THIRD SECTION. Relation of the Physician to Diseases consequent upon the Use or Misuse of the Genital Organs.

§ 38.

In the preceding Sections we have become acquainted with the various influences capable of favouring or counteracting the rise of diseases consequent upon the use or misuse of the genitals in Antiquity. At the same time we have shown how a multitude of affections of the most different kinds attacked, as a result of the unnatural gratification of sexual desire, those parts which under these circumstances had to undertake the rôle of the genital organs of the one or the other sex. Thirdly we have brought forward in the course of the enquiry at any rate some examples, proving beyond a doubt that the sexual parts themselves too under favourable external conditions sometimes became diseased as the consequence of indulgence in sexual intercourse. Still these results were for the most part based on the evidence of non-medical Writers, for of set purpose we abstained as much as possible from calling the professional Writers into Court on these points, so as to be able to treat in their proper mutual connexion whatever statements these latter have left us as to the maladies in question. This course appeared to us all the more necessary, as it is precisely the medical evidence which the opponents of the existence of Venereal disease in Antiquity believe themselves able to utilize in justification of their opinions.

But before we proceed to the detailed examination of the actual statements, it would seem expedient to get an answer to the following question: whether indeed the Physicians of Antiquity generally were in a position to acquire an adequate knowledge of the bodily consequences of vicious living? In fact on the correct answer to this question obviously depends the correct appreciation of the medical Writings as sources for the History of Venereal disease. Only under the condition that this question may be answered in the affirmative, can the evidence supplied by the Physicians be regarded as satisfactory for their own period. That it cannot of course be so for all periods, has been pointed out already in our examination of the authorities for Antiquity generally. Indeed for long periods of time Physicians had no special locus standi, inasmuch as each individual in the case of the most usual maladies endeavoured to help himself, and if the family recipes left him stranded, then betook himself with prayers for assistance to the Gods and their intermediaries on earth, the Priests. This still continued, even after the Physicians had won their recognition as a special profession, and we find accordingly throughout Antiquity popular, sacerdotal, and professional or medical medicine, if we may be allowed the expression, continuing to exist simultaneously side by side, and not a trace anywhere of the ridiculous limitation according to which no man has a right to be well without the help of a doctor.

Now having made it clear by what we have said, that in order to gain knowledge of a disease in Antiquity it is by no means enough to go to the Physicians only, even when such existed, that the latter should never be regarded as sole possessors of whatever was known from the point of view of pathology and therapeutics, we are bound to apply the same rule in the case of diseases consequent upon vicious habits. Of this the foregoing Sections contain amply sufficient proofs. It has there been shown how the genital organs were under the protection of special deities. Diseases affecting them were ascribed to the vengeance of the said deities, as at Athens to Dionysus, at Lampsacus to Priapus. To them sufferers had recourse to win by their prayers the removal of the divine anger, as well as its consequences; and all this happened not only in times when Physicians did not as yet exist, but no less when they did and in defiance of them, as the poems of the Priapeia sufficiently prove.270 How long these ideas lived on is shown by the pictures Philo (p. 315) and Palladius (p. 318) draw of their times, while the XVth. and XVIth. Centuries reproduced the same scenes.

The most obvious reason for this no doubt was the enigma presented by the origin of diseases of the genitals, particularly for any one unacquainted with the existence of contagions and their modes of activity. The man who with a healthy penis had accomplished coition, observed some days afterwards, though without resenting the fact, a mucous discharge to have been set up, or an ulcer, pustule, or what not, to have appeared. The cause of these affections he sought for in vain, for of course the mere act of coition was the very last thing he was likely to regard as such. Rather accustomed, wherever the cause of any phænomenon was unknown to him, to ascribe it to the intervention of the deity, he saw in his complaint likewise the Θεῖον (divine) as eventual cause. Naturally therefore it was divine assistance, and not human, that would avail to relieve him of his pain. Long after this time moreover, when men had ceased to refer all diseases to the vengeance of the gods, and now discovered natural causes for maladies of the genitals, as for other diseases, anything rather than just the act of coition was looked upon as cause of the observed effects, as indeed is the case to this day among the Turks,271 and as the earliest Writers on Venereal disease abundantly show to have been so in their time. That the Physicians were no exceptions to this rule, we shall show on a later page.

A much more weighty reason however why the patient attacked by some affection of the genitals turned not to men (Physicians) for help, but to the Gods, and the Priests who represented them, was the feeling of shame. Since first Adam and Eve had recourse to the fig-leaf, it has ever been a habit among all peoples of the ancient as of the modern world to withdraw the procreative parts from the view of others by covering them. But above all did the Ancients regard the exposure of these parts272 one of the severest trials to which modesty could be exposed; and rightly enough therefore designate them by the name of pudenda, αἰδοῖα, the parts of shame. Neither the wide extension of Phallic worship, nor yet the compulsory exposure of the Ephebi273 and the naked exercises of maidens and youths at Sparta274, can fairly be cited in this connexion as proofs to the contrary.

In our own day the most accomplished voluptuaries are in no wise shocked at undertaking in secret the most shameful doings, but yet when it comes to showing the Physician the diseased instruments of their bestial lusts, often put this off so long as to run great risks of entirely losing the signs of their manhood; and without a doubt it was the same at the period when habitual depravity had reached its culminating point of enormity. Even Priapus himself asks (Carm. 3):

(Nor let it be laid as a crime against me, that my member is ever covered up.) If with this is compared the poem from the Priapeia quoted on p. 74 of Vol. I., no one can fail to agree with us when we say that the field of observation open to Physicians in Antiquity with regard to diseases of the genitals can never have been at all extended. Even the Priests, at any rate in later times, were only resorted to in the more serious instances; but even so their journals of cases, supposing them ever to have kept such, would have been a far better source of information than those of the Physicians. We find a confirmation of this in the Mosaic Books of the Law, which contain the earliest and clearest delineations we possess of affections of the genital organs both in men and women.

