THIRD SECTION.
Relation of the Physician to Diseases
consequent upon the Use or Misuse
of the Genital Organs.
§ 38.
In the preceding Sections we have become acquainted with the various influences capable of favouring or counteracting the rise of diseases consequent upon the use or misuse of the genitals in Antiquity. At the same time we have shown how a multitude of affections of the most different kinds attacked, as a result of the unnatural gratification of sexual desire, those parts which under these circumstances had to undertake the rôle of the genital organs of the one or the other sex. Thirdly we have brought forward in the course of the enquiry at any rate some examples, proving beyond a doubt that the sexual parts themselves too under favourable external conditions sometimes became diseased as the consequence of indulgence in sexual intercourse. Still these results were for the most part based on the evidence of non-medical Writers, for of set purpose we abstained as much as possible from calling the professional Writers into Court on these points, so as to be able to treat in their proper mutual connexion whatever statements these latter have left us as to the maladies in question. This course appeared to us all the more necessary, as it is precisely the medical evidence which the opponents of the existence of Venereal disease in Antiquity believe themselves able to utilize in justification of their opinions.
But before we proceed to the detailed examination of the actual statements, it would seem expedient to get an answer to the following question: whether indeed the Physicians of Antiquity generally were in a position to acquire an adequate knowledge of the bodily consequences of vicious living? In fact on the correct answer to this question obviously depends the correct appreciation of the medical Writings as sources for the History of Venereal disease. Only under the condition that this question may be answered in the affirmative, can the evidence supplied by the Physicians be regarded as satisfactory for their own period. That it cannot of course be so for all periods, has been pointed out already in our examination of the authorities for Antiquity generally. Indeed for long periods of time Physicians had no special locus standi, inasmuch as each individual in the case of the most usual maladies endeavoured to help himself, and if the family recipes left him stranded, then betook himself with prayers for assistance to the Gods and their intermediaries on earth, the Priests. This still continued, even after the Physicians had won their recognition as a special profession, and we find accordingly throughout Antiquity popular, sacerdotal, and professional or medical medicine, if we may be allowed the expression, continuing to exist simultaneously side by side, and not a trace anywhere of the ridiculous limitation according to which no man has a right to be well without the help of a doctor.
Now having made it clear by what we have said, that in order to gain knowledge of a disease in Antiquity it is by no means enough to go to the Physicians only, even when such existed, that the latter should never be regarded as sole possessors of whatever was known from the point of view of pathology and therapeutics, we are bound to apply the same rule in the case of diseases consequent upon vicious habits. Of this the foregoing Sections contain amply sufficient proofs. It has there been shown how the genital organs were under the protection of special deities. Diseases affecting them were ascribed to the vengeance of the said deities, as at Athens to Dionysus, at Lampsacus to Priapus. To them sufferers had recourse to win by their prayers the removal of the divine anger, as well as its consequences; and all this happened not only in times when Physicians did not as yet exist, but no less when they did and in defiance of them, as the poems of the Priapeia sufficiently prove.270 How long these ideas lived on is shown by the pictures Philo (p. 315) and Palladius (p. 318) draw of their times, while the XVth. and XVIth. Centuries reproduced the same scenes.
The most obvious reason for this no doubt was the enigma presented by the origin of diseases of the genitals, particularly for any one unacquainted with the existence of contagions and their modes of activity. The man who with a healthy penis had accomplished coition, observed some days afterwards, though without resenting the fact, a mucous discharge to have been set up, or an ulcer, pustule, or what not, to have appeared. The cause of these affections he sought for in vain, for of course the mere act of coition was the very last thing he was likely to regard as such. Rather accustomed, wherever the cause of any phænomenon was unknown to him, to ascribe it to the intervention of the deity, he saw in his complaint likewise the Θεῖον (divine) as eventual cause. Naturally therefore it was divine assistance, and not human, that would avail to relieve him of his pain. Long after this time moreover, when men had ceased to refer all diseases to the vengeance of the gods, and now discovered natural causes for maladies of the genitals, as for other diseases, anything rather than just the act of coition was looked upon as cause of the observed effects, as indeed is the case to this day among the Turks,271 and as the earliest Writers on Venereal disease abundantly show to have been so in their time. That the Physicians were no exceptions to this rule, we shall show on a later page.
A much more weighty reason however why the patient attacked by some affection of the genitals turned not to men (Physicians) for help, but to the Gods, and the Priests who represented them, was the feeling of shame. Since first Adam and Eve had recourse to the fig-leaf, it has ever been a habit among all peoples of the ancient as of the modern world to withdraw the procreative parts from the view of others by covering them. But above all did the Ancients regard the exposure of these parts272 one of the severest trials to which modesty could be exposed; and rightly enough therefore designate them by the name of pudenda, αἰδοῖα, the parts of shame. Neither the wide extension of Phallic worship, nor yet the compulsory exposure of the Ephebi273 and the naked exercises of maidens and youths at Sparta274, can fairly be cited in this connexion as proofs to the contrary.
In our own day the most accomplished voluptuaries are in no wise shocked at undertaking in secret the most shameful doings, but yet when it comes to showing the Physician the diseased instruments of their bestial lusts, often put this off so long as to run great risks of entirely losing the signs of their manhood; and without a doubt it was the same at the period when habitual depravity had reached its culminating point of enormity. Even Priapus himself asks (Carm. 3):
(Nor let it be laid as a crime against me, that my member is ever covered up.) If with this is compared the poem from the Priapeia quoted on p. 74 of Vol. I., no one can fail to agree with us when we say that the field of observation open to Physicians in Antiquity with regard to diseases of the genitals can never have been at all extended. Even the Priests, at any rate in later times, were only resorted to in the more serious instances; but even so their journals of cases, supposing them ever to have kept such, would have been a far better source of information than those of the Physicians. We find a confirmation of this in the Mosaic Books of the Law, which contain the earliest and clearest delineations we possess of affections of the genital organs both in men and women.
