forms of ulceration of the genitals. The conditions to be enumerated
presently in the next Section were already present to counteract their
rise in any considerable proportion. Further, if they did appear in
the high lands of Asia and in Upper Egypt more frequently than did
blennorhoea,—this much is shown plainly at any rate by present-day
experience,—still they lasted but a short time, as the preponderant
activity of vegetative growth, seconded by extraneous assistance, soon
mastered the disease, and quickly restored again the loss of tissue.
The course of events was otherwise indeed on lower levels, as in Syria
and Lower Egypt, districts which besides their high temperature also
showed a considerable degree of moisture in the atmosphere and soil.
Here accordingly the different forms of ulceration, unless careful
precautions were taken, assumed a malignant character, and readily
passed over into gangrene (ἄνθραξ), as we saw a little above happened
in the cases of Apion and Hero. By this means it is true every specific
characteristic of the morbid alteration was annihilated; _but_ this
only made the risk to the individual so much the greater, the patient
being at best only too apt to lose the organ attacked
Again, though sometimes the part escaped destruction by gangrene,
even then its cure was often difficult owing to the fact that, where
the malady had been neglected, worms made their appearance in the
ulcers[163], and set up so profuse and so far spreading a suppuration
that the patient eventually succumbed to it. Of this we have an example
in the Emperor Galerius Maximianus, mentioned by _Eusebius_[164], and
to which allusion is made as early as in the Book of Ecclesiasticus
(XIX. 2, 3.), when the Author, Jesus the son of Sirach, says: “Wine and
women will make men of understanding to fall away: and he that cleaveth
to harlots will become impudent. _Moths_ (_otherwise[165]—Rottenness
and worms_) shall have him to heritage, and a bold man shall be taken
away.” The use of knife and actual cautery must naturally have played
an important part under these circumstances in the treatment adopted;
but these the patient often dreaded more than the malady itself,
and chose suicide rather than submit to them, like the “Municeps”
whose story Pliny tells in the passage quoted in a previous chapter.
But now supposing suchlike ulcers to be situated in the mouth of a
_fellator_ or _cunnilingue_, then their course must have been all the
more rapid, and the danger involved all the greater, if the patient
lived in such a climate as described; and it was in this way the
Αἰγύπτια καὶ Συριακὰ and Βουβαστικὰ ἕλκεα (Egyptian and Syrian sores,
Bubastic sores) mentioned above acquired their evil repute. Still in
the majority of cases these climatic influences could be counteracted
by appropriate medical aid and dietetic measures, or at any rate their
effect considerably reduced. Hence it was that cases of the sort only
very rarely appeared in Antiquity, and for this very reason were noted
by the Historians, when they did occur.
The human organism possessed in Southern lands yet another way of
combating the enemy’s attacks, one which would seem to have escaped the
notice of the Physicians of Antiquity, and which, though recognized
in modern times, has yet never been at all adequately appreciated
and utilized in the history of Venereal disease, viz. _the reaction
exhibited by the skin in diseases of the genital organs in hot
climates_. So long as authorities thought of the external skin as
merely compacted of separate and distinct layers of tissue, there could
not really be any question of an accurate knowledge of its functions
whether under healthy or under morbid conditions. The investigations of
_Breschet_ and _Roussel de Vauzène_[166] as confirmed and reinforced by
_Gurlt_[167], have now taught us to understand that the skin, over and
above these layers, possesses as a matter of fact,—a fact formerly only
conjectured,—special organs belonging to the same class as the glands,
to wit the skin, hair and sweat glands. These share amongst them the
function hitherto ascribed to the skin generally, and especially
bring into correlation the sympathies of the different parts, so much
so that they may be said to be almost the sole and only seat of the
manifold forms of skin-diseases. All this we endeavoured first to
demonstrate in the series of Articles on Skin-diseases in “_Blasius’_
Handwörterbuch der Chirurgie und Augenheilkunde” (Manual of Surgery and
Ophthalmology), and so pave the way for a compendious Survey of our
knowledge of the Skin-diseases up to the present time.
Now while the sweat-glands stand in a special connection of sympathy
and antagonism with the lungs, the same correlation exists in a
peculiar degree between the glands of the mucous membrane of the
intestinal canal and of the genital organs on the one hand and the
cutaneous glands on the other which secrete the _sebum_ or sebaceous
humour. It would take us too far a-field, if we undertook in this
place to enter upon a detailed explanation of this circumstance, which
however is still in sore need of further clearing up. We shall content
ourselves with recalling the fact that Onanists (Masturbators) not only
often betray themselves by having a nose with a shiny, tallowy looking
surface that comes from excessive secretion of _sebum_, but also not
less frequently by their face being covered with _acne_ pustulus.
One more fact we must mention is that the outbreak of _acne_ very
often with girls heralds the approach of each period of menstruation,
and accompanies it[168]. These are signs clearly pointing to the
conclusion that stimulations of the genitals are reflected back on the
glands of the skin, for _acne_ is nothing else but an affection of
these glands, as we have demonstrated in the Work just mentioned.
But indeed there are proofs of this antagonism still nearer to
hand. How frequently have our physicians observed an eruption[169]
resembling _roseola_ or _urticaria_ in character, at the—very often
sudden—appearance of which the gonorrhoeal symptoms have much decreased
in severity or disappeared altogether! These skin affections have been
ascribed to the balsam of Copaiva or the Cubebs pepper administered
in these cases, which are supposed to have stimulated the intestinal
mucous membrane and so sympathetically excited the skin. This may
very possibly sometimes be the case; but it could not but occur
much more frequently, if the remedial agents mentioned are to bear
the sole and entire blame. No doubt in some patients a particular
idiosyncrasy may have given rise to sympathetic action stimulative of
the intestinal canal, but in the majority the reaction of the mucous
membrane of the genitals on the cutaneous glands has undoubtedly been
a chief contributory factor under epidemic influences, while the drugs
exhibited have played only a subordinate part in producing the result.
There are cases where the gonorrhœa has been treated simply and solely
by mere antiphlogistic methods, and yet such an eruption has been
observed.
But it is not in gonorrhœa only that these phænomena appear; they have
been noted as well in chancre, being then ascribed to the sublimate
of mercury and looked upon as affording a criterion that the drug had
exercised its full effect on the original complaint. In most cases this
was without doubt a mistake, for Biett, Rayer and other authorities
have noted the most widely divergent forms of skin-disease to appear
concurrently with the existence of chancre, and in consequence have
come to regard them as primitive symptoms. In fact cases have actually
been observed, where these were the sole primary symptoms of contagion
after indulgence in unclean coition. At the same time it is only fair
to say that this has been doubted in many quarters, observers trying to
explain the fact of the absence of other symptoms by saying the ulcers,
which are frequently very minute, may have been overlooked. At least
experience has sufficiently taught us this much, that the so-called
secondary symptoms, and therefore the skin-affections as well, appear
the more readily in proportion as the ulcers of the genitals are
smaller and more superficial; and we ourselves believe that never
without local reaction on the genital organs from coition do so-called
secondary appearances arise,—only it is not invariably ulcers that are
to looked for.