But if men were so reluctant, how much more so must women have been, who were universally held to have committed a crime if they had given any part of their body to the eyes of a stranger. Just as the assistance of the Physician was disdained in childbirth, and to account for the fact the fable of Agnodicé invented, in the same way in complaints of the genitals women hesitated to submit themselves to the inquisition of the Physician. But seeing the female sexual organs are pre-eminently the home and breeding place of Venereal disease, this closed what was precisely the most direct way to a correct understanding of maladies of the genitals. The ancient Physicians, like our own forefathers, could at best make leucorrhœa the universal scape-goat; and accordingly even Galen, as we shall find presently, laid no stress on the circumstance, and drew no inference from it, that wherever men were attacked by gonorrhœa, the women with whom they had had coition likewise suffered from the complaint.

Further, to this general sense of shame was added a certain timidity before the professional status of real Physicians as a class, as well as the pretty universally prevalent idea of the ignominiousness of a sickness brought on by a person’s own fault, at any rate among the educated part of the population. This comes out in the following passage of Plato,275 where he says: “Does it appear to you disgraceful to stand in need of medical help, when it is not wounds at all or such sicknesses as depend on the seasons that have befallen, but when a man through indolence and a way of life such as we have noted (i.e. a very luxurious one), is filled full of fluxes and accumulations of wind like a sea, giving occasion to the noble sons of Asclepius to designate these complaints by the names of superfetations and catarrhs?” This was more than a mere expression of individual opinion; there is no doubt affections of the genital organs, more especially if their relation to sexual intercourse was known, belonged to the class of diseases held to be most disgraceful,276 and the Poet is justified in saying:

(To the lawful gods, deities too exalted for me, such for instance as Phoebus, and Phoebus’son, I feared to entrust my member for cure.) Thus it was not to the “noble sons of Asclepius”, in other words the Physicians, who treated freemen only, that patients resorted for help, but to the gods, or else to the medical underlings (ὑπηρέται τῶν ἰατρῶν,—subordinate assistants of the physicians), to the slave-doctors and quacks, who plied their trade in the doctor’s shops,—establishments where, as we have seen above, paederasts and pathics foregathered. Exactly the same state of things prevailed down to the middle of the last Century; and to this day a majority of such sufferers rarely as a matter of fact come under any other hands.

The knowledge and observations of these Cullers of simples and Compounders of balsams, if indeed as a rule they really possessed the former, or knew how to make the latter, necessarily perished on their decease, or at best were passed on by tradition to their successors in the doctor’s shops, without professional Physicians or medical Science being one whit advantaged. To such men it was a matter of perfect indifference what was the origin of the disease for which they sold their powders and decoctions, for as Plato (De legg. IV. 720) says, they paid no attention to the existing conditions of disease, and did not care to give a thought to any such thing. But at any rate,—and this was the chief point,—the patient was spared a humiliating confession, and was glad enough to buy the privilege even at the cost of possible ruin to his health. We must further remember that the “filles de joie” in Greece and at Rome were mostly slave-women, who from the very fact of their status could make no claim to treatment by free-born physicians, and that during the flourishing period of Greek medicine under the Hippocratic school it was chiefly persons of the lowest station or else sailors and foreign traders and the like who sought enjoyment in the arms of prostitutes. Such men by their constant change of abode made all continued observation a simple impossibility, so that the very imperfect knowledge possessed by the scientifically trained Physicians with regard to diseases of the genitals and their consequences need occasion little surprise.

It is true of course that at the period of universal degradation of morals Physicians must have found no lack of opportunities for observation; but the great majority of them were incapable of utilizing these, actually blocked the way of set purpose, as we shall see presently, that led in the direction of more accurate investigation, or else troubled their heads little about the cultivation of Science or the systematic record of observations. The latter, if they had published them, whether in writing or orally, could only have been detrimental, particularly in the case of physicians of the character of Charidemus’ medical attendant,277 to their own interests. In fact they were bound to call all their subtlety into play for the express purpose of concealing the true cause of diseases of this type, a circumstance which no doubt we have to thank for a large number of the extravagant and often more than ludicrous statements regarding the origin of Venereal disease in the XVth. and XVIth. Centuries.

But as a matter of fact the public itself was no less careful to guard the secret, as we gather from Martial,278 as well as from the fact that Galen felt himself constrained even in his day to compose a special Treatise on dissimulated diseases. This sort of intentional deception on the part of patients was so much the easier, as Physicians in those times, as said above, in virtue of their pathological views,—some of which indeed may very well have originated in this way,—were little accessible to the truth. For these reasons they deserved, at any rate to some degree, the satiric lash of Martial; and were very generally ridiculed by the more discerning of the laity. This comes out in the important words of Appuleius (Metamorph. X. 211.) as follows: “Crederes et illam fluctuare tantum vaporibus febrium: nisi quod et flebat: Heu medicorum ignavae mentes! Quid venae pulsus, quid caloris intemperantia, quid fatigatus anhelitus et utrimque secus iactatae crebriter laterum mutuae vicissitudines? Dii boni! Quam facilis, licet non artifici medico, cuivis tamen docto venereae cupidinis comprehensio, cum videas aliquem sine corporis calore flagrantem.” (Could you imagine her so tempest-tossed by the vapours of mere fever,—not to mention that she kept forever crying: “Oh! the sorry wits of doctors!” What means the throbbing vein, the excessive temperature, the labouring breath, and the hurried interchange of heaving flank, panting now on one side now on the other? Great heavens! how easy the diagnosis, not of course for a medical expert, but for any one learned in the symptoms of love, when you see a person burning, yet without bodily fever-heat).

But does all this justify us in casting a stone at our medical colleagues of Ancient times? For the last three hundred years we imagine ourselves clearly acquainted with Venereal disease and all its forms; yet how many a bubo has been mistaken for a strangulated hernia, anal callosity, or the like, how many a case of vaginal gonorrhœa for simple fluor albus (white discharge, leucorrhœa), how many a condyloma on the posteriors for hæmorrhoidal swellings, and accordingly not treated as the physician in Juvenal, medico ridente (the physician grinning the while), treated them,—that is duly cut away or ligatured?