But if men were so reluctant, how much more so must women have been, who were universally held to have committed a crime if they had given any part of their body to the eyes of a stranger. Just as the assistance of the Physician was disdained in childbirth, and to account for the fact the fable of Agnodicé invented, in the same way in complaints of the genitals women hesitated to submit themselves to the inquisition of the Physician. But seeing the female sexual organs are pre-eminently the home and breeding place of Venereal disease, this closed what was precisely the most direct way to a correct understanding of maladies of the genitals. The ancient Physicians, like our own forefathers, could at best make leucorrhœa the universal scape-goat; and accordingly even Galen, as we shall find presently, laid no stress on the circumstance, and drew no inference from it, that wherever men were attacked by gonorrhœa, the women with whom they had had coition likewise suffered from the complaint.
Further, to this general sense of shame was added a certain timidity before the professional status of real Physicians as a class, as well as the pretty universally prevalent idea of the ignominiousness of a sickness brought on by a person’s own fault, at any rate among the educated part of the population. This comes out in the following passage of Plato,275 where he says: “Does it appear to you disgraceful to stand in need of medical help, when it is not wounds at all or such sicknesses as depend on the seasons that have befallen, but when a man through indolence and a way of life such as we have noted (i.e. a very luxurious one), is filled full of fluxes and accumulations of wind like a sea, giving occasion to the noble sons of Asclepius to designate these complaints by the names of superfetations and catarrhs?” This was more than a mere expression of individual opinion; there is no doubt affections of the genital organs, more especially if their relation to sexual intercourse was known, belonged to the class of diseases held to be most disgraceful,276 and the Poet is justified in saying:
(To the lawful gods, deities too exalted for me, such for instance as Phoebus, and Phoebus’son, I feared to entrust my member for cure.) Thus it was not to the “noble sons of Asclepius”, in other words the Physicians, who treated freemen only, that patients resorted for help, but to the gods, or else to the medical underlings (ὑπηρέται τῶν ἰατρῶν,—subordinate assistants of the physicians), to the slave-doctors and quacks, who plied their trade in the doctor’s shops,—establishments where, as we have seen above, paederasts and pathics foregathered. Exactly the same state of things prevailed down to the middle of the last Century; and to this day a majority of such sufferers rarely as a matter of fact come under any other hands.
The knowledge and observations of these Cullers of simples and Compounders of balsams, if indeed as a rule they really possessed the former, or knew how to make the latter, necessarily perished on their decease, or at best were passed on by tradition to their successors in the doctor’s shops, without professional Physicians or medical Science being one whit advantaged. To such men it was a matter of perfect indifference what was the origin of the disease for which they sold their powders and decoctions, for as Plato (De legg. IV. 720) says, they paid no attention to the existing conditions of disease, and did not care to give a thought to any such thing. But at any rate,—and this was the chief point,—the patient was spared a humiliating confession, and was glad enough to buy the privilege even at the cost of possible ruin to his health. We must further remember that the “filles de joie” in Greece and at Rome were mostly slave-women, who from the very fact of their status could make no claim to treatment by free-born physicians, and that during the flourishing period of Greek medicine under the Hippocratic school it was chiefly persons of the lowest station or else sailors and foreign traders and the like who sought enjoyment in the arms of prostitutes. Such men by their constant change of abode made all continued observation a simple impossibility, so that the very imperfect knowledge possessed by the scientifically trained Physicians with regard to diseases of the genitals and their consequences need occasion little surprise.
It is true of course that at the period of universal degradation of morals Physicians must have found no lack of opportunities for observation; but the great majority of them were incapable of utilizing these, actually blocked the way of set purpose, as we shall see presently, that led in the direction of more accurate investigation, or else troubled their heads little about the cultivation of Science or the systematic record of observations. The latter, if they had published them, whether in writing or orally, could only have been detrimental, particularly in the case of physicians of the character of Charidemus’ medical attendant,277 to their own interests. In fact they were bound to call all their subtlety into play for the express purpose of concealing the true cause of diseases of this type, a circumstance which no doubt we have to thank for a large number of the extravagant and often more than ludicrous statements regarding the origin of Venereal disease in the XVth. and XVIth. Centuries.
But as a matter of fact the public itself was no less careful to guard the secret, as we gather from Martial,278 as well as from the fact that Galen felt himself constrained even in his day to compose a special Treatise on dissimulated diseases. This sort of intentional deception on the part of patients was so much the easier, as Physicians in those times, as said above, in virtue of their pathological views,—some of which indeed may very well have originated in this way,—were little accessible to the truth. For these reasons they deserved, at any rate to some degree, the satiric lash of Martial; and were very generally ridiculed by the more discerning of the laity. This comes out in the important words of Appuleius (Metamorph. X. 211.) as follows: “Crederes et illam fluctuare tantum vaporibus febrium: nisi quod et flebat: Heu medicorum ignavae mentes! Quid venae pulsus, quid caloris intemperantia, quid fatigatus anhelitus et utrimque secus iactatae crebriter laterum mutuae vicissitudines? Dii boni! Quam facilis, licet non artifici medico, cuivis tamen docto venereae cupidinis comprehensio, cum videas aliquem sine corporis calore flagrantem.” (Could you imagine her so tempest-tossed by the vapours of mere fever,—not to mention that she kept forever crying: “Oh! the sorry wits of doctors!” What means the throbbing vein, the excessive temperature, the labouring breath, and the hurried interchange of heaving flank, panting now on one side now on the other? Great heavens! how easy the diagnosis, not of course for a medical expert, but for any one learned in the symptoms of love, when you see a person burning, yet without bodily fever-heat).
But does all this justify us in casting a stone at our medical colleagues of Ancient times? For the last three hundred years we imagine ourselves clearly acquainted with Venereal disease and all its forms; yet how many a bubo has been mistaken for a strangulated hernia, anal callosity, or the like, how many a case of vaginal gonorrhœa for simple fluor albus (white discharge, leucorrhœa), how many a condyloma on the posteriors for hæmorrhoidal swellings, and accordingly not treated as the physician in Juvenal, medico ridente (the physician grinning the while), treated them,—that is duly cut away or ligatured?
