Part 16

The majority of Writers however are agreed that among other occasioning causes ulcers hold the first place,[412] though none of them speak expressly of ulcers of the genitals, unless indeed we see good to make the passage of Hippocrates discussed a little above refer to these. No doubt in this passage the words ἑλκώματα, φύματα ἔξωθεν ἔσωθεν τὰ περὶ βουβῶνας (ulcerations, tumours external and internal in the inguinal region) might admit of such an explanation, in which case the words must be taken not as referring to each single patient, but rather held to mean that ulcers and glandular swellings with a tendency to suppuration were set up, the latter occurring in some patients in the urethra, in others in the groin. Such an interpretation is favoured by the case of the Eunuch discussed in § 20, for there can be no doubt the metathesis of buboes into fistulous ulcers was noted by Celsus and other observers. Still it is highly improbable that ulcers on the feet should have afforded the sole and only cause of buboes; it is much more natural to suppose that this, as being the more rare case, was for that very reason brought into special prominence by the ancient Physicians. Besides we have seen above that the old Physicians seldom or never really had an opportunity of seeing the sympathetic buboes, as patients treated the ulcers themselves, and the buboes then disappeared spontaneously. Oribasius no less than other Writers holds buboes following on an ulcer to be without danger.

Lastly the cases are very rare in which secondary buboes under the prevailing tendency and course of the disease are thrown out on the skin, and if they do arise, the ulcer as a rule heals up. This being so, the Physician is consulted, only supposing the buboes refused to disappear. On the contrary if the ulcer was still there, the Physician sought actually to stimulate it to enhanced activity, as is distinctly implied by what _Galen_ says (loco citato). Lint smeared with _tetrapharmacum_ (compound of wax, tallow, pitch and resin), liquified by the addition of _oleum rosaceum_ (oil of roses) was applied and warm poultices over that; while on the actual bubo was laid in the first instance wool moistened with oil, to which when the pain and swelling of the part were relieved, was added an admixture of salt. Plethoric or cacochymic (generating evil humours) subjects are to be bled or cupped. If the bubo is inflamed and inclined to suppurate, it must be scarified, the patient having first been purged. Dispersion is then attempted, in this case by means of pulp and honey poultices, but not by plasters, as these are apt to provoke inflammation. If pus appears, recourse must not be had at once, as some advise, to opening with the knife; rather the poultices should be persevered with till the inflammation is relieved. Acrid poultices are suitable only when the metathesis to induration has already begun.

If dispersion does not follow and the matter has collected in greater quantities, then the most elevated spot, the same where the skin is the thinnest, should be opened. Should a part of the skin be discoloured, it must be cut away. Some advise always cutting out a piece in the shape of a myrtle-leaf, others make very long incisions; but this not only causes a disfiguring scar, but often also interferes with the movement of the part. As a general rule a single incision is sufficient, which should be made diagonally across the inguinal region, not parallel with the direct diameter of the thigh, as then the edges are brought actually into contact when the limb bends.[413] After the opening of the abscess, it should be treated by preference with finely sifted frankincense, as should all forms of ulcer. We may mention further that according to Sextus Placitus Papyriensis[414] the wearing of a stag’s genitals was considered a _prophylactic_ against buboes.