Lastly to all these reasons was added further the mildness and absence of danger characterizing the disease itself, at any rate in the majority of instances,—as proved in our earlier investigations. To our own day genuine amateurs of Love, thanks to those who supply “advice, direction and information” on these subjects, endeavour as a rule, at any rate in the earlier stages, to cure without assistance the wounds received in the fight. This was equally so in Antiquity, as the following significant passage of Galen279 shows: “This is pretty well all I have to say at present as to ephemeral fevers. For patients who have contracted fever consequent upon a bubo, do not consult physicians as to what they must do; but after first treating the ulcer which occasioned the bubo and then the bubo itself, bathe after the abatement of the severity of the attack. After that if any one says a word as to the “diatriton” (fast till the third day), all laugh and declare him a precisian: I suppose because they are of the opinion that nothing must be resigned to nature that is not invariably there.”

We know quite well that the Ancients called all glandular swellings buboes, and that they were perfectly well acquainted280 with those glandular swellings in the arm-pits and the groin which follow upon ulcers of the fingers and toes; but this in no way justifies us in referring the above passage, which is certainly written in a general sense, solely to suchlike buboes and not equally to those in the soft tissues; more particularly as Galen, in the place where he is dealing expressly with the treatment of buboes and the phlegmonous affections preceding them and occasioning ulcers (loco citato p. 881), explicitly mentions phlegmonous symptoms as κατὰ αἰδοῖον (affecting the privates) and γυναικὶ κατὰ μήτραν ἢ αἰδοῖον (in women affecting womb and privates),—loco citato p. 893. Hence we think ourselves justified in drawing attention to the passage as containing an indication of the reason why ulcers of the genital organs pursued a milder course and admitted of an easier cure in Antiquity, because the ephemera evidently facilitated the assimilation and elimination of the contagion, this taking place either at the point primarily attacked, or else occurring because it (the ephemeral fever) led to an enhanced activity of the cutaneous glands by provoking an exanthematous eruption.

§ 39.

But for no small part of this reluctance on the part of patients the Physicians were themselves to blame. We have no wish in this place to enlarge upon the possibility of professional indiscretion in their case, though long ago the Hippocratic masters saw themselves constrained to guard their scholars against it.281 Of far greater weight was the nature of the treatment, especially that applied to ulcers of all kinds, which was excellently adapted to fill sufferers with fear and trembling. Already Hippocrates282 taught that ulcers with callous margins must be cauterized or else cut away with the knife. Galen283 declares himself even more plainly in the same sense: “But if the margins of the ulcer merely are discoloured and callous, they must be removed right to where the healthy flesh begins. Supposing this condition to have extended more widely, then the question arises,—whether we ought to cut away all the diseased tissue, or prefer a more tedious method of cure. It is natural and necessary in this case to consult the inclination of the patient; for whereas some prefer to avoid the knife and submit to a more tedious treatment, others on the contrary are ready for anything, so long as they get cured.” The same procedure was adopted with ulcers of the genitals, especially gangrenous ulcers, as is proved at once by the passage already quoted on p. 176 of Vol. II above.

The Asiatic, for whom the genital organs were an object of veneration, was no doubt horrified, as the Turk is to this day,284 at the idea of any such operation on himself; while the licentious Roman, who must have dreaded its very probable result in the entire loss of the further use and enjoyment of the parts in question,285 sought any other means for choice, preferred to have recourse to Priapus or even resorted to suicide, like the Municeps of Pliny mentioned on p. 257, before he trusted himself to the physicians who ever since the Carnifex (Butcher) Archagathus had appeared at Rome, strove to rival one another in infatuation for cautery and amputation. In any case it was only the direst necessity286 that drove the sufferer under such circumstances to the physician; while the latter had really and truly no reason for enquiring into the origin of the evil, as very often absolutely no alternative was left him but to grasp the knife or cauterizing iron. In this way medical procedure could not but have fallen into disrepute, while physicians were in most instances necessarily deprived of all opportunity of systematic observation.

Whether there were other factors as well to induce the old Physicians to apply the ordinary treatment of ulcers in general to those of the genital organs, we cannot indeed as yet for the time being determine. Certainly the conjecture is an obvious one that they may well have had an inkling of the specific nature of such ulcers, and that it was not merely the local mischief they sought to put a stop to by early application of cautery and knife. However it is only further and more careful investigations that must be allowed to decide the point,—the more so, as the general views as to the formation of ulcers held by the Ancients seem in many respects to tell against it. Thus Galen287 says: “The mode in which these (ulcers involving destruction of substance) are set up however is twofold; they arise either by removal of surrounding tissue (ἐκ περιαιρέσεως) or by eating away (ἐξ ἀναβρώσεως). How the former acts is well known. As to the eating away, if it proceed from the inward parts of the organism, it is an outcome of the evil humours; but if it arise from outside, then it is a result of the physician’s remedial measures or of fire.” From this we gather that all ulcers of the genitals, as well as others, which did not result from the action either of remedial measures or of fire, were held as being necessarily an outcome of the evil humours of the body. Further, that this view was not in any way peculiar to the time of Galen, but was a direct and necessary consequence of the further development of the pathology of “humours,” follows from the circumstance that we find the same opinion expressed by Hippocrates.288 Again Plato shared the latter author’s general doctrine of apostasis (suppurative inflammation taking off evil humours) in his “Timaeus”, where he derives from the white phlegm, striking outwards to the skin, cutaneous eruptions, rashes and the like maladies, from the acrid, salty phlegm on the other hand the fluxes of all types, bearing different names according to the different parts of the body affected.

