Nimia profusio seminis,—excessive flow of seed (Celsus), γονόῤῥοια.
Gonorrhœa, the name of which is compounded of γονή (badly made semen)
and ῥεῖν (to flow),[298] consists in an affection of the seminal
vessels, not of the private parts themselves, which merely serve as the
road for the excretion of the seed.[299] _Two kinds_ of gonorrhœa must
be distinguished, according as the malady is, or is not, combined with
erection of the penis.[300]
_Gonorrhœa with erection of the penis_ is called sometimes _Satyriasis_
or _Satyriasmus_ sometimes _Priapism_,[301] and is a species of
cramp,[302] which however only attacks the penis, belongs to the
category of the emphysemata, or inflations,[303] and is conditioned
by an afflux of the humours, particularly of conspissated or badly
compounded humours.[304] However this last phænomenon is only a
symptom of that morbid lasciviousness which _Paulus Aegineta_ entitles
Priapism, while he designates the condition connected with it by
the name of Satyriasis, this having its origin in an inflammatory
affection of the seminal vessels.[305] No proof is needed that both
these views are right so far as this, that gonorrhœa is both spasmodic
and inflammatory, and in either case may be accompanied by priapism.
Nothing, or only very little, is evacuated of a nature to make the
patients experience relief; and if there is, they are again attacked
by the evil, until the original cause of the erection is eliminated,
on which the penis relaxes of itself and subsides.[306] According to
_Paulus Aegineta_ paresis of the spermatic vessels,—the second form
of gonorrhœa,[307]—supervenes, if the disease is not relieved, or
else general spasms. Patients attacked by such spasms succumb rapidly,
suffering from cold sweats and tympanitic distension of the abdomen.
_Alexander of Tralles_ (IX. 10) saw the erection even continue after
the death of the patient. This form is not a common one; it occurs
pre-eminently among young people,[308] and according to _Themison’s_
observations, who frequently saw the complaint in Crete, where however
it was probably very often a result of pederastia, is subject to
epidemic influence.
The _treatment_ of this form of gonorrhœa demands according to
_Paulus Aegineta_ (loco citato) immediate general blood-letting,—this
_Galen_[309] also recommends, and practised with advantage,—local
cupping or leeching, simple clysters, cooling and composing
embrocations and poultices of solanum (nightshade) or cicuta (hemlock)
in the lumbar region, of litharge, Cimolian earth, psymithium
(white-lead) with vinegar, water or sweet wine, on the perineum.
Internal remedies are a decoction of mallows, mercury and birch-bark,
sap of rue, decoction from the root of the iris, nymphaea (water-lily)
and adianthum (maidenhair). Diuretics are injurious. Patients should
at the same time be put upon a low, vegetable diet, and the supine
posture avoided. _Galen_ (loco citato) recommended in addition emetics,
but not purgatives, also embrocations of _ceratum rosaceum_, friction
and subsequently gymnastic exercises. _Alexander of Tralles_ insists
particularly on the patient avoiding[310] all wanton scenes and
thoughts, and forbids the use of any cold, specially astringent things,
whereby the resolution of the contraction is made more difficult (πάθος
δυσδιαφόρητον γενέσθαι,—the affection is rendered hard to be resolved).
Gonorrhœa without erection of the penis, that is to say gonorrhœa
proper, exhibits a persistent, involuntary discharge of the seed,[311]
has some analogy with _incontinentia urinae_, and usually depends
like the latter on weakness or failure in the retentive power of the
spermatic vessels.[312] Very often an inflammatory stage supervenes,
making the complaint approximate to the first form; patients secrete
copious and hot semen, which provokes them to ejaculation,—an
ejaculation however that is followed by great exhaustion. If they
avoid copulation, headache is established, pains in the stomach and
nausea, while nocturnal pollutions cause them similar inconveniences
to those they incur from coition. The ejaculation is accompanied by
heat and smarting pain,—and this not solely among men but with women
as well; for one of these patients, _Galen_ writes,[313] told me that
not only himself, but also _the women with whom he had accomplished
coition_, experienced during the discharge a biting, burning pain.