6. Exanthemata on the Genitals.

Long ago _Hensler_ endeavoured in the Graduation Theme of his mentioned in the list of Historical Authorities to prove that certain eruptions occurring on the genitals were communicated and acquired as the result of coition. In particular did this apply above all to _herpes_ (creeping eruption), under which name must be understood, as is distinctly implied in a passage of _Galen_,[415] a form of eruption accompanied by ulceration. It is true the passages of _Hippocrates_[416] cited by Hensler in regard to the _herpes esthiomenos_ (eating herpes) would appear to be open to some doubt and obscurity, while the interpretations given by _Pollux_ (Onomast. IV. 25. 191.) _φλυκτίς_, φλύκταινα ἐπιμήκες, μάλιστα περὶ βουβῶνας καὶ μασχάλας. _φύγεθλον_, φῦμα περὶ βουβῶνα μετὰ πυρετοῦ, (φλυκτίς, a long-shaped blister, particularly in the groin and armpits. φύγεθλον, a tumour in the groin accompanied by fever) refer probably only to bubonic swellings; still these objections hardly apply to the φύματα (swellings) described in § 32,—the less so as _Celsus_ himself (VI. 18.) explains: “Tubercula etiam, quae φύματα Graeci vocant, _circa glandem_ oriuntur, quae vel medicamentis vel ferro aduruntur; et cum crustae exciderunt, squama aeris inspergitur, ne quid ibi rursus increscat;” (Tuberculous swellings also, which the Greeks call φύματα, arise _about the glans penis_, and are burned away either by caustic drugs or by the actual cautery. Afterwards when the scabs have fallen off, the sore is dusted with slag of bronze, to prevent any second growth later on). Moreover it is possible the passage of _Galen_,[417] πρὸς δὲ τὰ ἐν αἰδοίοις φυόμενα ἀπίου σπέρμα ἐπίπασσε καὶ τραγείᾳ χολῇ περιχρῖε. (But for growths on the privates sprinkle pear-juice and rub in goat’s gall) may refer to these cases, though no doubt it may also be held to apply to the tubercles occurring in the female vagina (§ 41,—3. B.).

Again _epinyctis_ (night-pustule),[418] which Hensler also mentions but declares to be equally open to suspicion as to interpretation, would seem hardly pertinent in this connection, for the violent pain experienced at once tells against the likelihood of its being an affection of this class. Its appearance _in eminentibus partibus_ (on prominent parts, on the extremities) finds a clear explanation in the words added by _Pollux_ (loco citato, 197.) περὶ κνήμας καὶ πόδας ἐν νυκτὶ γενομένη (appearing on legs and feet during the night); while it is proved that Celsus meant to indicate nothing else by it from his words in describing φλυζάκιον (little blister), which he says occurs _raro in medio corpore, saepe in eminentibus partibus_,—rarely on the trunk, frequently on prominent parts, extremities. Still we do not for a moment wish to dispute the fact that the male genitals were at any rate among the Ancients counted as belonging to the _partes eminentes_, and as chancrous blebs do usually appear suddenly and often during the night, it is quite possible these may have been all along intended by _epinyctis_,—especially as on Hippocrates’ authority[419] creeping eruptions (ἕρπητες) arise from night-pustules (ἐκ τῶν ἐπινυκτίδων.) However _Pollux_ (loco citato, 206.) likewise again mentions the legs and feet (κνήμαις καὶ ποσίν), declaring these eruptions attack those of elderly people. From this we may conclude the epinyctis of the Ancient writers to have been very likely nothing else but that form of _impetigo_ (scabby eruption) which is vulgarly known as the _salt-flux_.

_Aetius_[420] mentions _pustulae spontaneae in pudendis_ (pustules spontaneously set up on the privates), provoking _phimosis_, and describes[421] _scabies scroti_ (scab of the scrotum) with metathesis into ulceration and scaliness, after the disappearance of which very often acute _pruritus scroti_ (itch of the scrotum) is left behind. _Galen_ (XIX. p. 449.) defines _psoriasis scroti_ (itching of the scrotum) as a form of induration of the scrotum accompanied by itching, as well as in some instances by ulcers.

