We have already seen from Hippocrates, Celsus and Galen that the
ancient Physicians had observed the inflammation and subsequent
matteration of the small mucous glands of the urethra evidenced by the
symptoms of painful micturition, and seeing that mere tenesmus, as
well as dysentery, are denominated ἑλκώσις (ulceration) by them, it is
by no means improbable that many a urethral ulcer and many a case of
gonorrhœa may have been treated under the name of ischuria (retention
of urine). This is the more likely, as we learn from a passage of
_Celsus_[329], one usually misinterpreted in several respects, that
the urethral discharge was explained as due to an extension of
the ulcer to the spermatic cords (_vasa deferentia_,—seed-bringing
vessels). Yet further confirmation is afforded by a passage of
_Actuarius_,[330] already cited by Simon, and our own conjecture
expressed on a previous page thus justified.
Ulcers however also occurred in the urethra[331] unconnected with
tubercular swellings (ἀφανὲς ἕλκος,—invisible ulcer); these not
unfrequently occasioned bleeding,[332] and made their presence known
by the accompanying pain, while synchronously small irregularly-shaped
particles (ἐφελκύδες) were ejected.[333] The appropriate treatment of
these ulcers has been described by _Paulus Aegineta_ (loco citato);
it consisted in injections of honey and milk (_Aëtius_, IV. 2. 19.,
and _Actuarius_ also recommended _enemata morsus expertia_,—clysters
free from biting acridity), introduction of lotus pounded in a leaden
mortar by means of a feather or a twisted piece of lint (λεπτὸν
στρεπτὸν,—light material twisted,—an anticipation of the bougie?)
along with a mixture of gall-apple, flowers of zinc (oxide of zinc),
starch-flour and aloes smeared in equal parts with rose-sap and
plantain-sap.
Not unfrequently such ulcers give rise to the establishment of
_caruncles in the urethra_, particularly _in the neighbourhood of
the neck of the bladder_, though they occur[334] also in the ear,
nose, as well as in connection with the privates and anus, in the
latter case presenting the symptoms of ischuria (retention of urine),
interfering as they do with the outflow of the urine. The presence of
these caruncles may be diagnosed by the preceding symptoms, as also
by the circumstance that the urine is evacuated by the introduction
of a _catheter_, that this occasions pain at the seat of ulceration
and breaks through the caruncle, causing the urine to pass mixed
with blood and the remains of the caruncle. It is necessary to know
if a thrombus (blood-clot) or calculus blocks the urethra; but as
to whether we pronounce the mischief to be situated in the urethra
itself and the cause of the ischuria to be there as well, this is a
distinction of no practical or scientific value.[335] For as a rule
it was solely as being the excretory duct of the bladder that the
urethra had some little attention directed to it; while any signs
it exhibited were generally regarded simply as symptoms connected
with the urinary bladder and the kidneys. Partial _growing up, or
morbid extuberance, in the urethra_ (συσσάρκωσις,—a growing together)
following on a previous ulceration is described by _Heliodorus_, as
given in Oribasius,[336] occasioning either a narrowing of the urethral
passage in one spot or its being filled up over its entire superficies
with morbid outgrowths of tissue. Partial narrowing causes dysuria or
strangury (difficulty of micturition), the narrowing of the whole canal
by morbid outgrowths, ischuria (impossibility of micturition, retention
of urine). The outgrowth must be removed by means of a small lancet.
The mode of procedure is then as follows. The patient is placed on his
back, the penis straight out; then with the fingers of the left hand
the operator compresses it behind the spot where the growth is found,
in order to prevent the blood from flowing inwards when the incision
is made; next he takes the knife in the right hand, pushes the point
into the urethra, divides it as far along as the base of the morbid
growth, but not so as to go beyond it. This done, he proceeds to cut
out the growth by means of a circular incision, and compresses the
urethra between the fingers, causing the growth to spring forwards.
Supposing it now projects but does not actually spring out, it is
extracted by means of a _mydion_ (boat-shaped instrument). After the
removal of the growth the urethra must be protected from contact with
the urine, which during the first few days is best done by applying an
_ipoterion_, or compress,[337] made of papyrus. The mode of preparing
this is described in detail later on, and a sort of elastic catheter
indicated. Catheters of copper and tin might also be used, or a
quill taken for the purpose. The tin or lead catheters are not to be
inserted till after the third day, and carry in front a projecting
shield. The application of a bandage described is declared to be of
great advantage. Scirrhosities of _the neck of the bladder_, abscesses
and the like, are mentioned by _Galen_ (loco citato) as occurring
occasionally. With regard to _diseases of the prostates_ subsequent
investigations must authenticate the amount of knowledge possessed of
these by the physicians of Antiquity.
_Inflammation of the testicles_[338] is usually characterized according
to _Paulus Aegineta_[339] by pain under strong pressure by the fingers,
while only a slight pressure causes no uneasiness. Redness and heat
are slight externally, but the latter is perceptible deep in by an
investigating finger. Sometimes fever is associated with it, and if
the inflammation is not quickly combated, the pain, _Celsus_ tells
us,[340] extends to the inguinal and lumbar regions, the parts swell,
the spermatic cord grows thicker and at the same time indurated. Both
authorities make the treatment consist at first in blood-letting at the
ankle,[341] and the use of soft poultices of bean-meal,[342] pounded
cumin, linseed, etc. to which in cases of induration is added later on
a mixture of crocus and wine. In obstinate instances poultices are used
of _rad. cucumeris agrestis_ (root of the wild cucumber);[343] _Paulus
Aegineta_ under these circumstances prescribes grapes, peas, cumin,
brimstone, nitre and resin, made into a cataplasm with honey, besides
sundry wax-salves. A considerable list of remedial agents is found
enumerated in _Marcellus_ (ch. 33.) intended to combat the _tumores et
dolores testiculorum_ (swellings and pains in the testicles); of these
we will only mention the salves of mutton-suet and nitre, the sea-water
compresses, the poultices of _rad. cicutae_ (hemlock root), white of
egg, frankincense and ceruse (white lead). _Aretaeus_[344] gives us
an interesting piece of information to the effect that in order to
counteract neuralgia of the testicles and spermatic cord, accompanied
at the same time by intestinal colic, the spermatic cord was _cut
out_, being looked upon as the cause of the suffering. Important too
is the case related by _Hippocrates_,[345] where a patient at Athens
suffered from _prurigo_ (itch) of the whole body, but above all of the
_testicles_ and the forehead, his skin having grown thick and hard as
it does in leprosy, so that nowhere could it be pulled up above the
general surface.
_Induration_ of the testicles is mentioned by _Galen_,[346] who assigns
it as one cause of sterility. The same author[347] 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.
§ 41.