Now when even in our temperate climate the cutaneous glands play a not
unimportant part in the morbid processes of Venereal disease, how much
more must this be the case in Asia and Egypt, where the activity of
the skin generally and that of the cutaneous glands in particular is
even under normal conditions far more conspicuously energetic, as may
be seen from the constant oily state of the skin, more particularly in
Negroes. This oily grease on the skin is in fact nothing more nor less
than the product of the action of the cutaneous glands. These glands
are peculiarly apt to become morbidly affected in travellers visiting
the South during their acclimatisation; though natives too are yearly
attacked in the Summer months by complaints of the skin-glands.[170]
The fact has long been recognized[171] that in Southern countries not
only the greater number of skin-diseases, but even Venereal disease
itself in an especial degree, appear as an exanthema of the skin,
and for this reason it there displays far less destructive effects;
but as a rule enquirers have contented themselves with the general
habit, without (as pointed out before) adequately turning the fact to
advantage in connection with the History and Theory of Venereal disease.
This preponderating bias towards the external skin must obviously
manifest itself equally in other diseases of the mucous membranes, and
so too in those of the genital organs. Reabsorption in particular,
acting with increased vigour on the mucous surfaces, will prove its
beneficial presence also in the diseases affecting them. The foreign
matter that comes in contact with these surfaces is assimilated to a
less degree by the mucous glands and by those of the _glans penis_, and
no time is allowed it to exert a destructive influence on the small
surface receiving it; on the other hand it is quickly thrown back
on the much more extensive surface of the external skin, and there
dealt with by the cutaneous glands with their powerful secretive and
assimilatory action, being either assimilated or expelled externally.
In particular localities this quickly happens without any striking
symptoms being locally perceptible in the skin, as e. g. in Numidia,
Libya[172] and the Northern part of Peru[173], where the disease is
said to cure itself without extraneous medical aid, and among the
inhabitants generally to be practically non-existent (?). Though
this is not the case in other countries, still the cutaneous glands
become involved in the morbid process of the disease, and secrete
with augmented copiousness, and the secretion being simultaneously
altered in character, it fails to be driven out externally, inasmuch
as external elimination is at once stopped owing to the fact that the
cutaneous glands, like the uterus in pregnancy, close their orifice,
so as to be enabled to carry out their function in their recesses.
For this reason the glands swell, and manifest themselves in the
form of _papillae_ or tubercles (very often as little bladders, or
blebs), changing later either into pustules, if the morbid products
are eventually expelled[174], or else gradually disappear, if the
process of assimilation and re-absorption has been sufficiently
vigorous. Supposing damp, cold or other unfavourable influences to be
at work, suppuration may very well supervene, or degenerative processes
commence, and so on, and _the disease pass over into leprosy and
elephantiasis_. This is above all the case in Egypt, where from the
first, chancres on the genitals would seem to possess a marked tendency
towards scurfy and scabby formations[175].
If these are the facts at the present day,—and no one doubts they
are,—there only remains the question: were they so in Ancient times
as well? Here we come face to face with the difficult problem as to
the relation of leprosy with Venereal disease,—a problem which for
Centuries has been the subject of dispute, and in spite of the very
careful enquiries of a Hensler and of other investigators, cannot
by any means be regarded as solved. Our own investigations on the
Leprosy of the Ancients are as yet too incomplete, and the nature of
the subject demands such far-reaching inquisition into the most widely
different individual phænomena, that we are compelled, in order to
economise our space, to renounce all idea of submitting the subject
to any more detailed examination in the present Work. Besides, in our
Second Part we shall be coming back to it again, when we have under
investigation the question as to whether or no the Venereal disease of
the XVth Century was developed from leprosy.
For our present purpose the following statement must suffice:
The Climate of Asia and Egypt was in Antiquity, as mentioned
already, undoubtedly but little different from what it is to-day,
and the influence it exerted therefore must have shared in this
resemblance[176].
As to _mentagra_, we have already proved a little above that it was
a consequence of the vice of the _cunnilingue_, and as according to
Pliny’s report the latter claimed Egypt for its fatherland, obviously
the climate of that country must have been in part responsible for
its origination. Now affections of the genital organs being found in
Antiquity as the result of sexual intercourse, it follows that in this
direction also Climate must have exerted its influence, and that in
the very same way as we have just above seen it do,—in other words
manifold affections of the skin must have originated in consequence of
irritation and other morbid effects on the genital organs. True the
Ancient physicians say not a word of this; but then they derive the
greater proportion of the skin-diseases, which they mass all together
in the most admired confusion, from internal mischief of various sorts,
and regard them all as _apostases_ (suppurative inflammations carrying
off the effect of fevers, etc.),—at any rate a proof they were not
entirely unacquainted with the antagonistic relations existing between
the skin and other organs.
So far as the genitals are concerned, they seem to have adequately
realized only the _consensus_ between the uterus and the skin[177],
whereas in male subjects they appear to have put down most of the
effects observed to the liver. But on these points we shall have
something further to say later on. Still the assertion to the effect
that Eunuchs are not attacked by _calvities_ (baldness) (_Hippocrates_,
I. 400; _Galen_, XVIII. A. 40., also p. 42., where mention is made
of the excesses _in Baccho et Venere_—in Wine and Love—peculiarly
prevalent at his epoch), which was a frequent consequence of vice in
Antiquity[178], points to the _consensus_ between genitals and skin
having been already noted. Even more is the fact, vouched for by
_Archigenes_[179], that castration was recommended by some Physicians
as a cure for elephantiasis, such as to arouse the suspicion that the
physicians of Antiquity knew perfectly well what influence affections
of the genital organs exerted on diseases of the skin. This is made
all the more likely by Archigenes (ch. 120.) not only speaking of the
disease as being contagious, but also describing the skin-affection as
secondary in character. He further declares its cause to be unknown,
puts on record the extreme lubricity of the patients (Satyriasis pp.
74, 133, 269.), and even says in so many words that such as were
castrated did not contract elephantiasis!