Lastly to all these reasons was added further the mildness and absence of danger characterizing the disease itself, at any rate in the majority of instances,—as proved in our earlier investigations. To our own day genuine amateurs of Love, thanks to those who supply “advice, direction and information” on these subjects, endeavour as a rule, at any rate in the earlier stages, to cure without assistance the wounds received in the fight. This was equally so in Antiquity, as the following significant passage of Galen279 shows: “This is pretty well all I have to say at present as to ephemeral fevers. For patients who have contracted fever consequent upon a bubo, do not consult physicians as to what they must do; but after first treating the ulcer which occasioned the bubo and then the bubo itself, bathe after the abatement of the severity of the attack. After that if any one says a word as to the “diatriton” (fast till the third day), all laugh and declare him a precisian: I suppose because they are of the opinion that nothing must be resigned to nature that is not invariably there.”
We know quite well that the Ancients called all glandular swellings buboes, and that they were perfectly well acquainted280 with those glandular swellings in the arm-pits and the groin which follow upon ulcers of the fingers and toes; but this in no way justifies us in referring the above passage, which is certainly written in a general sense, solely to suchlike buboes and not equally to those in the soft tissues; more particularly as Galen, in the place where he is dealing expressly with the treatment of buboes and the phlegmonous affections preceding them and occasioning ulcers (loco citato p. 881), explicitly mentions phlegmonous symptoms as κατὰ αἰδοῖον (affecting the privates) and γυναικὶ κατὰ μήτραν ἢ αἰδοῖον (in women affecting womb and privates),—loco citato p. 893. Hence we think ourselves justified in drawing attention to the passage as containing an indication of the reason why ulcers of the genital organs pursued a milder course and admitted of an easier cure in Antiquity, because the ephemera evidently facilitated the assimilation and elimination of the contagion, this taking place either at the point primarily attacked, or else occurring because it (the ephemeral fever) led to an enhanced activity of the cutaneous glands by provoking an exanthematous eruption.
§ 39.
But for no small part of this reluctance on the part of patients the Physicians were themselves to blame. We have no wish in this place to enlarge upon the possibility of professional indiscretion in their case, though long ago the Hippocratic masters saw themselves constrained to guard their scholars against it.281 Of far greater weight was the nature of the treatment, especially that applied to ulcers of all kinds, which was excellently adapted to fill sufferers with fear and trembling. Already Hippocrates282 taught that ulcers with callous margins must be cauterized or else cut away with the knife. Galen283 declares himself even more plainly in the same sense: “But if the margins of the ulcer merely are discoloured and callous, they must be removed right to where the healthy flesh begins. Supposing this condition to have extended more widely, then the question arises,—whether we ought to cut away all the diseased tissue, or prefer a more tedious method of cure. It is natural and necessary in this case to consult the inclination of the patient; for whereas some prefer to avoid the knife and submit to a more tedious treatment, others on the contrary are ready for anything, so long as they get cured.” The same procedure was adopted with ulcers of the genitals, especially gangrenous ulcers, as is proved at once by the passage already quoted on p. 176 of Vol. II above.
The Asiatic, for whom the genital organs were an object of veneration, was no doubt horrified, as the Turk is to this day,284 at the idea of any such operation on himself; while the licentious Roman, who must have dreaded its very probable result in the entire loss of the further use and enjoyment of the parts in question,285 sought any other means for choice, preferred to have recourse to Priapus or even resorted to suicide, like the Municeps of Pliny mentioned on p. 257, before he trusted himself to the physicians who ever since the Carnifex (Butcher) Archagathus had appeared at Rome, strove to rival one another in infatuation for cautery and amputation. In any case it was only the direst necessity286 that drove the sufferer under such circumstances to the physician; while the latter had really and truly no reason for enquiring into the origin of the evil, as very often absolutely no alternative was left him but to grasp the knife or cauterizing iron. In this way medical procedure could not but have fallen into disrepute, while physicians were in most instances necessarily deprived of all opportunity of systematic observation.
Whether there were other factors as well to induce the old Physicians to apply the ordinary treatment of ulcers in general to those of the genital organs, we cannot indeed as yet for the time being determine. Certainly the conjecture is an obvious one that they may well have had an inkling of the specific nature of such ulcers, and that it was not merely the local mischief they sought to put a stop to by early application of cautery and knife. However it is only further and more careful investigations that must be allowed to decide the point,—the more so, as the general views as to the formation of ulcers held by the Ancients seem in many respects to tell against it. Thus Galen287 says: “The mode in which these (ulcers involving destruction of substance) are set up however is twofold; they arise either by removal of surrounding tissue (ἐκ περιαιρέσεως) or by eating away (ἐξ ἀναβρώσεως). How the former acts is well known. As to the eating away, if it proceed from the inward parts of the organism, it is an outcome of the evil humours; but if it arise from outside, then it is a result of the physician’s remedial measures or of fire.” From this we gather that all ulcers of the genitals, as well as others, which did not result from the action either of remedial measures or of fire, were held as being necessarily an outcome of the evil humours of the body. Further, that this view was not in any way peculiar to the time of Galen, but was a direct and necessary consequence of the further development of the pathology of “humours,” follows from the circumstance that we find the same opinion expressed by Hippocrates.288 Again Plato shared the latter author’s general doctrine of apostasis (suppurative inflammation taking off evil humours) in his “Timaeus”, where he derives from the white phlegm, striking outwards to the skin, cutaneous eruptions, rashes and the like maladies, from the acrid, salty phlegm on the other hand the fluxes of all types, bearing different names according to the different parts of the body affected.
