PLAGUE OF LUST,
BEING A HISTORY OF VENEREAL DISEASE
and Including:—Detailed Investigations into the
Cult of Venus, and Phallic Worship, Brothels,
the Νοῦσος Θήλεια (Feminine disease) of the
Scythians, Paederastia, and other Sexual
Perversions amongst the Ancients,
AS CONTRIBUTIONS TOWARDS
THE EXACT INTERPRETATION OF THEIR WRITINGS
Dr. JULIUS ROSENBAUM
TRANSLATED FROM THE SIXTH (UNABRIDGED) GERMAN EDITION
AN OXFORD M.A.
The Second of Two Volumes
Publisher of Medical, Folk-lore and Historical Works
13, Faubourg Montmartre, 13
Irrumare: Penem in os alienum inserere, ut sugatur, itaque voluptas quaedam libidinosa paretur; to put the penis into another’s mouth to be sucked—a form of vicious indulgence.
Fellare: Penem alienum in os admittere, ibique eo sugere ut voluptas quaedam libidinosa paretur; to allow another’s penis to be put in the mouth and to suck it—the active form of the above vicious practice.
Fellator: Is qui pro habitudine fellat; one who practices this vice.
Cunnilingus: Qui mulierum pudenda lingit; a man who licks women’s private parts.
THE PLAGUE OF LUST
Irrumation and Fellation.
Very much more abominable and repulsive still is the habit of Irrumation1 (penem in os arrigere est irrumare—to erect the penis and insert it into the mouth of another person) and the practice of the4 Fellator2 (si quis vel labris vel lingua perfricandi atque exsugendi officium peni praestat—one who with the lips or the tongue performs the office of rubbing and sucking another’s penis). This the Greeks called λεσβιάζειν (to follow the Lesbian mode), because the vice was especially practised by the Lesbian women, though in common with all others of the sort it came originally from Asia. Lucian in his Pseudologista3, in which he severely criticizes the the dissolute Timarchus, who had taken the expression ἀποφρὰς (unmentionable) in ill part, says: “By the gods, what should make you fly into a passion, since it is a matter of common report that you are a Fellator and a Cunnilingus4. Are you5 as much in the dark as to the meaning of these words as you are about that of ἀποφρὰς (unmentionable)? and do you take them for titles of honour? Or is it that you are now accustomed to them, but not to6 ἀποφρὰς, and so wish to erase it as something unknown to you from the list of your Titles? (ch. 28).—I am well aware what were your practices in Palestine, in Egypt, in Phoenicia and Syria, as well as in Hellas and Italy, and above all just now in Ephesus, where you set the crown on your extravagances, (ch. 11).—However you will never persuade your fellow-citizens that they ought not to regard you as the filthiest of all men, the very refuse of the whole city. Now it may be you rely on the belief of the generality in Syria, that you have never been accused (there) of any guilt or vice. But by Hercules! the city of Antioch looked on at the whole history, when you carried off the young man who came from Tarsus, and—but there, it would not become me to go over such ground again. All who were there know the facts and remember it all, that time when they saw you sitting at his knees (καὶ σὲ μὲν ἐς γόνυ συγκαθήμενον ἰδόντες), and doing you know very well what to him, that is if you have not utterly and entirely forgotten the whole matter, (ch. 20).—But when they caught you lying at the knees of the son of Oinopion the Cooper (τοῦ μειρακίου … ἐν γόνασι κείμενον—lying at the knees of the stripling), what make you of that? Did they not surely take you for a man of the sort to be expected, when they saw you doing such a thing? (ch. 28).—How, by Zeus! after such a deed, have you the effrontery to give us the kiss of salutation?—Sooner kiss an adder or a viper? The danger and7 pain of the bite a Physician may yet remove, if called in. But after your kiss and with such poison on his lips who dare draw near to Temple or altar? What god would listen to the suppliant? how many vessels of holy water, how many lustrations, would be needful? (ch. 24).—In Syria you are known as ῥοδοδάφνη (rose-laurel)5; why, a man cannot explain for very shame, great Athené!—But in Palestine as φραγμὸς (the hedge)6, on account of the prickles of your beard, I suppose. In Egypt again as συνάγχη (sore throat),—and this is a well known business. It must have been a close thing with you not to be choked, that time you came across the sailor of a three-master, who fell upon you and stopped your mouth for you (ὃς ἐμπεσὼν ἀπέφραξέ σοι τὸ στόμα).”
This passage brings us next to a gloss of the Pseudo-Galen7, on which Naumann8, after laying8 down his view as to the Morbus phoeniceus (Purple Plague),—a subject to be discussed presently,—goes on to express himself thus: “However we must go yet farther. In the above cited work of the Pseudo-Galen is included an Index of words, which with a high degree of probability we may conclude to refer to Venereal diseases, so far as known to the Ancients (loco citato, under word στρυμάργου, p. 142). We read there that Dioscorides called στρυμάργους or στομάργους (evil-mouthed) men in whom the longing for sensual indulgence had risen to frenzy. Of similar meaning to this would seem to be the expressions μυοχάνη (maxillarum hiatu insignis—conspicuous for the wide opening of the arm-pits) or μυσάχνη (meretrix—prostitute), μῦσος (facinus abominandum—an abominable act), σαράπους (crura ambulando divaricans—straddling the legs in walking), and γρυπαλώπηξ (from γρύπος curvus—curved, hooked,) probably denoting the erection of the penis; at any rate a dissolute man is called in Aristophanes κυναλώπηξ (fox-dog). But most notable is the added observation, to the effect that Erasistratus called such persons ῥινοκολοῦροι (i.e. qui mutilati naribus sunt—men who have been mutilated in their noses). Just at the time of the Greek occupation of Egypt, Rhinocorura or Rhinocolura was the name of a wretched sort of “Botany Bay” situated at the North-Eastern extremity of the country, lying in the desert on the shores of the Mediterranean between Gaza and Pelusium, and serving as a place of residence for lepers (Pliny, Hist. Nat., Bk. V. ch. 4. Livy, Hists. Bk. XXXV. ch. 11). Now if we bring together all the information given here, and especially if we consider the various shameful forms of indulgence of the sexual impulse and the mutilation of the nose that is connected with them, there cannot be much doubt left that these ancient and fragmentary notices refer to Venereal evil, whether in conjunction with leprous affections or not.”
But to test the correctness of these explanations9 and conclusions, it will be necessary first of all to quote the gloss itself in full: στρυμάργου. οἶδε καὶ ταύτην τὴν γραφὴν ὁ Διοσκουρίδης, οὐ μόνον τὴν στομάργου, ἀλλὰ καὶ τοῦτο οὐχ ὡς κύριον ὄνομα ἐξηγεῖται, ἀλλὰ τὸν μανικῶς ἐπτοημένον περὶ τὰ ἀφροδίσια δηλοῦσθαί φησιν· εἰρῆσθαι γὰρ παρὰ τῷ Ἱπποκράτει καὶ ἀλλὰ πολλὰ κατὰ τὸν αὐτὸν τρόπον ἐπίθετα, καθάπερ μυοχάνη, σαράπους, γρυπαλώπηξ· ἀλλὰ καὶ παρ’ Ἐρασιστράτῳ φησὶν ὁ ῥινοκολοῦρος, that is to say:—στρυμάργου: Dioscorides knows this form also, not merely that of στομάργου, but this too he regards not as a proper name, but says that it signifies one who is madly set upon love-indulgences; for that in Hippocrates as well many other epithets of the same sort (which refer to the same sort of vice) are mentioned, e.g. μυοχάνη, σαράπους, γρυπαλώπηξ; also he says that in Erasistratus (the expression) ῥινοκολοῦρος is found.
The reader sees in the first place that it is not merely expressions peculiar to Dioscorides that are here cited, as we might be led to suppose by Naumann’s statement, but that they are every one of them found, as we shall presently prove more particularly, in Hippocrates, the ῥινοκολοῦρος of Erasistratus of course excepted. Dioscorides mentions them only in his commentary on the Second Book of the “Epidemia”, when laying down the passages to be cited immediately, and declares them not to be proper names, but adjectives which all refer to insane indulgence in the pleasures of love; accordingly there can be no question here of bodily disorders, let the words in themselves signify what they will. Now if we examine into this more closely, we shall find first of all that we must obviously read στυμάργου in place of στρυμάργου, for not only is this form given by the author of the gloss (under στομάργου9), quoted on the preceding page, but10 the text also of Hippocrates10 offers it in both passages; whereas στρυμάργου gives no sort of sense.
The word στυμάργος in fact is derived either11 from στῦμα11, the act of erecting the penis, and and ἔργον (work), so signifying anyone who performs the work of causing an erection of the penis,—or else from στύω12, I erect the penis, and μάργος13,12 (mad), i. e. one who erects, uses, the penis in a madly lascivious fashion, so an Irrumator, and with this Hesychius’ interpretation agrees: λεσβιάζειν,—πρὸς ἀνδρὸς στόμα στύειν, (to lesbianize,—to erect the penis in a man’s mouth). Στομάργος on the other hand is formed by a combination of στόμα, the mouth, and ἔργω or ἔργον (I work, work), a word constantly used to express the employment of the genital organs14, in fact indulgence in love generally, and signifies a man who performs the work (of love) with the mouth, so a Fellator15. Now13 since only the most abandoned lust, lust that has really grown into a form of insanity, is capable of undertaking such obscenities, the interpretation of Dioscorides μανικῶς ἐπτοημένον περὶ τὰ ἀφροδίσια (one that is insanely, madly, set on the pleasures of love) is quite satisfactory, assuming a hesitation on the part of the author to set forth the actual fact more explicitly, especially as we have already proved under the head of Paederastia16 how unnatural sexual desires were commonly regarded as a Mania14 or form of insanity. Even if we were not in a position adequately to explain the rest of the words, yet the phrase that comes next to them καὶ ἄλλα πολλὰ κατὰ τὸν αὐτὸν τρόπον (and many others of the same fashion) at once shows that they bear the same signification as στύμαργος and στομάργος, or at any rate that they must all alike refer to unnatural satisfaction of the sexual impulse, for τρόπος (fashion) is the very word particularly appropriated to imply such-like practices, as we see from the expressions Κρῆτα τρόπον, Ἑλληνικὸν τρόπον17, (Cretan fashion, Greek fashion) used to indicate paederastia.
In relation to the word μυοχάνη the readings differ greatly in the different MSS. of Galen. Franz in his edition of the Glossaries to Hippocrates gives μιοχάνης and μυοχάνης, while the Pseudo-Galen explains it under the word μυοχάνη as ἐπίθετον χασκούσης· εἰ δὲ μυριοχαύνη γράφοιτο, ἡ ἐπὶ μυρίοις ἂν εἴη χαυνουμένη (epithet applied to a woman who gapes; now if μυριοχαύνη were read, it would mean “the woman who gapes wide for ten thousand men”); besides, various readings are found here,—μηοχάνη for μυοχάνη, also μιριοχάνη, and μυιοχάνη for μυριοχαύνη. Erotian says15 μηριοχάνη ὄνομα γυναικὸς (Meriochané—a woman’s name). In the text of Hippocrates18 is found Μυριοχαύνη, and the same form is given by the editions of Galen19. Inasmuch as χάνω and χαύνω both have the same meaning of gaping wide, that is with the mouth, it will practically make no difference which we choose as the end of the word; hence we have merely to consider the first part μου- or μυριο-, all the rest of the forms being obviously erroneous. If we read μουχάνη, we must suppose it compounded of μύος and χάνη; but inasmuch as μύος is merely a mistaken variant for μῦσος, the word must be read μυσοχάνη. Μῦσος in its turn we must derive either from μύζω, I suck,—so a woman who sucks with open mouth20, or from μυσιάω, I snort through the nose, particularly in the act of coition, and consequently read μυσιοχάνη, i.e. a woman who with mouth open snorts through the nose, precisely what the fellatrix undoubtedly does when at her work. This emendation certainly makes better sense, and is all the more likely from the fact that μυιοχάνη and μυριοχάνη are also found as variae lectiones. Naumann would seem desirous of reading μυσάχνη (μυζάχνη), in which case it must be formed from μύζω, I suck, and ἄχνη (froth), in fact the secretion that adheres to the surface (of the glans penis)21. This last reading16 is all the more admissible, as according to Suidas22 the word also occurs in Archilochus. Possibly however we must regard as equally correct the form μυριοχαύνη, and take it in the meaning given by17 the Gloss, viz. in millibus hians! (gaping in a thousand openings!), bearing in mind Lampridius’23 expression about Heliogabalus: Quis enim ferre posset principem per cuncta cava corporis libidinem recipientem! (For18 who could endure a Prince that welcomed lustful pleasure by every opening of the body!)
The readings also vary as to σαράπους (turning out the feet); Franz gives ἀγράπους and ἀράπους; in the text of Hippocrates24 on the other hand, as well in the Commentary of Galen it appears as ἡ Σεραπὶς, the latter also giving it in the genitive—τῆς Σεράπιδος. But inasmuch as the name of the goddess occurs sometimes as Σέραπις, sometimes as Σάραπις;, and as the genitive ending—πιδος easily admits of change into—πόδος, it may very likely be that after all Σαράπους stood originally in Hippocrates’text. The author of the Gloss (loco citato p. 136.) explains the word by ἡ διασεσηρότας καὶ διεστῶτας ἔχουσα τοὺς δακτύλους τῶν ποδῶν that is, a woman who has the toes drawn apart and separated. But how are we to bring this explanation into agreement with the κατὰ τὸν αὐτὸν τρόπον, (after the same fashion), that is to say, with one of the modes of Love that are under discussion? Think of the fellator or fellatrix, we are told, cowering down (ἐν γόνασι,—on the knees) according to Lucian’s picture (p. 229 above), and you will see the stress of the body’s weight must always fall on the front part of the foot, and to widen the point of support he is instinctively compelled to spread the toes. Well! but who can fail to see how very forced such an explanation is? still we do not in the least know how we are to deal with it further. Of course we might leave the author of the Gloss his interpretation and proceed to look about for another of our own, though we have in many cases to confess the fact that our investigations undertaken with this end in view have not exactly led to any definite results. With the reading Σεραπίς we really do not know how to deal. Perhaps the common representation, or else some particular quality, of the19 goddess so named gave occasion for a comparison which we now fail to understand, one that might possibly suggest an explanation of the Harpocratem reddere (to recall Harpocrates) of Catullus (69.) implying irrumare25. Whether the reader will take20 within his purview the Σεραφίμ, ἐμπρηστάς· ἔμπυρα στόματα· ἢ θερμαίνοντας (Seraphim: kindlers; fiery mouths: or, making hot) of Suidas’ Lexicon, we must leave to him; in that case Martial’s (II. 28.) calda Vetustinae nec tibi bucca placet (nor does Vetustina’s hot mouth please you) might afford an analogy. Proceeding to consider σαράπους, we find Hesychius has σαραπίους, which he explains by μαινίδας (mad-women), and Dioscorides is at one with him in regarding the vice as something done μανικῶς (madly). In Diogenes Laertius (I. 4.) we read Pittacus was called: σαράποδα καὶ σάραπον διὰ τὸ πλατύπουν εἶναι καὶ ἐπισύρειν τὼ πόδε. (turning out the feet, because of his being flat-footed and trailing his two feet). It would be hardly credible to suppose that the author of the Gloss borrowed his explanation cited just above from Diogenes Laertius or Suidas, in whom the passage occurs as well. Further, the MSS. of Diogenes give also συράπους, a word found several times in the sense of “to stand with legs apart,” and Naumann too must have understood this in our passage, for he gives as his rendering crura ambulando divaricans (straddling the legs in walking). Now leaving altogether out of the question the fact that the feminine form is found in Hippocrates, and assuming the word to be used of men, it might perfectly well signify the irrumator, who takes the fellator between his opened thighs26, a posture that was generally22 regarded as obscene27. Indeed if we think of the fellator as sitting on the ground at his work, the word of course can be equally well used of a woman, or fellatrix.