If we do not choose to infer from this the proof of a then occurring, genuine and consistent genesis of the affections peculiar to the genitals, we are bound at any rate to admit that such a view must necessarily have debarred all thought of any specific character as belonging to ulcers of these organs,—the more so as to this very day we look in vain for any clear conception of really characteristic symptoms marking out Venereal ulcers in particular. Further, the knowledge that ulcers of the genitals were contracted through sexual intercourse, lacked entirely, so far as the ancient Physicians were concerned, the necessary confirmation and authority to induce them to make a special and distinctive class of morbid process to include them, because as a rule they paid no sort of attention to the occasioning cause, unless in virtue of its being still present and active, or else by the necessity for its elimination, it could afford some indication for therapeutic purposes. Galen brings this out best and most clearly in the following passage:289 “Moreover it will be a fitting occasion now to make it clear that not one of the causes directly occasioning the diathesis, or particular condition of body, will give any indication as to treatment; guiding signs for the purpose must rather be gathered from the complaint itself. What is to be done in any individual case depends on the immediate purpose and the nature of the part attacked, on the predominant temperament and the like facts. For to put it shortly, in no case can an indication as to what is beneficial be taken from any one of the factors that are no longer existent,—i.e. in actual operation. But as it often happens that in order to diagnose some affection that cannot be recognized either by help of ratiocination or by the senses, we are obliged to inquire into the cause that occasioned it, laymen conclude the guiding signs for remedial treatment to be taken from the same source. But this is by no means so. This may be plainly seen in those instances where the diathesis is quite well known in all its details; for whether it be ecchymosis or ulceration or erysipelas or putrescent ulcer (σηπεδὼν) or phlegmonous affection in any organ, it is perfectly useless to trace out the cause that occasioned it (αἴτιον ποίησαν), if this latter is now no longer active. On the other hand for any affection, a clear insight into which is lacking, a knowledge of the occasioning cause is useful.”

This principle was equally applied to affections of the genitals, the antecedent act of coition being regarded as affording absolutely no help in diagnosis, as we see from the passage of Galen to be next discussed. In this passage the declaration of a gonorrhœal patient to the effect that the women with whom he had connection suffered no less than himself from the malady, was entirely without influence on our author in the way of inducing him to assume and lay down a specific type of gonorrhœa. Under these circumstances it is really a matter for no surprise290 that the old Physicians in discussing affections of the genitals never allege sexual intercourse as an occasioning factor amongst others; and the conclusion drawn that such affections in Antiquity were not contracted by coition, because the ancient Writers do not definitely and in every single instance assign this as a cause, evidences really and truly merely the absence of any accurate study of their works and the knowledge of their views that is acquired as a result of such study. It is abundantly clear however that the neglect of the etiological factors referred to led eventually to their being completely overlooked; and it is no less obvious that this must needs have been a source of manifold mistakes, which degraded the physician in the eyes of the non-professional laity, very often made him ridiculous by reason of this ignorance, and brought down, as we have seen, many a cut of the satirist’s whip on his devoted shoulders. But how many of our colleagues are there not at the present day whom Venereal disease involves in the same doubts and difficulties?

However it may perhaps be suggested that, although the ancient Physicians did not feel themselves obliged to make any mention of sexual intercourse as cause of affections of the genitals, they cannot for all that have failed to notice the phænomena of infection. To say nothing of the fact that in no small proportion of instances affections of the genitals under the favouring conditions previously described did not as a matter of fact arise through infection, but actually in a sense spontaneously,291 and further that to this day we possess absolutely no criterion to distinguish such diseases arising in this way,—for it is only superficial and indolent observers that deny the possibility of such origination altogether,—apart from all this, the view which the Ancients took as a whole of the general question of infection was one in the highest degree inadequate. For this state of things, as Heyne292 long ago pointed out, the τὸ θεῖον (the divine element), or in other words the prevalent opinion that infectious diseases were an infliction of the offended deity, is mainly responsible. In these very diseases of the genitals, we have in fact seen how they were ascribed to the wrath of Dionysus and Priapus; and how long such ideas lasted, and how intimately they were interwoven with the life of the people, may be gauged by the circumstance that even the Christian Fathers themselves took every pains and used every effort to maintain them.

Now is it really in any way reasonable to expect the physicians of those times to have so completely extricated themselves from the predominant range of ideas? and have we any right to abuse them for their beliefs at the present moment, when in our own day there are to be found not a few physicians who deny absolutely the contagiousness of Venereal disease under its different forms? All the old practitioners could do was to draw attention to the fact that underlying the τὸ θεῖον there lurked some natural cause, and this view Hippocrates did actually maintain in his writings. As to the indicative signs of this cause perceptible by the senses, as to the material substance, whatever it may be, that communicates infection, into all this they could hardly be expected to initiate investigations,293 deficient as they were in every sort of aid and assistance for the task. For I ask, have we, in spite of all our researches, thus far attained to any satisfactory and certain results? Could the Anti-Contagionists ever have come forward at all, if we had been successful in demonstrating the contagion to be perceptible to the senses?

Besides all this, we actually find to the present day that in the countries in question the contagion exhibits but a low degree of virulence, and only under epidemic influence, as at the epoch of the Athenian Plague, did it assume a virulent character at all,—a fact that will be made yet clearer in our Continuation of the History of Venereal Disease. But wherever the contagion did exhibit this virulence of character, the ulcers that were set up passed over as a rule into gangrenous mortification, or else the physicians either exterminated it altogether by the actual cautery or removed it along with the part in which it had established itself. Thus any further spread of the contagion in its original form was not to be expected, as in patients of the sort there can be no doubt all desire for coition must have been destroyed.

If we now bring together the results of our discussion so far, we shall find reason to believe that, speaking generally, the ancient physicians,—that is physicians properly so called,—possessed but scanty opportunities, especially in the case of women,294 of observing with any precision the origin and course of affections of the genital organs, for it was mostly only the malignant forms of these that came under their notice, and these were of their very nature, except when epidemic conditions were at work, necessarily of infrequent occurrence. Their pathological views stood in the way of unprejudiced observation, conspicuous characteristic symptoms were as little to be found then as they are nowadays, any adequate knowledge of the material substrata of contagions was lacking to them in these as in other forms of disease, and thus they felt no direct inducement to class the primary affections of the genitals as forming a special category of disease.