If we do not choose to infer from this the proof of a then occurring, genuine and consistent genesis of the affections peculiar to the genitals, we are bound at any rate to admit that such a view must necessarily have debarred all thought of any specific character as belonging to ulcers of these organs,—the more so as to this very day we look in vain for any clear conception of really characteristic symptoms marking out Venereal ulcers in particular. Further, the knowledge that ulcers of the genitals were contracted through sexual intercourse, lacked entirely, so far as the ancient Physicians were concerned, the necessary confirmation and authority to induce them to make a special and distinctive class of morbid process to include them, because as a rule they paid no sort of attention to the occasioning cause, unless in virtue of its being still present and active, or else by the necessity for its elimination, it could afford some indication for therapeutic purposes. Galen brings this out best and most clearly in the following passage:289 “Moreover it will be a fitting occasion now to make it clear that not one of the causes directly occasioning the diathesis, or particular condition of body, will give any indication as to treatment; guiding signs for the purpose must rather be gathered from the complaint itself. What is to be done in any individual case depends on the immediate purpose and the nature of the part attacked, on the predominant temperament and the like facts. For to put it shortly, in no case can an indication as to what is beneficial be taken from any one of the factors that are no longer existent,—i.e. in actual operation. But as it often happens that in order to diagnose some affection that cannot be recognized either by help of ratiocination or by the senses, we are obliged to inquire into the cause that occasioned it, laymen conclude the guiding signs for remedial treatment to be taken from the same source. But this is by no means so. This may be plainly seen in those instances where the diathesis is quite well known in all its details; for whether it be ecchymosis or ulceration or erysipelas or putrescent ulcer (σηπεδὼν) or phlegmonous affection in any organ, it is perfectly useless to trace out the cause that occasioned it (αἴτιον ποίησαν), if this latter is now no longer active. On the other hand for any affection, a clear insight into which is lacking, a knowledge of the occasioning cause is useful.”
This principle was equally applied to affections of the genitals, the antecedent act of coition being regarded as affording absolutely no help in diagnosis, as we see from the passage of Galen to be next discussed. In this passage the declaration of a gonorrhœal patient to the effect that the women with whom he had connection suffered no less than himself from the malady, was entirely without influence on our author in the way of inducing him to assume and lay down a specific type of gonorrhœa. Under these circumstances it is really a matter for no surprise290 that the old Physicians in discussing affections of the genitals never allege sexual intercourse as an occasioning factor amongst others; and the conclusion drawn that such affections in Antiquity were not contracted by coition, because the ancient Writers do not definitely and in every single instance assign this as a cause, evidences really and truly merely the absence of any accurate study of their works and the knowledge of their views that is acquired as a result of such study. It is abundantly clear however that the neglect of the etiological factors referred to led eventually to their being completely overlooked; and it is no less obvious that this must needs have been a source of manifold mistakes, which degraded the physician in the eyes of the non-professional laity, very often made him ridiculous by reason of this ignorance, and brought down, as we have seen, many a cut of the satirist’s whip on his devoted shoulders. But how many of our colleagues are there not at the present day whom Venereal disease involves in the same doubts and difficulties?
However it may perhaps be suggested that, although the ancient Physicians did not feel themselves obliged to make any mention of sexual intercourse as cause of affections of the genitals, they cannot for all that have failed to notice the phænomena of infection. To say nothing of the fact that in no small proportion of instances affections of the genitals under the favouring conditions previously described did not as a matter of fact arise through infection, but actually in a sense spontaneously,291 and further that to this day we possess absolutely no criterion to distinguish such diseases arising in this way,—for it is only superficial and indolent observers that deny the possibility of such origination altogether,—apart from all this, the view which the Ancients took as a whole of the general question of infection was one in the highest degree inadequate. For this state of things, as Heyne292 long ago pointed out, the τὸ θεῖον (the divine element), or in other words the prevalent opinion that infectious diseases were an infliction of the offended deity, is mainly responsible. In these very diseases of the genitals, we have in fact seen how they were ascribed to the wrath of Dionysus and Priapus; and how long such ideas lasted, and how intimately they were interwoven with the life of the people, may be gauged by the circumstance that even the Christian Fathers themselves took every pains and used every effort to maintain them.
Now is it really in any way reasonable to expect the physicians of those times to have so completely extricated themselves from the predominant range of ideas? and have we any right to abuse them for their beliefs at the present moment, when in our own day there are to be found not a few physicians who deny absolutely the contagiousness of Venereal disease under its different forms? All the old practitioners could do was to draw attention to the fact that underlying the τὸ θεῖον there lurked some natural cause, and this view Hippocrates did actually maintain in his writings. As to the indicative signs of this cause perceptible by the senses, as to the material substance, whatever it may be, that communicates infection, into all this they could hardly be expected to initiate investigations,293 deficient as they were in every sort of aid and assistance for the task. For I ask, have we, in spite of all our researches, thus far attained to any satisfactory and certain results? Could the Anti-Contagionists ever have come forward at all, if we had been successful in demonstrating the contagion to be perceptible to the senses?
Besides all this, we actually find to the present day that in the countries in question the contagion exhibits but a low degree of virulence, and only under epidemic influence, as at the epoch of the Athenian Plague, did it assume a virulent character at all,—a fact that will be made yet clearer in our Continuation of the History of Venereal Disease. But wherever the contagion did exhibit this virulence of character, the ulcers that were set up passed over as a rule into gangrenous mortification, or else the physicians either exterminated it altogether by the actual cautery or removed it along with the part in which it had established itself. Thus any further spread of the contagion in its original form was not to be expected, as in patients of the sort there can be no doubt all desire for coition must have been destroyed.
If we now bring together the results of our discussion so far, we shall find reason to believe that, speaking generally, the ancient physicians,—that is physicians properly so called,—possessed but scanty opportunities, especially in the case of women,294 of observing with any precision the origin and course of affections of the genital organs, for it was mostly only the malignant forms of these that came under their notice, and these were of their very nature, except when epidemic conditions were at work, necessarily of infrequent occurrence. Their pathological views stood in the way of unprejudiced observation, conspicuous characteristic symptoms were as little to be found then as they are nowadays, any adequate knowledge of the material substrata of contagions was lacking to them in these as in other forms of disease, and thus they felt no direct inducement to class the primary affections of the genitals as forming a special category of disease.
Then again with regard to the secondary symptoms, the ancient practitioners in the cases treated by them made the occurrence of such all but impossible, for scalpel and cauterizing iron either entirely eradicated the contagion along with its material substratum, or else removed it with all speed before it could be reabsorbed into the system. Even when these did nevertheless appear, in some instances too great an interval of time intervened, in others the parts attacked were too remote from the spot primarily affected for it to have been possible for them to be referred to any direct inter-communication. Indeed this was made an actual impossibility in most cases, as it was just those very spots that are the usual seat of the secondary affections which were attacked primarily in consequence of the different modes of Venus illegitima (abnormal love) with such extreme frequency as to make it barely practicable for the keenest eye at a diagnosis to discover any actual distinction between the two,—and this without taking into account the circumstance that in view of the pronounced tendency conditioned by climatic causes for the morbid process to strike outwards to the external skin, mischief in the mucous membranes and bones must necessarily have fallen to a considerable extent into the background.
