Induration of the testicles is mentioned by Galen,346 who assigns it as one cause of sterility. The same author347 likewise speaks of the testicles being affected with aphthae (διδύμους ἀφθῶντας), which he says should be treated with terra cimolia (Cimolian chalk) and myrtle-berries.
φθινάς, ἄνθραξ, ἔσχαρα,—robigo, cancer. (Wasting ulcer, malignant pustule, scab,—ulcerous sore, eating, suppurating ulcer).
Though we cannot exactly subscribe to Alexander Simon’s declaration to the effect that it would fill whole volumes, if we wished to cite systematically and in full all that has been said by the oldest and earlier medical Writers on ulcerous affections that attack the sexual parts from the points of view of pathology and therapeutics, still the number of such passages is no doubt sufficiently imposing. Unfortunately their contents cannot be described as equally important; for the pathological side is sacrificed to the therapeutic,—in fact the great majority give nothing more than the general names ἕλκος (ulcer) or φλεγμονὴ αἰδοίου (inflamed tumour of the privates), and then at once pass on to discuss the remedial measures expedient. This mode of procedure is indeed quite consistent with the general character of medical science in those days, for it is always the case that the more medicine declines, the more practitioners think themselves bound to look for remedial means nowhere but in the prescription-books. Curiously enough we find that almost every thing given by the later physicians already has a place in the pages of Celsus; the latter probably utilized the Alexandrian physicians, on whose knowledge the later Writers appear to have made little advance.
Now with regard to ulcers of the genitals in general,—these are of frequent occurrence, as to begin with the parts are from their very constitution prone to putrefactive changes, as well owing to their moist nature, possessing as they do so many glands that draw moisture together, and being covered with hair, as because they are at the same time excretory organs348. The time of year exerts an influence on the appearance of such ulcers, for they show themselves chiefly in the summer,349 particularly when a South wind is blowing,350 a wind that is moist and warm and fosters a tendency towards the resolution of fluid and solid parts alike. Thus ulcers of the genitals are likewise subject to epidemic influence, as has been clearly demonstrated on previous pages. They are acquired by coition, and that equally by natural coition, as the instance of Hero mentioned on a previous page shows without a shadow of doubt, as by the unnatural forms, and particularly by paederastia, which last caused the malady of Naevolus’slave also referred to in an earlier passage. Moreover in the hot regions of Asia and Africa want of cleanliness also, especially when men were uncircumcised, gave occasion, as in Apion’s case, to the establishment of ulcers of the genitals. These were looked upon by the Ancient physicians in most instances as an outcome of the evil humours of the body,—an opinion which need cause us less surprise as even in much more modern times a large number of physicians have endeavoured to explain the origin of chancres by an antecedent general infection, that manifested itself in this way, viz. by the appearance of these sores. Ulcers not unfrequently took the form of aphthae, particularly in women,351 being in that case more superficial, but for that very reason readily eating their way over adjacent parts,—(cancer, eating ulcer). In many instances inflammation (φλεγμονὴ, ἐρυσίπελας—phlegmonous inflammation, erysipelas) and swelling of the parts affected were accompanying circumstances. They were often painful,—sometimes moist, sometimes dry. In the majority of cases they assumed under favouring conditions a putrefactive character (φαγέδαινα,—phagedenic or eating ulcer), under which circumstances worms actually bred in the sores, or else they manifested from the very first a marked tendency to pass over into gangrene (ἄνθραξ, carbunculus,—malignant pustule, carbuncle), where as a rule merely an ulcer developing from a minute bladder (bleb) or φύμα existed in the first instance. On the other hand its course was often very chronic, without phlegmonous ulcers at all, or if these were present, either they were callous, or else condylomatous outgrowths sprung from them.