Then again with regard to the secondary symptoms, the ancient practitioners in the cases treated by them made the occurrence of such all but impossible, for scalpel and cauterizing iron either entirely eradicated the contagion along with its material substratum, or else removed it with all speed before it could be reabsorbed into the system. Even when these did nevertheless appear, in some instances too great an interval of time intervened, in others the parts attacked were too remote from the spot primarily affected for it to have been possible for them to be referred to any direct inter-communication. Indeed this was made an actual impossibility in most cases, as it was just those very spots that are the usual seat of the secondary affections which were attacked primarily in consequence of the different modes of Venus illegitima (abnormal love) with such extreme frequency as to make it barely practicable for the keenest eye at a diagnosis to discover any actual distinction between the two,—and this without taking into account the circumstance that in view of the pronounced tendency conditioned by climatic causes for the morbid process to strike outwards to the external skin, mischief in the mucous membranes and bones must necessarily have fallen to a considerable extent into the background.

If circumstances put it out of the power of the ancient Physicians to unite under one whole the separate forms of Venereal disease, to look at the morbid process in its entirety, it is no less self-evident that for the same reasons they could have found no occasion to invent a special name for a thing that was simply invisible to them. Hence the conclusion drawn that, because no such special name is found, therefore Venereal disease cannot have existed, strictly speaking requires no further consideration. Still, granting for the sake of argument that they had recognized at any rate the generic difference of the primary affections, were they therefore bound to introduce a special name for them? Galen shall supply the answer. He says, mentioning295 that the old Physicians possessed no special name for depression of the skull in conjunction with fissure of the bone: “It is better to give a clear description than to fall back miserably on barbarous names, which the younger physicians have invented in great plenty.” In another place296 he finds fault with the different designations given to ulcers, and then proceeds: “If I consented to enumerate all the names, I should be running the risk of deliberately teaching what I recommend others to avoid, when I say that the true searcher after truth must needs withdraw his attention from the nomenclature that has grown up, and fix his eyes on the actual fact.”

While these expressions of opinion demonstrate the uselessness of the names, they show at the same time that no inconsiderable number of such names must no doubt have been in existence. So far as affections of the genitals are concerned, not only is this indicated by the Greek φθινὰς,—wasting disease and the Latin robigo,—ulcerous sore, not to mention the ambiguous ἄνθραξ,—carbuncle, malignant pustule, but Celsus expressly declares the fact, saying (Bk. VI ch. 18) at the beginning of his description of Diseases of the sexual parts: “Proxima sunt ea, quae ad partes obscoenas pertinent, quarum apud Graecos vocabula et tolerabilius se habent et accepta iam usu sunt, cum omni fere medicorum volumine atque sermone iactentur, apud nos foediora verba, ne consuetudine quidem aliqua verecundius loquentium commendata sunt.” (Next come such words as apply to the parts of shame, the Greek names for which are at once less offensive and are now sanctioned by usage, as they are constantly occurring in every medical book and medical discussion, whereas our native (Latin) names are coarser and are not even recommended by any custom on the part of those who speak with some regard to modesty). Celsus himself communicates but few of these words, for he wrote simul et pudorem et artis praecepta servans, (observing at once the laws of modesty and the rules of his art); while between him and the writers of the Hippocratic school medical Literature is all but a blank to us. The same is the case between Celsus and Galen; and of a period so important for our purpose as that of the licentious Emperors, likewise not a single independent medical Writer has come down to us. In fact even the Fragments of the Compiler Oribasius, lately made known to the world by Mai, contain, alas! nothing more than the headings of the Chapters most interesting to us.

In such a condition of things it is really verging on the borders of folly to hope to give a dogmatic and decisive judgement as to the knowledge of Venereal disease possessed by the Physicians of Antiquity,—the more so as the extant medical Works have never once been adequately ransacked, as Naumann only the other day proved in the case of Galen. But of a surety it is easier to maintain the Ancients knew nothing of Venereal disease, than to devote the best part of a man’s life-time to the investigation, how much the Ancients did actually know about it!

§ 40.

If we turn now from these discussions to the statements of the ancient Physicians themselves, there are two different ways in which we may regard them ourselves and present them to the reader’s eyes. Either we put down consecutively everything that has been said by one and the same Author and examine each single datum we owe to him by itself, or we bring together the data given by different writers on one and the same subject, and then compare these one with another. The first way, the one generally followed by historians of Venereal disease hitherto, gives us it is true the general results of the knowledge possessed by the several writers on the different forms of Venereal disease; but, seeing on the one hand we do not in most instances actually possess all the works of our Author, while on the other even when we do, we are not justified in looking upon his report as embodying a résumé of all the knowledge of his time, the advantages of such a way of dealing with the subject are on the whole but slight, while it has the disadvantage of rendering considerably more difficult the general survey of the information possessed by Antiquity as to Venereal disease, which nevertheless is really our immediate and capital concern, and cannot fail moreover to occasion a host of contradictions.

The second way not only relieves us from this disadvantage, but also ensures us that general Survey which is peculiarly necessary, and to the absence of which the circumstance is chiefly to be ascribed that it has been possible hitherto to convince the opponents of the antiquity of Venereal disease only in the most incomplete manner of its actual existence in those times at all, as the exposition of the contrary view, in itself incomplete, was bound in its fragmentary presentment to seem even more incomplete still. Of course, in following the second way of exposition, there is an unavoidable dislocation of the data communicated by each individual writer, but this is a thing of but little moment, more particularly as its inconvenience is minimised by our giving the passages, when quoted for the first time, in extenso, so as to have on subsequent occasions merely to refer back to them. Again the want of a clear marking of dates, a point undoubtedly of great importance in historical researches, is readily obviated by our laying down the available fixed points of our chronology in the general Survey that forms a necessary conclusion to our exposition.