If circumstances put it out of the power of the ancient Physicians to unite under one whole the separate forms of Venereal disease, to look at the morbid process in its entirety, it is no less self-evident that for the same reasons they could have found no occasion to invent a special name for a thing that was simply invisible to them. Hence the conclusion drawn that, because no such special name is found, therefore Venereal disease cannot have existed, strictly speaking requires no further consideration. Still, granting for the sake of argument that they had recognized at any rate the generic difference of the primary affections, were they therefore bound to introduce a special name for them? Galen shall supply the answer. He says, mentioning295 that the old Physicians possessed no special name for depression of the skull in conjunction with fissure of the bone: “It is better to give a clear description than to fall back miserably on barbarous names, which the younger physicians have invented in great plenty.” In another place296 he finds fault with the different designations given to ulcers, and then proceeds: “If I consented to enumerate all the names, I should be running the risk of deliberately teaching what I recommend others to avoid, when I say that the true searcher after truth must needs withdraw his attention from the nomenclature that has grown up, and fix his eyes on the actual fact.”
While these expressions of opinion demonstrate the uselessness of the names, they show at the same time that no inconsiderable number of such names must no doubt have been in existence. So far as affections of the genitals are concerned, not only is this indicated by the Greek φθινὰς,—wasting disease and the Latin robigo,—ulcerous sore, not to mention the ambiguous ἄνθραξ,—carbuncle, malignant pustule, but Celsus expressly declares the fact, saying (Bk. VI ch. 18) at the beginning of his description of Diseases of the sexual parts: “Proxima sunt ea, quae ad partes obscoenas pertinent, quarum apud Graecos vocabula et tolerabilius se habent et accepta iam usu sunt, cum omni fere medicorum volumine atque sermone iactentur, apud nos foediora verba, ne consuetudine quidem aliqua verecundius loquentium commendata sunt.” (Next come such words as apply to the parts of shame, the Greek names for which are at once less offensive and are now sanctioned by usage, as they are constantly occurring in every medical book and medical discussion, whereas our native (Latin) names are coarser and are not even recommended by any custom on the part of those who speak with some regard to modesty). Celsus himself communicates but few of these words, for he wrote simul et pudorem et artis praecepta servans, (observing at once the laws of modesty and the rules of his art); while between him and the writers of the Hippocratic school medical Literature is all but a blank to us. The same is the case between Celsus and Galen; and of a period so important for our purpose as that of the licentious Emperors, likewise not a single independent medical Writer has come down to us. In fact even the Fragments of the Compiler Oribasius, lately made known to the world by Mai, contain, alas! nothing more than the headings of the Chapters most interesting to us.
In such a condition of things it is really verging on the borders of folly to hope to give a dogmatic and decisive judgement as to the knowledge of Venereal disease possessed by the Physicians of Antiquity,—the more so as the extant medical Works have never once been adequately ransacked, as Naumann only the other day proved in the case of Galen. But of a surety it is easier to maintain the Ancients knew nothing of Venereal disease, than to devote the best part of a man’s life-time to the investigation, how much the Ancients did actually know about it!
§ 40.
If we turn now from these discussions to the statements of the ancient Physicians themselves, there are two different ways in which we may regard them ourselves and present them to the reader’s eyes. Either we put down consecutively everything that has been said by one and the same Author and examine each single datum we owe to him by itself, or we bring together the data given by different writers on one and the same subject, and then compare these one with another. The first way, the one generally followed by historians of Venereal disease hitherto, gives us it is true the general results of the knowledge possessed by the several writers on the different forms of Venereal disease; but, seeing on the one hand we do not in most instances actually possess all the works of our Author, while on the other even when we do, we are not justified in looking upon his report as embodying a résumé of all the knowledge of his time, the advantages of such a way of dealing with the subject are on the whole but slight, while it has the disadvantage of rendering considerably more difficult the general survey of the information possessed by Antiquity as to Venereal disease, which nevertheless is really our immediate and capital concern, and cannot fail moreover to occasion a host of contradictions.
The second way not only relieves us from this disadvantage, but also ensures us that general Survey which is peculiarly necessary, and to the absence of which the circumstance is chiefly to be ascribed that it has been possible hitherto to convince the opponents of the antiquity of Venereal disease only in the most incomplete manner of its actual existence in those times at all, as the exposition of the contrary view, in itself incomplete, was bound in its fragmentary presentment to seem even more incomplete still. Of course, in following the second way of exposition, there is an unavoidable dislocation of the data communicated by each individual writer, but this is a thing of but little moment, more particularly as its inconvenience is minimised by our giving the passages, when quoted for the first time, in extenso, so as to have on subsequent occasions merely to refer back to them. Again the want of a clear marking of dates, a point undoubtedly of great importance in historical researches, is readily obviated by our laying down the available fixed points of our chronology in the general Survey that forms a necessary conclusion to our exposition.
No doubt Hensler and Alex. Simon had already struck out this second way of exposition; but the latter writer merely examined the data of the several Writers by themselves without making any effort to build them up into one whole. To do this was, it is true, a proceeding quite foreign to the method adopted by the Ancients, but for our own time, accustomed as we now are to demand a systematic exposition of a subject, it seems absolutely indispensible. Hensler on the other hand in his treatment of the question fixed his particular attention solely on the Middle Ages, and made it his immediate aim merely to prove that previously to the ninetieth year of the XVth Century local affections of the genital organs were already well known, and had been subjected to treatment.297
Now with regard to the actual exposition that follows, we shall refrain in it as much as possible from going into particulars, such as the text itself or the views of the Authors might seem to make obligatory, as the needful space fails us, at any rate for the present. Moreover the matter coming under review has been discussed already by many others, while as for critical elucidations, let them be as pressingly required as they may, we lack all the necessary apparatus criticus. In fact in the case of several Writers, the translation, let alone the original text, was with difficulty accessible, for which reason many a passage of those already known may perhaps have been passed by unregarded. A complete collection of all passages, including those still unknown,—for the harvest as was mentioned above has by no means been all reaped,—will certainly not be demanded by any reasonable reader from a Student of thirty, for hardly even a greybeard Enquirer surely could boast of having read all printed works of the ancient Physicians. For the rest, our present object is not at all to give an exhaustive exposition of all the ideas and observations of ancient Physicians as to affections of the genital organs; it only concerns us here to bring together what is true and directly available for our task. Under this head would certainly seem to come the following seven points:
1. Gonorrhœa (Clap).
Nimia profusio seminis,—excessive flow of seed (Celsus), γονόῤῥοια.