Under exanthematic types come also the various _condylomata_. These when they appeared on the genitals and in other localities of the body, were called by the Greeks σῦκος, συκώσις, σύκωμα, συκώδης ὄγκος, (fig, figlike excrescence, figlike swelling, figlike lump), by the Romans _ficus_ (fig), whereas the same disease when it showed itself on the fundament, received the name of condyloma[422] _par excellence_. At the same time this distinction was by no means strictly observed; in particular the larger forms of _thymus_ (warty excrescence) were designated by the name σῦκος (fig), albeit it would seem that _thymus_ was used as specific name for all protuberances on the fundament and genitals. Σῦκος or _ficus_ is according to _Galen_[423] an ulcerative tubercle secreting moisture,—the _varus_ (blotchy eruption) on the contrary being dry, according to _Oribasius_[424] of circular shape and reddish colour, hardish and rather painful. It is found above all on the hairy parts of the body, the head, chin, fundament and genitals,[425] as the passages quoted above in § 13 from Martial show. They occurred, as it would seem, most frequently on the female genitals, in which situation they are described so long ago as by _Hippocrates_[426] under the name of κιων (pillar, pillar-like excrescence) and said to be evil-smelling. _Aspasia_[427] says, “condyloma est rugosa eminentia. Rugae enim circa os uteri existentes dum inflammantur, attolluntur et indurantur, tumoremque ac crassitudinem quandam in locis efficiunt.” (a condyloma is a wrinkled protuberance. For when the wrinkles surrounding the orifice of the uterus grow inflamed, they become prominent and indurated, occasioning a swelling and thickening in the parts). _Paulus Aegineta_ (III. 75., VI. 71.) describes them under the name of _hemorrhoids_ as painful, reddish, excrescences suffused with blood, which break (διαλείμμασι), and give off a pale discharge in drops. Much more common was the appearance of _condylomata on the fundament_,[428][429] particularly in male subjects; in which case they were specially ascribed to pederastia, as we have already seen. This makes it impossible to decide definitely which condylomata were of primary and which of secondary character; but the fact in no way authorizes us to deny altogether the occurrence of the latter in Ancient times.

7. Morbid Outgrowths on the Genital Organs.

σαρκώδη βλαστήματα, verrucae. (fleshy outgrowths, warty excrescences).

The general name θύμος (_thymus_,—warty excrescence), or according to Celsus perhaps more correctly θύμιον (small warty excrescence), appears to have been used by the Greeks to designate all morbid outgrowths, and particularly those of the genitals and fundament, while they appropriated the expressions σῦκος, ἀκροχορδὸν, and μυρμήκια (fig or figlike excrescence, wart with a neck, wart growing directly on the skin) to signify the different subordinate species. The θύμιον, which _Celsus_[430] is the first Writer to delineate in detail, is a warty, reddish,—according to Paulus Aegineta white too in some cases, and as a rule painless,—fleshy outgrowth, slender at the base, broader above, rather hard and rough at the top. Thus it bears a certain resemblance to the flower of the thyme, from which circumstance comes the name. The upper part is easily split, and then bleeds,—more than might be expected Aëtius says from its size; the same also sometimes happens spontaneously. Usually it has the size of an Egyptian bean, though occasionally it is quite small. Sometimes one such growth appears, at others several are found together, now on the palms of the hands, now on the soles of the feet; but the worst are always those on the genital organs.

According to _Aëtius_, who calls the larger sorts σῦκος (fig), _thymus_ is also found on the fundament and on the face, in women on the _labia_, in the entrance to the vagina and in the vagina itself, spreading thence to the fundament and even over the thighs. This is confirmed by _Oribasius_, who as well as Paulus Aegineta and perhaps Celsus, distinguishes a _malignant_ and a _non-malignant_ form. The non-malignant growths generally disappear of themselves; but if they are amputated, there remains behind, so says Celsus, a circular root which penetrates deep into the flesh; and not only do they grow again, but further take the character of the malignant form, become painful and filled with a bloody ichor. The malignant show themselves both with and without ulceration, as well as after the disappearance of the non-malignant growth; they are harder, rougher and larger, have a dirty livid hue, and are painful, particularly on being touched. Thymus on the glans penis is more dangerous than when affecting the prepuce,[431] more especially if it assume a carcinomatous character. If of the non-malignant type it should be lightly scarified with the point of a scalpel, then some mild escharotic employed, for which the Writer just named gives several prescriptions. If of the malignant type, it is according to Paulus Aegineta either tied with a horse-hair and then removed by knife or cautery, or according to what Oribasius says the latter is at once resorted to. But seeing thymus on the prepuce is often found affecting the inner and outer surfaces simultaneously, cautery must not be employed on both at once, for in that way the foreskin would be destroyed altogether. The better plan is to begin with those situated on the inner surface, first cutting them away, then cauterizing, and finally when they are cicatrized proceeding to the treatment of the others. But not a few are incurable.