We have seen how _mentagra_ attacked the _cunnilingue_, and afterwards
passed over into _psora_; in just the same way might elephantiasis,—a
complaint indeed which the Gloss of the Pseudo-Galen actually puts in
connection with the Morbus Phoeniceus (Phoenician Disease),—be brought
on by indulgence in coition. This is in no way contradicted by the
preference the disease exhibits for first making its appearance in the
face, inasmuch as the cutaneous glands of the face are in a relation
of special sympathy with the genital organs. That leprosy too no less
than elephantiasis was communicated and contracted by coition is shown
by a host of examples given in the Mediæval Historians[180]; in fact,
a large number of Physicians held Venereal disease to be a species of
leprosy or elephantiasis, while some made it actually originate in
the act of coition with leprous persons; yet for all that we do not,
according to _Hensler_, (“Vom Aussatz”,—On Leprosy, p. 396.), find it
anywhere recorded that the genital organs were first affected,—apart
that is from what _Astruc_ has brought forward on purpose to support
his own view. As everybody knows, _he_ refers all local evils existing
prior to the end of the XVth Century to Leprosy.
But what would follow supposing traces _were_ actually to be found
proving that what was known in Asia as leprosy did as a matter of fact
first show itself in the genitals? Before we enter upon the closer
examination of reasons for this supposition, we must quote a passage
from the Work of _Von Roeser_ already several times mentioned, a
passage equally important for the pathology of Venereal disease as for
its History. _Von Roeser_, (p. 68.) writes thus: “Primary syphilis
manifests itself _in Egypt in the very rarest cases on the prepuce
or glans of the verge_; the chancres are more commonly found on the
outer skin of the penis nearer the _mons Veneris_, or actually on
this in the hairy parts which among Egyptians and Arabs are generally
kept shaved, _or else on the scrotum_. _Pruner_[181] told me that the
occurrence of a chancre on the prepuce, which indeed is absent in
Mohammedans owing to circumcision, or on the _glans penis_ is in the
ratio of 1: 3 to chancres on the last mentioned parts, hence in that
country Astruc’s opinion that syphilitic ulcers hardly ever formed on
the exterior of the verge, is strongly contradicted,—as is no less true
amongst ourselves. That circumcision is not the sole cause of this
phænomenon is manifest from the fact that in Smyrna and Constantinople
I saw plenty of chancres on the _glans_, as well as amongst Jews at
home, though I am not going to deny that circumcision may have some
share in causing the rarity of the appearance of a chancre on the
_glans_,—but this does not in any way explain the frequency of their
appearance on the scrotum and the _mons Veneris_. A tendency to take
the exanthematic type, a tendency which makes itself known also by the
fact of _many chancres_ commonly appearing at once and _showing in a
marked degree a preference for scurfy and scabby forms_, might very
possibly afford a better explanation of the phænomenon in question.”
Now as to the supposition just expressed, this is based on a repeated
examination of a passage of the very utmost importance in the history
of leprosy, viz. Ch. XIII. of Leviticus—a chapter which has exercised
Theologians no less than Physicians for Centuries, but without our
being enabled to regard the investigations it has given rise to as in
any way concluded. However it is no intention of ours to provide in
this place a commentary on this Chapter, more particularly as we do
not possess the philological acquirements necessary for a critical
appreciation of the results so far obtained. Neither, speaking in
general terms, has anything like sufficient progress in the study of
original sources for the history of leprosy as yet been made to enable
an adequate judgement to be formed; we much prefer to limit our efforts
at present to contributing sundry observations, which stand in close
connection with our immediate object, and at the same time may afford
readers, whether scientific or philological authorities, an opportunity
of favouring us with their judgement as specialists.
The correct understanding of the whole passage appears to us to
depend in the first place on the success of the endeavour to find a
certain and definite explanation of the expression בְּעוֹר בְּשָׂרוֹ
(b’ôr b’sarô,—“skin of the flesh” in English Authorized Version).
Luther rendered this by: _on the skin of his flesh_; the Septuagint
translators give it as ἐν δέρματι χρωτὸς αὐτοῦ (in the skin of the
surface); while _de Wette_ (whose Translation of the passage generally
we hereby ask the reader to consult, space not allowing us to quote the
whole Chapter) translates it _on the skin of his body_, and understands
by the expression every part of the external skin.
Supposing this translation the correct one, it will be a hard matter to
explain how it was the hair should simultaneously have turned _white_,
a circumstance which strangely enough caused even Hensler no surprise.
Rosenmüller in his Scholia on the passage says: _Schilling_ (_De lepra
p. 7._) observat, in lepra alba pilos albescere_, (_Schilling_, On
Leprosy p. 7. notes that in white leprosy the hair grows white); but
it is only the _partes pilosae aut capillatae_ (hairy parts, parts
covered with long hair) that are here intended, and these are to be
understood as including merely the head, eye-brows, chin, armpits and
pubic region. Obviously the hair on other parts of the body cannot be
taken here into consideration, as it is specifically almost colourless,
and though it is true it may have had a stronger coloration in many
Jews, surely they did not _all_ belong to the race of Esau. Again
all writers on leprosy, when this mischief affecting the hair is in
question, speak solely of the hair of the parts named[182]. So when
_Haly Abbas_ in a passage quoted by Hensler (_Excerpta_ p. 9.), in
which he is treating of _Allopitia_ and _Tyria_ (forms of leprosy),
says, _Nonnunquam totius accidit pilis corporis_ (Sometimes this
happens to all the hair of the body), this also is to be understood
merely of the parts above named. Indeed _Hensler_ himself (Vom
Aussatz,—On Leprosy, p. 304.) assumes this when, after speaking of the
hair of the head and beard, he goes on: “But this mischief may also
attack other hairy parts of the body. _Haly Abbas_ says, (_Excerpta_
p. 9.) At times this affects also the hair of the whole body. True the
passage of _Hippocrates_, in view of the erroneous punctuation, seems
to belong more properly to what follows, still even by itself it would
be probable enough, as _the preliminary symptoms are found particularly
in the arm-pit and the groin_, and might of course extend their ravages
there, just as much as on the head.” However should anyone wish to
understand here _all_ the hairy parts of the body mentioned, and
suppose the Author to be speaking in the first instance in a general
sense, then what follows will not agree, for the hair of the head and
beard was _not_ changed into _white_, but into _yellow_ (צָהֹב), as V.
30 states. There are left therefore only the eye-brows, arm-pits and
the pubic region, to which the transformation to white can apply.