As to γρυπαλώπηξ we read in Hippocrates (loco citato p. 629.) as follows: “Satyrus in Thasos bore the nick-name of γρυπαλώπηξ; when about twenty five he suffered from frequent nightly pollutions, and yet by day the same happened him even more constantly. When he was thirty years of age, he got consumption and died.” From this we see at once the question is of a dissolute man, who in consequence of his vicious practises had brought on such a weakness of the genitals, that he suffered from continual evacuation of seed, the result being that eventually Phthisis was set up, to which he succumbed. As variations of reading we find noted in Franz’s Gloss ῥυπαλώπηξ and τρυπαλάπηξ; Schneider in his Lexicon renders γρυπαλώπηξ by “griffin-fox”, so he must evidently have derived it from γρύψ (a griffin) and ἀλώπηξ (a fox). The Ancients depict the fox as a cunning, crafty animal and assign several characteristics as marking his behaviour that must probably be taken into consideration in the present connection,—and particularly the way he seizes and kills the hedge-hog. According to Aelian28 he endeavours to throw the creature on23 its back, so that its mouth comes uppermost, and then discharges its urine into it. Now in order to signify the irrumator, the Ancients really could hardly have invented a better expression, when they, firmly convinced of course of the fact as stated, compared him to a fox. But what is a γρυπαλώπηξ? Hesychius under the word γρυπός (hooked, curved) explains it as τὰ ἔξω τοῦ στόματος καμπυλόῤῥις· ὁ ἐπικαμπῆ τὴν ῥῖνα ἔχων. (hook-nosed outside the mouth; a man having his nose bent down). Suidas again says γρυπός, ὁ καμπυλόῤῥιν (γρυπός,—a hook-nosed man); so a man with a nose bent down crooked over the mouth. Now this we might very well understand as applying to the fellator, inasmuch as his nose, when the irrumator presses down hard on him, as the sailor does to Timarchus (p. 230 above), is of necessity compressed and bent down towards the mouth; γρυπαλώπηξ would according to this be a man who, like Timarchus in Lucian, is at once an irrumator and a fellator. Of yet another word, κυναλώπηξ (fox-dog) cited by Naumann, we propose to speak under the head of the Cunnilingue, who as we shall see might likewise be signified by the expression.
Finally, as to ῥινοκολοῦρος (nose-docked), for which the MSS. also have ῥινοκλοῦρος, it is certainly the case that in Antiquity the man who practised vice with strange women (Moechus,—adulterer) had his nose cut off29, and as Moechus24 equally signifies the fellator30, the latter also may very well have been obliged to forfeit his nose. Following this hint, it would be quite legitimate to suppose the punishment to have been put for the vice, and a fellator called ῥινοκολοῦρος (nose-docked) on this ground; in the same way as the loss of the nose might be looked upon as a consequence of vice, and anyone seeing a man in this case would at once think of his dissolute past life, as indeed frequently happens at the present day amongst ourselves.
The town of Rhinocolurus,—and its history is more than problematical,—would seem to have nothing whatever to do with the question. The passages from Pliny and Livy which Naumann quotes give absolutely nothing beyond the name; and the mere25 existence of the name Diodorus31 certifies, in his story of how Actisanes proceeded against the Robbers in a way of his own: “He did not wish to put the guilty to death, nor yet to leave them unpunished. So he had the accused brought up out of the whole country and inquired into each case most scrupulously; such as were found to be guilty all had their noses cut off by his orders, and were banished to the most remote spot in the Desert. The town he founded for them there received in remembrance of the punishment inflicted on its inhabitants the name of Rhinocolura. It lies on the borders of Egypt and Syria, not far from the sea-shore that borders the desert in that region, and displays an almost complete absence of all requisites for comfortable habitation. For the surrounding district possesses a soil thoroughly saturated with salt, while inside the town very little water is to be found and that positively tainted and of quite a bitter taste.” Diodorus relates further that these Colonists lived by catching quails; but of Leprosy there is no mention either here or in Strabo or Seneca, so that Naumann’s statement to the effect that it served as a dwelling-place for Lepers lacks entirely, up to the present and at any rate so far as we know, any historical foundation, though the character of the place is not against such a hypothesis. Nor is any question raised in any author as to the vicious life of the inhabitants of Rhinocolura,—in fact in later times it was actually famous for the number of its men of piety32.
Though the explanation of ῥινοκολοῦρος given just now might very well at a pinch be regarded as satisfactory, still we think it hardly answers sufficiently well to the κατὰ τὸν αὐτὸν τρόπον (after the same fashion), while the variant ῥινοκλοῦρος seems to point to ῥιναύλουρος or ῥιναύλουρις as the true reading. In Tatian (Orat. ad Graecos p. 83.) in fact we read: ῥιναυλοῦσι τὰ αἰσχρά, κινοῦνται δὲ κινήσεις ἃς οὐκ ἐχρῆν, καὶ τοὺς ὄπως δεῖ μοιχεύειν ἐπὶ τῆς σκηνῆς σοφιστεύοντας αἱ θυγατέρες ὑμῶν καὶ οἱ παῖδες θεωροῦσι. (They flute their obscenities through the nose, and make movements that in decency they should not make, while actors who teach on the stage the whole art of how to debauch a woman are the spectacle your daughters and your boys gaze at.) The Scholiast observes on this ῥινοκτυποῦσιν, οἱονεὶ τὸ πνεῦμα τοῖς ῥώδωσι, συνέλκοντες ποιὸν ἦχον ἐπὶ καταγέλωτι ἀποτελοῦσι, (they make a noise with the nose, a sort of breathing with the nostrils; by drawing in these they produce a certain sound by way of mockery), and in Lucian, Lexiphanes ch. 19., we find ἔοικα δὲ καὶ ῥιναυστῆσειν, (and I am like to go nose-playing), of which the Scholiast gives the following explanation: ἀντὶ τοῦ ταῖς ῥισὶ καταυλῆσαι, ἐποίουν γὰρ τοῦτο ῥιναυλοῦντες, ἤτοι διὰ τῶν ῥινῶν ψοφοῦντες ἐπὶ διασυρμῷ τινῶν καὶ χλεύῃ. (put instead of fluting with the nostrils; for they used to do this when they nose-fluted, or in other words,27 made a noise with the nostrils by way of mocking people and joking). Now if we take ῥιναυλεῖν (to nose-flute) in these passages,—and all this confirms what has been previously said (above p. 144.) on the word ῥέγχειν (to snort) in the Speech of Dio Chrysostom,—for fistulam canere per nares, to play the flute with the nose, and at the same time remember that Eustathius (as was noted above, p. 236. Note 2.) derived ἀπομύζουρις and μύζουρις from μυζᾶν-οὐράν (οὐρά,—the tail, the penis), the Greeks would seem to have said ῥιναυλεῖν-οὐράν, penem pro fistula canere, (to play on the penis instead of a flute), and we should have the adjective or substantive ῥιναύλουρις, qui penem pro fistula canit per nares, (one who plays on the penis instead of a flute with the nostrils), which admirably expresses not only the action of the fellator, but also the music he makes to accompany it, as he is compelled to snort, drawing his breath heavily through the nose.
Which explanation the reader will choose, we must really leave to him, for interpretations of words of this sort can never be brought to the absolute test of evidence, inasmuch as nick-names as a rule take their origin only too often in external circumstances. Still this much we think we may pronounce with certainty, that the words of the Gloss have to do simply de rebus venereis, with matters of love, and not with Venereal complaints, and thus Naumann’s propositions33 at least are devoid of foundation. Perhaps it may be possible by means of a comparison of the licentious representations on old Vases, of which the late Hofrath Böttiger would seem to have possessed a choice collection, and some examples of which are preserved also at Berlin, in connection with one or other of the words given in the Gloss, as generally with the embodiments in Art of the Venus ebria (drunken Venus), to afford a28 better explanation, one that may indeed be of no particular value to the student of Antiquity pure and simple, but nevertheless is indispensable to the Physician for the correct understanding of sundry diseases of the Ancients, or at any rate one sufficient to avoid incorrect assertions and false conclusions, and to refute such.
We are not in a position to give a systematic history of the spread of the vice of the fellator and irrumator; but at any rate this much is certain that in Imperial times the Vice was most widely indulged in, as the Epigrams of Martial, and what Suetonius relates in his Life of Tiberius (chs. 44, 45.) sufficiently bear witness.
Diseases of the Fellator.
Now to pass on to the medical point of view, no one presumably will deny that the mouth of the fellator must necessarily be exposed to various complaints as a consequence of his Vice. Nevertheless there prevails universally, so far as our studies up to the present have enabled us to judge, complete silence among the Physicians of Antiquity as to the practice of λεσβιάζειν (to Lesbianize, to practise fellation) as a cause occasioning morbid affections of the mouth and the contiguous parts. This is the more surprising, as we find that non-professional Writers are not entirely unacquainted with such effects, as we shall show directly. For our purpose this silence is doubly unfortunate, depriving us as it does of all means of submitting such affections of the mouth as are described by Physicians to any proper appreciation in regard to their ætiological relationships,—an appreciation that in any case must naturally have been in view of our knowledge of the vice of the fellator one of extreme difficulty. The difficulty is29 this: fellator and fellatrix, equally with the Cunnilingue, the fornicater and fornicatrix, were liable to suffer from ulcers of the throat, for example, as a result of their peculiar vice, but in the former case these ulcers were primary, in the latter secondary,—now how is an inquirer to discover any diagnostic sign here, whereby to distinguish the one class from the other? Yet all the while, certainty on this point is of the very highest importance in view of the question as to the existence of Venereal disease in Antiquity, the chief argument always alleged against accepting the fact of such existence being the absence of secondary symptoms such as are nowadays commonly met with, especially about the throat34.
It is remarkable that not one, so far as we know, of the authors who have studied the history of Venereal Disease makes any mention of this circumstance; neither do the Pathologists ever bring forward the vice of the fellator as an ætiological factor. Clossius35 it is true speaks of Irrumatio, relying on Perenotti di Cigliano and Fabre; but these last are really speaking of the Cunnilingue, not of the fellator. Probably they are of Erasmus’opinion: λείχαζειν ni fallor tale quiddam est Graecis, quale fellare Latinis. Nam vox etiamnum manet, tametsi rem iam olim e medio sublatam arbritor. (λειχάζειν—to practise licking,—if I am not mistaken, is a similar practice with the Greeks to that of fellation with the Romans. The word indeed still remains, but the thing I believe to have long since entirely disappeared). On this however Forberg (loco citato p. 304.) very justly adds: Vereor ut vere: certe audio, ne ab nunc hominum quidem moribus plane abhorrere id schematis, quid viderint ii, quibus magnas urbes adire licet. (I fear this is not true: at any rate I am told30 this sort of practice is not entirely repugnant to the habits of some men even of our own day, to judge by what those see who have the opportunity of visiting large cities). How many primary ulcers of the throat, especially in the case of common Prostitutes, may have been mistaken for secondary ones, and have been treated accordingly, in fact are treated so still, without the Physician having a suspicion of how they were actually incurred! But what the Physicians of our own times are ignorant of, though familiar enough to many of the Laity, this knowledge we cannot reasonably demand from the Physicians of Antiquity. Yet supposing they did actually possess this knowledge, it was very excusable if they looked at what lay nearest before their eyes and regarded all throat ulcers as being primary,—in just the same way as any Practitioner of to-day finds it excusable in a Colleague that he thinks only of secondary ulcers, inasmuch as what in Ancient times happened very commonly is practised at the present day at any rate much less frequently. Consequently the absence of mention on the part of the old Physicians of secondary ulcers of the throat in connection with complaints of the genital organs cannot be considered as any sort of proof of their non-existence.
Among the maladies to which the fellator was exposed, we have in the first place to reckon the foul smell from the mouth36, which is mentioned as31 especially prevalent among the Romans. The Physicians as a rule derived it, if no local symptoms, of ulcers, etc., were apparent, from some fault of the stomach37,—an instance surely where the Laity were cleverer than the Profession! The sympathy between the mouth and the genitals and anus makes it evident why at the present day we notice, particularly in immoral women, an evil smell from the mouth, which they endeavour to conceal by chewing burned coffee and the like. No doubt this was the case in Antiquity38 as well, so we are by no means justified in attributing every instance of foul breath in harlots and cinaedi to the practice of fellation.
Yet another consequence of fellation was pain in the mouth (στομαλγία, mouth-ache; only we must remember as to this that Pollux, Onomast. III. 7. 69., cites ἀλγεῖν,—to suffer pain, as a synonym of to love), tongue-ache (γλωσσαλγία39) and toothache40, and generally pains of the palate and32 throat, rendering voice and speech indistinct. Hence Martial says41:
Qui recitat lana fauces et colla revinctus,
Hic se posse loqui, posse tacere negat.
(The man who reads aloud his works, his throat and neck bound about with wool, declares he cannot speak, yet cannot hold his tongue).
But the evil by no means stopped here; there more often occurred as the result of the habit of fellation acute no less than chronic inflammations of the palate (sore throats, quinseys). In the passage quoted a little above from Lucian’s Pseudologistae, it is said of Timarchus: “In Egypt on the other hand they called you συνάγχη (sore throat),—as everybody knows.” In explanation Lucian adds: “It must have been a close thing with you not to be choked, that time you came across the sailor of a three-master, who fell upon you and stopped your mouth for you.” Without in any way detracting from the importance of what we are told here, it still appears to us, on full consideration, that Timarchus33 was not merely a fellator, but an irrumator as well, and this is the more probable as he no doubt acquired this nickname, because he, bene vasatus (well provided with a big member), frequently brought on sore throat, that is to say in those who served him as fellators!
Moreover this reveals to us the real meaning of a passage of Aretaeus, one that has often been quoted before as connected with Venereal disease. This occurs in the 9th Chapter of the Book42, which would certainly seem to admit only of a direct application; still we are convinced that much of the pathological description of sore throat (Ch. 7.) and many symptoms of the complaints of the uvula (Ch. 8.) owe their origin to fellation. Undoubtedly we have nowadays much fewer occasions to note affections of the uvula, which were of very common occurrence among the Ancients43, as is shown by their own accounts,—a circumstance hardly to be wondered at if we consider the particulars told us about Timarchus. Aretaeus in Ch. 9. makes a distinction between κίων (pillar, uvula) or columella (little pillar, uvula), when the whole uvula is inflamed and swollen, σταφυλὴ or uva (bunch of grapes), when only the lower part is affected, and ἰμάντιον (little strap), when the palatal membrane is attacked. “Κίων”, he goes on, “occurs most frequently with old men, σταφυλὴ with young men and such as are in the prime of life, affection of the palatal membranes (τὰ ὑμενώδεα) in those who are at the age of puberty and in boys.” The ninth Chapter runs as follows:
Of Ulcers of the Throat.
Ulcers arising in the throat of a benignant and harmless nature are common, the malignant and dangerous rare. Benignant ulcers of the sort are clean, of slight extent and superficial, neither inflamed nor painful. The malignant on the contrary are broad, hollow, lardaceous, with a white, livid, or black covering. These ulcers are known as aphthae. But if the covering is very tough, then the malady is an eschar, and is so called. At the edge of the eschar are set up an intense redness, inflammation and a congested state of the veins, as in anthrax (carbuncle, malignant pustule), while small, distinct and unconnected, elevations of the mucous membrane appear, which are continually uniting with fresh ones that successively follow, and so an extensive ulcer is established. If this extends from the outer mouth too far inwards, in fact once it has attacked the uvula and relaxed it, the disease spreads over the tongue, gums and lips, while the teeth become loose and blackened. Further the inflammation attacks the throat. Patients so affected die in a few days after the inflammation and fever are set up, of the evil odour and of hunger; the ulcer propagates itself by way of the wind-pipe to the chest, so that very likely suffocation supervenes the same day. For lungs and heart can tolerate neither so foul an odour nor the ulcers themselves nor the ichor (puriform, septic matter) coming from them, but cough and difficulty of breathing supervene. Origin of this affection of the throat is the swallowing of cold, pungent, hot, sour, or strongly astringent, substances. Now these parts serve the chest on behalf of the voice and the breathing, as also the abdomen for sifting the nutriment, and the stomach for swallowing food. But when these inward parts, viz. abdomen, stomach and chest, are attacked by a disease, the disease is in turn conveyed and carried to the35 œsophagus, the tonsils and neighbouring regions.
Children up to the age of puberty suffer most in this way, for children have the very greatest and most marked desire for coolness, because with them the natural heat is at its greatest; the longing for foods of various sorts and cold beverages is boundless; while they shout loudly both in quarrel and at play. This is equally true of girls up to the commencement of menstruation.
With regard to locality, Egypt gives most numerous examples of the disease, for this country has at once a dry air to breathe, and many sorts of comestibles,—roots, herbs, garden vegetables, pungent seeds; while the drink is either thick, being Nile water, or artificially made pungent with barley or with grape-skins. In Syria the disease is also found, especially in Coelesyria. For this reason the ulcers in question are known as Egyptian or Syrian ulcers.
The mode and fashion in which death occurs in these cases is deplorable. The pain is a cutting and burning pain, as in anthrax (carbuncle, malignant pustule), the breath foul-smelling, the patient exhaling an intensely offensive breath, and re-inhaling into the chest another no less so. Patients are so loathsome to themselves they cannot tolerate their own smell; the face is pale or livid, the temperature excessively high, the thirst as distressing as in fever. Yet they reject drink when offered from dread of the pain of swallowing; for they undergo great agony both by the compression of the palate and by the return of the liquid through the nose. No sooner have they lain down than they spring up again; then finding they cannot bear an upright posture, no sooner have they sat down than they are forced by their agony to lie back once more. Most commonly they move about in an upright attitude. For as they are unable to sleep, they avoid all rest, as though they were fain to drive away one torture with another. Inhalation is deep, for they long for fresh air to cool themselves; exhalation on the36 contrary short and hurried, for the ulcers already burning like fire are heated yet further by contact of the feverish breath as it streams out. Hoarseness comes on, and loss of voice, and this goes on continuously increasing, until suddenly coming to the end of their resistance they give up the ghost.”