In accordance with these varying factors did the treatment of ulcers of the genitals vary, though without any universally recognized special distinction from that adopted for ulcers in general. Speaking generally, purgings by the rectum are not indicated; but preferably in affections of the genitals revulsory treatment by emetics is employed.352 If blood-letting is resorted to, it must be either in the hollow of the knee or at the ankle.353 As to local measures, fatty matters according to Antyllus are not good for the genitals,354 whereas astringents and desiccatives are beneficial, if that is to say the phlegmonous condition is absent.355 On the contrary if the latter is found, this must in the first place be combated, then a mixture applied consisting of sifted resin and pounded cumin, or alternatively a poultice of barley-meal, hydromel and vine-leaves reduced to a pulp, or else cumin with butter and tree-resin.356 Above all Galen357 recommended in the early stages before the appearance of an eating or phagedenic ulcer (κατὰ τῶν ἐν αἰδοίοις φλεγμονῶν ἐν ἀρχῇ, πρὶν ὑποφαίνεσθαι τινα νομώδη σηπέδονα,—in phlegmonous affections of the privates at the commencement, before any eating ulceration appear) a ceratum rosaceum (wax-salve of roses), the preparation of which he gives in extenso, and Aëtius copying from him; its activity is enhanced by the addition of a little oleum sabinum (Sabine oil). If the ulcers are complicated with swelling, a compound of white-lead (ψιμύθιον) and triturated vine-leaves is applied,358 sea-water compresses,359 or poultices of boiled lentils and pomegranate rind.360 For painful ulcers pompholyx (flowers of zinc)361 was particularly recommended, or a decoction of linseed with the addition of myrrh; also woman’s milk may be advantageously used as well,362 especially with the addition of anodynes, and above all pompholyx or flowers of zinc. Paulus Aegineta (loco citato) prescribed the application of butter and resin melted together in equal parts, or linseed ground up with myrrh and resin. In raw and dry ulcers of the genitals the aloe was very generally prescribed; it was powdered and sprinkled over the sore,363 or if a phlegmonous condition was already established, dissolved in water.364 In the second case Oribasius365 prescribed likewise the use of lead,—and indeed it was a usual recommendation with regard to most of the recognized remedies that they should be pounded and triturated in leaden mortars with leaden pestles.
Superficial ulcers of an aphthae-like character were treated as early as in Hippocrates’ time and indeed by him366 with a decoction of myrtle-berries boiled in wine. As a remedy against moist ulcers a certain mixture of Crito’s, compounded of frankincense and myrrh boiled in sweet wine, had a great reputation;367 but above all the powder of charta usta (papyrus ash), anise and cucurbita (gourd)368 was employed, after the ulcer had been washed with urine; further the cortex pinus (cork-tree), lapis haematites (bloodstone, haematite iron-ore),369 to which frankincense was added in the case of more deep-seated ulcers,370 also cadmium ustum (burnt calamine) (Paulus Aegineta); likewise washing with urine proved beneficial.371 In spreading or eating ulcers (νομῶδες ἕλκος) a poultice was applied of lentils, pomegranates and oxymel372 reduced to a pulp; but a still more usual remedy was to sprinkle verdigris over the sore,373 and especially verdigris in conjunction with a salve made of charta usta (papyrus ash), sulphur, lead-slag, honey and ceratum rosaceum (wax-salve of roses); another remedy highly thought of was the pastillus corax (corax cake), the ingredients of which were verdigris, chalk, gallnut, frankincense, turpentine, wax, oil of myrtles and beef-tallow; this was particularly beneficial in combating the carbunculous form of the disease. Very often however recourse to the cauterizing iron and the knife was unavoidable, especially if gangrene supervened, or if the callosity of the edges of the ulcer made cicatrisation impossible.
Such were the general methods of treatment employed for ulcers of the genital organs, but these naturally varied according to the various distinctions between the several sorts conditional on the situation of the sore. Thus it becomes our next business to indicate on what parts of the body ulcers were observed:—
A. Ulcers on the male Genital Organs.
It is invariably the case that forms of ulceration affecting the male genitals are the most familiar and best known, and this was equally true in Antiquity. Whatever information the Ancient physicians deemed it necessary to record on the subject is found as early as Celsus laid down with something approaching to completeness in his writings (VI. 18.).
a. Ulcers of the Prepuce.