Granting these considerations to be correct, it is impossible to
understand the _b’ôr b’sarô_ as signifying the whole exterior surface
of the skin; it must imply a local limitation. But the limited area
intended can be nothing but _the genitals_, and this agrees best at
once with the facts and with the usages of Biblical phraseology. In
more than one passage, in fact, of the Old Testament _basar_, like σάρξ
(flesh) in the New, has the meaning of “sexual parts”; and even in
English the word _flesh_, particularly in ecclesiastical language, is
consecrated by custom in this sense. So Luther was perfectly justified
in the passage under discussion in translating as he did: _on the
skin of his flesh_, that is to say, of his genitals. The particular
combination of _b’ôr b’sarô_ we have not it is true been able to find
used generally in the books of the Old Testament, but we must not
therefore conclude absolutely that it is unique and peculiar to this
XIIIth. Chapter; though indeed, if such _were_ the case, it would
merely be an additional confirmation of the explanation we have given.
So far as the matter of fact goes, such an assumption offers no
difficulties,—indeed it actually removes several, as e. g. that
connected with the coloration of the skin, and not only proves that
already at that date pustules on the genitals had been observed that
were free from any suspicion of malignant character, but further that
along with a suspicious pustule or similar symptom (scurf, ulcer) there
went a simultaneous general affection of the skin as a whole, which was
held to be diagnostic for the local malady, and accordingly proclaimed
even the suspected leper free from taint after his recovery from it.
For evidently we must take verses 12 and 13 as indicating this, where
it is stated in so many words: “And if the leprosy break out (פָּרַח,
—blossom) abroad in the skin, and the leprosy cover all the skin of
him that hath the plague from his head even to his feet, as far as
appeareth to the priest; then the priest shall look: and behold, if
the leprosy have covered all his flesh, he shall pronounce him clean
that hath the plague; it is all turned white: he is clean.” (English
Revised Version). The last words have been wrongly referred by some
Interpreters to the “Bohak” (bright spot), which is mentioned in verse
39., but really nothing more than this is intended:—after the eruption
is dried up, and the skin has returned to its natural white colour,
then the hitherto sick man is to be declared clean[183].
This diagnostic eruption again points to another fact, viz. that the
leprosy must have had its seat in a part of the body, the cutaneous
glands of which stand in a relation of lively sympathy with those of
the skin generally, and this according to modern experience can only
be the cutaneous glands of the genital organs. Sometimes inoculation
with cow-pox lymph brings out a general eruption of the whole skin,
but this circumstance cannot well be made pertinent here, as really
and truly the lymph is a resultant product of a feverish affection,
and therefore its innate tendency is towards a reproduction of itself
under circumstances of feverish stimulation, and to set the whole
organism, and consequently the whole cutaneous glandular system, in a
state of enhanced activity. How the diagnostic eruption comes about
may be gathered from the statement of the case given just above; while
the passage quoted from _von Roeser’s_ Work will explain the rest.
Still for the present this much may suffice to put the expert reader
in a position to test our conjecture,—for indeed so far it makes no
profession to be more than a conjecture. Supposing it found tenable,
then the further consequences that cannot but grow from it for the
elucidation of the Chapter in discussion may be readily developed. On
the other hand, if it is devoid of justification, it would be quite
useless further to elaborate a hypothesis, plunging a subject obscure
enough without this in even deeper darkness. Further than this we
only need to mention that _Hensler_ and others hold _mentagra_ to be
indicated in the bald chin and scurfy (scall) chin of Leviticus (XIII.
29 sqq.), which if they are right would merely be another point in
favour of our view.
Finally there can hardly be any need for us to observe that we have no
idea of holding leprosy in general to be a consequence of excesses;
on the contrary we believe, to return to the problem we started with
at the beginning of this Section, that we are bound to agree to the
opinion first explicitly laid down by _Becket_[184], viz. _that under
the widely comprehensive notion of Leprosy were included other forms
of skin-diseases owing their existence to some previous affection of
the genital organs_,—in precisely the same way as this happened in the
Middle Ages, and as may be the case occasionally even at the present
day.
§ 31.
What precise influence Climate exerted on the form taken and course run
by affections of the genital organs _in Greece and Italy_, can be only
approximately laid down, as the information supplied by Physicians,
though ample in quantity, mostly leaves the point indefinite as to
where the observations were made, whether in Asia Minor and Egypt
(Alexandria), or in Greece and Italy. The last named country indeed
was, as is well known, almost entirely devoid of independent native
medical Writers.
The mild, genial sky of Greece and Italy impressed on all forms of
disease, including diseases of the genitals, a mild character. There,
on the confines of East and West, we find, it is true, the same natural
tendencies prevailing as in Asia, but always on a less exaggerated
scale. _Von Roeser_ (loco citato p. 70.) says: “In conclusion we
should note further that in Egypt gonorrhœa is a complaint of very
rare occurrence, in Greece and Turkey a very common one. That the
exanthematic character taken by syphilis is not(?) responsible for the
fact of its not manifesting itself as gonorrhœa is confirmed by the
circumstance that it occurs much more frequently in Greece than amongst
ourselves, whereas syphilis in that country has (though not in an
identical form) the exanthematic type to an even greater degree than in
our own.” _D. Hennen_[185] found Venereal disease rare in Cephalonia,
but on the contrary gonorrhœa quite common.
No doubt the tendency to determine towards the skin is clearly
noticeable in Greece as well, but not to such an extent as to outweigh
the local affection. The latter accordingly takes a more independent
form than is the case in Asia, and for this reason, though making its
appearance more frequently, neither follows so rapid a course nor
shows so destructive a character,—if only the organism is seconded to
some extent in the efforts to combat the malady. This is shown by the
statements _Galen_ has left as to gonorrhœa and ulcers occurring in
connection with bubonic swellings,—a matter we shall have occasion to
speak of later. While in Asia the skin affection is manifested by the
formation of pustules and scurf, in Greece and neighbouring countries
of the South it rather takes the shape of _papillae_ and small blisters
or blebs, and only in obstinate cases breaks out in tubercles. Hence
_lepra_, _psora_, _lichen_, and _elephantiasis_ are the forms under
which we must look for it in the medical Writers of Antiquity, who
however say nothing as to the origin of these diseases, or else,
as we have seen before, refer them all to deficiency of the moist
humours[186].