No doubt Hensler and Alex. Simon had already struck out this second way of exposition; but the latter writer merely examined the data of the several Writers by themselves without making any effort to build them up into one whole. To do this was, it is true, a proceeding quite foreign to the method adopted by the Ancients, but for our own time, accustomed as we now are to demand a systematic exposition of a subject, it seems absolutely indispensible. Hensler on the other hand in his treatment of the question fixed his particular attention solely on the Middle Ages, and made it his immediate aim merely to prove that previously to the ninetieth year of the XVth Century local affections of the genital organs were already well known, and had been subjected to treatment.297

Now with regard to the actual exposition that follows, we shall refrain in it as much as possible from going into particulars, such as the text itself or the views of the Authors might seem to make obligatory, as the needful space fails us, at any rate for the present. Moreover the matter coming under review has been discussed already by many others, while as for critical elucidations, let them be as pressingly required as they may, we lack all the necessary apparatus criticus. In fact in the case of several Writers, the translation, let alone the original text, was with difficulty accessible, for which reason many a passage of those already known may perhaps have been passed by unregarded. A complete collection of all passages, including those still unknown,—for the harvest as was mentioned above has by no means been all reaped,—will certainly not be demanded by any reasonable reader from a Student of thirty, for hardly even a greybeard Enquirer surely could boast of having read all printed works of the ancient Physicians. For the rest, our present object is not at all to give an exhaustive exposition of all the ideas and observations of ancient Physicians as to affections of the genital organs; it only concerns us here to bring together what is true and directly available for our task. Under this head would certainly seem to come the following seven points:

1. Gonorrhœa (Clap).

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 Galen309 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 avoiding310 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 Celsus324 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. Galen325 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!

2. Ulcers and Caruncles in the Urethra.

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 Celsus329, 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 urethra331 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 occur334 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 testicles338 is usually characterized according to Paulus Aegineta339 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). Aretaeus344 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 author347 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. 3. Ulcers of the Genitals.

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 organs348. 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 Galen357 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 Oribasius365 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 him366 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 oxymel372 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:—

A. Ulcers on the male Genital Organs.

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 Leonidas374 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 Galen376 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 Aëtius382 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. Galen384 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 Pollux386 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.

B. Ulcers of the Female Genital Organs.

In this connection, as indeed in the discussion of the female genital organs generally, we once again meet with the difficulty due to the indefiniteness of the names given to the several parts. Not only do the Greeks constantly make use of the general expression αἰδοία, μόρια (privates, parts), but they likewise employ ὑστέρον and μήτρα (the womb) sometimes as meaning the vagina, sometimes the uterus, though it is true the later Writers like Galen388 designate the vagina ἡ ὑστέρα, the uterus ὁ ὑστέρος, yet without keeping consistently to the distinction. The same applies to the use in Latin of locus (place), pars (part), and vulva (womb), which last word stands for the uterus in Celsus, Pliny and most of the later Writers.

Passing over the indefinite expressions dolores (pains), inflammatio or phlegmoné (inflammation) of the genitals, although the treatment prescribed for them clearly implies that very often ulceration was concurrently present, we find the various kinds of ulcers of the female genitals most fully and systematically described by Aretaeus,389 Paulus Aegineta (III. 65-68.) and Aëtius390 following Archigenes, Soranus and Aspasia.391392

Abscesses Aëtius says (loco citato, ch. 110.) occur on the female labia; if these extend in the direction of the anus, they must not be opened with the knife, as fistulas are liable to be set up, but there is no fear of this when they extend towards the urethra. The same author (p. 109.) speaks of pustulae scabrae (scabrous, scurfy pustules) in the vagina and orifice of the womb, which throw off bran-like scales, as also (ch. 108.) of tubercula miliaria (miliary tubercles) in the same localities. These may no doubt be recognized by touch, but are better diagnosed by means of the uterine speculum, or Dioptra, and ex coitus affrictu (in consequence of friction in coition) interfere with menstruation and conception. Obviously what is here pointed to is the swollen mucous glands, which in our modern practice likewise are frequently observed in gonorrhœal cases. Often the ulcers take a form characterized by fissures (ῥαγάδες, fissurae,—fissures, rimae,—cracks), particularly at the orifice of the uterus.393 Sometimes they become callous, at others give rise to morbid outgrowths; as a rule the discharge is a thin watery juice, and pain is felt during coition.394

Ulcers strictly so called, says Aretaeus, are either superficial, in fact rather excoriations than ulcers, and far-spreading; they itch as though salt had been sprinkled on the surface, give off a small quantity of thick pus, free from smell, and are not malignant. To this class probably belong the aphthae-like ulcers of Hippocrates.395 In other cases they are more deep-seated; being then painful, discharging an evil-smelling pus, and having a less mild character than the former, but still not such as to be described as malignant. If they penetrate yet deeper, the edges then become rough, the discharge takes the form of a malodorous juice, while the pain is more severe than in the other kinds. The actual tissue of the womb is partially destroyed in the latter case, while morbid outgrowths form, which make cicatrization extremely difficult. This last kind was known also as phagedaena, (eating ulcer); it is dangerous, especially if the pain increases and the patient falls into low spirits. An offensive juice is discharged, so foul that the patient herself is hard put to bear it; the ulcer is highly intolerant of being touched for the application of remedial means; it may end fatally, and is known under the name of “Crab-ulcer”. Νομὴ (spreading ulcer),396 carbuncle and sordida ulcera (foul ulcers) of the uterus are mentioned by Aëtius (loco citato), who shows the mode of investigating them by means of the uterine speculum and a treatment consisting mainly of injections397 and pessaries prepared of a number of different remedies. Not unfrequently unskilful treatment of ulcers of the vagina occasioned morbid outgrowths, which according to Celsus’ teaching,398 must be removed by surgical means. Lastly the fact that ulcers of the genital organs of women were prejudicial to men who consummated coition with them and were for that reason dreaded by them, is clearly implied in the narrative of Cedrenus.399

4. Ulcers of the Fundament.

We have already seen how fissures and ulcers of the fundament were a not unusual consequence of the vice of the pathic, yet not the faintest indication of the fact is to be found in the medical Writers. The knowledge possessed by the Ancients as to affections of the fundament have been collected with a very considerable degree of completeness by Aëtius,400 especially as copying Galen; the remaining authorities treat them as a rule in conjunction with the corresponding affections of the genitals, and mostly recommend the same remedies for them. So far therefore as they are concerned we refer back to the information given in connection with the latter. At the same time the remark may be permitted that this juxtaposition of the two seems to point to the Ancients having held, as we maintain they did, the view that affections of the genitals and affections of the anus arose from like causes and were of like character, as is shown by their dealing with the one and the other class of diseases on the same general lines.