Gonorrhœa, the name of which is compounded of γονή (badly made semen) and ῥεῖν (to flow),298 consists in an affection of the seminal vessels, not of the private parts themselves, which merely serve as the road for the excretion of the seed.299 Two kinds of gonorrhœa must be distinguished, according as the malady is, or is not, combined with erection of the penis.300
Gonorrhœa with erection of the penis is called sometimes Satyriasis or Satyriasmus sometimes Priapism,301 and is a species of cramp,302 which however only attacks the penis, belongs to the category of the emphysemata, or inflations,303 and is conditioned by an afflux of the humours, particularly of conspissated or badly compounded humours.304 However this last phænomenon is only a symptom of that morbid lasciviousness which Paulus Aegineta entitles Priapism, while he designates the condition connected with it by the name of Satyriasis, this having its origin in an inflammatory affection of the seminal vessels.305 No proof is needed that both these views are right so far as this, that gonorrhœa is both spasmodic and inflammatory, and in either case may be accompanied by priapism. Nothing, or only very little, is evacuated of a nature to make the patients experience relief; and if there is, they are again attacked by the evil, until the original cause of the erection is eliminated, on which the penis relaxes of itself and subsides.306 According to Paulus Aegineta paresis of the spermatic vessels,—the second form of gonorrhœa,307—supervenes, if the disease is not relieved, or else general spasms. Patients attacked by such spasms succumb rapidly, suffering from cold sweats and tympanitic distension of the abdomen. Alexander of Tralles (IX. 10) saw the erection even continue after the death of the patient. This form is not a common one; it occurs pre-eminently among young people,308 and according to Themison’s observations, who frequently saw the complaint in Crete, where however it was probably very often a result of pederastia, is subject to epidemic influence.
The treatment of this form of gonorrhœa demands according to Paulus Aegineta (loco citato) immediate general blood-letting,—this Galen309 also recommends, and practised with advantage,—local cupping or leeching, simple clysters, cooling and composing embrocations and poultices of solanum (nightshade) or cicuta (hemlock) in the lumbar region, of litharge, Cimolian earth, psymithium (white-lead) with vinegar, water or sweet wine, on the perineum. Internal remedies are a decoction of mallows, mercury and birch-bark, sap of rue, decoction from the root of the iris, nymphaea (water-lily) and adianthum (maidenhair). Diuretics are injurious. Patients should at the same time be put upon a low, vegetable diet, and the supine posture avoided. Galen (loco citato) recommended in addition emetics, but not purgatives, also embrocations of ceratum rosaceum, friction and subsequently gymnastic exercises. Alexander of Tralles insists particularly on the patient avoiding310 all wanton scenes and thoughts, and forbids the use of any cold, specially astringent things, whereby the resolution of the contraction is made more difficult (πάθος δυσδιαφόρητον γενέσθαι,—the affection is rendered hard to be resolved).
Gonorrhœa without erection of the penis, that is to say gonorrhœa proper, exhibits a persistent, involuntary discharge of the seed,311 has some analogy with incontinentia urinae, and usually depends like the latter on weakness or failure in the retentive power of the spermatic vessels.312 Very often an inflammatory stage supervenes, making the complaint approximate to the first form; patients secrete copious and hot semen, which provokes them to ejaculation,—an ejaculation however that is followed by great exhaustion. If they avoid copulation, headache is established, pains in the stomach and nausea, while nocturnal pollutions cause them similar inconveniences to those they incur from coition. The ejaculation is accompanied by heat and smarting pain,—and this not solely among men but with women as well; for one of these patients, Galen writes,313 told me that not only himself, but also the women with whom he had accomplished coition, experienced during the discharge a biting, burning pain. On the contrary, according to Aretaeus,314 it would seem the only symptoms found in conjunction with the complaint are itching of the privates, a voluptuous feeling and a violent inclination to sexual intercourse. This datum admits of ready explanation if we consider the fact that in southern countries the inflammatory stage that makes its appearance is very brief and as a rule hardly noticeable, provided,—though no doubt this condition was pretty often broken,—coition was not indulged in during its course.
As a matter of fact in the great majority of instances the Physician had only the chronic form to treat. Generally speaking a patient first notices the complaint, when the discharge begins; and then the latter, when once the inflammatory stage is over, proceeds day and night undisturbed and without special voluptuous feeling, without wanton dreams,315 often without any particular sensation at all. The actual discharge is a thin, cold, pale, sterile flux. Towards the end of the illness it becomes thicker, assumes an acrid quality, and eventually ceases altogether to flow.316 But if the malady persists, especially in young people, then according to Aretaeus, the whole visage of the sufferers assumes a greyish look; they grow sluggish, atonic, spiritless, faint-hearted, indolent, dull, weak, emaciated, incapable of effort, unhealthy-looking,317 pale, womanish, have no appetite, feel chilly, complain of heaviness in the limbs, are weak-loined, feeble and unfit for anything. According to Galen, the abdomen falls in, besides all the rest of the body collapsing more or less and withering; while patients become lean, of a yellowish pale complexion and hollow-eyed. In this way the complaint not unfrequently paves the road to paralysis, or else sufferers die of tabes or wasting.318 Specifically and in itself the disease is not dangerous, but it provokes various other complaints, and represents a highly disagreeable, ill-reputed affection (Aretaeus),319 that almost always follows a chronic course,320—for which reason Aretaeus and Caelius Aurelianus actually treat of it under the head of chronic diseases.