We have never yet succeeded, though we have before now expended much
time on the effort, in getting a clear grasp of the ideas the Ancient
physicians intended to express by the different designations they gave
to the various skin-diseases. So we are constrained to postpone deeper
investigation of the question to a subsequent occasion, or wait to see
whether meantime some other enquirer, better equipped for the work,
may not throw light on the chaos. Only so far as _Scabies_ (Scab) is
concerned, it would seem allowable to assume allusions to be intended
to vicious living as a cause of the malady. It cannot be without a
reason that for centuries this one above all other skin diseases seems
to have fallen under special disrepute; and the term to have been used
by poets, by _Martial_[187] for example, to indicate that sensual
indulgence had been at work. In fact, several of the earliest Writers
on Venereal disease hold it to be a sort of _scabies_, and even at a
later period there is for long frequent mention made of _Venereal scars
or scabs_. Possibly also in Greece lepra (leprosy) was looked upon as a
form of skin-disease that was come by in no reputable way, and commonly
regarded as an inheritance of the debauchees[188], just as we saw to be
the case with _mentagra_ at Rome.
Affections of the external skin consequent upon complaints of the
genital organs being thus no less common in Ancient times than they are
to-day, it follows that in inverse proportion forms of ulceration of
the palate and nose, as well as complaints affecting the bones, must
have fallen into the background and have been of more rare occurrence,
just as is observed to be the case in the present day[189]. So, to
combine all the varying forms under one generalisation, we may say that
this represents a type of disease of an exceedingly mild and favourable
character, particularly if attention is directed only to the external
symptoms, as indeed was habitually done by the old pathologists.
For even the skin-affection itself presents so little that is
characteristic, or at any rate shows itself under such varying shapes,
that even at the present day its diagnosis is extremely difficult,
being very often based solely and entirely on the admission of the
patient, whether voluntary or forced from him, of having suffered from
gonorrhœa or chancre. But if the so-called secondary symptoms are
more or less completely absent, or lack distinctness, what is there
then left beyond the primary affections of the genitals and their
succedanea? Full and sufficient descriptions of these are not lacking;
we have already quoted numerous examples, and we shall find others yet
clearer and more precise later on.
Before quitting the subject of the influence exerted by Climate, we
are bound to return once more to the question, _in what relation
did contagion_, if contagion there was, _stand to this climatic
influence?_ The existence of contagion in the case of gonorrhœa is
certified by the passage of _Galen_ already quoted by Naumann, which
we propose later on to give in full, besides being implied long before
by the law of purification of the Mosaic Books. So far as ulcerous
formations, condylomata and skin-affections such as _mentagra_ etc.,
are concerned, proof is supplied by the facts we have previously given.
According to more modern experience all forms of contagion exhibit in
Southern countries a more fugitive type than elsewhere and spread with
proportionately greater readiness. Whereas in such as are naturally
fugitive, the intensity may for that very reason be less injurious,
fixed and stable forms of contagion on the contrary must obviously
lose in strength, at any rate so far as their local effects go. They
will be the less able to make good a lodgement in the organism,
from the fact that, stimulating the latter as they do to a general
activity, they are the more readily resisted and prevented by this very
state of enhanced activity. For just as, speaking generally, chronic
complaints, uncomplicated by fever, can only be removed by artificially
setting up a feverish condition, that is to say by calling on the
organism as a whole to share in the local manifestations of disease.
Precisely the same is true of local affections set up by any fixed
and stable contagion, and so the removal of the actual contagion can
only be successfully brought about either by direct decomposition and
destruction of the affected tissue or by metamorphosis into a fugitive
form.
Now inasmuch as the contagion was rapidly thrown off from the point of
first infection upon the cutaneous glands,—and this happened the more
readily, the more fugitive its character was,—the affections there set
up by it standing in such clear relation as they did with the primary
symptoms, were necessarily bound also to exhibit a greater or less
degree of the contagious character, as indeed is observed according
to _Jos. Frank_, _Biett_ and other authorities even in Europe to the
present day. In Greece, where the transformation was less often to
pustular and scurfy forms, more frequently merely to papillae or at
worst little bladder-like risings, or blebs (Phlyctaenae), while at the
same time the energy of the skin was not so pronounced, the interval
between the appearance of the primary and secondary symptoms was
greater, and the contagiousness of the skin-affections undoubtedly less
prominent, it cost the organism in that climate much more strenuous
effort to set in action the elimination of the disease by the skin.
Consequently the nervous system as well was injuriously affected by
sympathy to a greater extent, while the exanthematic forms showed
themselves in more obvious conjunction with itch (_psora!_). This was
partially the case in Italy too, though here the climate approximated
more nearly to that of Lower Egypt, leading to a more frequent
appearance of pustulous forms, as shown by the prevalence in that
country of _mentagra_.
But just as climatic influence relaxed the intensity of contagion, and
diminished concurrently the malignancy of disease-types, local as well
as general, so on the contrary, in those cases where other influences
tended to counteract its effect, while the organism was not strong
enough to overmaster the assaults of the enemy by general or local
activity, it sought to guard against the contagion rising to a higher
degree of independence; it set up mortification of the ulcers, by which
means the contagion itself was directly destroyed. From all this it
may be concluded, that although climate must evidently be acknowledged
to be an important factor favourable to the rise of affections of the
genital organs in Antiquity as much as at the present day, yet on the
other hand it tended by its own action to combat the mischief it had
originated; and so, at any rate so far as the development of the morbid
process is concerned, is to be regarded to an almost equal degree as a
counteracting influence at the same time.
§ 32.
The experience of all ages has conclusively proved that a large
proportion of such morbid phæenomena as occur in consequence of local
climatic conditions are capable equally of being produced sooner or
later in countries and neighbourhoods the climate of which is entirely
different by help of the _genius epidemicus_; and that the readiness
with which they are so produced varies in direct ratio with the degree
in which the climate is associated with and seconds the favourable
factors. It is indeed extremely difficult, in view of the low level
of development to which the science of Epidemics, in general no less
than in particular, has as yet attained, to show this as applicable in
any given case, more especially if it is a question of the epidemic
condition of some disease of which the pathological relations
themselves are far from being as yet adequately known. Still this must
not prevent us from making at any rate an attempt at investigation of
the question, how much or how little effort has been manifested by such
influence in the course of years.
But the influence of the genius epidemicus on diseases in general
is a twofold one. _Either_ it supplies the capital, most essential
external circumstances conditioning the production of a disease,
in fact is related to it as cause to effect. In virtue of it the
disease is an _epidemic_ disease, coming into existence for the first
time concurrently with the development of the genius epidemicus,
disappearing again with the cessation of its prevalence, and once
again springing up if and when the genius epidemicus makes a second
re-appearance. _Or else_ the most essential external conditioning
circumstances are specifically independent of the genius epidemicus;
while the latter takes merely a remote share in the way of favouring or
counteracting the production of the disease, manifesting its influence
rather in modifying the form and direction of such morbid reactions as
have arisen in the organism without its intervention at all,—in other
words _the disease is subject to epidemic influence_.