According to Leonidas374 fissures and cracks in the prepuce frequently occurred, in all cases of the latter being too tight and being forcibly drawn back. On these supervened pain and phlegmonous inflammation; and then if a cure were not speedily effected, the edges assumed a condition of callosity, necessitating the use of the knife for its removal. However, more often than not the wound broke out again, because as was noted as early as by Hippocrates,375 wounds of the prepuce are as a rule obstinate in healing. To meet this eventuality Galen376 provides an entirely suitable procedure. While ulcers of the glans penis demand desiccative remedies, those of the prepuce rather call for epilotics,377 especially anise. Supposing the prepuce to become gangrenous, it must be cut away circularly, and the bleeding stopped by cauterization; if this treatment is not needful, a mixture of verdigris with honey, or pomegranate and vetch is applied.378 Ulcers on the inner fold of the prepuce, as also on the skin of the penis generally, are mentioned by Celsus (VI. 18.), the latter likewise by Galen.379 Such ulcers on the inner fold of the prepuce, Celsus states, not unfrequently give occasion to the setting up of phimosis and paraphimosis; and yet another consequence, a morbid growing together of glans and prepuce was observed by Oribasius (loco citato, 5.) and Paulus Aegineta (VI. 56.), for which these authors prescribe appropriate medical and surgical treatment. Under the name of cancer (eating ulcer) of the prepuce Celsus, it would seem, describes the νομὴ (spreading ulcer) of the Greek physicians, which commences by the ulcer turning black. Occasionally too the ulcers developed out of themselves morbid growths, excrescences or condylomata, particularly the form known as thymion (warty excrescence).
b. Ulcers of the Glans Penis.
These are, as pointed out by Celsus (VI. 18.), best described by taking their pathological and therapeutic aspects together; but it would serve no useful purpose to quote once more in this place the passages dealing with this part of the subject, which have been so often printed already. He makes a distinction, as does Galen,380 between dry and clean, moist and suppurative, ulcers, the latter of which readily lead to phimosis and paraphimosis. The discharge is sometimes thin and watery, sometimes purulent, and on occasion becomes evil-smelling; the ulcerations both spread superficially and penetrate inwards, and may actually destroy the glans underneath the prepuce, so that it perishes altogether. When this happens, Paulus Aegineta (VI. 57.) has a leaden pipette inserted in the orifice of the urethra, to enable the patient to pass water. In other cases the prepuce grows into one with the ulcerated glans penis (Celsus, Paulus Aegineta, Oribasius). Ulcers circa coronam glandis (round the crown of the glans penis) are mentioned by Aëtius.381
A special kind is the cancer colis (eating ulcer of the member), probably the same as the νομὴ (spreading ulcer) of the Greeks, which Aëtius382 delineates as a spreading, flaccid ulcer, which on pressure emits a thin bloody discharge, that subsequently becomes feculent. Hemorrhage is apt to supervene according to Celsus on the shedding of a cicatrix artificially produced by operation or the cauterizing iron. Another species of cancer is the φαγέδαινα (phagedenic, eating ulcer) of the Greeks, which extends rapidly and penetrates to the bladder. It appears to be identical with ἄνθραξ (malignant pustule), though Celsus mentions the carbunculus colis (carbuncle of the member) in a special category; for the description he gives, bk. V. ch. 28., of carbuncle is equally applicable to the phagedaena.383 Ἄνθραξ (malignant pustule) begins with itching, later on a pustule, or else a number of little bladders or blebs resembling millet-seeds appear, which burst in much the same way as a blister due to burning does, leaving behind an ulcus crustaceum (scab-encrusted ulcer), resembling the cicatrix of a burn; this is firmly adherent and black in colour. The surrounding tissue is likewise black and violently inflamed, the inflammation not unfrequently having an erysipelas-like character. Galen384 designates the process ἀνθράκωσις, and declares that buboes are an accompanying feature. He holds the ulcers of the genitals occurring under the special climatic conditions laid down by Hippocrates above to have been partly ἄνθραξ,385 the disease to which Hero succumbed.