Ardentes dolores (burning pains)401 and pruritus (itching)402 of the anus are not uncommon. Inflammations403 often supervene as a consequence of fissures, morbid growths and ulcers. Rhagades (cracks) and fissures404 are found either in the sphincter muscle or in the rectum, and are an accompaniment of condylomata, whenever the latter become inflamed and spread, causing the surrounding tissue to rupture; the edges frequently assume a callous condition, and then require to be broken down and thus transformed into a simple ulcer. Often abscesses are set up405 as a result of the inflammation, and these are liable to lead to fistulas. The ulcers406 on occasion assume the character of the νομὴ φαγέδαινα (eating and spreading ulcer). Supposing them situated on the sphincter ani, they must neither be cut nor cauterized, as severance of the muscle makes it impossible for the patient to retain the faeces. This loss of retentive power may also occur apart from any operation, if the νομη (spreading ulcer) destroy the muscle. Supposing on the contrary the νομὴ to be below the sphincter, knife or cauterizing iron may either of them be employed. In some instances ulcers lead to a morbid growth at the orificium ani, that must be obviated by means of pipettes of lead.407 In other cases rhagades (cracks) and ulcers lead eventually to morbid outgrowths.

5. Buboes.

Bubo, panus (swelling resembling the thread wound on bobbin of a shuttle), paniculus (diminutive of same), inguen (swelling in the groin).

Under the name of bubo the ancient Physicians understood any form of inflammation of the lymphatic glands. Now such inflammation occurs above all other places in the inguinal region, and thus inflammation of the inguinal glands came to be especially indicated by the word, as well as the inguinal region itself. Similarly the Romans used inguen (the groin) both for the region and for the disease. Subsequently many distinctions were drawn; a phlegmonous affection combined with swelling was called a βουβὼν (bubo), while the name φῦμα (swelling) was appropriated to a swelling of the glands characterized by its rapid establishment and its tendency to suppuration (bubo with suppurative pustule in the centre), and φύγεθλον (burning swelling) to one conjoined with (cutaneous) inflammation of an erysipelas character,408 which last form, if it passes on into induration, is known as χοιρὰς or struma (scrofulous or strumous swelling). The best exposition from the points of view equally of pathology and therapeutics is found in Galen.409 The glands in virtue of their spongy structure are peculiarly liable to take up rheums or fluxes of all descriptions; accordingly the glands of the groin, armpits and neck swell, directly ulcers are set up in the toes, fingers or head. The body being overloaded with evil humours is another reason for the establishment of buboes, and in this case they are more difficult to cure. Further, Hippocrates410 derived buboes in women from interrupted menstruation, and maintains411 that the most part owe their origin to some affection of the liver.

The majority of Writers however are agreed that among other occasioning causes ulcers hold the first place,412 though none of them speak expressly of ulcers of the genitals, unless indeed we see good to make the passage of Hippocrates discussed a little above refer to these. No doubt in this passage the words ἑλκώματα, φύματα ἔξωθεν ἔσωθεν τὰ περὶ βουβῶνας (ulcerations, tumours external and internal in the inguinal region) might admit of such an explanation, in which case the words must be taken not as referring to each single patient, but rather held to mean that ulcers and glandular swellings with a tendency to suppuration were set up, the latter occurring in some patients in the urethra, in others in the groin. Such an interpretation is favoured by the case of the Eunuch discussed in § 20, for there can be no doubt the metathesis of buboes into fistulous ulcers was noted by Celsus and other observers. Still it is highly improbable that ulcers on the feet should have afforded the sole and only cause of buboes; it is much more natural to suppose that this, as being the more rare case, was for that very reason brought into special prominence by the ancient Physicians. Besides we have seen above that the old Physicians seldom or never really had an opportunity of seeing the sympathetic buboes, as patients treated the ulcers themselves, and the buboes then disappeared spontaneously. Oribasius no less than other Writers holds buboes following on an ulcer to be without danger.

Lastly the cases are very rare in which secondary buboes under the prevailing tendency and course of the disease are thrown out on the skin, and if they do arise, the ulcer as a rule heals up. This being so, the Physician is consulted, only supposing the buboes refused to disappear. On the contrary if the ulcer was still there, the Physician sought actually to stimulate it to enhanced activity, as is distinctly implied by what Galen says (loco citato). Lint smeared with tetrapharmacum (compound of wax, tallow, pitch and resin), liquified by the addition of oleum rosaceum (oil of roses) was applied and warm poultices over that; while on the actual bubo was laid in the first instance wool moistened with oil, to which when the pain and swelling of the part were relieved, was added an admixture of salt. Plethoric or cacochymic (generating evil humours) subjects are to be bled or cupped. If the bubo is inflamed and inclined to suppurate, it must be scarified, the patient having first been purged. Dispersion is then attempted, in this case by means of pulp and honey poultices, but not by plasters, as these are apt to provoke inflammation. If pus appears, recourse must not be had at once, as some advise, to opening with the knife; rather the poultices should be persevered with till the inflammation is relieved. Acrid poultices are suitable only when the metathesis to induration has already begun.

If dispersion does not follow and the matter has collected in greater quantities, then the most elevated spot, the same where the skin is the thinnest, should be opened. Should a part of the skin be discoloured, it must be cut away. Some advise always cutting out a piece in the shape of a myrtle-leaf, others make very long incisions; but this not only causes a disfiguring scar, but often also interferes with the movement of the part. As a general rule a single incision is sufficient, which should be made diagonally across the inguinal region, not parallel with the direct diameter of the thigh, as then the edges are brought actually into contact when the limb bends.413 After the opening of the abscess, it should be treated by preference with finely sifted frankincense, as should all forms of ulcer. We may mention further that according to Sextus Placitus Papyriensis414 the wearing of a stag’s genitals was considered a prophylactic against buboes.