Unfortunately hitherto these two kinds of influence exerted by the
genius epidemicus have been only too often confounded, and no adequate
distinction drawn between epidemic diseases on the one hand and
diseases subject to epidemic influence on the other. This has been
especially so with regard to Venereal disease, the epidemic character
of which curiously enough enquirers have felt bound to vindicate, as
well at the beginning of the XVth. Century as here and there even at
the present day. The baselessness of such an opinion is so perfectly
obvious to anyone who weighs the matter with any care, that we really
do not think it necessary to devote more pains now to proving the
point, particularly as we propose to treat it more fully in another
place. On the other hand Venereal disease _is_ subject to epidemic
influence, in fact it is so perhaps to a greater extent than many
other forms of sickness, as will be clearly shown in the course of
our historical investigations. Accordingly the only question still
wanting an answer is, how far such influence may have been effectual
in Antiquity. This question of course presupposes the existence
already of a number of diseases appearing in consequence of Venereal
excesses; still we possess sufficient proof, as previously stated
in the course of our enquiries into the influence of climate, to
justify a provisional assumption of their existence for our immediate
purpose. For openly admitting as we do our ignorance in relation to the
influence of the genius epidemicus on sexual activity generally and on
the individual activity of the genital organs in particular, and noting
the problem to be one that can only be solved in the future, there is
nothing else left us to investigate here but this, viz. _the influence
of the genius epidemicus in reference to the forms taken and course
followed by diseases occurring in consequence of Venereal excesses_.
It may be collected from later experience and observation that there
are three clearly marked forms of the genius epidemicus or _epidemic
condition_, that exercise a preponderating influence on affections
of the genitals and Venereal disease, and condition the frequency of
the occurrence of one or the other type of these, viz. _catarrhal_,
conditioning blennorrhœal affections, the _exanthematic_, conditioning
complaints of the cutaneous glands, and the _typhoïdal_, conditioning
various forms of chancre and their malignancy.
With regard to the influence of the _genius epidemicus catarrhalis_
and _exanthematicus_, it would seem to be difficult to arrive at
any definite conclusion as to what precisely this was in Asia and
the South of Europe, since the Climate was _ipso facto_, as already
shown, pre-eminently favourable to blennorrhœal and cutaneous
affections; nevertheless the rise and spread of mentagra as well as
of elephantiasis in the time of Pompey the Great does afford some
indication at any rate so far as Italy is concerned. No doubt the
Hippocratic writers several times mention the prevalence of skin
affections at particular periods; but the expressions they employ are
too general to make it possible for us to take these into special
consideration in this place. However there is one passage we must
make an exception of,—a passage of the greatest importance for our
purpose, even though in all probability it refers to the commencement
of a combined erysipelas-typhoïdal condition, to which we shall have
occasion to return again later. In it Hippocrates relates how after
a dry Summer with Southerly winds and frequent rain there followed
a mild, wet Winter, next cold and even snow-storms succeeded in the
Spring with much rain, and finally a very hot Summer again. In the
Spring began inflammatory fevers and erysipelas, and[190] “in many
cases aphthae and ulcerations formed in the mouth, many rheums occurred
in the genitals taking the form of ulcers and abscesses on the external
and internal surface of the sexual parts; also eye troubles, with
discharge, obstinate, persistent and painful; also growths, which are
called σῦκα (figs) on the inner and outer surface of the eye-lids,
causing many to lose their sight; besides they frequently occurred
on other parts liable to ulceration and particularly on the genital
organs.” In this passage the expressions ἑλκώματα, φύματα, ἔξωθεν
ἔσωθεν τὰ περὶ βουβῶνας (ulcers and abscesses on the external and
internal surface of the sexual parts) is as a rule misunderstood by
the annotators. But really ἔξωθεν (on the outside) evidently refers
to ἑλκώματα (ulcers), while ἔσωθεν (on the inside) goes with φύματα
(abscesses), and signifies a swelling and inflammation of a mucous
gland resulting in suppuration, as may be seen from the next quoted
Aphorism[191]. “Such patients as have φύματα (abscesses) in the urethra
find relief, so soon as these have suppurated and broken.” That this
relief (λύσις) consisted in the cessation of pain and of the retention
of urine may be gathered not only from Galen’s commentary on the first
passage, and from the λύεται ὁ πόνος (the suffering is relieved) in
the repetition of the same Aphorism, but Hippocrates actually says so
distinctly in a third passage[192].
Supposing the view, still generally held even in the last Century,
that regards gonorrhœa as a result of an ulcer in the urethra, to
have been already adopted in Hippocrates’ time,—and inasmuch as the
expression γονοῤῥοία, so far as we know, never occurs in his writings,
the assumption would not only not be absurd, but such a view would
really be preferable to that which makes out the discharge to be badly
made semen,—we shall find in this passage an expression of the fact of
the more common occurrence of gonorrhœa, the most troublesome symptom
of which, viz. the pain suffered during micturition (πόνος, δυσουρία,
ἰσχουρία, suffering, difficulty in micturition, retention of urine),
disappears, as is well known, concurrently with the commencement of
the discharge (πύου ῥαγέντος, φυμάτων ῥαγέντων,—when the pus has
broken out, when the abscess has broken), or if it does not entirely
disappear, is at any rate sensibly diminished. But it is not really
needful to accept this as having been the ruling opinion; the facts may
very well be accounted for by supposing that in virtue of the _epidemic
condition_ a strongly marked tendency was set up on the part of the
glandular organs to inflammatory and suppurative action, by which not
merely the glands of the external skin (ἑλκώματα ἔξωθεν),—ulcerations
on the outside, Moses’ יְהֹוָה צְבָאוֹת), but also those of the mucous
membrane of the urethra (φύματα ἔσωθεν,—abscesses on the inside) were
affected, exactly as is observed at the present day, especially in the
chronic forms of gonorrhœa.
The gonorrhœa then in this case would seem to have been of a more
malignant type and to have been combined with ulceration. This best
agrees with the general delineation of the _epidemic condition_ as
a whole, the exanthematic character of which declared itself in
the fig-like growths or tumours,—the σῦκα αἰδοίοισιν (figs on the
genitals). _Grimm_ (Vol. I. p. 490.) already remarks on this passage
of Hippocrates: “One might be tempted in this case to regard the
ulcerations of the genital parts and their consequences, the fig-like
tumours, as being the first signs of disease due to incontinence.
Indeed what was there to hinder an evil of the sort in those times
and under a warm climate from signalizing itself,—then subsequently
so far losing its malignant character that its nature was completely
misunderstood? Something of the same kind actually happens under our
own eyes in connection with this very disease.”