Another kind of ulcer affecting the male genitals is mentioned by Pollux386 under the name of θηρίωμα (malignant sore), which Celsus (V. 28.) likewise speaks of, but without particularizing its situation. The same fact applies to ulcers of the glans penis as to those of the prepuce, viz. that many forms of morbid outgrowths arise from them; in other instances callosities on the edges of the ulcers are built up, leaving behind a callous protuberance, which the Greeks appear to have called ἥλος (a nail), the Romans clavus (a nail).387 The proper treatment to be followed in each of these special cases is given by Celsus and the Writers he cites.
B. Ulcers of the Female Genital Organs.
In this connection, as indeed in the discussion of the female genital organs generally, we once again meet with the difficulty due to the indefiniteness of the names given to the several parts. Not only do the Greeks constantly make use of the general expression αἰδοία, μόρια (privates, parts), but they likewise employ ὑστέρον and μήτρα (the womb) sometimes as meaning the vagina, sometimes the uterus, though it is true the later Writers like Galen388 designate the vagina ἡ ὑστέρα, the uterus ὁ ὑστέρος, yet without keeping consistently to the distinction. The same applies to the use in Latin of locus (place), pars (part), and vulva (womb), which last word stands for the uterus in Celsus, Pliny and most of the later Writers.
Passing over the indefinite expressions dolores (pains), inflammatio or phlegmoné (inflammation) of the genitals, although the treatment prescribed for them clearly implies that very often ulceration was concurrently present, we find the various kinds of ulcers of the female genitals most fully and systematically described by Aretaeus,389 Paulus Aegineta (III. 65-68.) and Aëtius390 following Archigenes, Soranus and Aspasia.391392
Abscesses Aëtius says (loco citato, ch. 110.) occur on the female labia; if these extend in the direction of the anus, they must not be opened with the knife, as fistulas are liable to be set up, but there is no fear of this when they extend towards the urethra. The same author (p. 109.) speaks of pustulae scabrae (scabrous, scurfy pustules) in the vagina and orifice of the womb, which throw off bran-like scales, as also (ch. 108.) of tubercula miliaria (miliary tubercles) in the same localities. These may no doubt be recognized by touch, but are better diagnosed by means of the uterine speculum, or Dioptra, and ex coitus affrictu (in consequence of friction in coition) interfere with menstruation and conception. Obviously what is here pointed to is the swollen mucous glands, which in our modern practice likewise are frequently observed in gonorrhœal cases. Often the ulcers take a form characterized by fissures (ῥαγάδες, fissurae,—fissures, rimae,—cracks), particularly at the orifice of the uterus.393 Sometimes they become callous, at others give rise to morbid outgrowths; as a rule the discharge is a thin watery juice, and pain is felt during coition.394
Ulcers strictly so called, says Aretaeus, are either superficial, in fact rather excoriations than ulcers, and far-spreading; they itch as though salt had been sprinkled on the surface, give off a small quantity of thick pus, free from smell, and are not malignant. To this class probably belong the aphthae-like ulcers of Hippocrates.395 In other cases they are more deep-seated; being then painful, discharging an evil-smelling pus, and having a less mild character than the former, but still not such as to be described as malignant. If they penetrate yet deeper, the edges then become rough, the discharge takes the form of a malodorous juice, while the pain is more severe than in the other kinds. The actual tissue of the womb is partially destroyed in the latter case, while morbid outgrowths form, which make cicatrization extremely difficult. This last kind was known also as phagedaena, (eating ulcer); it is dangerous, especially if the pain increases and the patient falls into low spirits. An offensive juice is discharged, so foul that the patient herself is hard put to bear it; the ulcer is highly intolerant of being touched for the application of remedial means; it may end fatally, and is known under the name of “Crab-ulcer”. Νομὴ (spreading ulcer),396 carbuncle and sordida ulcera (foul ulcers) of the uterus are mentioned by Aëtius (loco citato), who shows the mode of investigating them by means of the uterine speculum and a treatment consisting mainly of injections397 and pessaries prepared of a number of different remedies. Not unfrequently unskilful treatment of ulcers of the vagina occasioned morbid outgrowths, which according to Celsus’ teaching,398 must be removed by surgical means. Lastly the fact that ulcers of the genital organs of women were prejudicial to men who consummated coition with them and were for that reason dreaded by them, is clearly implied in the narrative of Cedrenus.399
We have already seen how fissures and ulcers of the fundament were a not unusual consequence of the vice of the pathic, yet not the faintest indication of the fact is to be found in the medical Writers. The knowledge possessed by the Ancients as to affections of the fundament have been collected with a very considerable degree of completeness by Aëtius,400 especially as copying Galen; the remaining authorities treat them as a rule in conjunction with the corresponding affections of the genitals, and mostly recommend the same remedies for them. So far therefore as they are concerned we refer back to the information given in connection with the latter. At the same time the remark may be permitted that this juxtaposition of the two seems to point to the Ancients having held, as we maintain they did, the view that affections of the genitals and affections of the anus arose from like causes and were of like character, as is shown by their dealing with the one and the other class of diseases on the same general lines.