Ἀκροχορδὸν[432] is a smooth, circular, fleshy protuberance, having a slender circular base, so that it looks as though it hung on a string, whence the name. It is painless and callous, usually has the same colour as the skin, while its dimensions seldom exceed those of a bean. As a rule several occur together, but disappear again of their own accord, especially if they are only small, though on occasion they get inflamed and suppuration follows; they leave no root behind on amputation. According to _Galen_ and _Aëtius_ they occur on the fundament, according to Philumenes, as given in the latter author, likewise on the female genitals. They are removed either by means of a thread or with the lancet, though escharotics and other acrid remedies are also employed.

A highly inveterate form is the μυρμήκια, or _formica_ (ant) of later Writers, which is almost always discussed by medical Authors concurrently with ἀκροχορδόν. It is, Celsus tells us, less prominent and harder than the θύμιον, has deeper roots, is more painful, broad at the bass and slender at the top, less suffused with blood and seldom larger than a lupin-bean. The colour according to Aëtius is blackish. On its being touched, the patient has the sensation of having been bitten by an ant. As an exactly similar growth appears on the hands, most Writers, e. g. Celsus and Oribasius, speak only of this latter; but Aëtius describes it expressly as occurring on the fundament and on the female genitals; and it was observed in the latter situation by Philumenes, or Aëtius (loco citato, ch. 105.) in the case of _his own wife_, whom he cured by three days’ fumigation with _origanum_, (wild-marjoram). Not to mention the usual escharotic remedies, for which Aëtius in especial gives several formulæ, the following modes of treatment recommended by the medical Writers evidently apply to warts on the hands only,—by extirpation with a myrtle-leaf shaped scalpel called a _scolopomachaerion_ (small pointed surgical knife), squeezing off by means of a quill or metal pipette, and above all sucking with the lips and gnawing off. This last was in _Galen’s_ time especially[433] a very fashionable treatment and is described by him as a new discovery made at Rome.

§ 42.

Retrospect.

If we now turn back again and make a brief survey of the various forms of affections of the genitals described on preceding pages, comparing them with those of the present day, such as we have opportunity to observe in modern times, we think every unprejudiced reader will be found ready to admit that they agree with these latter in _very nearly every_ respect whatever, and that _every_ doubt would be removed, if only the medical Writers had appended to the records of their observations in each case the words, “got by infection in coition.” But to what cause do we refer such cases as a matter of fact, notwithstanding the denial on the part of the patient that he has exposed himself to any infection? Do we not take it for granted as a certainty that such infection did actually precede? Are we in the habit of noting down in every instance in our day-book of cases the antecedent act of coition that occasioned the chancre or what not; and does this omission in any way imply that this did not first occur? To our mind at any rate the fact suffices that non-professional observers and even a professional one like Galen have supplied irrefutable evidence that some of these affections were acquired by coition. Amongst others, morbid outgrowths for example are manifestly shown to have been so set up by the statement that they occurred on the fundament of pathics; and it needs no great perspicacity to draw the conclusion that if (unnatural) coition produced them in the pederast, the same maladies occurring on the genital organs owed their origin to the same cause.

But granting these maladies originated in coition, there must necessarily have been some other factors active as well, besides the mere act. Thus when patients are found explaining to the physician (Galen) that the women with whom they had accomplished coition suffered from the same evil as themselves (gonorrhœa), no one surely can suppose anything but that a transmission of the disease took place in virtue of a contagion. Such affections of the genitals as are transmitted in coition by contagion we are wont to regard as primary forms of Venereal disease; and those acquired and disseminated in the same way in Antiquity must accordingly be designated by the same name. But these primary forms extended not only to the genitals; they were equally and in the same way acquired through the various modes of _Venus illegitima_ (abnormal Love) in the anus and the mouth, localities where we are accustomed nowadays to see the secondary symptoms chiefly appear. Consequently it was impossible for the Ancients,—and is really and truly no less so down to the present moment for the Moderns,—to make a definite distinction between primary and secondary forms. It is equally impossible to deny outright the former existence of the latter in these localities, the more so as, however wide the dissemination of vicious practices of various sorts, no very large number of men suffering from a diseased member are likely to have misused mouth or anus.