In the portion of the work devoted to Therapeutics (Bk. I. ch. 9.), which bears the title: Θεραπεία τῶν κατὰ τὴν φαρύγγα λοιμικῶν παθῶν, (Pestilential Affections of the Throat Regions, their Curative Treatment), caustics are especially recommended, as the actual cautery cannot be employed, and finally we read: “In some cases the uvula is destroyed right back to the bones of the palate, and the throat to the root of the tongue and the epiglottis, and in consequence of this destruction they can get down neither solid food nor liquid, for liquids return through the nose, and so the patient dies of hunger.”
Now if we examine these statements more closely, we cannot first of all help wondering how the ætiological factors named by Aretaeus could possibly be regarded by him as sufficient to account for such dangerous ulcerations,—ulcerations which he himself even calls λοιμώδεα (of pestilential character), though of course they are perfectly adequate to explain simple ulcers of the throat. Indulgence in pungent comestibles and beverages is as little adequate to cause such symptoms as are the shouting and greediness of children, not to mention the fact that these are in no way peculiar to Egypt or Syria. The whole account shows us clearly that while Aretaeus was well acquainted with the forms the disease took, the ætiological factors were obscure to him and it was merely in a spirit of ill-timed speculation he subjoined them, proving once more how right Appuleius was when he exclaims: Dii boni! Quam facilis, licet non artifici medico, cuivis tamen docto Venereae cupidinis comprehensio. (Great gods! how37 easy it is for any educated man, always excepting a medical practitioner, to understand the passion of love).
We have already more than once in the course of these investigations proved how Egypt and Syria must be regarded as the nursery of licentiousness in Antiquity, and the passage quoted from Lucian (above p. 229.) directly establishes the fact for us; again, a little further on (p. 240. Note I.) it was mentioned how boys particularly, (but also young girls), were used and specially trained as fellators. Hence Martial44 wishes he had a boy,
Niliacis primum puer is nascatur in oris:
Nequitias tellus scit dare nulla magis.
(In the first place my boy must be born on the banks of Nile: no other land can produce more finished wickedness). From all this, as well as from a comparison of the passage in Lucian, we believe we are amply justified in concluding that Aretaeus’ulcers of the throat, these Αἰγύπτια καὶ Συριακὰ ἕλκεα (Egyptian and Syrian sores) were not unfrequently a consequence of fellation45. That this should be so is readily intelligible, when we consider the liability to corruption and the acrid quality of secretions from the glans penis in hot countries. Again the βουβαστικὰ ἕλκεα (Bubastic sores), which Salmasius cites from Aëtius46 as being identical with38 the Egyptian and Syrian ulcers, find a satisfactory explanation on this hypothesis, for Herodotus47 tells us in his time of the licentious worship of Bubastis, daughter of Isis, at Bubastos. In this expression (βουβαστικὰ ἕλκεα) the malady is named from one particular place, where it was probably specially prevalent, whereas in Aretaeus it is spoken of as general throughout the country.
In this connection we must not pass over the fact that Casaubon commenting on the passage of Persius (V. 187.) to be quoted directly is inclined to regard the ἕλκεα Συριακὰ (Syrian sores) as a punishment of the Dea Syra (Syrian goddess). In this he relies on a passage of Plutarch48 that runs to this effect: “But of the Syrian goddess the superstitious believe that, if a man eat a sprat or anchovy, the goddess consumes his shin-bones, fills his body full of sores, melts down his liver.” The legend must at any rate be of great antiquity, for we meet with it in Menander, in a fragment which Porphyrius49 has39 preserved,—in which however swelling of the belly and the feet is in question. To this also would seem to refer what Persius (loco citato) says:
Hinc grandes Galli et cum sistro lusca sacerdos,
Incussere Deos inflantes corpora, si non
Praedictum ter mane caput gustaveris alli.
(Then the tall Galli, and the one-eyed priestess with her sacred rattle, instil terror of the gods that make men’s bodies swell, unless three times at dawn you have eaten the prescribed head of garlic). True we cannot from the passage of Plutarch directly conclude that ulcers of the throat also were ascribed to the anger of the Syrian goddess in consequence of indulgence in a fish diet; rather should we expect what is said to apply primarily to external skin-ulcers, occurring on other parts, as just on the shin-bone. Still we shall be quite justified in making the reference general, more particularly as liver-complaint is also ascribed to the goddess’s interference, and we shall see that in Antiquity the cause of all ulcers was supposed to lie in some fault of the liver. Now as the fish had necessarily to be put into the mouth to be swallowed, and as it was always supposed the punishment of the goddess followed immediately on the offence, and affected the immediately active part, throat-ulcers might very naturally be taken to be a result of such punishment. This again only further confirms our explanation just above to the effect that ulcers of the throat were a consequence resulting from vicious indulgence. For the40 Temple-service of the Dea Syra was of course connected with every sort of licentious practice.
Taking into consideration this marked prevalence of Corrosion of the Shin-bones, we might argue with considerable probability that it pointed to the existence of a disease of the bones following as a result of vicious indulgence. On the other hand the observation that the precise time the body became covered with ulceration was after indulgence in fish-eating cannot help being of weight in connection with the doctrine of Leprosy; for to the present day we note as very frequent among peoples whose chief nutriment is fish various forms of Leprosy. And again, we may very likely see in this prohibition of a fish diet, which is also mentioned by Athenaeus50, a sanitary regulation justified by experience as necessary in Syria, where skin-diseases and ulcerations were so common.
But not alone in Egypt and Syria did fellation lead to suchlike unhappy results; we find the same to have been the case at Rome, as is proved by the following passage of Martial51, a passage that has hitherto been completely overlooked in this connection, but which is none the less of great importance:
Indignas premeret pestis cum tabida fauces
Inque ipsos vultus serperet atra lues:
Siccis ipse genis flentes hortatus amicos
Decrevit Stygios Festus adire lacus.
Nec tamen obscuro pia polluit ora veneno,
Aut torsit lenta tristia fata fame:
Sanctam Romana vitam sed morte peregit,
Dimisitque animam nobiliore via.
Hanc mortem fatis magni praeferre Catonis
Fama potest: huius Caesar amicus erat.
(When corrupting disease began to sorely afflict his unworthy throat and black contagion was creeping to his very face, Festus, himself with dry cheeks, comforted his weeping friends, and determined to seek the pools of Styx. But still he never disgraced his dutiful lips with darkling poison, nor brought on a painful, miserable end by slow hunger; nay! rather by a Roman death he completed his holy life, and dismissed his soul the nobler way. Such a death fame may well exalt above great Cato’s end; Caesar was his friend).
The words indignae fauces (unworthy throat) obviously point to the practice of fellation, whereby he had brought on himself the pestis tabida and atra lues, (corrupting disease, black contagion), and so we have here a clear statement of the cause by one doctus venereae cupidinis (learned in the passion of love), which cause was quite unknown to the artifex medicus (medical practitioner). The pia ora (dutiful lips) are therefore to be taken merely ironically, as also the sancta vita (holy life). Even the Cinaedus, as well as the maidens who prostitute themselves in honour of Astarté, are invariably, as we have seen, described in the Old Testament as sanctus (holy), and we read e. g. in Job. Ch. XXXV. 14., of a good-for-nothing, how he will die like such a sanctus. It was precisely this signification of sanctus that led us to the idea of taking the throat affection for a secondary consequence of paederastia, especially if we understand a double entendre to underlie the last42 words huius Caesar amicus erat (Caesar was his friend). The Commentators it is true take them merely as said by way of contrast with the death of Cato of Utica, who was forced by Caesar’s enmity to take his own life, and as implying this was not the case with Festus, consequently that his suicide is so much the more remarkable52. However it is43 doubtful which Caesar is meant, whether the word is merely a Title or a proper name. In the second—and certainly this at first appeared to us to be the more likely,—view we were of course bound then to turn our attention to his character for dissoluteness. However as both Catullus53 and Suetonius54 represent him merely as a Cinaedus in regard to the male sex, if that is to say we subscribe to the accepted opinion, we afterwards came to the conclusion it was rather the Emperor generally that is spoken of here, and consequently that any other Emperor, e. g. Tiberius, or Nero, or another, might be intended. It is true that if pathicus (pathic) and omnium virorum mulier (wife of all men) are taken in a wider sense, there would be nothing to make the supposition impossible that Julius Caesar is pointed at. Only that perhaps another passage of Martial would seem to go against this, a passage where he seeks to excuse the several excesses and vices of a certain Gaurus by instancing an exalted personage as patronizing each of them, and says finally (Bk. II. 89.):
Quod fellas; vitium dic mihi cuius habes?
(But for your fellation: tell me whose vice you follow in this?) Still against the cinaedus view the words indignae fauces (unworthy throat) speak clearly. Probably in this connection the following passage of Martial should also come in,—where the Poet says of his servant (Bk. I. Epigr. 102.):
Destituit primos virides Demetrius annos:
Quarta tribus lustris addita messis erat.
Ne tamen ad Stygias famulus descenderet umbras,
Ureret implicitum cum scelerata lues,
Cavimus et domini ius omne remisimus aegro:
Munere dignus erat convaluisse meo.
Sensit deficiens sua praemia, meque patronum
Dixit, ad infernas liber iturus aquas.
(Demetrius left us in the first years of his bloom; the fourth summer was but just added to his three lustres. We took all means to save our faithful house-slave from descending to the shades of Styx, when he was consuming under a malignant contagion that had fastened upon him, and remitted all my master’s rights for the sick lad,—who indeed well deserved to win recovery at my hands. On his death-bed he recognized what I had done for him, and called me his master, though so soon to go forth a free man to the streams of the nether world.)
Was this famulus (house-slave) the same person as the puer (boy, slave), who is mentioned by Martial, bk. XI. 95.?
That not boys only, but girls too, had to suffer in this way among the Romans, and lost their lives from the complaint in question, is shown, we think, by the following Epigram of Martial, Bk. XI. Epigr. 91.:
Aeolidon Canace iacet hoc tumulata sepulchro,
Ultima cui parvae septima venit hiems.
Ah scelus, ah facinus! properas quid flere viator?
Non licet hic vitae de brevitate queri.
Tristius est leto leti genus: horrida vultus
Abstulit et tenero sedit in ore lues:
Ipsaque crudeles ederunt oscula morbi;
Nec data sunt nigris tota labella rogis.
Si tam praecipiti fuerant ventura volatu,
Debuerant alia fata venire via.
(Canacé of the Aeolians lies buried in this tomb, who died a child,—her seventh winter was her last. Oh! the shame and horror of it! haste, a tear, thou that passest by. Here is no occasion to lament the short span of human life. Sadder than death is the way of her death; a dread contagion ate away her face, and settled in the tender little mouth. Cruel disease infected her very kisses; and her lips were half gone when they were consigned to the grim pyre. If death must needs have come to her with a flight so swift, at least he should have taken another way. Death so hasted to close the issue of her persuasive voice, that her tongue might not have time to bend the cruel goddesses to mercy).
Besides the passages quoted, there are several others to be found in Martial, that must be taken as referring to the fellator; but since the maladies that occur are equally prevalent in the case of the Cunnilingue, it will be more convenient to adduce them under that head. Further, we only require to mention the fact that pale lips seem to have been regarded as a mark of the fellator55.
But the vice of the fellator is far surpassed in baseness by that of the Cunnilingue (qui opus peragit linguam arrigendo in cunnum, eumque lambit,—one who works by putting his tongue up into the female organ, and licking it). The Greeks called this practice σκύλαξ (a puppy), because it is a habit of dogs56, and Hesychius explains it by47 σχῆμα ἀφροδισιακὸν, ὡς τὸ τῶν φοινικιζόντων (a method of love, resembling that of those who phoenicize). We have already, in the passage of Lucian quoted a little above, found φοινικίζειν and λεσβιάζειν put48 side by side; Galen moreover57 does the same in the following passage, a noteworthy one for our49 purpose on several accounts: “The drinking of sweat, urine and the menstrual blood of women is vicious and shameful, and not less so when a person, as Xenocrates proposes to do, smears the regions of the mouth and throat with excrement, and swallows it down. He speaks also of taking the wax of the ears. For my part I could never bring myself to take this, even though by that means I were never to be ill again. But excrement I consider yet more disgusting, and it is for a man of any decency far more shameful to be called an Excrement-Eater58 than an αἰσχρουργὸς (worker of obscenities) or a cinaedus. But of αἰσχρουργοὶ59 (workers of obscenities),50 we abominate Phoenicians more than the Lesbians, and it seems to me the man does something of the same sort as the former who drinks menstrual blood (μᾶλλον βδελλυττόμεθα τοὺς φοινικίζοντας τῶν λεσβιαζόντων ᾧ60 φαίνεταί μοι παραπλήσιόν τι πάσχειν ὁ καὶ καταμηνίου πίνων.) A sensible man will neither seek to collect experiences on the point, nor yet on a practice, which it is true involves less, but still is sufficiently shameful, that of smearing a part of the body with excrement, because he has some hurt at that spot,—or with human seed. Xenocrates calls this latter commonly γόνος (seed, semen), and distinguishes with minute care between cases where simple seed rubbed in by itself is of benefit, and cases where the female has the same effect after combination with the male, as it is discharged from the woman’s womb.”
This explanation of Galen’s to the effect that the φοινικίζων (one who phoenicizes) resembles the man who drinks menstrual blood, shows clearly that φοινικίζειν is not, as all the Lexicons give it, and Forbiger (loco citato) also assumes, identical with λεσβιάζειν. It is true Forbiger (p. 329. Note v.) gives the meaning cunnilingere as well, although the explanation is undoubtedly unsatisfactory which he offers à propos of an Epigram,61—one certainly apposite in this connection, to the effect that the reason51 for this signification is, quod cunnilingos a natando in mari quodam Phoenicei coloris (mari rubro) dixissent, (that they had called them cunnilingues from their swimming as it were in a sea of Phoenician purple colour—a red sea); for the words in the Epigram, ἐν φοινίκῃ δὲ καθεύδεις (but you sleep in Phoenicia) cannot stand for anything else but simply φοινικίζειν, as indeed the passage from Aloisia Sigaea, which is quoted by Forbiger himself, proves conclusively62: Cum vellet mediam lambere, se velle dicebat in Liguriam, (When he wanted to lick my middle, he used to say he would fain be into Liguria—that is, would fain lick, ligurire). Accordingly just as λεσβιάζειν came into use as the distinctive name for the vice of the fellator, because it was practised to a distinctive degree in Lesbos, so too to be a cunnilingue was called φοινικίζειν,52 because the habit was at home among the Phoenicians. Undoubtedly men’s shamelessness was carried so far that they actually used women and girls at their period of menstruation for this purpose,—a fact of the highest interest for us, as we shall show directly. Seneca63 expresses himself plainly enough on the subject: “Quid tu, cum Mamercum Scaurum consulem faceres, ingnorabas, ancillarum suarum menstruum ore illum hiante exceptare? num quid enim ipse dissimulabat? num quid purus videri volebat?” (How came it you were ignorant, when making Mamercus Scaurus consul, that he was in the habit of catching in his open mouth the menstrual discharge of his maidservants? Did he make any concealment of it himself? did he pose as a pure-minded man? nay! not he). Again in another place64:
“Nuper Natalis tam improbae linguae quam impurae, in cuius ore feminae purgabantur.” (Quite lately Natalis showed himself as malignant of tongue as he is unchaste, into whose mouth women were used to purge themselves).
Now if first of all we bear steadfastly in mind that this φοινικίζειν was a vice, which prevailed primarily and especially among the Phoenicians and was later on disseminated abroad by them, and then consider how the Greeks designated every vice, and particularly excesses in love, as νόσος (disease), in the same way precisely as the Romans used morbus (disease),—comp. § 17—we must see that φοινικίζειν is the same thing as νόσος φοινικίη (Phoenician disease), and shall be in a position to form an opinion on the Gloss65 falsely ascribed to Galen, which reads: φοινικίη νόσος· ἡ κατὰ Φοινίκην καὶ κατὰ τὰ ἄλλα ἀνατολικὰ μέρη πλεονάζουσα. δηλοῦσθαι δὲ κἀνταῦθα δοκεῖ ἡ ἐλεφαντιάσις. (Phoenician disease: a disease prevalent in Phoenicia and about the Eastern parts. Elephantiasis appears53 to be signified by this).
