Part 8

Nevertheless, then as now distinctions no doubt existed, and probably in Antiquity as at the present day there were districts, whose physical conditions of climate might be regarded as actually forming a counteracting factor, and where in spite of excesses the genital organs seldom became diseased. The evidence for this must be given by later investigations, for we must of necessity first possess a geographical Nosology of Venereal disease at the present day, if we are ever to succeed in finding and utilizing the materials for the same in Antiquity. What has been so far collected by the meritorious _Schnurrer_ in his Geographical Nosology is too incomplete to justify us at present in drawing any certain conclusions, more particularly as the greatest part of the material contributed by him is drawn from the communications of non-medical enquirers.

The climate of _Greece_ neither exercised any pre-eminently stimulating effect on the sexual activity of the genitals, nor yet did it afford a ground for the enhancement of their individual activity. Thus enjoying as it did in consequence of that happy combination of its seasons justly celebrated by ancient Writers[161] the advantages, without the disadvantages, of the Tropics, and its inhabitants possessing all functions in a more vigorous proportion, the climate could not possibly have been directly favourable to the rise of affections of the genitals; and for this reason made unnecessary all precautionary measures aimed at them, such as were required in Asia. _Italy_ exhibits but little analogy with the Greek climate; still it cannot certainly without considerable qualification be reckoned among factors favourable to maladies of the genital organs. From this we may at any rate partly explain why the physicians of Greece and Rome give so little satisfactory information on the diseases in question, though indeed, as we shall see presently, in this case other and quite distinct factors were at work.

§ 30.

We have now seen that Climate is _ipso facto_ an important factor favourable to the rise of affections of the genital organs. How much _more_ powerful an influence must it exert on such affections when already in existence. Thus the question, _what influence did Climate manifest in Antiquity on the character and course of affections of the genitals_, is one of the utmost moment in connection with a History of Venereal disease,—the more so as on a correct answer being given to it depends the correctness of our views as to the form taken in such cases by the morbid process in Ancient times. True such a question presupposes the existence of these affections, and ought therefore, strictly speaking, only to be raised after the conclusion of our present investigations. However we think enough evidence has already been adduced in the preceding pages to remove all possible doubt from the mind of an attentive reader as to such being the case. Besides, this appears to us the more convenient course,—to survey in its entirety the influence exerted by Climate, rather than to take up our investigation of the subject afresh in different places, and thus to a greater or less extent mangle the discussion of it.

Preponderance of the vegetative principle combined with a certain slackness of tissue is the character of all organisms coming under the influence of the climate of Southern lands. In these countries an extra-ordinary stimulus acts on the mucous membrane of the genitals, and the character described will find its expression here also. Reaction will proceed not so much from the arterial side, or show itself under the guise of sthenic inflammation, but rather take the form merely of intensified secretion. What this increased secretion aims at is the removal of the abnormal stimulus, and the flow of mucus so originating manifests itself as simple, so to speak merely catarrhal, blennorrhoea. This, where the atmosphere is not impregnated with moist vapours, readily disappears, if only somewhat greater care is bestowed on the maintenance of cleanliness,—and all the more so, as re-absorption, which in hot climates acts vigorously on all the mucous membranes generally, very soon gets the upper hand again in the case of that of the genital organs, seconded as it is by the activity of the external skin. The latter is always in a condition of enhanced action at the same time, while the extent of its surface of course markedly exceeds that of the mucous membrane of the genitals. On the other hand where the atmosphere is especially moist, the activity of the skin, as well as the process of re-absorption internally, appears to be less; and so under these circumstances the mucous flow will assume more of a chronic character, but at the same time to an even greater degree be free from inflammatory reaction.

All the more recent observations agree in one thing, viz. that in Southern countries the gonorrhoeal forms predominate, and speaking generally, almost always run a mild course that hardly calls for medical interference. There is no doubt Climatic conditions in Antiquity differed but little from those of to-day; so that we may safely assume that equally in Ancient times blennorrhoea showed the same general characteristics, a fact which existing traditions moreover prove beyond question. The frequency of blennorrhoea of the genital organs in Antiquity is shown at once by the just quoted passage from the Mosaic Books, while its mildness of character may be gathered amongst other things from the remedies employed by the old Physicians, who almost without exception followed the principle laid down by _Celsus_ (VI. 18.), to treat gonorrhoea _levibus medicamentis_ (with gentle remedial measures), if they were called upon to apply treatment at all. At least this is true of acute blennorrhoea; the chronic form of the complaint, with which alone as a general rule they had to do, of course required astringents. No doubt each failure of arterial reaction afforded yet another reason for the belief on the part of the Ancients that gonorrhoea was a result of weakness of the seed-secreting vessels, and their idea that the discharge was merely badly prepared semen. Supposing, as must have happened, that marks of increased activity appeared, these proceeded not so much from the circulatory system at all as from the nerves, and _Galen_[162] was correct in referring Priapism under these conditions to spasmodic convulsion.