Gonorrhœal pus is infectious, as is implied by the Mosaic Laws of Purification (Leviticus Ch. XV.), and the malady is communicated by coition, as is seen from the words of Galen,—p. 428. But as early as the Fourth Century the idea was prevalent that the conjunction of the stars was not devoid of influence, as such or such a conjunction might from a man’s very birth determine that the individual was to die of gonorrhœa. This at any rate is maintained by Julius Firmicus Maternus,321 who lived in the time of Constantine the Great. The disease has to be carefully distinguished from the nocturnal pollutions,322 that are at times one of the sequelae of gonorrhœa.
The treatment is, according to Aretaeus, at the commencement that for an ordinary rheum or flux, by keeping the parts affected cool, in order to counteract the flow of the humours to them; by degrees going on to a heating and at the same time desiccating procedure, then the application of fresh wool to the part, the employment of friction, embrocations of ceratum rosaceum or oinanthinum with white wine, olive oil with melilot, marjoram, rosemary, poultices of barley-meal, saltpetre and dyll, but above all rue, with the addition of honey or, according to Celsus, vinegar; as further treatment, stimulating cataplasms, of a strength to redden the skin or even to bring out pustules on it, so as to draw off the afflux of the humours, or else as an alternative, plasters of the nature of the emplastrum viride (green plaster), of baccae lauri (laurel berries). As for internal treatment, the patient should drink decoctions of: semen lactucae (lettuce juice), cannabis (hemp), rad. orcheos (orchis root), nymphaeae (waterlily), halicacabi (bladder-wort), etc.; and take castoreum (beaver oil), or the antidotes of Symphon, Philo, or Bestinus, which are prepared from viper’s flesh. In case of very profuse discharge, the patient should be directed to drink hard red wine; if he is acrid with bile (χολωδέστερον καὶ δριμύτερον,—over-bilious and acrid), lukewarm baths are brought into requisition (Alexander of Tralles). On one point all authorities are agreed, that the main thing to depend on is diet. Both food and drink, says Celsus, must be cold, a precaution Themison also recommended in satyriasis, whereas Caelius Aurelianus denounces it. The patient must not indulge in semen-forming matters, such as cause flatulency, but take nourishing food, flesh of animals but not fish, a little light wine with it, for the constant ejaculation is weakening; he should be careful as to resting,323 lie on a cool bed, either on the right side or the left (Paulus Aegineta), not on the back (Celsus).
Where the complaint is of longer continuance, exercise in the open air and the use of cold baths is to be recommended, which latter Celsus324 it appears prefers to see resorted to, as well as cold aspersions, almost at the very commencement; a mode of treatment that is even now coming into fashion again among ourselves, as the water-cure mania makes further and further progress. Galen325 recommended, besides diet and medicine, that with a view to retarding the preparation of semen, gymnastic exercises, particularly such as bring the upper part of the body into activity, e.g. ball-playing both with great and little balls and the casting of leaden disks, be resorted to. After bathing, patients must rub and wash over the hips with desiccative ointments, oil expressed from red, coarse olives, roses or quinces, wax-salves with the juices of sempervivum (evergreen house-leek), solanum (nightshade), umbilicus Veneris (navelwort), portulaca (purslain), linseed boiled in water, etc. I once saw, he says, the Intendant of a Gymnasium Athletes lay a leaden disk on the lumbar region of an athlete as a measure against nocturnal pollution,—a means Caelius Aurelianus prescribed also for gonorrhœal patients,—and afterwards recommended the same treatment to another sufferer from these, who was thankful for the advice. Others again found lying on the agnus castus beneficial to them, as well as the taking of its juice along with rue. Violently active refrigerants in the form of ointments, prepared from poppy and atropa mandragora should not be employed, and this equally applies to sleeping on these plants when they are in bloom, for they act injuriously on the kidneys. On the other hand sleeping on roses was advantageous,—Caelius Aurelianus added to the list the leaves and flowers of vitex (agnus castus, Abraham’s balm). “Besides these I have excogitated many other specifics for patients of the sort, and found their utility confirmed in practice. For instance those afflicted with such a condition of body should pay particular attention to this. When the accumulation of semen that has to be ejaculated is at its greatest, they should during the day take a nourishing yet moderate meal, and then when they lie down to sleep accomplish sexual intercourse.326 But on the following day, after taking their fill of sleep, they should on rising chafe themselves till the skin is reddened. Next they should rub the body all over with oil; then soon after take some well-leavened, pure bread, baked in the baking-pan, and mixed with wine, after which they may then go about their customary business. Between the rubbing with oil and the meal of bread patients may go for a walk, if there is a spot convenient for the purpose in the neighbourhood, except in the colder time of the year, for at that season it is better for them to stay indoors.”
With regard to gonorrhœa in women, it is all but impossible to arrive at any accurate knowledge of what the Ancient Physicians knew concerning it. The reason of this is that the views held as to the effect of deteriorated menstrual blood and of the ῥοῦς γυναικεῖος (female discharge), by means of which the whole body was supposed to purge itself of evil humours,327 absolutely precluded the possibility of any unprejudiced observation, in precisely the same way as down to quite modern times the fluor albus (white flux, blennorrhœa) conditioned the extremely imperfect knowledge possessed by the faculty of female gonorrhœa. We purpose to leave over the inquiry into the points which differentiate the two (male and female gonorrhœa) to another opportunity; and will only note here that gonorrhœa in women, strictly so called, was by no means utterly unknown,—in fact there is no doubt whatever as to its being distinguished from the ῥοῦς γυναικεῖος (female discharge), as is shown by the passage of Galen quoted above, and still more clearly by Aretaeus,328 who speaks of γονόῤῥοια γυναικεῖα (female gonorrhœa) distinctly as ἄλλος ῥόος λευκὸς, another species of white flux. Whether perhaps this knowledge was first accumulated at the epoch of Tiberius and his fellows cannot indeed be positively determined; but certainly the word ἐλέξαμεν (we have named it) of the text of Aretaeus may very well leave room for such a conjecture, and as a matter of fact Aretaeus would appear to have lived under Domitian, and was therefore a contemporary of Martial’s!