On the contrary, according to _Aretaeus_,[314] it would seem the
only symptoms found in conjunction with the complaint are itching
of the privates, a voluptuous feeling and a violent inclination
to sexual intercourse. This datum admits of ready explanation if
we consider the fact that in southern countries the inflammatory
stage that makes its appearance is very brief and as a rule hardly
noticeable, provided,—though no doubt this condition was pretty often
broken,—coition was not indulged in during its course.
As a matter of fact in the great majority of instances the Physician
had only the chronic form to treat. Generally speaking a patient
first notices the complaint, when the discharge begins; and then the
latter, when once the inflammatory stage is over, proceeds day and
night undisturbed and without special voluptuous feeling, without
wanton dreams,[315] often without any particular sensation at all.
The actual discharge is a thin, cold, pale, sterile flux. Towards the
end of the illness it becomes thicker, assumes an acrid quality, and
eventually ceases altogether to flow.[316] But if the malady persists,
especially in young people, then according to _Aretaeus_, the whole
visage of the sufferers assumes a greyish look; they grow sluggish,
atonic, spiritless, faint-hearted, indolent, dull, weak, emaciated,
incapable of effort, unhealthy-looking,[317] pale, womanish, have
no appetite, feel chilly, complain of heaviness in the limbs, are
weak-loined, feeble and unfit for anything. According to _Galen_, the
abdomen falls in, besides all the rest of the body collapsing more or
less and withering; while patients become lean, of a yellowish pale
complexion and hollow-eyed. In this way the complaint not unfrequently
paves the road to paralysis, or else sufferers die of _tabes_ or
wasting.[318] Specifically and in itself the disease is not dangerous,
but it provokes various other complaints, and represents a highly
disagreeable, ill-reputed affection (Aretaeus),[319] that almost
always follows a chronic course,[320]—for which reason Aretaeus and
Caelius Aurelianus actually treat of it under the head of chronic
diseases.
Gonorrhœal pus is infectious, as is implied by the Mosaic Laws of
Purification (Leviticus Ch. XV.), and the malady is communicated by
coition, as is seen from the words of _Galen_,—p. 428. But as early
as the Fourth Century the idea was prevalent that the _conjunction of
the stars_ was not devoid of influence, as such or such a conjunction
might from a man’s very birth determine that _the individual was to
die of gonorrhœa_. This at any rate is maintained by _Julius Firmicus
Maternus_,[321] who lived in the time of Constantine the Great.
The disease has to be carefully distinguished from the nocturnal
pollutions,[322] that are at times one of the sequelae of gonorrhœa.
The treatment is, according to _Aretaeus_, at the commencement that
for an ordinary rheum or flux, by keeping the parts affected cool,
in order to counteract the flow of the humours to them; by degrees
going on to a heating and at the same time desiccating procedure,
then the application of fresh wool to the part, the employment of
friction, embrocations of _ceratum rosaceum_ or _oinanthinum_ with
white wine, olive oil with melilot, marjoram, rosemary, poultices of
barley-meal, saltpetre and dyll, but above all rue, with the addition
of honey or, according to _Celsus_, vinegar; as further treatment,
stimulating cataplasms, of a strength to redden the skin or even to
bring out pustules on it, so as to draw off the afflux of the humours,
or else as an alternative, plasters of the nature of the _emplastrum
viride_ (green plaster), of _baccae lauri_ (laurel berries). As for
internal treatment, the patient should drink decoctions of: _semen
lactucae_ (lettuce juice), _cannabis_ (hemp), _rad. orcheos_ (orchis
root), _nymphaeae_ (waterlily), _halicacabi_ (bladder-wort), etc.;
and take _castoreum_ (beaver oil), or the antidotes of _Symphon_,
_Philo_, or _Bestinus_, which are prepared from _viper’s flesh_.
In case of very profuse discharge, the patient should be directed
to drink hard red wine; if he is acrid with bile (χολωδέστερον καὶ
δριμύτερον,—over-bilious and acrid), lukewarm baths are brought into
requisition (Alexander of Tralles). On one point all authorities are
agreed, that the main thing to depend on is diet. Both food and drink,
says Celsus, must be cold, a precaution Themison also recommended in
satyriasis, whereas Caelius Aurelianus denounces it. The patient must
not indulge in semen-forming matters, such as cause flatulency, but
take nourishing food, flesh of animals but not fish, a little light
wine with it, for the constant ejaculation is weakening; he should be
careful as to resting,[323] lie on a cool bed, either on the right side
or the left (Paulus Aegineta), not on the back (Celsus).
