σαρκώδη βλαστήματα, verrucae. (fleshy outgrowths, warty excrescences).
The general name θύμος (_thymus_,—warty excrescence), or according to
Celsus perhaps more correctly θύμιον (small warty excrescence), appears
to have been used by the Greeks to designate all morbid outgrowths,
and particularly those of the genitals and fundament, while they
appropriated the expressions σῦκος, ἀκροχορδὸν, and μυρμήκια (fig or
figlike excrescence, wart with a neck, wart growing directly on the
skin) to signify the different subordinate species. The θύμιον, which
_Celsus_[430] is the first Writer to delineate in detail, is a warty,
reddish,—according to Paulus Aegineta white too in some cases, and as
a rule painless,—fleshy outgrowth, slender at the base, broader above,
rather hard and rough at the top. Thus it bears a certain resemblance
to the flower of the thyme, from which circumstance comes the name.
The upper part is easily split, and then bleeds,—more than might be
expected Aëtius says from its size; the same also sometimes happens
spontaneously. Usually it has the size of an Egyptian bean, though
occasionally it is quite small. Sometimes one such growth appears, at
others several are found together, now on the palms of the hands, now
on the soles of the feet; but the worst are always those on the genital
organs.
According to _Aëtius_, who calls the larger sorts σῦκος (fig),
_thymus_ is also found on the fundament and on the face, in women on
the _labia_, in the entrance to the vagina and in the vagina itself,
spreading thence to the fundament and even over the thighs. This is
confirmed by _Oribasius_, who as well as Paulus Aegineta and perhaps
Celsus, distinguishes a _malignant_ and a _non-malignant_ form. The
non-malignant growths generally disappear of themselves; but if they
are amputated, there remains behind, so says Celsus, a circular root
which penetrates deep into the flesh; and not only do they grow again,
but further take the character of the malignant form, become painful
and filled with a bloody ichor. The malignant show themselves both
with and without ulceration, as well as after the disappearance of the
non-malignant growth; they are harder, rougher and larger, have a dirty
livid hue, and are painful, particularly on being touched. Thymus on
the glans penis is more dangerous than when affecting the prepuce,[431]
more especially if it assume a carcinomatous character. If of the
non-malignant type it should be lightly scarified with the point of
a scalpel, then some mild escharotic employed, for which the Writer
just named gives several prescriptions. If of the malignant type, it
is according to Paulus Aegineta either tied with a horse-hair and then
removed by knife or cautery, or according to what Oribasius says the
latter is at once resorted to. But seeing thymus on the prepuce is
often found affecting the inner and outer surfaces simultaneously,
cautery must not be employed on both at once, for in that way the
foreskin would be destroyed altogether. The better plan is to begin
with those situated on the inner surface, first cutting them away, then
cauterizing, and finally when they are cicatrized proceeding to the
treatment of the others. But not a few are incurable.
Ἀκροχορδὸν[432] is a smooth, circular, fleshy protuberance, having a
slender circular base, so that it looks as though it hung on a string,
whence the name. It is painless and callous, usually has the same
colour as the skin, while its dimensions seldom exceed those of a
bean. As a rule several occur together, but disappear again of their
own accord, especially if they are only small, though on occasion
they get inflamed and suppuration follows; they leave no root behind
on amputation. According to _Galen_ and _Aëtius_ they occur on the
fundament, according to Philumenes, as given in the latter author,
likewise on the female genitals. They are removed either by means of a
thread or with the lancet, though escharotics and other acrid remedies
are also employed.
A highly inveterate form is the μυρμήκια, or _formica_ (ant) of
later Writers, which is almost always discussed by medical Authors
concurrently with ἀκροχορδόν. It is, Celsus tells us, less prominent
and harder than the θύμιον, has deeper roots, is more painful, broad at
the bass and slender at the top, less suffused with blood and seldom
larger than a lupin-bean. The colour according to Aëtius is blackish.
On its being touched, the patient has the sensation of having been
bitten by an ant. As an exactly similar growth appears on the hands,
most Writers, e. g. Celsus and Oribasius, speak only of this latter;
but Aëtius describes it expressly as occurring on the fundament and
on the female genitals; and it was observed in the latter situation
by Philumenes, or Aëtius (loco citato, ch. 105.) in the case of _his
own wife_, whom he cured by three days’ fumigation with _origanum_,
(wild-marjoram). Not to mention the usual escharotic remedies, for
which Aëtius in especial gives several formulæ, the following modes
of treatment recommended by the medical Writers evidently apply to
warts on the hands only,—by extirpation with a myrtle-leaf shaped
scalpel called a _scolopomachaerion_ (small pointed surgical knife),
squeezing off by means of a quill or metal pipette, and above all
sucking with the lips and gnawing off. This last was in _Galen’s_ time
especially[433] a very fashionable treatment and is described by him as
a new discovery made at Rome.
§ 42.
Retrospect.