Even granting the first part of this Gloss to have been really written by Galen, the last sentence at any rate is obviously an extraneous and later addition. This is at once indicated by the use of the word δοκεῖ (it appears), which comes in curiously, standing as it does next-door to the definite statement that this νόσος (disease) was common in Phoenicia; for surely anyone who knew this, must also have known what the disease was. Again if he had wished to describe it by some such phrase as the English “a sort of Elephantiasis”, he could hardly have failed to express himself in a different way to what he has. But as a matter of fact, Galen knew perfectly well, as we have already seen, what φοινικίζειν was, and consequently what the φοινικίη νόσος (Phoenician disease) was, and it could not by any possibility have occurred to him to suppose it any form of Elephantiasis. Unfortunately Prof. Naumann66 has allowed himself to be misled by this extraneous addition; he writes: “In the Work of a Pseudo-Galen is given a short explanation of the φοινικίη νόσος (Phoenician disease), or rather to speak strictly, the conjecture is made,67 that this malady, a common one in Phoenicia and the East, may have been Elephantiasis.” True indeed the word might with equal likelihood express a disease characterized by redness of the skin φοινίκιος s. φοινίκεος i. q. puniceus, purpureus, cruentus; φοινιγμὸς irritatio cutis per vesicantia—φοινίκιος or φοινίκεος =54 Phoenician purple, purple, blood-red; φοινιγμὸς = irritation of the skin by rubefacients). Or should we suppose some leprous-venereal malady endemic and aboriginal among the trading Phoenicians to be signified, which was called the Morbus Phoeniceus (Phoenician disease) in the same way as in more modern times people spoke of the Morbus Gallicus (French disease,—Syphilis)? In any case it is remarkable that Themison (who also noted incidentally that Satyriasis at times attacks a population epidemically,—speaks of the special frequency of Satyriasis in Crete (Caelius Aurelianus, Acut. Morb. bk. III. ch. 18). As is well known, Phoenician and Hellenic Colonies had converged here; and the island remained in uninterrupted and active commercial intercourse with the maritime cities of Phoenicia.
According to the general supposition the Gloss of the Pseudo-Galen has reference to a passage of Hippocrates occurring in the Second book of the Prorrhetica,68 where we read as follows: “But λειχῆνες—tetters, as also λέπραι and λεῦκαι,—scaly leprosies and white leprosies, where any of these occur in the young or mere children, or after appearing on a small scale shall then increase but slowly, in these cases it is not right to call the exanthema or eruption an apostasis, (transitional state), but a νόσημα,—condition of disease. On the other hand where any of these affections occurs on55 a large scale and suddenly, it would then be an apostasis. But whereas λεῦκαι arise out of the most deadly diseases, as e. g. the νοῦσος ἡ φθινικὴ,—wasting disease, as it is called, λέπραι and λειχῆνες do so from the melancholic, or diseases proceeding from black bile. And of such the easier to cure are those that occur in the youngest patients and are of the latest origin, and arise in the softest and most fleshy parts of the body.” Foesius observes on the passage: “Nemini autem dubium est, quin hac parte mendosi sint codices omnes, cum ἡ νοῦσος ἡ φθινικὴ καλουμένη scribitur. Nam φοινικίη νόσος ex Galeni exegesi procul omni dubio reponendum.” (Now no one can doubt that all the MSS. are deceptive here, reading as they do ἡ νοῦσος ἡ φθινική. For φοινικίη vόσος must undoubtedly be restored from the Exegesis of Galen). J. W. Wedel69 on the contrary writes: “Legunt quidam pro φοινικίη—φθινικὴ, et vertunt tabem seu morbum tabidum, sed contra fidem codicum correctiorum, quibus Galenus ipse assentitur, et rei ipsius, de qua textus agit, evidentiam.” (Some read φθινικὴ for φοινικίη, and render it wasting or wasting disease,—but against the authority of the better class of MSS., with which Galen himself agrees, and against the evidence of the context of the matter treated of). In the latter of these two statements Wedel, in spite of his mistaken view of the matter generally, is perfectly right; whether he is so in the former as well, we are not in a position to say, for alas! we lack the critical apparatus absolutely indispensable for56 such a decision, not so much as the Edition of Mackius being on the shelves of our University Library.
In the first place we ought to make quite sure what Hippocrates understood under the name λεῦκαι. A disease of the Skin no doubt; but of what particular nature it was, would seem not to be so easy to determine. According to Coac. praenotion. (Vol. I. p. 321.) Hippocrates distinguished a λεύκη συγγενής and a λεύκη μὴ συγγενής (λεύκη inborn, and not inborn), the latter attacking individuals only after puberty. Hesychius says λεύκη, ἄνθος τι τῶν περὶ τὸ σῶμα γινόμενον, ἄλφος δὲ λευκή τις ἐν τῷ σώματι. (λεύκη—white leprosy, an eruption coming out on the exterior parts of the body, but ἄλφος—dull-white leprosy, a form of λεύκη in the body). Galen, Definit. med. (Vol. XIX. p. 140) λευκή ἐστιν ἡ ἐπὶ λευκὸν χρῶμα τοῦ σώματος παρὰ φύσιν μεταβολή. (λεύκη is the change to an unnatural white colour of the body). According to this it would appear to be merely superficial discolorations of the skin that writers understood by λεῦκαι,—a view that Rayer70 seems to coincide with. Pollux on the other hand offers an explanation as follows: ἀλφὸς μέλας, ἐπιδρομὴ σκιώδης, ἐπιπόλαιος, εὐίατος, ἀλφὸς λευκὸς, λευκότης ἐπιτρέχουσα τῇ ἐπιδερματίδι, αὐχμηρὰ, δυσίατος· λεύκη, ὅταν ἐπιτείνῃ 57ἡ λευκότης, καὶ φύσῃ τρίχωσιν λευκήν, εἰ δὲ κεντήσειας, ὕφαιμος, δυσίατος, ἐστιν ὅτε ὑπέρυθρος· ἐπανθεῖ δὲ αὐτὸ (?) τοῖς χείλεσιν, οἷον ἁλὸς ἄχνη. (Black ἀλφός, a dark-coloured spreading eruption, superficial and easily curable; white alphos, a whiteness running over the epidermis (of the prepuce), dry harsh and difficult to cure; λεύκη, when the whiteness extends, and produces a growth of white hairs, and if you prick it, it is suffused with blood, difficult to cure, also sometimes reddish in hue. And the eruption comes out on the lips like sea-foam). Here λεύκη is evidently a much more deeply penetrating malady, as indeed it is described by Celsus71 and Galen.72 It corresponds with the white Leprosy of Moses. But the most curious thing is the statement appended to the effect that the affection broke out on the lips like sea-foam. This is certainly to be referred to some other form of λεύκη, unless indeed we are to take it in connection with the succeeding words in the text, λειχὴν ἄγριο58ς (malignant tetter), in which case, as we have seen with regard to Mentagra (Tetter of the chin), the remark is based on a perfectly sound observation; and besides, the αὐτὸ gives absolutely no sense. On the other hand if Pollux’datum in reference to the seat of λεύκη is correct, it must obviously afford much light for clearing up the meaning of the passage in Hippocrates, and in deference to it we shall be bound to read φοινικίη instead of φθινικὴ,73—an59 emendation that presents no difficulty, since φθινικὴ might very easily be read for φοινικίη, and indeed (as pointed out in the Note) was actually so read.
But one emendation leads on to another, and we shall find ourselves bound, on the analogy of the θαυμαστὸν πάθος (wonderful complaint) in Dio61 Chrysostom, to read here also θαυμαστωτάτων νοσημάτων (of the most wonderful diseases) for θανατωδεστάτων ν., and translate accordingly: “but λεῦκαι arise out of the most terrible aberrations of the mind,” such for instance as the vice of the cunnilingue is. If we examine further, we shall see it is not λευκαὶ but λεῦκαι that stands in the text, so it cannot be a question of a skin-affection of the leprosy type at all, for λευκὸς (white) rather implies transparent and shiny, and Martial (XI. 99.) in a passage to be discussed more fully later on, says:
Non ulcus acre, pustulaeve lucentes,
Nec triste mentum, sordidique lichenes,
(No biting ulcer, or shiny pustules, nor yet disfigured chin, and foul scabs). Accordingly we have here nothing whatever to do with the leprous-like λευκὴ, but only with pustulae lucentes (shiny pustules), which as we shall show presently were a consequence of the practices of the cunnilinigue. We have the more right to assume this, as the old Physicians ascribe λευκὴ to the φλέγμα (phlegmatic humour),—an explanation all the more likely to have been given, as directly afterwards follow the words, αἱ δὲ λέπραι καὶ οἱ λειχῆνες ἐκ τῶν μελαγχολικῶν (but leprosies and tetters arise out of the melancholic diseases). True this is in contradiction with another passage of Hippocrates,74 for in this we read: λέπρη καὶ κνησμὸς καὶ ψώρη καὶ λειχῆνες καὶ ἀλφὸς καὶ ἀλώπεκες ὑπὸ φλέγματος γίνονται. (leprosy, and itch, and scab, and tetters, and dull-white leprosy, and manges, arise from phlegm). This much at any rate appears to us to result, viz. that the whole passage under discussion cannot possibly be by Hippocrates, but much more probably is due to some author of the62 Alexandrine age, who enjoyed ample opportunities for studying the consequences of the unnatural excesses as so often observed since Pompey the Great’s time.
To assume that Hippocrates was actually acquainted with these in any completeness would up to the present be premature; at any rate we are bound, so far as our study of his writings enables us to judge, to deny him any knowledge of the fact that sexual excesses were the cause of the different affections of the genital organs chronicled by him. Of course he may have supposed all this to be notorious and the knowledge of it common property, but a host of statements would be found to tell against any such supposition. Opportunities of making acquaintance with the vice of the cunnilingue could certainly not have been lacking, it being so familiar a thing in his time that Aristophanes75 again and again derided it in his Comedies. Whatever conclusion we come to on this head, at least the passage of Hippocrates cannot justify anyone in maintaining63 that the φοινικίη νοῦσος,—(Phœnician disease) was true Elephantiasis, even if, as may be, the preliminary proposition that elephantiasis was a consequence of debauchery be made good,—a point to which we propose later on to return. On the subject of Satyriasis in Crete, we have already expressed our views.
Just as the Phoenicians carried the seed of the vice to Greece and other lands, so at a later period was it disseminated from Syria to Italy; and so Ausonius says (Epigr. 128.):
Eunus Syriscus inguinum liguritor,
Opicus76 magister (sic eum ducet Phyllis)
Muliebre membrum quadriangulum cernit:
Triquetro coactu Δ literam ducit.
De valle femorum altrinsecus pares rugas,
Mediumque, fissi rima qua patet, callem
Ψ dicit esse: nam trifissilis forma est.
Cui ipse linguam quum dedit suam, Λ est:
Veramque in illis esse Φ notam sentit.
Quid imperite, Ρ putas ibi scriptum
Ubi locari Ι convenit longum?
Miselle doctor, Ȣ tibi sit obscoeno,
Tuumque nomen Θ sectilis signet.
(Eunus from Syria, glutton of the privy parts, Opican (clownish) master (Phyllis teaches him his letters) sees the woman’s organ four-cornered: when compressed to a triangle he makes it out the letter Δ. From the valley between the thighs start two furrows, a pair one on either side, while between them is a line, where lies the opening, the crack of the fissure; this he declares is Ψ; for ’tis three-pronged in outline. Then when he puts in his own tongue to it, lo! it is Λ; and he can feel there is a true Φ marked therein. What, dunce, think you a Ρ is64 inscribed there, where a long Ι should by rights be placed? Miserable, contemptible scholar, may the Ȣ (a noose) reward your foulness, and the cleft Θ (letter of condemnation, being initial of θάνατος,—death) be set against your name!) The more detailed interpretation of these obscene hieroglyphics the reader may find in the commentators on the passage, as well as in Forberg, loco citato p. 335.
Diseases of the Cunnilingue. § 24.
Can anyone believe such a vice as this was practised without incurring punishment? Yet there prevails amongst the Physicians of Antiquity, even including Galen, who knew the facts, an unbroken silence. It is impossible to suppose that girls and women could have their genital organs purged in this mode altogether without evil results, more particularly as actual experience in more modern times has proved that as a consequence of the habit of cunnilingere inflammations of the external genitals have been set up in girls, as well as ulcerations in older women through the licking of these parts by dogs. Among Ancient writers we have found no vouchers for this; but on the other hand several such exist to show the mischief that results from the habit to the cunnilingue himself. Excluding from consideration the pale complexion7765 and evil smell from the mouth, which were equally consequences of the other forms of vice already mentioned, we have paralysis of the tongue mentioned, at any rate in one passage78:
Sidere percussa est subito tibi, Zoile, lingua,
Dum lingis. Certe, Zoile, nunc futuis.
(Your tongue, Zoilus, has been stricken with a sudden doom, while in the act of licking. Why! surely, Zoilus, you copulate now). True this malady must be counted as one of very rare occurrence; but this is by no means the case with the ulcerations, which would seem not always to have confined their attacks to the tongue, but to have extended also, just as with the fellator, to the other parts of the mouth as well. This cannot but have had the effect of making it very difficult in diagnosis to distinguish between an affection of the sort due to fellation and one due to the vice of the cunnilingue.
Here again it is Martial to whom we are indebted for the proofs of our assertions. He leaves no room for doubt as to the way Manneius was punished for his debauchery in the following passage79:
Lingua maritus, moechus ore Manneius,
Summoenianis inquinatior buccis:
Quem cum fenestra vidit a Suburrana
Obscoena nudum lena, fornicem claudit,
Mediumque mavult basiare, quam summum:
Modo qui per omnes viscerum tubos ibat,
Et voce certa consciaque dicebat:
Puer, an puella matris esset in ventre;
(Gaudete cunni, vestra namque res acta est!)
Arrigere linguam non potest fututricem
Nam, dum tumenti mersus haeret in vulva80
Et vagientes intus audit infantes,
Partem gulosam solvit indecens morbus;
Nec purus esse nunc potest, nec impurus.
(Manneius was a husband with his tongue, a fornicator with his mouth, a more polluted wretch than the big-cheeked wenches of the suburbs. When a vile bawd saw him naked from a window in the Suburra, she shuts her brothel up, and had rather kiss his middle than his head. The man who but now could penetrate every vessel of the inwards, and say with assured voice and certain knowledge whether it were a boy or a girl in the mother’s belly,—rejoice, rejoice, organs of women, for your business is done for you,—the same cannot erect a fornicating tongue. For at the very moment he is plunged tight in the swollen vulva, and hears the babes whimpering within, lo! a shocking disease paralyses his greedy tongue. Now can he be neither clean, nor yet unclean).
The Commentators, in particular Farnabius, refer the complaint spoken of in the passage just quoted to paralysis of the tongue. Farnabius says in fact: “Paralysisne ἀπὸ τῆς ἀφέδρου καὶ τῶν ἐμμηνιῶν, quorum malefico humore marcescunt segetes, apes moriuntur etc., Plin. c. 15 Lib. V., an sideratio?” (Is paralysis intended, resulting from the menstruation and menstrual discharges, the poisonous humour of which will wither up crops, kill bees, etc.—Pliny ch. 15. Bk. V., or a sudden stroke?) Even supposing us willing to admit the possibility of menstrual blood bringing on paralysis of the tongue, there can at any rate be no question of such a thing here, inasmuch as it was with a pregnant woman Manneius carried out his vicious practises, and women in pregnancy do not usually menstruate,—a fact about which the Philologist naturally enough was only imperfectly posted. Of course the possibility is always there,67 although the Poet says nothing about it; and the expression vulva tumens (swollen organ) evidently stands here, as is clearly shown by what follows, for uterus gravidus (pregnant womb)81. The solvere (to loose, destroy) points in any case to a destruction, a dwindling, of the part, brought about by the indecens morbus (shocking disease),—which disease might very likely find its explanation in the scelerata lues (noxious contagion) mentioned on page 258 above. As a result of this, naturally enough not only did arrigere (to erect—the tongue) become impossible, but the impurus (Cunnilingus) (unclean cunnilingue) grew generally incapable of practising his vice. Nor yet was he purus (clean)82 altogether, for was he not a cunnilingue?—and now he was even less purus, because he suffered from the indecens morbus (shocking disease), which even Farnabius has so far rightly understood, that he explains nec purus (nor yet clean) by morbo illo contaminatus (because contaminated by the said disease).
Rather more doubtful and difficult is the interpretation of the following passage of Martial83, which would yet appear to be pertinent here:
Non dixi, Coracine, te cinaedum;
Non sum tam temerarius, nec audax,
Nec mendacia qui loquar libenter.
Si dixi, Coracine, te cinaedum,
Iratam mihi Pontiae lagenam,
Iratum calicem mihi Metili.
Iuro per Syrios tibi tumores,
Iuro per Berecynthios furores.
Quod dixi tamen, hoc leve et pusillum est.
Quod notum est, quod et ipse non negabis:
Dixi te, Coracine, cunnilingum.
(I never called you a cinaedus, Coracinus; I am not so rash or so reckless, not being one to speak lies willingly. If I called you a cinaedus, Coracinus, may Pontia’s jar be my enemy, and Metilius’poisoned cup. I take oath by your Syrian tumours, by your Berecynthian frenzies. What I did say is a trivial, an insignificant thing, a thing well known, that you will not yourself deny,—I said, Coracinus, you were a cunnilingue).