Ardentes dolores (burning pains)401 and pruritus (itching)402 of the anus are not uncommon. Inflammations403 often supervene as a consequence of fissures, morbid growths and ulcers. Rhagades (cracks) and fissures404 are found either in the sphincter muscle or in the rectum, and are an accompaniment of condylomata, whenever the latter become inflamed and spread, causing the surrounding tissue to rupture; the edges frequently assume a callous condition, and then require to be broken down and thus transformed into a simple ulcer. Often abscesses are set up405 as a result of the inflammation, and these are liable to lead to fistulas. The ulcers406 on occasion assume the character of the νομὴ φαγέδαινα (eating and spreading ulcer). Supposing them situated on the sphincter ani, they must neither be cut nor cauterized, as severance of the muscle makes it impossible for the patient to retain the faeces. This loss of retentive power may also occur apart from any operation, if the νομη (spreading ulcer) destroy the muscle. Supposing on the contrary the νομὴ to be below the sphincter, knife or cauterizing iron may either of them be employed. In some instances ulcers lead to a morbid growth at the orificium ani, that must be obviated by means of pipettes of lead.407 In other cases rhagades (cracks) and ulcers lead eventually to morbid outgrowths.
Bubo, panus (swelling resembling the thread wound on bobbin of a shuttle), paniculus (diminutive of same), inguen (swelling in the groin).
Under the name of bubo the ancient Physicians understood any form of inflammation of the lymphatic glands. Now such inflammation occurs above all other places in the inguinal region, and thus inflammation of the inguinal glands came to be especially indicated by the word, as well as the inguinal region itself. Similarly the Romans used inguen (the groin) both for the region and for the disease. Subsequently many distinctions were drawn; a phlegmonous affection combined with swelling was called a βουβὼν (bubo), while the name φῦμα (swelling) was appropriated to a swelling of the glands characterized by its rapid establishment and its tendency to suppuration (bubo with suppurative pustule in the centre), and φύγεθλον (burning swelling) to one conjoined with (cutaneous) inflammation of an erysipelas character,408 which last form, if it passes on into induration, is known as χοιρὰς or struma (scrofulous or strumous swelling). The best exposition from the points of view equally of pathology and therapeutics is found in Galen.409 The glands in virtue of their spongy structure are peculiarly liable to take up rheums or fluxes of all descriptions; accordingly the glands of the groin, armpits and neck swell, directly ulcers are set up in the toes, fingers or head. The body being overloaded with evil humours is another reason for the establishment of buboes, and in this case they are more difficult to cure. Further, Hippocrates410 derived buboes in women from interrupted menstruation, and maintains411 that the most part owe their origin to some affection of the liver.
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 Papyriensis414 the wearing of a stag’s genitals was considered a prophylactic against buboes.
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 Hippocrates416 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’ authority419 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.
Aetius420 mentions pustulae spontaneae in pudendis (pustules spontaneously set up on the privates), provoking phimosis, and describes421 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 condyloma422 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 Galen423 an ulcerative tubercle secreting moisture,—the varus (blotchy eruption) on the contrary being dry, according to Oribasius424 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 Hippocrates426 under the name of κιων (pillar, pillar-like excrescence) and said to be evil-smelling. Aspasia427 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,428429 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.
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 Celsus430 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.
Ἀκροχορδὸν432 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 especially433 a very fashionable treatment and is described by him as a new discovery made at Rome.
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 Moschus436 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.