6. Exanthemata on the Genitals.

Long ago Hensler endeavoured in the Graduation Theme of his mentioned in the list of Historical Authorities to prove that certain eruptions occurring on the genitals were communicated and acquired as the result of coition. In particular did this apply above all to herpes (creeping eruption), under which name must be understood, as is distinctly implied in a passage of Galen,415 a form of eruption accompanied by ulceration. It is true the passages of Hippocrates416 cited by Hensler in regard to the herpes esthiomenos (eating herpes) would appear to be open to some doubt and obscurity, while the interpretations given by Pollux (Onomast. IV. 25. 191.) φλυκτίς, φλύκταινα ἐπιμήκες, μάλιστα περὶ βουβῶνας καὶ μασχάλας. φύγεθλον, φῦμα περὶ βουβῶνα μετὰ πυρετοῦ, (φλυκτίς, a long-shaped blister, particularly in the groin and armpits. φύγεθλον, a tumour in the groin accompanied by fever) refer probably only to bubonic swellings; still these objections hardly apply to the φύματα (swellings) described in § 32,—the less so as Celsus himself (VI. 18.) explains: “Tubercula etiam, quae φύματα Graeci vocant, circa glandem oriuntur, quae vel medicamentis vel ferro aduruntur; et cum crustae exciderunt, squama aeris inspergitur, ne quid ibi rursus increscat;” (Tuberculous swellings also, which the Greeks call φύματα, arise about the glans penis, and are burned away either by caustic drugs or by the actual cautery. Afterwards when the scabs have fallen off, the sore is dusted with slag of bronze, to prevent any second growth later on). Moreover it is possible the passage of Galen,417 πρὸς δὲ τὰ ἐν αἰδοίοις φυόμενα ἀπίου σπέρμα ἐπίπασσε καὶ τραγείᾳ χολῇ περιχρῖε. (But for growths on the privates sprinkle pear-juice and rub in goat’s gall) may refer to these cases, though no doubt it may also be held to apply to the tubercles occurring in the female vagina (§ 41,—3. B.).

Again epinyctis (night-pustule),418 which Hensler also mentions but declares to be equally open to suspicion as to interpretation, would seem hardly pertinent in this connection, for the violent pain experienced at once tells against the likelihood of its being an affection of this class. Its appearance in eminentibus partibus (on prominent parts, on the extremities) finds a clear explanation in the words added by Pollux (loco citato, 197.) περὶ κνήμας καὶ πόδας ἐν νυκτὶ γενομένη (appearing on legs and feet during the night); while it is proved that Celsus meant to indicate nothing else by it from his words in describing φλυζάκιον (little blister), which he says occurs raro in medio corpore, saepe in eminentibus partibus,—rarely on the trunk, frequently on prominent parts, extremities. Still we do not for a moment wish to dispute the fact that the male genitals were at any rate among the Ancients counted as belonging to the partes eminentes, and as chancrous blebs do usually appear suddenly and often during the night, it is quite possible these may have been all along intended by epinyctis,—especially as on Hippocrates’ authority419 creeping eruptions (ἕρπητες) arise from night-pustules (ἐκ τῶν ἐπινυκτίδων.) However Pollux (loco citato, 206.) likewise again mentions the legs and feet (κνήμαις καὶ ποσίν), declaring these eruptions attack those of elderly people. From this we may conclude the epinyctis of the Ancient writers to have been very likely nothing else but that form of impetigo (scabby eruption) which is vulgarly known as the salt-flux.

Aetius420 mentions pustulae spontaneae in pudendis (pustules spontaneously set up on the privates), provoking phimosis, and describes421 scabies scroti (scab of the scrotum) with metathesis into ulceration and scaliness, after the disappearance of which very often acute pruritus scroti (itch of the scrotum) is left behind. Galen (XIX. p. 449.) defines psoriasis scroti (itching of the scrotum) as a form of induration of the scrotum accompanied by itching, as well as in some instances by ulcers.

Under exanthematic types come also the various condylomata. These when they appeared on the genitals and in other localities of the body, were called by the Greeks σῦκος, συκώσις, σύκωμα, συκώδης ὄγκος, (fig, figlike excrescence, figlike swelling, figlike lump), by the Romans ficus (fig), whereas the same disease when it showed itself on the fundament, received the name of condyloma422 par excellence. At the same time this distinction was by no means strictly observed; in particular the larger forms of thymus (warty excrescence) were designated by the name σῦκος (fig), albeit it would seem that thymus was used as specific name for all protuberances on the fundament and genitals. Σῦκος or ficus is according to Galen423 an ulcerative tubercle secreting moisture,—the varus (blotchy eruption) on the contrary being dry, according to Oribasius424 of circular shape and reddish colour, hardish and rather painful. It is found above all on the hairy parts of the body, the head, chin, fundament and genitals,425 as the passages quoted above in § 13 from Martial show. They occurred, as it would seem, most frequently on the female genitals, in which situation they are described so long ago as by Hippocrates426 under the name of κιων (pillar, pillar-like excrescence) and said to be evil-smelling. Aspasia427 says, “condyloma est rugosa eminentia. Rugae enim circa os uteri existentes dum inflammantur, attolluntur et indurantur, tumoremque ac crassitudinem quandam in locis efficiunt.” (a condyloma is a wrinkled protuberance. For when the wrinkles surrounding the orifice of the uterus grow inflamed, they become prominent and indurated, occasioning a swelling and thickening in the parts). Paulus Aegineta (III. 75., VI. 71.) describes them under the name of hemorrhoids as painful, reddish, excrescences suffused with blood, which break (διαλείμμασι), and give off a pale discharge in drops. Much more common was the appearance of condylomata on the fundament,428429 particularly in male subjects; in which case they were specially ascribed to pederastia, as we have already seen. This makes it impossible to decide definitely which condylomata were of primary and which of secondary character; but the fact in no way authorizes us to deny altogether the occurrence of the latter in Ancient times.

7. Morbid Outgrowths on the Genital Organs.

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 Celsus430 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.