So much for mucous discharge. It was the same also with the various forms of ulceration of the genitals. The conditions to be enumerated presently in the next Section were already present to counteract their rise in any considerable proportion. Further, if they did appear in the high lands of Asia and in Upper Egypt more frequently than did blennorhoea,—this much is shown plainly at any rate by present-day experience,—still they lasted but a short time, as the preponderant activity of vegetative growth, seconded by extraneous assistance, soon mastered the disease, and quickly restored again the loss of tissue. The course of events was otherwise indeed on lower levels, as in Syria and Lower Egypt, districts which besides their high temperature also showed a considerable degree of moisture in the atmosphere and soil. Here accordingly the different forms of ulceration, unless careful precautions were taken, assumed a malignant character, and readily passed over into gangrene (ἄνθραξ), as we saw a little above happened in the cases of Apion and Hero. By this means it is true every specific characteristic of the morbid alteration was annihilated; _but_ this only made the risk to the individual so much the greater, the patient being at best only too apt to lose the organ attacked

Again, though sometimes the part escaped destruction by gangrene, even then its cure was often difficult owing to the fact that, where the malady had been neglected, worms made their appearance in the ulcers[163], and set up so profuse and so far spreading a suppuration that the patient eventually succumbed to it. Of this we have an example in the Emperor Galerius Maximianus, mentioned by _Eusebius_[164], and to which allusion is made as early as in the Book of Ecclesiasticus (XIX. 2, 3.), when the Author, Jesus the son of Sirach, says: “Wine and women will make men of understanding to fall away: and he that cleaveth to harlots will become impudent. _Moths_ (_otherwise[165]—Rottenness and worms_) shall have him to heritage, and a bold man shall be taken away.” The use of knife and actual cautery must naturally have played an important part under these circumstances in the treatment adopted; but these the patient often dreaded more than the malady itself, and chose suicide rather than submit to them, like the “Municeps” whose story Pliny tells in the passage quoted in a previous chapter. But now supposing suchlike ulcers to be situated in the mouth of a _fellator_ or _cunnilingue_, then their course must have been all the more rapid, and the danger involved all the greater, if the patient lived in such a climate as described; and it was in this way the Αἰγύπτια καὶ Συριακὰ and Βουβαστικὰ ἕλκεα (Egyptian and Syrian sores, Bubastic sores) mentioned above acquired their evil repute. Still in the majority of cases these climatic influences could be counteracted by appropriate medical aid and dietetic measures, or at any rate their effect considerably reduced. Hence it was that cases of the sort only very rarely appeared in Antiquity, and for this very reason were noted by the Historians, when they did occur.

The human organism possessed in Southern lands yet another way of combating the enemy’s attacks, one which would seem to have escaped the notice of the Physicians of Antiquity, and which, though recognized in modern times, has yet never been at all adequately appreciated and utilized in the history of Venereal disease, viz. _the reaction exhibited by the skin in diseases of the genital organs in hot climates_. So long as authorities thought of the external skin as merely compacted of separate and distinct layers of tissue, there could not really be any question of an accurate knowledge of its functions whether under healthy or under morbid conditions. The investigations of _Breschet_ and _Roussel de Vauzène_[166] as confirmed and reinforced by _Gurlt_[167], have now taught us to understand that the skin, over and above these layers, possesses as a matter of fact,—a fact formerly only conjectured,—special organs belonging to the same class as the glands, to wit the skin, hair and sweat glands. These share amongst them the function hitherto ascribed to the skin generally, and especially bring into correlation the sympathies of the different parts, so much so that they may be said to be almost the sole and only seat of the manifold forms of skin-diseases. All this we endeavoured first to demonstrate in the series of Articles on Skin-diseases in “_Blasius’_ Handwörterbuch der Chirurgie und Augenheilkunde” (Manual of Surgery and Ophthalmology), and so pave the way for a compendious Survey of our knowledge of the Skin-diseases up to the present time.