But if we are forced in considering the secondary forms to leave mouth and anus almost entirely out of the question,[434] then only cutaneous diseases and those affecting the bones are left us, for _ozaena_ (fetid polypus), which was regarded as incurable by the Ancient physicians,[435] cannot any more than the others be taken into account in connection with primary affections of the mouth, unless indeed we are prepared to look upon the ῥέγχειν (snorting) of the men of Tarsus as a secondary complaint of pathics.

With regard to _cutaneous affections_, we have seen how the forms of _lichen_ and _mentagra_ passed over into _psora_ and _lepra_ (§§ 23, 25), and how the conclusion to be drawn from this is plain, viz. that the secondary cutaneous forms of Venereal disease were formerly assigned as belonging to leprosy. This seems to be confirmed by a passage of _Johannes Moschus_[436] that has only just been brought under our notice, in which it is related how a monk of the Monastery of Penthula could no longer master the appeals of the flesh, travelled to Jericho to get relief from the “superfluity of his naughtiness” in a brothel in that place; how when he had entered the house, he was suddenly attacked by leprosy, whereupon he speedily returned to his Monastery. How much Venereal disease has in common with elephantiasis must be determined by later investigations. At any rate it is worth while to note its frequent occurrence in Egypt, its establishment in Italy along with the various forms of _lichen_, its infectiousness, as well as the statement of Celsus (III. 25.), who calls it an _ignotus paene in Italia morbus_ (a disease almost unknown in Italy), and that even the bones would appear to be affected by it.

Lastly, inasmuch as the tendency of the morbid process to strike outwards to the skin was conditioned by the influence of climate, while cutaneous forms of Venereal disease were amongst the most common of occurrences, it follows that not only were affections of the mucous membranes bound to fall proportionally into the background and appear with less frequency, but those of the bones as well. Still the mucous membranes _were_ sometimes attacked, and _affections of the bones_ did also undoubtedly occur, though with incomparably greater rarity,—such affections being, as is well known, at the present day of rare occurrence, and especially so in hot climates. Corrosion of the tibia is mentioned by Plutarch, and peculiar pains of the periosteum, which are so deep-seated and stable as to make the patient believe the bones themselves to be the seat of the mischief, are spoken of as early as by _Archigenes_ cited by _Galen_,[437] the latter adding that these pains were commonly known as οστοκοποι (racking the bones). If further we ought to count in this connection those forms of _exostosis_ (morbid excrescence) _of the bones of the skull_ described above in § 26, which it seems were so prevalent among the inhabitants of Cyprus as to have gained for the island according to some authorities its name of Κεραστία (horned),[438] we should actually have to hand proofs of the existence in Antiquity of _all_ the symptoms that at the present day constitute Venereal disease. All we need to do is to unite these into one general picture and give the name that is now sanctioned by custom, in order to arrive at the final result,—that _Venereal Disease_, though not recognized and described as such by the Ancient Physicians, _was as a matter of fact existent in Antiquity_.

CONCLUSION.

Having reached this general result at the conclusion of the first Part of our Investigations, we would now seem only to have to co-ordinate the various pieces of evidence thus far brought together without reference to time and place, but merely on the principle of similarity of contents, under local and temporal conditions, in order to obtain a general exposition of _the development of Venereal Disease in Antiquity_. Willing as we may be to undertake the task, and necessary as its performance is,—for it is precisely this that constitutes the History properly so called of the Disease,—still we must freely admit that for the present the fixed data indispensable for the work are too few to enable us to do more than offer suggestive hints. At the same time to supply these missing data by hypotheses that must necessarily lack all positive grounds, is not, at any rate in our opinion, consistent with the dignity and duty of a Historian.