2. Ulcers and Caruncles in the Urethra.
We have already seen from Hippocrates, Celsus and Galen that the ancient Physicians had observed the inflammation and subsequent matteration of the small mucous glands of the urethra evidenced by the symptoms of painful micturition, and seeing that mere tenesmus, as well as dysentery, are denominated ἑλκώσις (ulceration) by them, it is by no means improbable that many a urethral ulcer and many a case of gonorrhœa may have been treated under the name of ischuria (retention of urine). This is the more likely, as we learn from a passage of Celsus329, one usually misinterpreted in several respects, that the urethral discharge was explained as due to an extension of the ulcer to the spermatic cords (vasa deferentia,—seed-bringing vessels). Yet further confirmation is afforded by a passage of Actuarius,330 already cited by Simon, and our own conjecture expressed on a previous page thus justified.
Ulcers however also occurred in the urethra331 unconnected with tubercular swellings (ἀφανὲς ἕλκος,—invisible ulcer); these not unfrequently occasioned bleeding,332 and made their presence known by the accompanying pain, while synchronously small irregularly-shaped particles (ἐφελκύδες) were ejected.333 The appropriate treatment of these ulcers has been described by Paulus Aegineta (loco citato); it consisted in injections of honey and milk (Aëtius, IV. 2. 19., and Actuarius also recommended enemata morsus expertia,—clysters free from biting acridity), introduction of lotus pounded in a leaden mortar by means of a feather or a twisted piece of lint (λεπτὸν στρεπτὸν,—light material twisted,—an anticipation of the bougie?) along with a mixture of gall-apple, flowers of zinc (oxide of zinc), starch-flour and aloes smeared in equal parts with rose-sap and plantain-sap.
Not unfrequently such ulcers give rise to the establishment of caruncles in the urethra, particularly in the neighbourhood of the neck of the bladder, though they occur334 also in the ear, nose, as well as in connection with the privates and anus, in the latter case presenting the symptoms of ischuria (retention of urine), interfering as they do with the outflow of the urine. The presence of these caruncles may be diagnosed by the preceding symptoms, as also by the circumstance that the urine is evacuated by the introduction of a catheter, that this occasions pain at the seat of ulceration and breaks through the caruncle, causing the urine to pass mixed with blood and the remains of the caruncle. It is necessary to know if a thrombus (blood-clot) or calculus blocks the urethra; but as to whether we pronounce the mischief to be situated in the urethra itself and the cause of the ischuria to be there as well, this is a distinction of no practical or scientific value.335 For as a rule it was solely as being the excretory duct of the bladder that the urethra had some little attention directed to it; while any signs it exhibited were generally regarded simply as symptoms connected with the urinary bladder and the kidneys. Partial growing up, or morbid extuberance, in the urethra (συσσάρκωσις,—a growing together) following on a previous ulceration is described by Heliodorus, as given in Oribasius,336 occasioning either a narrowing of the urethral passage in one spot or its being filled up over its entire superficies with morbid outgrowths of tissue. Partial narrowing causes dysuria or strangury (difficulty of micturition), the narrowing of the whole canal by morbid outgrowths, ischuria (impossibility of micturition, retention of urine). The outgrowth must be removed by means of a small lancet. The mode of procedure is then as follows. The patient is placed on his back, the penis straight out; then with the fingers of the left hand the operator compresses it behind the spot where the growth is found, in order to prevent the blood from flowing inwards when the incision is made; next he takes the knife in the right hand, pushes the point into the urethra, divides it as far along as the base of the morbid growth, but not so as to go beyond it. This done, he proceeds to cut out the growth by means of a circular incision, and compresses the urethra between the fingers, causing the growth to spring forwards. Supposing it now projects but does not actually spring out, it is extracted by means of a mydion (boat-shaped instrument). After the removal of the growth the urethra must be protected from contact with the urine, which during the first few days is best done by applying an ipoterion, or compress,337 made of papyrus. The mode of preparing this is described in detail later on, and a sort of elastic catheter indicated. Catheters of copper and tin might also be used, or a quill taken for the purpose. The tin or lead catheters are not to be inserted till after the third day, and carry in front a projecting shield. The application of a bandage described is declared to be of great advantage. Scirrhosities of the neck of the bladder, abscesses and the like, are mentioned by Galen (loco citato) as occurring occasionally. With regard to diseases of the prostates subsequent investigations must authenticate the amount of knowledge possessed of these by the physicians of Antiquity.
Inflammation of the testicles338 is usually characterized according to Paulus Aegineta339 by pain under strong pressure by the fingers, while only a slight pressure causes no uneasiness. Redness and heat are slight externally, but the latter is perceptible deep in by an investigating finger. Sometimes fever is associated with it, and if the inflammation is not quickly combated, the pain, Celsus tells us,340 extends to the inguinal and lumbar regions, the parts swell, the spermatic cord grows thicker and at the same time indurated. Both authorities make the treatment consist at first in blood-letting at the ankle,341 and the use of soft poultices of bean-meal,342 pounded cumin, linseed, etc. to which in cases of induration is added later on a mixture of crocus and wine. In obstinate instances poultices are used of rad. cucumeris agrestis (root of the wild cucumber);343 Paulus Aegineta under these circumstances prescribes grapes, peas, cumin, brimstone, nitre and resin, made into a cataplasm with honey, besides sundry wax-salves. A considerable list of remedial agents is found enumerated in Marcellus (ch. 33.) intended to combat the tumores et dolores testiculorum (swellings and pains in the testicles); of these we will only mention the salves of mutton-suet and nitre, the sea-water compresses, the poultices of rad. cicutae (hemlock root), white of egg, frankincense and ceruse (white lead). Aretaeus344 gives us an interesting piece of information to the effect that in order to counteract neuralgia of the testicles and spermatic cord, accompanied at the same time by intestinal colic, the spermatic cord was cut out, being looked upon as the cause of the suffering. Important too is the case related by Hippocrates,345 where a patient at Athens suffered from prurigo (itch) of the whole body, but above all of the testicles and the forehead, his skin having grown thick and hard as it does in leprosy, so that nowhere could it be pulled up above the general surface.