What were these Syrii tumores (Syrian tumours) that afflicted the cunnilingue Coracinus? Beroaldus, Annotat. ch. 25., understands them as “tumores et vibices a cultris et flagris quibus sacerdotes Cybeles (quam deam Syriam esse volunt) se sauciabant.” (the swellings and weals from the knives and scourges with which the priests of Cybelé,—whom they claim to be the Syrian goddess—used to wound themselves). Farnabius on the contrary thinks only Berecynthios furores (Berecynthian frenzies) to be intended in this explanation, and makes the tumores Syrii mean “ulcera et morbos quibus credebatur irata Isis inflare peierantes,” (ulcers and maladies with which the angry Isis was supposed to afflict false swearers), appealing to the passage of Persius84, already brought forward a few pages back (p. 254.), which reads:
Hinc grandes Galli et cum sistro lusca sacerdos,
Incussere Deos inflantes corpora, si non
Praedictum ter mane caput gustaveris alli.
(Then the tall Galli, and the one-eyed priestess with her sacred rattle, instil terror of the gods that make men’s bodies swell, unless three times at dawn you have eaten the prescribed head of garlic).
Whether this passage affords any direct proof would seem doubtful, inasmuch as the inflare corpus (to make the body swell) properly speaking only refers to the abdomen. To this also the eating of the allium (garlic), which no doubt first won its magic significance on account of its carminative properties, appears to point.
However another explanation is possible. Referring back to the passage of Porphyrius quoted above on p. 254., the tumores Coracinus had contracted in consequence of his general incontinence with women, which incontinence had at last brought him as a senex? (old man) to such a condition of weakness that nothing was left him but the vice of cunnilingere to satisfy his still unexhausted lubricity. A side light in this case may be thrown on the matter by Horace’s description of the Anus libidinosa (The lecherous old woman) in Epodes VIII. 9. 19.:
Venter mollis et femur tumentibus
Exile suris additum.—Fascinum
Quod ut superbo provoces ab inguine
Ore allaborandum est tibi.
(Flabby belly and skinny thigh joined with swollen calves,—A tool, that requires you, in order to call it up from the supercilious groin, to work it with the mouth). Casaubon in his commentary on the passage of Persius is for connecting this, as well as the Tumores Syrii, with ἕλκεα Συριακὰ (Syrian sores), and—as quoted on p. 253 above—to regard them as a consequence of the wrath of the Dea Syria (Syrian goddess). No doubt as a matter of fact the tumores were a result of debauchery, one that was prevalent in Syria and was disseminated thence to Rome, for they attacked a cunnilingue no less than other debauchees; but this brings us no nearer to a70 knowledge of their nature. We should perhaps be inclined to regard them as swellings of the tonsils or of the lympathic glands of the throat, having the same significance as the inguinal buboes in affections of the genitals.
But what are the Berecynthii furores (Berecynthian frenzies)? Possibly nocturnal pains in the bones, that torment a patient to the pitch of frenzy? The metaphor, drawn from the nocturnal rites of Cybelé, must be admitted to be a happy one. Still, however acceptable conjectures of the sort may be to many, we cannot take them seriously. It appears to us most judicious to regard the Syrii tumores as being ulcerations that covered the body of Coracinus, and by their violent itching reduced him to a state of frenzy. Our view as stated is confirmed by Epigram 108. of Ausonius:
In scabiosum Polygitonem.
Thermarum in solio si quis Polygitona vidit
Ulcera membrorum scabie putrefacta foventem,
Praeposuit cunctis spectacula talia ludis.
Principio tremulis gannitibus aëra pulsat,
Verbaque lascivos meretricum imitantia coetus
Vibrat et obscoenae numeros pruriginis implet.
Brachia deinde rotat velut enthea daemone Maenas,
Pectus, crura, latus, ventrem, femora, inguina, suras,
Tergum, colla, humeros luteae Symplegadis antrum.
Tam diversa locis vaga carnificina pererrat,
Donec marcentem calidi fervore lavacri
Blandus letali solvat dulcedine morbus.
Desectos sic fama viros, ubi cassa libido
Femineos coetus et non sua bella lacessit,
Irrita vexato consumere gaudia lecto:
Titillata brevi quum iam sub fine voluptas
Fervet et ingesto peragit ludibria morsu.
Turpia non aliter Polygiton membra resolvit,
Et quia debentur suprema piacula vitae,
Ad Phlegethonteas sese iam praeparat undas.
(To the scabby Polygiton.—If any man caught sight of Polygiton on the seat of the Thermae bathing71 the sores on his limbs all rotten with scab, he preferred so entertaining a spectacle to all the games. First he beats the air with twittering, whining noises, and utters broken sounds in imitation of the wanton embraces of harlots, and completes the symphony of his foul-minded lechery. Then he twirls his arms about like a Maenad under the god’s afflatus; breast, legs, flank, belly, thighs, groin, calves, back, neck, shoulders, cave of the bemired Symplegades,—i.e. hollow between buttocks,—in so many different places does the shooting torture fly, until he droops and faints in the warmth of the hot bath and the disease is soothed and gives a fatal respite. So it is said castrated eunuchs, when barren desire tries hard for embraces with women and for contests they cannot properly engage in, are consumed with empty transports on the tossed and tumbled bed,—till eventually their lust, tickled and tickled, flames high for a last moment, and completes the wanton act by applying the mouth and biting. So with Polygiton a final spasm relaxes his disfigured limbs, and the last sin-offerings of his life being due, thus makes himself ready for the waves of Phlegethon).
True the connexion with the vice of cunnilingere is apparently lost here, but this also may be preserved without any great straining of the words, as we shall see presently; and accordingly the Tumores Syrii can be quite well regarded as a consequence of the vice of the cunnilingus.
Mentagra (Tetter of the Chin).
Ever since the so-called first appearance of Venereal Disease, most of the advocates of the antiquity of the complaint have made a point of bringing in72 Mentagra85 within the purview of the quotations they adduce to prove their contention, although strictly speaking they were never likely to succeed in a direct demonstration that the disease was really and truly connected with sexual excesses. Accordingly, to the present day the majority of them see in it nothing more than a form of Leprosy, particularly as Hensler86 and Sprengel were among those who decided in favour of its leprous character. Instead of giving a useless list of names of the different authors, who in former days declared for the one view or the other, we think it more expedient to quote first of all the capital authority, a passage in Pliny87, setting this down as it stands so as to be able afterwards to form a correct appreciation of its bearing:
Cap. I. “Sensit et facies hominum novos omnique aevo priore incognitos, non Italiae modo, verum etiam universae prope Europae morbos: tunc quoque non tota Italia, nec per Illyricum73 Galliasve aut Hispanias magnopere vagatos, aut alibi, quam Romae circaque: sine dolore quidem illos ac sine pernicie vitae: sed tanta foeditate, ut quaecunque mors praeferenda esset.
Cap. II. “Gravissimum ex his lichenas appellavere Graeco nomine: Latine, quoniam a mento fere oriebatur, ioculari primum lascivia (ut est procax natura multorum in alienis miseriis) mox et usurpato vocabulo, mentagram: occupantem in multis totos utique vultus, oculis tantum immunibus, descendentem88 vero et in colla pectusque ac manus, foedo cutis furfure89.
Cap. III. “Non fuerat haec lues apud maiores patresque nostros. Et primum Tiberii Claudii, Caesaris principatu medio irrepsit in Italiam, quodam Perusino equite Romano Quaestorio scriba, quum in Asia apparuisset inde contagionem eius importante. Nec sensere id malum feminae aut servitia, plebesque humilis, aut media: sed proceres veloci transitu osculi maxime: foediore multorum qui perpeti medicinam toleraverant, citatrice, quam morbo. Causticis90 namque curabatur, ni usque in ossa corpus exustum esset, rebellante taedio. Advenerunt ex Aegypto, genitrice talium vitiorum, medici, hanc solam operam afferentes, magna sua praeda. Siquidem certum est, Manilium Cornutum, e Praetoriis legatum Aquitanicae provinciae, H.S. CC. elocasse in eo morbo curandum sese.”
(Ch. I. Moreover the human face experienced new diseases, and such as had been unknown in any former age not merely to Italy but to the whole of Europe very nearly, and these not widely diffused over Italy generally, or through Illyricum or the provinces of Gaul or of Spain, or indeed anywhere else but just in Rome and its neighbourhood. They were painless, it is true, and did not involve loss of life, but were of such a horrible nature that death in any form would have been preferable.
Ch. II. The most serious of these diseases they called lichenes,—scabs, a Greek name; in Latin, as the malady generally showed itself first on the chin, it was known as mentagra,—chin-bane, scab or tetter75 of the chin, at the first by way of jest and mockery—for it is the nature of the multitude to make merry at others’misfortunes,—but soon this became the recognized word. In many persons it covered absolutely the whole countenance, the eyes alone being left unaffected, with a horrible scurf of the skin, going down sometimes to the neck as well, and breast, and hands.
Ch. III. This plague had not existed among our ancestors or fathers. For the first time it crept into Italy in the middle of the reign of Tiberius Claudius Caesar, a certain Perusinius, a Roman knight and Quaestorian secretary, after a period of service in Asia, importing the contagion from there. But women did not suffer from the malady, or slaves, nor yet common folk of humble or middle-class station; but nobles, and this particularly by the rapid infection of an embrace. In many cases the scar, where patients had submitted to medical treatment, was more horrible than the disease itself. For indeed it was curable by caustics, except when the body had been consumed to the very bones, the slowness of the treatment defeating its own end. Physicians arrived from Egypt, mother-land of such taints, practising this cure exclusively, to their own great profit. If, that is, it is true that Manilius Cornutus, of the Praetorians and governor of the Province of Aquitania, offered 200,000 sesterces for his cure when attacked by this disease).
Here if ever, it particularly behoves us to begin with an elucidation of the meaning of the name given to the malady under discussion. Gruner91 long ago called attention to the divergence of opinion as to the signification of λειχῆνες (scabs) among the writers of Antiquity, but without success in putting the actual facts in a clear light. We must try if we can be more fortunate. An old etymologist says: λειχὴν παρὰ τὸ λείχω, καὶ γὰρ φάσιν ἐκ το76ῦ λείχειν τὸ πάθος ἐπαίρεται92, (λειχὴν comes from λείχω,—I lick, because they say the complaint is set up by licking). On this we may say.—there is no doubt λειχῆνες and λιχῆνες are derived from λείχειν or λίχειν, but the explanation Kraus gives of the reason in his Lexicon we cannot think conceivable, viz. “because Lichen, the same as a parasitic plant does, or a skin-disease in animals, always creeps round further and further (see Herpes,—creeping eruption), or as it were licks its way,” for λείχειν is not so much lambere, λάπτειν,—to lick over, lick along, as lingere, ligurire93,—to lick up, lick up greedily. At the same time it is true the word (lambere) was used by the Romans in a somewhat similar sense, so perhaps we ought not to refer to lambit flamma (a flame licks), but rather to Plautus’expression (Pers. prolog. 5.), “quorum imagines lambunt hederae sequaces” (whose images creeping ivy-tendrils lick, i.e. entwine). Most probably there are two different stems underlying the word. Of these one is λέγειν,—to lay, etc., hence λέγνη, the edging, the border, λίγνυς, soot (depositing itself on the edge), together with the bye-forms λέχω, λίχω with which in fact λιχὴν, moss94, so far as it forms on the edge, the surface, fringes it, would be connected. The other stem will be λίγω, or λείγω (comp. λίβω and λείβω), λείχω and λείχην, λίγγω, λίζω, to which would have to be referred also λίγυς and λιγυρὸς,—clear, shrill (ligurire, lingere,—to lick greedily, to lick), in77 all of which the underlying sense is of licking, and the noise connected with it.
It is plain that later on the derivatives of these stems suffered manifold variations and corruptions; but how much of all this is to be attributed to speakers and writers among the Greeks themselves, and how much to subsequent transcribers and editors of their work, it might be difficult to decide. But every day we have occasion to note a number of words, to which accident or other circumstances have given an ambiguous character. These, used quite unsuspectingly by the ignorant, make the better informed person blush, or else extort a smile from him that often enough causes the speaker no little embarrassment to know the reason. Undoubtedly it was the same with the Greeks and Romans, and so confusions between λίχω and λείχω, λιχὴν and λειχὴν, might have easily arisen, from which people were subsequently unable to extricate themselves. Originally perhaps λείχω, equally with lingo and ligurio (to lick), may have had the simple sense of licking, and only through later accretions to the meaning, have acquired an ambiguous character; soon however this got transferred to it to the exclusion of all others, and we find it used preferentially as the regular word for cunnilingere. The correctness of our conclusion would seem to follow above all from the passage of Aristophanes95 given78 below, where it is the additional words that narrow down the meaning of λείχω (I lick), and definitely bring out the special signification. The words are said of Ariphrades, who reminds us of the ἀποφρὰς (unmentionable), the name Lucian appropriates to Timarchus:
Οὐδὲ παμπόνηρος, ἀλλὰ καὶ προσεξεύρηκέ τι·
τὴν γὰρ αὑτοῦ γλῶτταν αἰσχραῖς ἡδοναῖς μαίνεται,
ἐν κασαυρίοισι λείχων τὴν ἀπόπτυστον δρόσον,
καὶ μολύνων τὴν ὑπήνην, καὶ κυκῶν τὰς ἐσχάρας.
(Nor yet utterly villainous is he, but he has discovered yet another device; for he polluted his own tongue with foul delights, in the stews licking up the abominable dew, defiling the hair on the upper lip, and tumbling the girls’nymphae).
In the following Epigram96 of an unknown author79 λείχω is found used absolutely, without any supplementary words:
Χείλων καὶ λείχων ἴσα γράμματα· ἐς τί δὲ τοῦτο;
Λείχει καὶ Χείλων, κἂν ἴσα, κἂν ἄνισα.
(Χείλων,—a proper name, also means of the lips,—and λείχων,—licking,—have the like letters; now what does this point to? Chilon licks lips, whether lips like his own, or whether unlike). In explanation of this Epigram Forbiger says (loco citato p. 326.): “Lusus in Chilonem cunnilingum. Hunc ait iure quodam suo lingere, qui vel nomine iisdem literis constante prae se fert lingentem et lingentem quidem tum labra oris, ut labris ligentis similia, tum cunni, ut dissimilia.” (Pun on the name of Chilon, a cunnilingue. The poet says he (Chilon) licks by a sort of inherent right of his own, who even in his name, made up of the same letters, proclaims himself as licking, and licking now the lips of the mouth, which are like the lips of the licker, now those of the female organ, which are unlike). Χεῖλος was in fact used also of the lips of a woman’s organ, the nymphae; the Scholiast on τὰς ἐσχάρας (the nymphae) in the passage from Aristophanes given a little above, interprets this word by τὰ χείλη τῶν γυναικείων αἰδοίων (the lips of the female privates). According to Schneider in his Lexicon χείλων (adj.) signifies thick-lipped. Perhaps it was this very Epigram that led Lambert Bosius to make the statement that χείλων arose by a mere transposition of the letters from λείχον.
Now if λείχην,—for we consider it should be thus accented,—is derived from λείχω (I lick), we cannot but regard it as meaning: something produced by licking, a complaint brought on by licking, and particularly by the licking of the cunnilingue! Surely the Greeks could hardly have expressed themselves more clearly. Then the fact that the name came from the mouth of the common people is the very best reason for its not having been understood by the educated. Yet all the while an entirely similar form81 of expression has grown up in the mouth of the German common people, the real meaning of which very few have fathomed, but which most certainly arose in the same way as the Greek λείχην. No doubt many of my readers have again and again heard it said of some one with an eruption round the mouth, that is, someone suffering from Herpes labialis (Creeping eruption of the lips): “Well! you have been licking!”—for which educated people substitute the obviously insufficient, “You have been picking!” Very commonly again one may hear: “You have been licking greben, or picking greben; and this word greben is understood as being identical with grieben,—greaves in English, i.e. the remnants of lard that has been cut up into pieces and fried, because the separate pustules of the herpes labialis resemble in appearance the greaves. So people sometimes also say still more explicitly, “You have been licking, or picking, greaves; and one of them has been left sticking to your mouth, to prove your greediness!”
This explanation may seem a very likely one to many; nevertheless we incline to believe the word to be of later origin, and to have arisen from ignorance of the actual facts. We consider it more probable that greben owes its origin to some corruption of language growing out of gremium, the bosom. We have been led to this conjecture by a statement of Adelung’s in his Dictionary, Article “Grieben”, where he says: “In middle-Latin grieben, (greaves), were called, in accordance with a common interchange change of the letters b. and m. gremium”,—though indeed we cannot regard the word as solely and entirely mediæval Latin, for it is found occurring as early as Pliny (Hist. Nat. XII. 19.) and Columella (Res Rust. XII. 19. 3.), and is evidently connected with cremare (to burn). So just as in this case cremium and gremium may have been used interchangeably, has grebe grown out of greme in German, and the latter come to be used as a synonym of82 griebe,—the latter words according to this having as little in common with one another as the former. However those better practised in the science of word formation must here decide!