If we now turn back again and make a brief survey of the various forms
of affections of the genitals described on preceding pages, comparing
them with those of the present day, such as we have opportunity to
observe in modern times, we think every unprejudiced reader will be
found ready to admit that they agree with these latter in _very
nearly every_ respect whatever, and that _every_ doubt would be
removed, if only the medical Writers had appended to the records
of their observations in each case the words, “got by infection in
coition.” But to what cause do we refer such cases as a matter of
fact, notwithstanding the denial on the part of the patient that he
has exposed himself to any infection? Do we not take it for granted as
a certainty that such infection did actually precede? Are we in the
habit of noting down in every instance in our day-book of cases the
antecedent act of coition that occasioned the chancre or what not; and
does this omission in any way imply that this did not first occur? To
our mind at any rate the fact suffices that non-professional observers
and even a professional one like Galen have supplied irrefutable
evidence that some of these affections were acquired by coition.
Amongst others, morbid outgrowths for example are manifestly shown
to have been so set up by the statement that they occurred on the
fundament of pathics; and it needs no great perspicacity to draw the
conclusion that if (unnatural) coition produced them in the pederast,
the same maladies occurring on the genital organs owed their origin to
the same cause.
But granting these maladies originated in coition, there must
necessarily have been some other factors active as well, besides the
mere act. Thus when patients are found explaining to the physician
(Galen) that the women with whom they had accomplished coition suffered
from the same evil as themselves (gonorrhœa), no one surely can suppose
anything but that a transmission of the disease took place in virtue
of a contagion. Such affections of the genitals as are transmitted
in coition by contagion we are wont to regard as primary forms of
Venereal disease; and those acquired and disseminated in the same way
in Antiquity must accordingly be designated by the same name. But these
primary forms extended not only to the genitals; they were equally
and in the same way acquired through the various modes of _Venus
illegitima_ (abnormal Love) in the anus and the mouth, localities
where we are accustomed nowadays to see the secondary symptoms chiefly
appear. Consequently it was impossible for the Ancients,—and is really
and truly no less so down to the present moment for the Moderns,—to
make a definite distinction between primary and secondary forms. It is
equally impossible to deny outright the former existence of the latter
in these localities, the more so as, however wide the dissemination
of vicious practices of various sorts, no very large number of men
suffering from a diseased member are likely to have misused mouth or
anus.
But if we are forced in considering the secondary forms to leave mouth
and anus almost entirely out of the question,[434] then only cutaneous
diseases and those affecting the bones are left us, for _ozaena_
(fetid polypus), which was regarded as incurable by the Ancient
physicians,[435] cannot any more than the others be taken into account
in connection with primary affections of the mouth, unless indeed we
are prepared to look upon the ῥέγχειν (snorting) of the men of Tarsus
as a secondary complaint of pathics.
With regard to _cutaneous affections_, we have seen how the forms
of _lichen_ and _mentagra_ passed over into _psora_ and _lepra_ (§§
23, 25), and how the conclusion to be drawn from this is plain, viz.
that the secondary cutaneous forms of Venereal disease were formerly
assigned as belonging to leprosy. This seems to be confirmed by a
passage of _Johannes Moschus_[436] that has only just been brought
under our notice, in which it is related how a monk of the Monastery
of Penthula could no longer master the appeals of the flesh, travelled
to Jericho to get relief from the “superfluity of his naughtiness” in
a brothel in that place; how when he had entered the house, he was
suddenly attacked by leprosy, whereupon he speedily returned to his
Monastery. How much Venereal disease has in common with elephantiasis
must be determined by later investigations. At any rate it is worth
while to note its frequent occurrence in Egypt, its establishment in
Italy along with the various forms of _lichen_, its infectiousness, as
well as the statement of Celsus (III. 25.), who calls it an _ignotus
paene in Italia morbus_ (a disease almost unknown in Italy), and that
even the bones would appear to be affected by it.
Lastly, inasmuch as the tendency of the morbid process to strike
outwards to the skin was conditioned by the influence of climate, while
cutaneous forms of Venereal disease were amongst the most common of
occurrences, it follows that not only were affections of the mucous
membranes bound to fall proportionally into the background and appear
with less frequency, but those of the bones as well. Still the mucous
membranes _were_ sometimes attacked, and _affections of the bones_ did
also undoubtedly occur, though with incomparably greater rarity,—such
affections being, as is well known, at the present day of rare
occurrence, and especially so in hot climates. Corrosion of the tibia
is mentioned by Plutarch, and peculiar pains of the periosteum, which
are so deep-seated and stable as to make the patient believe the bones
themselves to be the seat of the mischief, are spoken of as early as
by _Archigenes_ cited by _Galen_,[437] the latter adding that these
pains were commonly known as οστοκοποι (racking the bones). If further
we ought to count in this connection those forms of _exostosis_ (morbid
excrescence) _of the bones of the skull_ described above in § 26,
which it seems were so prevalent among the inhabitants of Cyprus as to
have gained for the island according to some authorities its name of
Κεραστία (horned),[438] we should actually have to hand proofs of the
existence in Antiquity of _all_ the symptoms that at the present day
constitute Venereal disease. All we need to do is to unite these into
one general picture and give the name that is now sanctioned by custom,
in order to arrive at the final result,—that _Venereal Disease_, though
not recognized and described as such by the Ancient Physicians, _was as
a matter of fact existent in Antiquity_.