Now while the sweat-glands stand in a special connection of sympathy and antagonism with the lungs, the same correlation exists in a peculiar degree between the glands of the mucous membrane of the intestinal canal and of the genital organs on the one hand and the cutaneous glands on the other which secrete the _sebum_ or sebaceous humour. It would take us too far a-field, if we undertook in this place to enter upon a detailed explanation of this circumstance, which however is still in sore need of further clearing up. We shall content ourselves with recalling the fact that Onanists (Masturbators) not only often betray themselves by having a nose with a shiny, tallowy looking surface that comes from excessive secretion of _sebum_, but also not less frequently by their face being covered with _acne_ pustulus. One more fact we must mention is that the outbreak of _acne_ very often with girls heralds the approach of each period of menstruation, and accompanies it[168]. These are signs clearly pointing to the conclusion that stimulations of the genitals are reflected back on the glands of the skin, for _acne_ is nothing else but an affection of these glands, as we have demonstrated in the Work just mentioned.

But indeed there are proofs of this antagonism still nearer to hand. How frequently have our physicians observed an eruption[169] resembling _roseola_ or _urticaria_ in character, at the—very often sudden—appearance of which the gonorrhoeal symptoms have much decreased in severity or disappeared altogether! These skin affections have been ascribed to the balsam of Copaiva or the Cubebs pepper administered in these cases, which are supposed to have stimulated the intestinal mucous membrane and so sympathetically excited the skin. This may very possibly sometimes be the case; but it could not but occur much more frequently, if the remedial agents mentioned are to bear the sole and entire blame. No doubt in some patients a particular idiosyncrasy may have given rise to sympathetic action stimulative of the intestinal canal, but in the majority the reaction of the mucous membrane of the genitals on the cutaneous glands has undoubtedly been a chief contributory factor under epidemic influences, while the drugs exhibited have played only a subordinate part in producing the result. There are cases where the gonorrhœa has been treated simply and solely by mere antiphlogistic methods, and yet such an eruption has been observed.

But it is not in gonorrhœa only that these phænomena appear; they have been noted as well in chancre, being then ascribed to the sublimate of mercury and looked upon as affording a criterion that the drug had exercised its full effect on the original complaint. In most cases this was without doubt a mistake, for Biett, Rayer and other authorities have noted the most widely divergent forms of skin-disease to appear concurrently with the existence of chancre, and in consequence have come to regard them as primitive symptoms. In fact cases have actually been observed, where these were the sole primary symptoms of contagion after indulgence in unclean coition. At the same time it is only fair to say that this has been doubted in many quarters, observers trying to explain the fact of the absence of other symptoms by saying the ulcers, which are frequently very minute, may have been overlooked. At least experience has sufficiently taught us this much, that the so-called secondary symptoms, and therefore the skin-affections as well, appear the more readily in proportion as the ulcers of the genitals are smaller and more superficial; and we ourselves believe that never without local reaction on the genital organs from coition do so-called secondary appearances arise,—only it is not invariably ulcers that are to looked for.

Now when even in our temperate climate the cutaneous glands play a not unimportant part in the morbid processes of Venereal disease, how much more must this be the case in Asia and Egypt, where the activity of the skin generally and that of the cutaneous glands in particular is even under normal conditions far more conspicuously energetic, as may be seen from the constant oily state of the skin, more particularly in Negroes. This oily grease on the skin is in fact nothing more nor less than the product of the action of the cutaneous glands. These glands are peculiarly apt to become morbidly affected in travellers visiting the South during their acclimatisation; though natives too are yearly attacked in the Summer months by complaints of the skin-glands.[170] The fact has long been recognized[171] that in Southern countries not only the greater number of skin-diseases, but even Venereal disease itself in an especial degree, appear as an exanthema of the skin, and for this reason it there displays far less destructive effects; but as a rule enquirers have contented themselves with the general habit, without (as pointed out before) adequately turning the fact to advantage in connection with the History and Theory of Venereal disease.

This preponderating bias towards the external skin must obviously manifest itself equally in other diseases of the mucous membranes, and so too in those of the genital organs. Reabsorption in particular, acting with increased vigour on the mucous surfaces, will prove its beneficial presence also in the diseases affecting them. The foreign matter that comes in contact with these surfaces is assimilated to a less degree by the mucous glands and by those of the _glans penis_, and no time is allowed it to exert a destructive influence on the small surface receiving it; on the other hand it is quickly thrown back on the much more extensive surface of the external skin, and there dealt with by the cutaneous glands with their powerful secretive and assimilatory action, being either assimilated or expelled externally.