Now as to the word Mentagra (Tetter, Scab). This was evidently a word first framed by the Romans, as is distinctly stated not alone by Pliny, but by Galen as well (De compos. medic. secundum locos Bk. V., edit. Kühn Vol. XII. p. 839.). The latter says: Ἐκδόριον λειχήνων· ταύτῃ Πάμφιλος χρησάμενος ἐπὶ Ῥώμης πλεῖστον ἐπορίσατο ἐπικρατούσης ἐν τῇ πόλει τῆς μεντάγρας λεγομένης. (Blister for Lichenes (Scabs); in this way Pamphilus in his practise at Rome made most headway against the Mentagra as it was called, then prevalent in the city). It is usually considered to be formed on the analogy of Podagra, Chiragra (gout of the feet, gout of the hands) etc. from mentum, the chin, and ἄγρα, the act of catching, seizing hold of,—so a disease that attacks the chin. But more probably all these words are compounded not with ἄγρα at all, but with ἄλγος (suffering). That is to say just as ἀλγαλέος, by Attic interchange of letters, becomes ἀργαλέος (grievous), κεφαλαλγία becomes κεφαλαργία (head-ache), and ληθαλγία, ληθαργία (drowsiness, lethargy), so from ποδαλγία we get ποδαργία, and then by metathesis ποδάγρα (gout). (Comp. Doederlein “Lateinische Synonyme und Etymologien”,—Latin Synonyms and Etymologies Pt. 4. p. 424.). The remark Pliny adds however “ioculari primum lascivia” (at first by way of jesting mockery) evidently points to some ambiguity underlying the word. But whether this consists in the recognition of the likeness in sound between mentum, the chin, and menta, or mentula, the virile member, or is to be looked for in the ἄγρα, it might be difficult to determine. Still it seems probable, but without wishing to entirely exclude the former hypothesis, that the latter is the case, as will appear directly.
Galen97 distinguishes between λειχὴν ἁπλοῦς and λειχὴν ἄγριος (simple lichen, and malignant lichen) in his enumeration of Skin-diseases, and still more plainly in another place98 he says: “λειχὴν is likewise a Skin-disease; there are two forms of it, ὁ μὲν ἥμερος καὶ πρᾳότερος, ὁ δὲ ἄγριος καὶ χαλεπώτερος (the one benignant and milder, the other malignant and more serious). But in both of them minute scales are detached from the skin, and the part of the skin underneath the scales is reddened and almost ulcerated. The affection arises from a salt phlegmatic humour (φλέγματος ἁλμυροῦ) and yellow gall, hence the scales fall from the skin as in glazed pottery-ware (? ἐπὶ τῶν ἁλμῶν τῶν κεραμίων). The affection is cured by internal phlegmagogues and external embrocations.” We have already on p. 139. above, in the footnote on ἄγριος (wild, savage) and χαλεπός (hard, harsh), noted how these words are used with special reference to the vice of paederastia, but they are also applied generally to the vice, the different forms of which we have been examining here. This follows from Plato99 and Plutarch100, at any rate so far as ἄγριος is84 concerned, which indeed we may conveniently render by vicious. The original meaning being overlooked, λείχην and λιχὴν had been taken as synonymous,—possibly the Latin lichenos first led to the mistake; then naturally enough an appropriate epithet was sought, to signify the lichen which was the result of licking in a vicious fashion. But this according to the already existing mode of speech could be nothing else than ἄγριος101 again,—λειχὴν ἄγριος, with which λειχὴν ἁπλοῦς, lichen insons, (simple, innocent lichen) was naturally contrasted.
Yet while Criton, as cited in Aëtius, simply and quite correctly interpreted Mentagra by ἄγριος λειχὴν (fierce, malignant lichen), Galen appears to have been still ignorant of the special meaning. This is shown by the words ἥμερος and πρᾳότερος (gentle, benignant,—milder), which obviously are correct opposites of ἄγριος only if the latter is understood, as it is in Celsus, as equivalent to ferus (fierce, malignant), but in no way account for the ἁπλοῦς (simple, innocent), which Galen no doubt found already established as distinguishing epithet of λιχὴν. How little he fathomed the nature of the evil, is proved by his ætiology of it, which makes the complaint result from the φλέγμα ἁλμυρὸν (salt phlegmatic humour) and the χολὴ ξανθὴ (yellow gall). The unprofessional Martial had a better word to say on the subject when he wrote his sordidique lichenes (filthy, squalid-looking lichens). Similarly it would seem the agra in Mentagra should be taken as pointing to ἄγριος (fierce, malignant). Can it be perhaps that in this way the μολύνων τὴν ὑπήνην (polluting the hair on the upper lip) of Aristophanes,85 the Latin barbam inquinare (to pollute the beard), have come to be used as synonyms for cunnilingere? Martial seems to imply it by his triste mentum, mentum periculosum (disfigured chin, perilous chin). Perhaps too the Sycosis menti (Sycosis,—fig-like eruption, of the chin) of Celsus and the later Greek medical writers should likewise be regarded as coming under this head. At a matter of fact, Archigenes says so in so many words, as cited in Galen (De comp. med. secundum locos. Bk. V. edit. Kühn Vol. XII. p. 847.), ἐπὶ δὲ τῶν συκωδῶν τῶν ἐπὶ τοῦ γενείου, λεγομένων δὲ μενταγρῶν, ὑπὸ δέ τινων λειχήνων ἀγρίων, ποιεῖ κ. τ. λ. (but in the case of the sycotic, or fig-like, eruptions on the chin, which are called mentagrae, and by others malignant lichens, he proceeds as follows, etc.), and calls the affection of the chin, as do other Physicians, generally ἐξανθήματα ἐν τοῖς γενείοις (efflorescences, eruptions on the chin),—p. 824.
If we have thus succeeded in establishing the meanings of lichens and mentagra, the rest of the passage of Pliny will admit of easy explanation. The disease in many cases it seems invaded the whole face, in the same way as the atra lues (black contagion) in the passages quoted above from Martial under fellation. Perhaps all of these,—indeed, Pliny also says lues,—are the be referred, as is actually done by Farnabius in his notes, to mentagra, seeing that the disease could perfectly well, though certainly much seldomer, arise equally from the practise of fellation. The double entendre between mentum (the chin) and menta or mentula (the virile member) would so acquire all the more point.
The expression foedo cutis furfure (with a horrible scurf of the skin) appears to have led a number of authors to believe that this was the capital characteristic of the complaint, and that the distinction between λιχὴν and λείχην was merely one of degree. This view was advocated in particular by86 Willian102, who ascribes it also to Paulus Aegineta103 as well as to Oribasius104 though both of these authors limit themselves to saying that the moderately siccative remedies are of no benefit in λείχην ἄγριος (malignant lichen), whereas the more violent ones aggravate it, and that for this reason it was called ἄγριος. Hence Willian’s Lichen agrius (malignant lichen) has nothing in common with the lichen of the Greeks and Romans but the mere name, for it follows clearly from the words foediore cicatrice (with a more horrible scar) that occur a little further down in Pliny, that a process of skinning over by ulceration was part of the disease, and did not owe its existence solely to the caustic remedies employed.
The immunity of women105 equally admits of easy87 explanation, for in the first place women were not likely to have readily conceived the idea of acting after the manner of a cunnilingue106, and even if fellation is admitted to be an occasionally concurrent cause of mentagra, still it would seem, as already stated, to supervene much less often as a consequence of the latter vice; while in cases where it does, it is of a milder form and it is rather the internal parts of the mouth that are imperilled. Besides, it is to be remembered that women generally speaking suffer less frequently from pustulous disorders of the cutaneous glands affecting the face than men do, as is well seen at the present day with Acne. In the parts neighbouring on the genitals this is exactly reversed. Still this immunity of women must not be insisted on too far, as those persons of the female sex who used to practise fellation, the Summoenianae (women88 of the suburbs) lay too completely outside the range of Pliny’s observation.
As to the servi (slaves) and Plebs humilis (Commons of humble station), these were surely unlikely, however little restraint they may have put on their sensual appetites, to have readily fallen into suchlike forms of vice,—forms which spring as a rule from the brain of unoccupied, rich idlers. We have only to appeal to modern experience to substantiate this. How many individuals of the lowest and middle classes have the records of forensic medicine to show as having been paederasts and so on? Wild aberrations in morals have at no period begun with the common man! So we see it was the Proceres (Nobles) who were in an especial degree attacked by the mentagra.
At the same time the most conspicuous cause of mentagra, the practice of cunnilingere was by no means the only way of getting it, for the malady, like condylomata on the genital organs, was evidently connected with a contagion,—a fact which is clearly enough brought out by the layman Pliny, whereas the Physicians say nothing about this. Accordingly the disorder was capable of being disseminated by kissing from one individual to another. But it was not the velox transitus osculi (swift transmission of a kiss) that was instrumental in spreading the disease, but rather the basium (wanton kiss),—which depended on some yet unidentified lascivious device107, sucking, playing with89 the tongue or the like. Still we must remember that at the very time the mentagra was spreading with such terrible rapidity, a perfect mania for kissing had broken out at Rome. Martial describes this admirably in the two following Epigrams, which are of the very highest importance in connection with our subject:
Book XII. Epigram 59:
De importunis basiatoribus.
Tantum dat tibi Roma basiorum
Post annos modo quindecim reverso,
Quantum Lesbia non dedit Catullo.
Te vicinia tota, te pilosus
Hircoso premit osculo colonus.
Hinc instat tibi textor, inde fullo,
Hinc sutor modo pelle basiata,
Hinc menti dominus periculosi,
Hinc defioculusque et inde lippus,
Fellatorque recensque cunnilingus.
Iam tanti tibi non fuit redire.
(Of pestilent Kissers: Rome bestows more kisses on you, on your return to her after fifteen years’ absence, than ever Lesbia gave Catullus. The whole neighbourhood kisses you, and the hirsute countryman presses you in his goaty embrace. One side the weaver is upon you, the other the fuller, here the cobbler who but now kissed his leather; here comes the owner of a perilous chin, here the one-eyed man and here the blear, and the fellator, and the cunnilingue90 fresh from work. Now surely to return was not of such importance to you as all this.)
Book XI. Epigram 98:
Effugere non est, Basse, basiatores.
Instant, morantur, persequuntur, occurrunt
Et hinc et illinc, usquequaque, quacunque.
Non ulcus acre pustulaeve lucentes,
Nec triste mentum sordidique lichenes,
Nec labra pingui delibuta ceroto,
Nec congelati gutta proderit nasi.
Et aestuantem basiant et algentem,
Et nuptiale basium reservantem.
Non te cucullis asseret caput tectum,
Lectica nec te tuta pelle veloque,
Nec vindicabit sella saepius clausa.
Rimas per omnes basiator intrabit.
Non consulatus ipse, non tribunatus,
Saevique fasces, nec superba clamosi
Lictoris abiget virga basiatorem.
Sedeas in alto tu licet tribunali,
Et e curuli iura gentibus reddas:
Ascendet illa basiator atque illa:
Febricitantem basiabit et flentem:
Dabit oscitanti basium natantique,
Dabit et cacanti. Remedium mali solum est
Facias amicum, basiare quem nolis.
(To Bassus: Escape the kissers, no! it is not to be done, Bassus. They set upon you, wait for you, pursue you, meet you, here, there, and everywhere, in every street, at every corner. Neither acrid ulcer nor shiny pustules, neither disfigured chin nor foul scabs, nor lips anointed with pink salve, nor the drop at the tip of a frozen nose will save you. They kiss a man sweating with heat and starving with cold, nay! even a man keeping his lips pure for the nuptial kiss. A head muffled in hoods will not exempt you, nor a litter guarded with rug and curtain, nor the sedan kept closed most of the time get you off.91 The kisser will in by every chink. Not the very consulship, not the tribuneship, not the stern fasces and threatening rod of the shouting lictor will keep away the kisser. Though you sit exalted on the high tribunal, or give laws to the people from the curule seat, both to one and the other the kisser will climb up. He will kiss a man shaking with fever, and drivelling with cold. He will give a kiss to a man gaping, to a man swimming, even to a man shitting! The one and only cure for the plague is to make a real friend, whom you will not need to kiss).
Now we shall be in a position to explain to our satisfaction what Martial meant by basia lasciva (wanton kisses),—XI. 24.—basia maligna (pestilent kisses),—XII. 55.—and Petronius (ch. 23.) by his conspuere aliquem basio immundissimo (to beslobber anyone with a most filthy kiss); and we shall be in no way surprised at the fact that mentagra not only attacked the Roman nobles as a virtual epidemic, but that the velox transitus osculi (the swift transmission of a kiss) was alleged by Pliny as a reason of its communication.
Finally as to the historical factor in connection with mentagra,—it is implied in the account Pliny gives that it was only at Rome it was regarded as a new disease. It must have been already known to the Greeks, for they possessed the name Lichen for it. The Greek physicians, of whom several of the ones quoted by Galen lived some considerable time before Claudius, know nothing about the disease being a new one, while Galen himself says simply, ἐπικρατούσης ἐν τῇ πόλει τῆς μεντάγρας λεγομέμης, (when the mentagra as it was called was prevalent in the city). Plutarch again, though he (Symposiaca bk. VIII. Quaest. 9.) wrote a special Chapter on new diseases, with particular reference to Elephantiasis, never mentions mentagra at all. He represents it as having been introduced into Rome from Asia, and it was from Egypt, the Genetrix92 talium vitiorum (Mother-land of suchlike abominations), the Physicians108 were imported who understood how to cure the disorder. We have more than once noted that Asia was the breeding place of sexual excesses, and described how vice spread from thence over different countries and how as a result of these practices the affections of the parts naturally concerned that arose first in Asia subsequently passed on to these same countries. For Rome this was in an especial degree the case with Egypt, where the undermining of morality had gone farthest; Martial109 spoke justly when he said “Nequitias tellus scit dare nulla magis,” (No other land knows better how to produce finished rascality). But the intercourse with Asia and Egypt arose mainly in the time of Pompey, and became from that period ever more active, while concurrently luxury was on the increase and the old Virtus (manly virtue) of the Romans disappearing more and more every day,—above all when Tiberius by his own example elevated every form of vice into a sort of fancy article demanded by fashion.
Not that the Emperor went unpunished, for he himself probably suffered from mentagra. Julian11093 says of him, that when Romulus had invited to the feast of the Saturnalia all gods and Caesars, Tiberius appeared with the rest, “but when he turned round to take his seat, on his back could be seen in thousands scars, marks of burnings and scrapings, indurated weals and callosities, results of his excesses and wild lusts, cankers and scabs as it were burnt in”. Nay! according to Suetonius111 his face itself bore crebri et subtiles tumores (a multitude of minute swellings); and Tacitus112 says of him: Praegracilis et incurva proceritas, nudus capillo vertex, ulcerosa facies, ac plerumque medicaminibus interstincta, (Tall and of a most graceful, albeit bowed, figure; the head bald, the face covered with ulcers, and generally patched with medical plasters). When Galen113 mentions a τροχίσκος πρὸς ἕρπητας ὁ Τιβηρίου Καίσαρος (a lozenge for creeping eruptions, Tiberius Caesar’s), this does not in any way necessarily imply that this was prescribed as a remedy against eruptive symptoms on the face, for Tiberius, as we see from the passage quoted from Julian, suffered from eruptions on all the other parts of his body. Even if an affection of the face was intended, the expression ἕρπης (creeping eruption), in view of the marked tendency of the disease to spread to neighbouring parts, was not at all an unnatural one to be used; and we may say, speaking generally, that the view which holds the Greeks to have indicated by the word ἕρπης any one definite and distinct form of eruption is entirely mistaken. Bertrandi114 indeed endeavours to show that mentagra was a form of malignant tetter. That the application of plasters as a remedy in mentagra was frequently recommended and94 employed is shown both by Galen and Aëtius115.
But in proportion as the exciting cause grew ever more and more common, the cunnilingue being now no longer contented with girls, but employing for the satisfaction of his shameful mania women and even pregnant women as well, and at last actually women during menstruation, the resulting consequences were bound to occur not only more frequently but also in a more dangerous form. At first it was merely single pustules, which appeared round the mouth and took possession of the chin, and which were confounded with Sycosis menti (Sycosis,—fig-like eruption of the chin), a complaint liable to arise from other causes as well and one long since familiar, without attracting particular attention as anything uncommon. Later on when neither morbid vaginal phlegm nor yet menstrual blood repelled the cunnilingue any longer, there was set up a diseased process in the cutaneous glands, the resulting secretion rapidly drying formed a white crust or scurf, and this was detached in flakes resembling bran. All this could not fail to arouse remark, and accordingly the Romans, little practised in medical diagnosis, saw in it a new disease, which in turn received a new name. Just as in more modern times the introduction of Venereal disease was attributed to a leprous Knight from the Holy Land, so now at Rome Perusinus, eques Romanus, Quaestorius scriba (Perusinus, a Roman knight, a secretary in the Quaestorian office) was held95 responsible for bringing mentagra from Asia. As a matter of fact he probably got his mentagra in Asia in exactly the same manner in which it was acquired in Rome,—if indeed we are on general grounds to give any weight to this part of the story. At any rate modern times have given us many examples of how much credence mankind is ready to give to an account of the introduction of a disease by one definite individual. But the disease did not stop at the cutaneous glands, the hair-glands were also involved, the hair fell away, and ulcers formed, which spread around with destructive virulence, as was particularly the case in Martial’s day. On the other hand it is true deep-seated ulceration never supervened, but the disease rather extended on the surface from the face onwards, spreading more or less over the whole of the rest of the body116, and thus assumed the form of Psora (Itch) or Lepra (Leprosy),—a phænomenon we shall have to return to once more later, its right appreciation being of the96 utmost importance for the History of Venereal Disease.
