one who will compare the just quoted passages of Hippocrates and Galen with the account of Thucydides, will want no further proof that as a matter of fact mortification of the extremities did supervene, an occurrence that even in later times[204] is not of the extreme rarity that _Kraus_ and others believe. Again the fact that _many_ of those attacked escaped with their lives is the less surprising when one remembers that Thucydides is not speaking of entire arms and feet as having fallen off, but only of ἄκρας χεῖρας καὶ πόδας, that is to say, fingers and toes. However supposing any one to prefer not to supply ἄκρων with τούτων, but take it as used in its full extent, maintaining that hands and feet as well as genitals were entirely destroyed, even this would not belong to the category of _extremely rare_ phenomena, for Hippocrates actually saw the extremities entirely fall off in similar circumstances, while if only the ῥεύματα (morbid discharges) came duly to maturity and maturation supervened, the major part (οἱ πλεῖστοι τούτων ἐσώζοντο,—the majority of these were saved) escaped with their life.

Finally the passage of Thucydides gives no sort of evidence to prove that the ἀκρωτηρίων ἀντίληψις (seizure of extremities) occurred solely in those attacked by the fever as metastasis and so on. For the first sentence quoted, to the effect that the disease traversed the whole body, evidently refers back to the preceding clause ἐπικατιόντος τοῦ νοσήματος ἐς τὴν κοιλίαν (when the disease descends into the abdomen), and for this reason is connected with it by the conjunction γὰρ—“for”. The succeeding words καὶ εἴ τις ἐκ τῶν μεγίστων περιγένοιτο (and even supposing a patient to have escaped the worst) may very well be taken in this way; μεγίστων (the greatest, worst things) is made not a Neuter absolute, like τὰ ἔσχατα (last extremities) and such like phrases in other places, but κακῶν (evils) is supplied to go with it, and the whole translated: “even supposing a patient escaped the greatest evils”, that is to say if he were not attacked by the λοῖμος (Plague) in the forms of head and abdominal affections, “yet it marked him”, that is it made its existence manifest by gangrene of the extremities supervening[205]. This Thucydides, a layman writing on a medical subject, supposes to be a mere manifestation of the λοῖμος (Plague), while Hippocrates regarded it as the proof of the erysipelas-putrid condition, which caused the already previously existing ulcers etc. to assume this character.

We have already mentioned the fact that at Athens ulcers of the feet were of frequent occurrence; and these must, no less than the ulcers of the genitals previously existing in any case, have necessarily been likewise assailed by the general unhealthy condition of things, and when this happened, have passed over into gangrene. Thucydides in fact says expressly at the beginning of his delineation of the disease (ch. 49.): τὸ μὲν γὰρ ἔτος, ὡς ὡμολογεῖτο, ἐκ πάντων μάλιστα δὴ ἐκεῖνο ἄνοσον ἐς τὰς ἄλλας ἀσθενείας ἐτύγχανεν ὄν. εἰ δέ τις καὶ προέκαμνέ τι, _ἐς τοῦτο πάντα ἀπεκρίθη_. (For indeed that year, as was universally admitted, chanced to be of all years one especially free from other diseases in general; and indeed if any one suffered previously from any complaint, _all ended in this_, the plague.)” We have seen how Hippocrates observed the prevalence of ulcers of the genitals at the period of the special meteorological conditions he drew attention to, and without doubt in the same way such existed at Athens as well, and were subsequently dominated by the prevailing erysipelas-typhoïdal conditions. This was manifested in one of two ways; either the ulcers became gangrenous, or the patient was attacked by typhus, precisely as is noted to be the case at the present day[206]. But under either eventuality the existing contagion was annihilated, in the one case by the general feverish reaction of the organism[207]. But in those cases where neither fever nor mortification supervened, the contagion undoubtedly assumed a more strongly effective character, was more readily infectious, set up more deeply penetrating ulcerations, and the tendency towards the skin being the predominating one, exanthematic eruptions with an inclination to ulcerative forms (ἐκθύματα μεγάλα, ἕρπητες πολλοῖσιν μεγάλοι,—great pustules, extensive creeping eruptions in many cases) were observed by Hippocrates to be set up in Summer, (loco citato p. 487.). All these are factors of the highest importance for the history of Venereal disease, as it is only by them that we shall be enabled to solve the great riddle of the origin of Venereal disease in the XVth. Century,—a riddle to which the answer would long ago have been found, if only enquirers had not been in the habit almost down to our own days of persistently looking upon Venereal disease as an isolated phænomenon.

True it is impossible from the passage of Thucydides to decide with any certainty whether the extremities, hands, feet and genitals, fell off of their own accord or were removed by the knife; but our own opinion is that both was the case, for of course there were Physicians at Athens, and until they had learned their powerlessness against the prevailing sickness, they no doubt employed the remedial means at their disposal, and these consisted according to Hippocrates solely and simply in the use of scalpel and cauterizing iron, all other measures having proved unavailing. That these were equally resorted to in ulcerations of the genitals we see from the passage of Galen quoted above, and the Poem of the Priapeia, p. 74, confirms the same in the most convincing way.

Enough has been alleged to prove how far the view expressed in many different forms, to the effect that, in the Athenian Plague as well as in the meteorological conditions and their results as laid down by Hippocrates, it is a question of Venereal disease, is justified by facts, and to show that even in Antiquity materials are to be found to demonstrate conclusively that the _genius epidemicus_ exercised a not unimportant influence on the rise, form and course of the ulcerations of the genital organs. In what way this influence acted on the complaints consequent on paederastia and the vices of the _cunnilingue_ and the _fellator_ and affecting the posterior and mouth, we cannot at any rate at the moment demonstrate historically, but it seems only probable that previously existing ulcerations in the mouth and throat must under an erysipelas-typhoïdal general condition have proved themselves in the highest degree dangerous to the sufferers.

SECOND SECTION.

Influences which served to hinder to a greater or less degree the inception of Diseases consequent upon the Use or Misuse of the Genital Organs.

§ 34.