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 organs[348]. 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 Galen[357] 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 _Oribasius_[365] 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 him[366] 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 oxymel[372] 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:—