In particular localities this quickly happens without any striking symptoms being locally perceptible in the skin, as e. g. in Numidia, Libya[172] and the Northern part of Peru[173], where the disease is said to cure itself without extraneous medical aid, and among the inhabitants generally to be practically non-existent (?). Though this is not the case in other countries, still the cutaneous glands become involved in the morbid process of the disease, and secrete with augmented copiousness, and the secretion being simultaneously altered in character, it fails to be driven out externally, inasmuch as external elimination is at once stopped owing to the fact that the cutaneous glands, like the uterus in pregnancy, close their orifice, so as to be enabled to carry out their function in their recesses. For this reason the glands swell, and manifest themselves in the form of _papillae_ or tubercles (very often as little bladders, or blebs), changing later either into pustules, if the morbid products are eventually expelled[174], or else gradually disappear, if the process of assimilation and re-absorption has been sufficiently vigorous. Supposing damp, cold or other unfavourable influences to be at work, suppuration may very well supervene, or degenerative processes commence, and so on, and _the disease pass over into leprosy and elephantiasis_. This is above all the case in Egypt, where from the first, chancres on the genitals would seem to possess a marked tendency towards scurfy and scabby formations[175].

If these are the facts at the present day,—and no one doubts they are,—there only remains the question: were they so in Ancient times as well? Here we come face to face with the difficult problem as to the relation of leprosy with Venereal disease,—a problem which for Centuries has been the subject of dispute, and in spite of the very careful enquiries of a Hensler and of other investigators, cannot by any means be regarded as solved. Our own investigations on the Leprosy of the Ancients are as yet too incomplete, and the nature of the subject demands such far-reaching inquisition into the most widely different individual phænomena, that we are compelled, in order to economise our space, to renounce all idea of submitting the subject to any more detailed examination in the present Work. Besides, in our Second Part we shall be coming back to it again, when we have under investigation the question as to whether or no the Venereal disease of the XVth Century was developed from leprosy.

For our present purpose the following statement must suffice: The Climate of Asia and Egypt was in Antiquity, as mentioned already, undoubtedly but little different from what it is to-day, and the influence it exerted therefore must have shared in this resemblance[176].

As to _mentagra_, we have already proved a little above that it was a consequence of the vice of the _cunnilingue_, and as according to Pliny’s report the latter claimed Egypt for its fatherland, obviously the climate of that country must have been in part responsible for its origination. Now affections of the genital organs being found in Antiquity as the result of sexual intercourse, it follows that in this direction also Climate must have exerted its influence, and that in the very same way as we have just above seen it do,—in other words manifold affections of the skin must have originated in consequence of irritation and other morbid effects on the genital organs. True the Ancient physicians say not a word of this; but then they derive the greater proportion of the skin-diseases, which they mass all together in the most admired confusion, from internal mischief of various sorts, and regard them all as _apostases_ (suppurative inflammations carrying off the effect of fevers, etc.),—at any rate a proof they were not entirely unacquainted with the antagonistic relations existing between the skin and other organs.

So far as the genitals are concerned, they seem to have adequately realized only the _consensus_ between the uterus and the skin[177], whereas in male subjects they appear to have put down most of the effects observed to the liver. But on these points we shall have something further to say later on. Still the assertion to the effect that Eunuchs are not attacked by _calvities_ (baldness) (_Hippocrates_, I. 400; _Galen_, XVIII. A. 40., also p. 42., where mention is made of the excesses _in Baccho et Venere_—in Wine and Love—peculiarly prevalent at his epoch), which was a frequent consequence of vice in Antiquity[178], points to the _consensus_ between genitals and skin having been already noted. Even more is the fact, vouched for by _Archigenes_[179], that castration was recommended by some Physicians as a cure for elephantiasis, such as to arouse the suspicion that the physicians of Antiquity knew perfectly well what influence affections of the genital organs exerted on diseases of the skin. This is made all the more likely by Archigenes (ch. 120.) not only speaking of the disease as being contagious, but also describing the skin-affection as secondary in character. He further declares its cause to be unknown, puts on record the extreme lubricity of the patients (Satyriasis pp. 74, 133, 269.), and even says in so many words that such as were castrated did not contract elephantiasis!

We have seen how _mentagra_ attacked the _cunnilingue_, and afterwards passed over into _psora_; in just the same way might elephantiasis,—a complaint indeed which the Gloss of the Pseudo-Galen actually puts in connection with the Morbus Phoeniceus (Phoenician Disease),—be brought on by indulgence in coition. This is in no way contradicted by the preference the disease exhibits for first making its appearance in the face, inasmuch as the cutaneous glands of the face are in a relation of special sympathy with the genital organs. That leprosy too no less than elephantiasis was communicated and contracted by coition is shown by a host of examples given in the Mediæval Historians[180]; in fact, a large number of Physicians held Venereal disease to be a species of leprosy or elephantiasis, while some made it actually originate in the act of coition with leprous persons; yet for all that we do not, according to _Hensler_, (“Vom Aussatz”,—On Leprosy, p. 396.), find it anywhere recorded that the genital organs were first affected,—apart that is from what _Astruc_ has brought forward on purpose to support his own view. As everybody knows, _he_ refers all local evils existing prior to the end of the XVth Century to Leprosy.