§ 33.
Still more important were the effects of these meteorological
conditions on ulcers of the genitals _already in existence_. We
read (loco citato p. 482.): “Even before the beginning of Spring,
concurrently with the commencement of the cold time, erysipelas made
frequent appearances sometimes with, sometimes without, visible cause;
it showed itself highly malignant in type, and carried off many. Many
again suffered from painful affections of the pharynx (anginae,—sore
throats), loss of voice (affections of the wind-pipe), inflammatory
fevers with delirium, aphthae in the mouth, φύματα (abscesses) in the
genital organs, ophthalmias, ἄνθρακες (malignant pustules), etc.—Also
many got erysipelas from external causes, at such spots as these had
happened to affect them, even after the smallest injuries[193], and
in all parts of the body. Above all sexagenarians suffered in this way
in the head, if they were treated in the smallest degree carelessly.
Even under careful and scientific treatment wide-spread phlegmonous
affections frequently occurred, while the erysipelas spread to a
serious extent and with great rapidity in all directions. In most
of the patients so affected the metamorphosis that succeeded was to
ulcerations, whilst _muscles, sinews and bones fell away to a serious
degree_. But the morbid product that collected did not resemble
ordinary matter (pus), but was a sort of putrid _sanies_, occurring
equally in combination and by itself[194]. Such as were attacked in the
head, became bald over the whole head and chin, the bones were laid
bare and fell away, and such ῥεύματα (morbid discharges) as described
occurred frequently, whether with or without fever. Symptoms of the
kind however were more terrifying than really destructive[195], for
among patients in whom these (ῥεύματα) came to maturity and resulted
in suppuration, the majority were saved; on the contrary many died
among those in whom the phlegmonous affections and the erysipelas
disappeared, without undergoing any such metamorphosis into other forms
of disease. Moreover the same thing happened to those in whose case
(the morbid product) attacked some other part of the body. For with
many of them the whole upper and fore arm fell away; while in some
patients the disease attacked the ribs, the sole difference being
whether some destruction was wrought on their anterior or posterior
aspect; in others again the whole thigh or the lower leg or the whole
foot was laid bare. _But the most dangerous of all was, when this or
the like happened in the neighbourhood of the private parts or to the
private parts themselves_, and the mischief manifested itself in the
form of ulcers, and as the result of external causes. In many patients
suchlike symptoms occurred during, before, as well as after the
fever”[196].
_Galen_, who has left us a Commentary on this passage (Vol. XVII.
A.) mentions in the first place that aphthae, φύματα (abscesses)
of the genitals, etc. specifically possessed (p. 661.) nothing of
κακοηθεία (malignity), but only when as in this case they occurred in
conjunction with a putrid general condition. “The putrid character
easily arises even without a pestilential general condition, if the
parts are attacked by phlegmonous affections or erysipelas, and spreads
likewise over the neighbouring parts lying uppermost; hence it is we
are compelled after cutting away the decayed tissues to cauterize the
place. It is no wonder then, when such a condition has arisen that
upper and fore-arm, thigh and lower leg, ribs and head are attacked,
if the private parts suffer above all others.—So far the author has
discussed those affections of a kind akin to erysipelas which associate
themselves with ulcerations or other comparatively insignificant
external cause; in what follows he speaks of such attacks as occurred
without any such occasioning cause”[197].
Now if we examine these statements, so far as they are of immediate
interest in view of our object, we may unhesitatingly conclude from
them, that in Hippocrates’ time a large number of patients suffered
from ulcers of the genitals. These it seems under the influence of the
prevailing typhoïdal conditions were assailed by inflammation of an
erysipelas-like type, rapidly passing over into humid gangrene, which
latter destroyed the parts attacked, readily extended its ravages, and
eventually killed the patient. This is an observation which _Galen_
likewise had frequent occasion to make (so probably under the head of
Influence of the Climate of Asia, pp. 318, 326, 329.), without any
exactly definite typhoïdal conditions having been prevalent[198], and
even saw himself under these circumstances very generally constrained,
in order to put a stop to the spread of the mortification, _to amputate
the gangrenous tissue, and afterwards cauterize the wound_. What was
the origin of these ulcers of the genitals is indeed not stated; but
it is certain they were not invariably conditioned by the prevailing
_genius epidemicus_. Besides, since Hippocrates several times mentions
them without giving the cause that produced them, it is a more likely
conjecture to suppose that this cause was one universally familiar (it
consisted in an act of unclean intercourse with women), than to assume
it to have been _absolutely unknown_ to physicians generally[199].
Again the result of this investigation is of still more especial
interest in so far as it enables us to properly appreciate
Thucydides’ notice of the so-called _Plague of Athens_.[200] This has
been discussed by very many writers, and has given occasion to the
most widely different explanations. He relates as follows: “For the
disease which at first had its stronghold in the head, beginning from
above downwards traversed by degrees the whole body; and even supposing
a patient to have escaped the worst, yet a seizure of the extremities
put its mark upon him. For it attacked the genitals and the extremities
of the hands and feet; and many escaped death, but with the loss of
these parts.” Even more clearly does the poet _Lucretius_[201] paint
the disease, when he says:
Profluvium porro qui tetri sanguinis acre
Exierat; tamen in nervos huic morbus et artus
Ibat et _in partes genitales corporis ipsas_,
Et graviter partim metuentes limina leti
_Vivebant ferro privati virili_.
(Then too if any one had escaped the acrid discharge of noisome blood,
the disease would yet pass into his sinews and joints and onward even
_into the sexual organs of the body_; and some from excessive dread of
the gates of death _would live bereaved of these parts by the knife_.
Munro’s translation).
