It is invariably the case that forms of ulceration affecting the male
genitals are the most familiar and best known, and this was equally
true in Antiquity. Whatever information the Ancient physicians deemed
it necessary to record on the subject is found as early as _Celsus_
laid down with something approaching to completeness in his writings
(VI. 18.).
a. _Ulcers of the Prepuce._
According to Leonidas[374] fissures and cracks in the prepuce
frequently occurred, in all cases of the latter being too tight and
being forcibly drawn back. On these supervened pain and phlegmonous
inflammation; and then if a cure were not speedily effected, the
edges assumed a condition of callosity, necessitating the use of the
knife for its removal. However, more often than not the wound broke
out again, because as was noted as early as by _Hippocrates_,[375]
wounds of the prepuce are as a rule obstinate in healing. To meet this
eventuality _Galen_[376] provides an entirely suitable procedure. While
ulcers of the glans penis demand desiccative remedies, those of the
prepuce rather call for _epilotics_,[377] especially anise. Supposing
the prepuce to become gangrenous, it must be cut away circularly,
and the bleeding stopped by cauterization; if this treatment is not
needful, a mixture of verdigris with honey, or pomegranate and vetch is
applied.[378] Ulcers on the inner fold of the prepuce, as also on the
skin of the penis generally, are mentioned by _Celsus_ (VI. 18.), the
latter likewise by _Galen_.[379] Such ulcers on the inner fold of the
prepuce, Celsus states, not unfrequently give occasion to the setting
up of phimosis and paraphimosis; and yet another consequence, a morbid
growing together of glans and prepuce was observed by _Oribasius_ (loco
citato, 5.) and _Paulus Aegineta_ (VI. 56.), for which these authors
prescribe appropriate medical and surgical treatment. Under the name of
_cancer_ (eating ulcer) of the prepuce Celsus, it would seem, describes
the νομὴ (spreading ulcer) of the Greek physicians, which commences by
the ulcer turning black. Occasionally too the ulcers developed out of
themselves morbid growths, excrescences or condylomata, particularly
the form known as _thymion_ (warty excrescence).
b. _Ulcers of the Glans Penis._
These are, as pointed out by _Celsus_ (VI. 18.), best described by
taking their pathological and therapeutic aspects together; but it
would serve no useful purpose to quote once more in this place the
passages dealing with this part of the subject, which have been so
often printed already. He makes a distinction, as does _Galen_,[380]
between dry and clean, moist and suppurative, ulcers, the latter of
which readily lead to phimosis and paraphimosis. The discharge is
sometimes thin and watery, sometimes purulent, and on occasion becomes
evil-smelling; the ulcerations both spread superficially and penetrate
inwards, and may actually destroy the glans underneath the prepuce,
so that it perishes altogether. When this happens, _Paulus Aegineta_
(VI. 57.) has a leaden pipette inserted in the orifice of the urethra,
to enable the patient to pass water. In other cases the prepuce grows
into one with the ulcerated glans penis (_Celsus_, _Paulus Aegineta_,
_Oribasius_). Ulcers _circa coronam glandis_ (round the crown of the
glans penis) are mentioned by _Aëtius_.[381]
A special kind is the _cancer colis_ (eating ulcer of the member),
probably the same as the νομὴ (spreading ulcer) of the Greeks, which
Aëtius[382] delineates as a spreading, flaccid ulcer, which on pressure
emits a thin bloody discharge, that subsequently becomes feculent.
Hemorrhage is apt to supervene according to Celsus on the shedding of
a cicatrix artificially produced by operation or the cauterizing iron.
Another species of _cancer_ is the φαγέδαινα (phagedenic, eating
ulcer) of the Greeks, which extends rapidly and penetrates to the
bladder. It appears to be identical with ἄνθραξ (malignant pustule),
though Celsus mentions the _carbunculus colis_ (carbuncle of the
member) in a special category; for the description he gives, bk. V.
ch. 28., of carbuncle is equally applicable to the phagedaena.[383]
Ἄνθραξ (malignant pustule) begins with itching, later on a pustule,
or else a number of little bladders or blebs resembling millet-seeds
appear, which burst in much the same way as a blister due to burning
does, leaving behind an _ulcus crustaceum_ (scab-encrusted ulcer),
resembling the cicatrix of a burn; this is firmly adherent and black
in colour. The surrounding tissue is likewise black and violently
inflamed, the inflammation not unfrequently having an erysipelas-like
character. _Galen_[384] designates the process ἀνθράκωσις, and declares
that buboes are an accompanying feature. He holds the ulcers of the
genitals occurring under the special climatic conditions laid down by
Hippocrates above to have been partly ἄνθραξ,[385] the disease to which
Hero succumbed.
Another kind of ulcer affecting the male genitals is mentioned by
_Pollux_[386] under the name of θηρίωμα (malignant sore), which
_Celsus_ (V. 28.) likewise speaks of, but without particularizing its
situation. The same fact applies to ulcers of the glans penis as to
those of the prepuce, viz. that many forms of morbid outgrowths arise
from them; in other instances callosities on the edges of the ulcers
are built up, leaving behind a callous protuberance, which the Greeks
appear to have called ἥλος (a nail), the Romans _clavus_ (a nail).[387]
The proper treatment to be followed in each of these special cases is
given by Celsus and the Writers he cites.