Now, since on the one hand every cunnilingue is not attacked by mentagra, while on the other sometimes ulcers of the inner portion of the mouth, sometimes mentagra, and the latter sometimes local, sometimes of wide extent, are noted, the following question calls for an answer. What circumstances conditioned these phænomena and, generally, the special frequency of mentagra in Italy? Leaving out of account a variety of other considerations, we are bound in this place to call in along with other factors of our explanation some special and particular influence of the Genius epidemicus (the aggregate of epidemical conditions at large), which just at that time favoured the rise of skin complaints. However slight the material Antiquity affords us on this point, and especially so far as concerns the time a little before and after Our Lord’s birth, still we do find a datum for Italy at any rate which we certainly ought not to leave unutilized. This is the statement of Pliny (ch. 5. and Bk. XX. ch. 52.) to the effect that it was in the time of Pompey the Great, or according to Plutarch (loco citato) in that of Asclepiades, that elephantiasis first showed itself in Italy. It follows that at that period favourable external circumstances also were in existence in connection with the conditions of disease at large,—as indeed the ready extension of mentagra from the chin onwards to the rest of the body proves even more clearly.
But it must not for a moment be supposed that therefore mentagra was of epidemic origin. Without at all wishing to embark on the consideration of the ætiological factors of elephantiasis, we may just mention the fact that according to Pliny’s account this disease too, equally with mentagra, would seem to have always begun with the face117. The conjecture97 is all but unavoidable, that very possibly in either case it was the practices of the cunnilingue that supplied the exciting cause for the misfortune; and this would also probably explain how it was elephantiasis came to be connected in men’s minds with the Morbus phoeniceus (Phoenician disease). Still, as already explained, this would only be equivalent to making it responsible in individual cases,—cases that tend inevitably to render the proper98 understanding of the action of elephantiasis, as well as of its history, considerably more difficult. May it not also be to some extent the case that under the general name of elephantiasis forms of disease of very different sorts have been confounded? The views held by the Ancients on this and on the other skin diseases still remain in too much obscurity for anyone to be able to give a decisive judgement on the point. For the rest most probably the atra lues and scelerata lues (black contagion, abominable contagion), spoken of above, likewise come under the category of mentagra. This we have felt ourselves constrained to ascribe not solely to the practise of the vice of the cunnilingue as a cause, but to fellation also,—only that in the latter case, as we have pointed out, it is rather the inner, in the former rather the external parts, that became affected.
Several of the commentators on Horace, and particularly Laevinus Torrentius118 have referred the much-discussed Morbus Campanus119 to the head of mentagra;99 accordingly this will be no inappropriate place at any rate to mention it, though without aiming at a complete explanation. Horace represents two buffoons, Messius and Sarmentus, as rallying each other for the amusement of the company:
— — Messi clarum genus Osci,
Sarmenti domina extat, ab his maioribus orti
Ad pugnam venere. Prior Sarmentus: Equi te
Esse feri similem dico. Ridemus: et ipse
Messius: Accipio; caput et movet. O, tua cornu
Ni foret exsecto frons, inquit, quid faceres, cum
Sic mutilus miniteris? At illi foeda cicatrix
Setosam laevi frontem turpaverat oris.
Campanum in morbum, in faciem permulta iocatus
Pastorem saltaret uti Cyclopa, rogabat;
Nil illi larva aut tragicis opus esse cothurnis.
Multa Cicirrus ad haec.
(Messius was sprung of the renowned race of the Oscans, Sarmentus’mistress is yet living; from these ancestors derived, they came to the fray. First begins Sarmentus: “I declare you are just like an unbroken horse.” At this sally we laugh, and Messius himself says: “I accept the likeness,” and tosses his head. “Oh! if your horn had not been amputated from your brow,” says he then, “what would you do, since you threaten us so fiercely, mutilated as you are?” Now an ugly scar disfigured the left side of his shaggy brow. After making a number of jibes at his Campanian disease, and his face, he asked him to dance the shepherd Cyclops; saying there needed no mask and tragic buskins. Many jests Cicirrus added as well).
Messius who is chiefly spoken of in the above passage, is in the first place represented as an Oscan by birth. Now the whole race of the Oscans was,100 as Festus informs us, notorious for its unnatural excesses in matters of Love; we read in him, p. 191: “Obscum duas diversas et contrarias significationes habet. Nam Cloatius putat eo vocabulo significari sacrum, quo etiam leges sacrae Oscae dicuntur, et in omnibus fere antiquis commentariis scribitur Opicum pro Obsco, ut in Titini fabula quinta: Qui Obsce et Volsce fabulantur, nam Latine nesciunt. A quo etiam verba impudentia, et elata appellantur obscena, quia frequentissimus fuit usus Oscis libidinum spurcarum.” (Obscum has two different and contrary meanings. For Cloatius considers sacred to be signified by the word, in which sense sacred laws are spoken of as leges Oscae (Oscan laws), and in almost all the old commentaries Opicum is written for Obscum, as in the fifth Fable of Titinius: “Who converse in Obscan and Volscian, because they know not how in Latin.” Whence also indecent words, and swelling ones, are called obscene, because the practice of unclean lusts was most frequent among the Oscans120.)
Again on p. 194., “Oscos, quos dicimus, ait Verrius Opscos ante dictos, teste Ennio, cum dicat: De muris res gerit Opscus. Adiicit etiam, quod stupra inconcessae libidinis obscena dicantur, ab eius gentis consuetudine inducta. Quod verum esse non satis adducor, cum apud antiquos omnes fere obscena dicta sint, quae mali ominis habebantur.” (The Oscans, as we call them,101 Verrius says were formerly called Opscans, on the evidence of Ennius, for he says: “The Opscan directs his attack upon the walls.” He adds further that debaucheries of lawless love are called “obscene”, as taking this name from the habits of the nation in question. But I am not sufficiently convinced of the truth of this, inasmuch as in nearly all the ancient writers things are called obscene that were held to be of evil omen). However what the spurca libido (unclean lust) consisted in may be readily conjectured from the following explanations of Festus: Oscines aves Appius Claudius esse ait, quae ore canentes faciant auspicium, ut corvus121, cornix, noctua, (Divinatory birds—Oscines aves—are, says Appius Claudius, such as give an augury by singing with the mouth, as the raven, the crow, the owl); if only we remember how the fellator, as was shown on a previous page, was nicknamed corvus (raven). Again in an Epigram of Ausonius already quoted a cunnilingue is called Opicus magister; so that we cannot doubt the question is here of that vice which is practised with the mouth.
In another Epigram of Ausonius quoted and explained above, where the different forms of the obscoena Venus (obscene Love) are specified, Crispa there mentioned practises,
Et quam Nolanis capitalis luxus inussit,
(That vice too which headlong wantonness branded on the men of Nola), and this capitalis luxus122 of102 the men of Nola, as the general sense of the whole passage clearly shows, is nothing else but fellation. But the town of Nola was in Campania, and the inhabitants of Campania again consisted for the most part of Oscans; so whatever is true of the latter, must needs also apply to the Campanians. The Nolans and Oscans or Opicans being fellators and cunnilingues, the Campanians must be so too; and as a matter of fact Plautus (Trinum. II. 4. 144.) tells us: Campas genus multo Syrorum antidit patientia, (The Campanian race far outdoes that of the Syrians in passivity).
Now Messius being represented as an Oscan, and this by way of mockery, as all expounders admit, the point of the jest must evidently refer to this luxus capitalis, and Messius accordingly be regarded as a fellator. Now let us look if this view finds any confirmation in what follows123. First of all Sarmentus says Messius is equi feri similis (like an unbroken horse). Wherein precisely the satire of this consists103 is indeed somewhat doubtful, the commentators maintaining an obstinate silence on the point; but there must be some allusion of some sort intended. We can scarcely suppose this to be to the Hectoreus equus (the Hectorean stallion) of Ovid124 or the equus supinus (the stallion lying supine) of Horace,—Sat. II. 7. 50.125. The unbroken horse is noticeable as galloping with head down between the fore-feet, a position taken, as we have already pointed out, by the cunnilingue, but which in accordance with the passage of Lucian quoted above can equally well be that of the fellator126. Messius must have understood the allusion, for he says, “Accipio”,—caput et movet, (“I accept”,—and moves his head). Sarmentus takes the movement as a threat, for he in his turn understands the equus ferus (wild horse) in yet another sense as aries (a ram)127, and adds:104 If only your horn had not been amputated! What should make you threaten to butt, mutilus (mutilated)128 as you are?
Now in explanation of what it was led Sarmentus to indulge in this jest, Horace goes on to say that Messius carried on the left side of his brow a hideous scar. At this Sarmentus directs his wit, making allusion to the Campanus morbus (Campanian disease) and Messius’disfigured face, finishing up by asking the latter pastorem saltaret uti Cyclopa (to dance the shepherd Cyclops), adding that for this he would need neither mask nor tragic buskins. But the Campanus morbus129 is indeed nothing else but the105 capitalis luxus (headlong wantonness) of the Nolans, the peculiar vice of the Oscans, fellation in fact, which Messius practised, and to which he owed his foeda cicatrix (hideous scar), his disfigured face; and on both these points Sarmentus proceeds to rally him at great length (permulta iocatus,—indulging in very many jests), without Horace however recording his wit any further. In the pastorem Cyclopa saltare (to dance the shepherd Cyclops) again is contained an allusion that has hitherto been quite misunderstood, one which Lucian in his Pseudologistae (ch. 27.) will best explain for us. He says to Timarchus: “But in Italy, great gods! you acquired the heroic nickname of ὁ Κύκλωψ (the Cyclops), because at one time you wanted to practise your vice in imitation of the old legend, as it is found in Homer, and actually, as you lay there drunk, held the κισσύβιον (wassail-bowl) in your hand like a wanton Polyphemus; and the young man hired for the purpose with outstretched hasta (spear), that was well sharpened, threw himself upon you like another Odysseus, to thrust out your eye130.
Yet did he miss his aim, and the spear turned slantwise beside you;
So that its point sped past, the edge of your chin merely grazing.
Thus it is by no means unreasonable to speak of you as using “cold-mouthed phrases” (Ψυχρολογεῖν). But you, Cyclops, opening your mouth, and gaping as wide as mortal man can, had your cheeks plugged by him, or better you longed, as Charybdis with the ships was fain to swallow down helm and sail and all, you longed to absorb the whole Οὖτις (No-man).”
Finally the nickname Messius bears, Cicirrus or Cicerrus, would seem to embody a jesting allusion, as it was no doubt given him on account of his throaty, croaking voice. It signifies the same thing as κερκίδες (hawks) in Dio Chrysostom, and like that word is to be derived from κέρχω (to croak)131.
The Morbus Phoeniceus (Phoenician disease) was not, as we have seen, elephantiasis at all, and neither was the Morbus Campanus (Campanian disease) mentagra. But just as elephantiasis might supervene as a consequence of Morbus Phoeniceus, so the foeda cicatrix (hideous scar), a mark left behind it by a previous malady, was a consequence of the Morbus Campanus. Now what was the nature of this malady that the mark it left behind showed as a foeda cicatrix, is precisely what we would wish to determine. The Commentators all take the cornu exsectum (a horn amputated) as giving the explanation, though this is by no means absolutely necessary according to the general drift of the passage as explained; and Sarmentus might perfectly well under these circumstances, arguing from the presence of a scar, assume or at any rate profess to assume as the cause from which this had originated, the previous existence of a horny excrescence, without the latter as an actual matter of fact having ever had any previous existence. To us at any rate the cornu exsectum appears to stand in only a remote connection with107 the foeda cicatrix, which was no doubt later on made the subject of manifold further witticisms; only Horace has given us no more details about the matter, either because they had entirely escaped his memory, or possibly because he had not perfectly grasped the point of these jokes. Certainly the conspicuously placed at (but) seems to point to a distinction of what follows from what precedes—unless indeed it is so placed merely to mark the transition from the oratio directa to the oratio indirecta.
However, granted there actually was an excrescence previously existing, which had been removed by the knife, of what nature was the said excrescence? It is scarcely possible, with Heindorf, to suppose the Satyriasis of Aristotle132 to be intended here; with much greater probability Schneider in his Greek Dictionary, under the word διονυσιακὸς (Dionysiac, connected with Dionysus) drew attention to the definition of Galen (edit. Kühn XIX. p. 443.): διονυσίσκοι εἰσὶν ὀστώδεις ὑπεροχαὶ ἐγγὺς κροτάφων γιγνόμεναι. λέγονται δὲ κέρατα ἀπὸ τῶν κερασφορούντων ζάων κεκλημένα. (διονυσίσκοι are bony excrescences growing near the temples, and they are called horns, so named from the animals that carry horns). A passage of Heliodorus (Cocchi Ant., Graecorum chirurgici libri, e collect. Nicetae Florent. 1754. fol., p. 125.) which Oribasius, De fracturis, has preserved, gives a slightly different account; it reads: Ὀστώδης ἐπίφυσις ἐν παντὶ μὲν γίγνεται μέρει τοῦ σώματος, πλεοναζόντως δὲ ἐ108ν τῇ κεφαλῇ, μάλιστα δὲ πλησίον τῶν κροτάφων· Ὅταν δὲ δύο ἐπιφύσεις γένωνται πλησιάζουσαι τοῖς κροτάφοις, κέρατα ταῦτα τινες εἴωθασιν ὀνομάζειν, ἔνιοι δὲ διονυσιακοὺς τοὺς οὕτω πεπονθότας ἀνθρώπους προσηγόρευσαν. (Bony outgrowth may occur in every part of the body, but pre-eminently on the head, and particularly near the temples. But when there are two such growths in the neighbourhood of the temples, some are wont to call them horns, but others name the patients so afflicted διονυσιακοὶ). Then follows the description of the outgrowth, and the method of its removal by excision. On this passage Cocchi found an old marginal gloss from the hand of Nicotas (?), κέρατα μὲν λέγεται ἀπὸ τῆς τῶν κεράτων ἐκφύσεως, τῶν γιγνομένων τοῖς ἀλόγοις ζώοις. Διονυσιακοὺς δὲ αὐτοὺς προσαγορεύουσιν, ἀπὸ τῆς πρὸς τὸν θεὸν ἐμφερείας ὡς αὐτός φησιν ἐν τοῖς χειρουργουμένοις,—(they are called horns from the growth of the horns that appear on the lower animals. And they name them διονυσιακοὶ from the likeness to the god Dionysus, as he says himself, in the carved figures),—which on the whole confirms the statement of Heliodorus, though he (Cocchi) prefers, following this indication, to emend the passage of Galen also so as to read, διονυσιακοί, οἷς ὀστώδεις ὑπεροχαὶ ἐγγὺς κροτάφων γίγνονται, (Dionysiaci, so they are called, i.e. those in whom bony excrescences grow near the temples). This much, that we should read διονυσιακοὶ for διονυσίσκοι, is evident, but whether the rest of the emendations are to be accepted may well be open to doubt, as the second clause of the sentence, “and they are called κέρατα (horns), so named from the animals that carry horns”, obviously implies that the term διονυσιακοὶ is used in reference not to the individual, but to the outgrowth. Schneider indeed agrees with the emendation of Cocchi, but has in error put Sarmentus in the place of Messius.
Now supposing the latter has actually had an earlier bony outgrowth, it is not exactly evident why after its skilful removal a foeda cicatrix (hideous scar) should have remained,—if indeed we do not prefer to regard the foedus (hideous, foul) as perhaps pointing to the cause that had occasioned the outgrowth in question. In that case it would certainly be interesting to see thus referred to the vice of the fellator affections of the bones carrying the same meaning as our own tophi (concretions on the bone in gouty affections). But in all probability it was merely cutaneous tubercles that had been removed by surgical means, the actual cautery or the knife, and these, as is invariably their nature to do, had left behind an ugly scar. Thus Messius would seem to have resembled Calvus tuberossimae frontis (with brow most thickly covered with tubercles) in Petronius (ch. 15.) and the face represented on a gem, of which a delineation is said to be found in Corius’ Museum Etruriae Plate II. fig. 3.,—a work we have been unable to procure. But enough of the Morbus Campanus133!
Sodomy, or Bestiality.