Where the complaint is of longer continuance, exercise in the open
air and the use of cold baths is to be recommended, which latter
_Celsus_[324] it appears prefers to see resorted to, as well as cold
aspersions, almost at the very commencement; a mode of treatment
that is even now coming into fashion again among ourselves, as the
water-cure mania makes further and further progress. _Galen_[325]
recommended, besides diet and medicine, that with a view to
retarding the preparation of semen, gymnastic exercises, particularly
such as bring the upper part of the body into activity, e. g.
ball-playing both with great and little balls and the casting of leaden
disks, be resorted to. After bathing, patients must rub and wash over
the hips with desiccative ointments, oil expressed from red, coarse
olives, roses or quinces, wax-salves with the juices of _sempervivum_
(evergreen house-leek), _solanum_ (nightshade), _umbilicus Veneris_
(navelwort), _portulaca_ (purslain), linseed boiled in water, etc.
I once saw, he says, the Intendant of a Gymnasium Athletes lay a
leaden disk on the lumbar region of an athlete as a measure against
nocturnal pollution,—a means _Caelius Aurelianus_ prescribed _also_ for
gonorrhœal patients,—and afterwards recommended the same treatment to
another sufferer from these, who was thankful for the advice. Others
again found lying on the _agnus castus_ beneficial to them, as well as
the taking of its juice along with rue. Violently active refrigerants
in the form of ointments, prepared from poppy and _atropa mandragora_
should not be employed, and this equally applies to sleeping on
these plants when they are in bloom, for they act injuriously on the
kidneys. On the other hand sleeping on roses was advantageous,—Caelius
Aurelianus added to the list the leaves and flowers of _vitex_ (agnus
castus, Abraham’s balm). “Besides these I have excogitated many other
specifics for patients of the sort, and found their utility confirmed
in practice. For instance those afflicted with such a condition of
body should pay particular attention to this. When the accumulation of
semen that has to be ejaculated is at its greatest, they should during
the day take a nourishing yet moderate meal, and then when they lie
down to sleep accomplish sexual intercourse.[326] But on the following
day, after taking their fill of sleep, they should on rising chafe
themselves till the skin is reddened. Next they should rub the body all
over with oil; then soon after take some well-leavened, pure bread,
baked in the baking-pan, and mixed with wine, after which they may then
go about their customary business. Between the rubbing with oil and the
meal of bread patients may go for a walk, if there is a spot convenient
for the purpose in the neighbourhood, _except in the colder time of the
year, for at that season it is better for them to stay indoors_.”
With regard to _gonorrhœa in women_, it is all but impossible to
arrive at any accurate knowledge of what the Ancient Physicians knew
concerning it. The reason of this is that the views held as to the
effect of deteriorated menstrual blood and of the ῥοῦς γυναικεῖος
(female discharge), by means of which the whole body was supposed
to purge itself of evil humours,[327] absolutely precluded the
possibility of any unprejudiced observation, in precisely the same
way as down to quite modern times the _fluor albus_ (white flux,
blennorrhœa) conditioned the extremely imperfect knowledge possessed by
the faculty of female gonorrhœa. We purpose to leave over the inquiry
into the points which differentiate the two (male and female gonorrhœa)
to another opportunity; and will only note here that gonorrhœa in
women, strictly so called, was by no means utterly unknown,—in fact
there is no doubt whatever as to its being distinguished from the ῥοῦς
γυναικεῖος (female discharge), as is shown by the passage of _Galen_
quoted above, and still more clearly by _Aretaeus_,[328] who speaks
of γονόῤῥοια γυναικεῖα (female gonorrhœa) distinctly as ἄλλος ῥόος
λευκὸς, another species of white flux. Whether perhaps this knowledge
was first accumulated at the epoch of Tiberius and his fellows cannot
indeed be positively determined; but certainly the word ἐλέξαμεν (we
have named it) of the text of Aretaeus may very well leave room for
such a conjecture, and as a matter of fact Aretaeus would appear
to have lived under Domitian, and was therefore a contemporary of
Martial’s!