Though we really are concerned only with the last words of Thucydides,
so far as they relate to the genitals, yet what precedes has given
occasion to such extraordinary interpretations that we feel bound to
devote some attention to this as well. The whole passage proved itself
an especial _stone of stumbling_ to those writers who endeavoured to
identify the Athenian plague with _scarlet-fever_, as _Malfatti_ did,
or with _small-pox_, like _Scuderi_ and _Kraus_. In fact this is why
the last named says as he does[202]: “The loss of the private parts
and the extremities (στερισκόμενοι τούτων,—being deprived of these,
with the loss of these) would certainly seem to point merely to the
loss of the _free use_ of these parts, in consequence of ulcerations,
swellings of the joints, lesions and contractions, for the entire
members are not likely to have been destroyed by mortification or
amputated by the surgeon? Indeed it is only in deference to the verses
of Lucretius that the latter opinion has become the one generally held;
but even Ancient commentators[203] have felt that the Roman poet may
very possibly have mistaken Thucydides’ meaning. Moreover I feel myself
disposed to agree with them particularly on this ground, that the
mortification of the whole of any of the greater limbs, though it _has_
been observed in pestilential fevers, in _Typhus contagiosus putridus_
(putrid infectious Typhus) amongst others, yet makes a comparatively
rare symptom of the disease, and at the same time so dangerous a one
that it can hardly be, as Thucydides alleges it was, that many (πολλοὶ)
after such a serious affection escaped death, while on the contrary
some (εἰσὶ δ’ οἵ) only did so with the loss of the eyes.” Any one who
will compare the just quoted passages of Hippocrates and Galen with the
account of Thucydides, will want no further proof that as a matter of
fact mortification of the extremities did supervene, an occurrence that
even in later times[204] is not of the extreme rarity that _Kraus_
and others believe. Again the fact that _many_ of those attacked
escaped with their lives is the less surprising when one remembers that
Thucydides is not speaking of entire arms and feet as having fallen
off, but only of ἄκρας χεῖρας καὶ πόδας, that is to say, fingers and
toes. However supposing any one to prefer not to supply ἄκρων with
τούτων, but take it as used in its full extent, maintaining that
hands and feet as well as genitals were entirely destroyed, even this
would not belong to the category of _extremely rare_ phenomena, for
Hippocrates actually saw the extremities entirely fall off in similar
circumstances, while if only the ῥεύματα (morbid discharges) came duly
to maturity and maturation supervened, the major part (οἱ πλεῖστοι
τούτων ἐσώζοντο,—the majority of these were saved) escaped with their
life.
Finally the passage of Thucydides gives no sort of evidence to prove
that the ἀκρωτηρίων ἀντίληψις (seizure of extremities) occurred solely
in those attacked by the fever as metastasis and so on. For the first
sentence quoted, to the effect that the disease traversed the whole
body, evidently refers back to the preceding clause ἐπικατιόντος τοῦ
νοσήματος ἐς τὴν κοιλίαν (when the disease descends into the abdomen),
and for this reason is connected with it by the conjunction γὰρ—“for”.
The succeeding words καὶ εἴ τις ἐκ τῶν μεγίστων περιγένοιτο (and even
supposing a patient to have escaped the worst) may very well be taken
in this way; μεγίστων (the greatest, worst things) is made not a Neuter
absolute, like τὰ ἔσχατα (last extremities) and such like phrases
in other places, but κακῶν (evils) is supplied to go with it, and
the whole translated: “even supposing a patient escaped the greatest
evils”, that is to say if he were not attacked by the λοῖμος (Plague)
in the forms of head and abdominal affections, “yet it marked him”,
that is it made its existence manifest by gangrene of the extremities
supervening[205]. This Thucydides, a layman writing on a medical
subject, supposes to be a mere manifestation of the λοῖμος (Plague),
while Hippocrates regarded it as the proof of the erysipelas-putrid
condition, which caused the already previously existing ulcers etc. to
assume this character.
We have already mentioned the fact that at Athens ulcers of the feet
were of frequent occurrence; and these must, no less than the ulcers
of the genitals previously existing in any case, have necessarily
been likewise assailed by the general unhealthy condition of things,
and when this happened, have passed over into gangrene. Thucydides in
fact says expressly at the beginning of his delineation of the disease
(ch. 49.): τὸ μὲν γὰρ ἔτος, ὡς ὡμολογεῖτο, ἐκ πάντων μάλιστα δὴ ἐκεῖνο
ἄνοσον ἐς τὰς ἄλλας ἀσθενείας ἐτύγχανεν ὄν. εἰ δέ τις καὶ προέκαμνέ τι,
_ἐς τοῦτο πάντα ἀπεκρίθη_. (For indeed that year, as was universally
admitted, chanced to be of all years one especially free from other
diseases in general; and indeed if any one suffered previously from
any complaint, _all ended in this_, the plague.)” We have seen how
Hippocrates observed the prevalence of ulcers of the genitals at the
period of the special meteorological conditions he drew attention to,
and without doubt in the same way such existed at Athens as well, and
were subsequently dominated by the prevailing erysipelas-typhoïdal
conditions. This was manifested in one of two ways; either the ulcers
became gangrenous, or the patient was attacked by typhus, precisely
as is noted to be the case at the present day[206]. But under either
eventuality the existing contagion was annihilated, in the one case
by the general feverish reaction of the organism[207]. But in those
cases where neither fever nor mortification supervened, the contagion
undoubtedly assumed a more strongly effective character, was more
readily infectious, set up more deeply penetrating ulcerations, and
the tendency towards the skin being the predominating one, exanthematic
eruptions with an inclination to ulcerative forms (ἐκθύματα μεγάλα,
ἕρπητες πολλοῖσιν μεγάλοι,—great pustules, extensive creeping eruptions
in many cases) were observed by Hippocrates to be set up in Summer,
(loco citato p. 487.). All these are factors of the highest importance
for the history of Venereal disease, as it is only by them that we
shall be enabled to solve the great riddle of the origin of Venereal
disease in the XVth. Century,—a riddle to which the answer would long
ago have been found, if only enquirers had not been in the habit almost
down to our own days of persistently looking upon Venereal disease as
an isolated phænomenon.
True it is impossible from the passage of Thucydides to decide with
any certainty whether the extremities, hands, feet and genitals, fell
off of their own accord or were removed by the knife; but our own
opinion is that both was the case, for of course there were Physicians
at Athens, and until they had learned their powerlessness against the
prevailing sickness, they no doubt employed the remedial means at
their disposal, and these consisted according to Hippocrates solely
and simply in the use of scalpel and cauterizing iron, all other
measures having proved unavailing. That these were equally resorted to
in ulcerations of the genitals we see from the passage of Galen quoted
above, and the Poem of the Priapeia, p. 74, confirms the same in the
most convincing way.
Enough has been alleged to prove how far the view expressed in many
different forms, to the effect that, in the Athenian Plague as well
as in the meteorological conditions and their results as laid down by
Hippocrates, it is a question of Venereal disease, is justified by
facts, and to show that even in Antiquity materials are to be found to
demonstrate conclusively that the _genius epidemicus_ exercised a not
unimportant influence on the rise, form and course of the ulcerations
of the genital organs. In what way this influence acted on the
complaints consequent on paederastia and the vices of the _cunnilingue_
and the _fellator_ and affecting the posterior and mouth, we cannot
at any rate at the moment demonstrate historically, but it seems only
probable that previously existing ulcerations in the mouth and throat
must under an erysipelas-typhoïdal general condition have proved
themselves in the highest degree dangerous to the sufferers.