In the various forms of vice hitherto considered we have seen mankind approximating more and more closely to the animal and putting himself to a greater or less degree on the same footing; now we behold him in Sodomy134 sinking finally far below the level of the animal, renouncing not merely the human but even the animal nature, in virtue of which he has been able so far to call himself at lowest a member of the species. So it is with complete justice that Plutarch135 says:111 “At gallus si gallum conscendat absente gallina, vivus comburitur, aruspice aliquo pronuntiante grave atroxque id esse ostentum. Ita ipsi homines hoc confessi sunt, castitate a brutis se superari, eaque naturae vim non facere voluptatum percipiendarum causa. Vestras libidines natura, quamquam legis auxilio fulta, tamen intra suos non potest coercere fines: quin eae instar fluvii exundantes atrocem foeditatem, tumultum confusionemque naturae gignant in re venerea. Nam et capras, porcas, equas iniverunt viri, et feminae insano mascularum bestiarum amore exarserunt. Ex huiusmodi enim coitibus vobis sunt Minotauri, Silvani seu Aegipanes atque (ut mea fert sententia) etiam Sphinges et Centauri nati. Enimvero fame coactus canis aut avis aliquando cadavere humano vescitur; ad coitum nullus unquam est homo a bestia sollicitatus, bestias vero cum ad hanc, tum ad alias voluptates vos vi trahitis ac contra jus usurpatis.” (But if the cock tread the cock in the absence of the hen, he is burned alive, any augur pronouncing this to be a serious and sinister prodigy. Thus men have themselves admitted that they are surpassed by brutes in chastity, and that the latter do not do violence to nature with a view to the gratification of their desires. Whereas your lusts nature cannot, though seconded by the aid of law, restrain within their due bounds, or stay them from overflowing like a river in flood and producing horrid abominations, a wild cataclysm and confusion of nature in matters of love. For men have had intercourse with she-goats and sows and mares, while women have been inflamed with mad love of male beasts. Indeed it is from such unions that your Minotaurs have been engendered, and Silvani or Aegipans, and—as I suppose,—the Sphinxes too and Centaurs136. True under compulsion of hunger, dog and bird sometimes feed on a human corpse; but no man has ever been invited to coition by any beast, though you constrain beasts by force to this as well as to other shameful pleasures, and use them contrary to all right).
Like all other forms of vicious lust, Sodomy too was an outcome of Asiatic137 and Egyptian luxury,112 and already in quite early times familiar in those regions,—in fact, as is the case with sexual excesses generally, this vice appears to have developed from the religious cult of the countries named. Among the Egyptians138 at any rate we meet with Mendes, the sacred Goat or Pan, worshipped by means of Sodomy on the part of his female devotees, who were shut up along with him.
Boettiger139 goes so far as to conjecture that the tame snakes in the temple of Aesculapius, which were also kept in private houses140 as a plaything of the women, were trained and employed by them for purposes of Sodomy. In confirmation a passage is brought forward in this connection by Forberg, loco citato, p. 368, from Suetonius141, in which the mother of Augustus, Atia, is spoken of: “In Asclepiadis Mendetis Θεολογουμένων libris lego, Atiam cum ad sollemne Apollinis sacrum media nocte venisset, posita in templo lectica, dum ceterae matronae dormirent, obdormisse; draconem repente irrepsisse ad eam paulloque post egressum: illamque expergefactam quasi a concubitu mariti purificasse se et statim in corpore eius exstitisse maculam, velut depicti draconis, nec potuisse unquam eximi, adeo ut mox publicis balneis perpetuo abstinuerit”142. (In the books of the114 Theologoumena (sacred writings) of the Asclepiad Mendes I read how Atia, who had come to the wonted festival of Apollo at midnight, when her litter had been set down in the Temple, and the other matrons were sleeping, herself fell asleep; how a snake suddenly crept in to her, and presently emerged again; and how on waking she purified herself as after intercourse with her husband, and immediately there appeared a mark on her body, representing the likeness of a snake, which could never be got rid of, so much so that soon she left off ever after frequenting the public baths).
However the Roman women seem to have especially made use of the ass143 for the satisfaction of their nymphomania, an animal that was famed in Antiquity for its salaciousness.
That under such circumstances the women’s genitals, and the men’s no less, were exposed to many sorts of injury, may be readily supposed; though we have115 sought in vain so far for any direct evidence of the fact. So we may perhaps be allowed to quote here an observation originating with Abu Oseibah, De vitis medicorum illustrium, (On the Lives of Famous Physicians), according to Reiske144. This properly speaking belongs to a later period chronologically, but it is pertinent in the present connection. Reiske says: “Caput XIII. habet observationem—2. de ingenti penis inflammatione, quae nata fuerat ex impuro cum bestia concubitu, cum coruncula urethram obstruente, sanata modo prorsum empirico atque crudeli. Impositum glabro lapidi penem medicus subito praeter aegri expectationem, qua poterat vi percutiebat manu in pugnum coacta, ut obturaculum et ulcus dissiliret. Sapit hic casus luem veneream; et posset inservire illis pro argumento, qui morbum hunc etiam veteribus cognitum fuisse contendunt. Cadit autem is casus circa annum Christi 940.” (Chapter XIII contains the following observation,—2. Of a violent inflammation of the penis, which had originated in unclean intercourse with a beast, with a coruncle, or knot, constricting the urethra, cured in a manner to the last degree empirical and cruel. The penis being laid on a rough stone, the Physician suddenly when the patient was not expecting it, struck it as heavily as ever he could with his doubled fist, so that the stoppage and ulcer might burst. This case has a smack of the Venereal disease about it; and might serve as an argument for those who hold that this disease was known to the Ancients as well. But the case falls about the year of Our Lord 940.)
Now that we have made ourselves acquainted with the various use to which the Ancients put the genital organs, we are confronted inevitably with the question,—how were the genitals themselves affected by it all? Impossible to suppose they can have preserved their integrity absolutely intact, while at the same time such parts as were substituted in use for the one or the other form of them, were exposed,—as is abundantly proved by the different diseases described, diseases affecting the pathic, the fellator and the cunnilingue respectively,—to manifold complaints, and very often had to pay severely for the misuse to which they were put. Granting that the unnatural use of the mouth and the rectum must necessarily have endangered those parts specifically more than the penis, an organ particularly adapted and intended for friction, still this will by no means imply the entire immunity of the latter from ill effects. Indeed the fact of such immunity is sufficiently disproved by the passages quoted specifically under paederastia, without taking into account at all the large number of actual maladies of the genitals that are mentioned by professional and non-professional writers of Antiquity. With some of these we have already made acquaintance,—maladies which no one would for a moment think of ascribing exclusively to the practice of the vice of paederastia.
Accordingly we must look for other factors, which being in part unconnected with the use of the genitals, are not like this to be regarded as an immediately efficient cause, but rather as predisposing circumstances, exercising from the first an independent influence on the normal condition of those organs. For mere use or misuse cannot possibly be taken as in itself a sufficient reason to account for disease, even though the Ancients may have looked upon117 complaints of the genitals partly as a direct consequence of illicita Venus (unlawful Love), or in other words as it were a result of the vengeance of outraged Nature. The genitals, like all organs of the human body, exhibit over and above their functional activity on behalf of the general organism and its reproduction, evidences also of an independent activity directed towards the maintenance of their own integrity and individual existence,—and these are bound to differ more or less according to difference of locality and difference of time, as indeed may be predicated of the organism as a whole, if we trust the indications it gives.
Now this differentiation according to locality is conditioned above all else by climate; hence the question we have now first of all to answer is this: what influence did climate manifest in Ancient times on the activity of the genital organs in general and in particular? and, to what extent may a factor favourable to the rise of affections of the genitals be deduced from it? True, direct information on the point has so far reached us only sparingly, still such as we have is enough to justify a general view on the whole question, especially if we reinforce it with the results of more recent observation,—always provided this be done with proper precaution, for we sometimes find the Ancients commending the climate of a particular country as being exceedingly healthy, whereas in more modern times exactly the opposite is noted. As the evidence extant and available extends only to Asia, and in particular Syria, Palestine and Asia Minor, to Egypt, Greece and Italy, there can for the present be no question except as to the climate of these countries.
Next as to the influence of sexual activity in general, Hippocrates145 himself tells us, after discussing the climate of Asia:118 “But ἡδονή (pleasure) must necessarily predominate (among them), and this is why among animals so many varieties are found; and I suppose this to be equally true in the case of the Egyptians and Lydians also.” Of course ἡδονή in this passage signifies concupiscence in particular;—no special proof is needed of this. As a matter of fact we observe at the present day how in hot climates, where the whole vegetative life presents a luxuriant character, and all Nature appears to feel the procreative impulse unceasingly, man too falls in with the universal stress and strain of each species to maintain its foothold. Yet as this must inevitably be done at the expense of the individual life, we see the effort very frequently resulting in the production of barren or sexless blossoms, and not fruit at all. The son of the South is like a tree growing in rich, rank soil; he ripens betimes to the sexual life, but equally early is constrained to abandon it again. The youthful imagination springs up in its fresh quick activity, while the body withers concurrently, and stung by lust,—lust that is yet further exaggerated by the misuse of aphrodisiacs, at last has nothing left but to drag out an invalid existence, finding a morbid gratification in the artificial ways and means whereby imagination, sickened and debauched by its own extravagances, seeks to supply from extraneous sources the failing titillation of desire the organ craves. No better confirmation of all this can be found than what is supplied already in our investigations as so far conducted.
We saw how in Asia lust and its abominable brood arose and extended thence over neighbouring lands, and how the rhythmic rites of the Venus ebria (drunken Venus) could indeed refine, but hardly increase their excesses. Babylon, Syria and Egypt were the nurseries of licentiousness, finding only at Rome a really self-taught and competent rival. The clear sky of Greece could cover only inhabitants of corresponding character in body and mind, and none but a Greek was capable of setting up the ideal, and verifying it in practice, of a fair soul in119 a fair body. Deep as the Greek may have sunk in degradation after the fall of national liberty and under foreign influence, and though unbridled lust may have often mastered individuals, it never dominated the nation as a whole, it was artificially brought into existence and was never dependent on climate. Even at Rome, colossal as was the scale on which vice manifested itself, it ever remained but a foreign importation, for which foreign wantons had first paved the way at a period when the climate of Asia exerted a more immediate influence there than that of Greece.
Like licentiousness in general, Polygamy also, in part owing its existence to it as it does, was a consequence of the Asiatic climate; but how far it may be fairly held to have influenced the rise of Venereal disease, we do not as yet venture to decide; we feel constrained to keep this point over for later investigations. The same applies to Polyandry,—in its strict sense, when we regard it as a form of marriage; though of course over and above this it comes into connection with vice, inasmuch as every prostitute lives in a state of Polyandry, as does every amateur of the sex in one of Polygamy. Under these circumstances affections of the genitals cannot but arise among persons otherwise healthy, as every Physician of large practice can verify by examples, and as experiments on animals have sufficiently demonstrated to be the case146. Nevertheless these hints, for we cannot and ought not to look upon them as anything more than hints, as any more complete discussion would carry us too far a-field for our present purpose,—may very well suffice to120 recall to the reader’s memory the influence exerted by climate on the genital functions, especially as adequate proofs in confirmation of all this are comprised in our preceding Sections.
Far more important in view of our immediate object is the influence exerted by Climate on the individual activity of the genital organs, and here again we have in the first place to fix our eyes on Asia and Egypt. The burning rays of the sun to which these regions and their inhabitants are exposed, increase in a marked way the activity of the skin, and of course in the same proportion do the secretions from the mucous surfaces become less in quantity, but their product more highly charged in quality. Then, this being the case, a certain acridity or corroding quality of the secretion is readily set up, often making itself noticeable by a characteristic smell. This same influence must equally manifest itself in the mucous membrane of the inner parts of the genitals, and vaginal mucus accordingly acquire an acrid quality147, if it is not removed pretty frequently from the surface of the membrane, and becoming as it were rancid, exert a corrosive effect on everything it comes in contact with148.
Now shortly before as well as shortly after the commencement of menstruation the secretion of mucus in the genitals is increased, and thus the menstrual blood, having in any case a tendency to decomposition, will mingle with this acrid, strong-smelling mucous discharge, and in this way assume a foul, acrid character itself149. This is the origin122 of the ill repute into which menstrual blood, and this especially in hot climates, has fallen from the earliest times onwards, for no doubt the virulent qualities alleged against it really belong to it solely and entirely as a result of the admixture with it of this vaginal mucus. Sea-water and fresh river-water are each of them separately innocuous for health, but mix them together so as to make brackish water, and the exhalations given off become highly detrimental!
A similar state of things exists also in connection with the male genital organs. The surface of the glans penis, where it lies contiguous to the external skin, exhibits along with the latter an increased secretion from the sebaceous follicles150, the discharge from which, if it is allowed to remain any length123 of time between the prepuce and the glans151, likewise acquires an acrid quality; then re-acting on these parts, sets up an inflammatory condition of the aforesaid sebaceous follicles. “In fact”, says Niebuhr152 “the Medical Officer of the English at Haleb (Russel) ascertained that in hot countries more copious humours collect about the glans penis than in cold; and a friend of mine in India, who in that hot climate had employed only the ordinary European precautions to ensure cleanliness, got a sort of ulcers on the glans, an inconvenience he would have been much more likely to escape, had he been circumcised. Subsequently he always washed this part of his person very carefully, and from that time forth experienced no trace of a recurrence of the trouble. Washing the whole body and particularly the privates is an absolute necessity in hot countries; and it is perhaps for this reason that the religious founders of the Jews, the Mohammedans, the Fire-Worshippers, the Heathen in India, etc., have commanded the observation of this practice.”
In close accord with this is the story Flavius Josephus153 relates of Apion the Egyptian:124 “Wherefore it appears to me Apion deservedly paid a fitting penalty for his scorn of ancestral customs; for only when forced by necessity was he circumcised, ulceration having been set up about his privates (his glans penis); and as a matter of fact the circumcision proved vain, for gangrene supervened, and he died in terrible pain.” Again the passage just quoted will also afford a clear understanding of the following from Philo154:
“Therefore were it more becoming, quitting childish and frivolous mockery altogether, intelligently and earnestly to investigate the causes in which this custom (Circumcision) originated, rather than to accuse whole nations of folly in a spirit of mere prejudice. It certainly does not seem probable to an intelligent enquirer, approaching the question in this mood, that so many thousands of folk in every age should have been circumcised without a sufficient cause, submitting to great pain merely to mutilate their own and their children’s bodies. On the other hand there are many inducements to adopt outright and follow up the custom of our forefathers; and in an especial degree the four following. First, the prevention of a virulent disease and one very difficult to cure. This is known as Anthrax,—a denomination derived, as I suppose, from the ardent (fierce)125 burning (ἀπὸ τοῦ καίειν ἐντυφόμενον) that accompanies it, and readily arises in such as have the foreskin intact. Secondly, to secure that purity of the whole person obligatory upon the Priestly caste. Whence it comes that the Priests in Egypt also scrupulously shave the whole body; for there is something collects and is deposited underneath the hair as well as under the foreskin, that must be removed.”
From a comparison of these two passages from Niebuhr and from Philo respectively it may be gathered that the anthrax disease above mentioned did not in any way owe its rise to a specifically syphilitic origin, as has been now and again assumed by different enquirers. What we really learn from them is to recognize the liability of the sebaceous follicles of the glans penis to lapse into a condition of ulceration. True this tendency can be minimised to some extent by circumcision, as well as by unremitting care to secure cleanliness; yet it can never be completely removed, conditioned as it really is by climatic influences that do not admit of elimination. When once the corroding vaginal mucus of the woman, particularly in combination with the menstrual blood with its readiness to undergo putrefaction155 re-acting on the mucous membrane,126 has set up sores and ulcers, then follows as a necessary consequence a still more dangerous mixture of matter and mucus. Next when under these conditions the man’s glans, possessing as it does an equally great liability in its cutaneous glands to be attacked by ulceration, enters in coition a vagina in this state, it cannot occasion much surprise if blennorhoea of the urethra or ulceration of the glans penis supervene156, especially if we consider the fact that127 the act of coition sets the organs concerned in enhanced activity, making them more susceptible than ever to external injurious irritations. This is yet more likely to be the case, as concurrently a large amount of secretion is yielded by the morbidly affected mucous surface of the vagina, and very possibly this secretion undergoes under the influence of nervous excitation (as the saliva does under the influence of anger) some vital-chemical, contagious alteration of composition. Again supposing the woman to be at the time of coition actually in menstruation, a period when her genital organs are ipso facto roused to a condition of exaggerated activity, the disturbance must be yet greater, and the mischief resulting even more manifest.
This will in part account for the fact that ulcers on the genitals, brought about by coition, are so ready in Asia to assume a putrid character, and show that the Ancients had good reason to designate them by the name ἄνθραξ (anthrax, malignant pustule). For that ἄνθραξ was actually a consequence of coition we may see from a passage, already cited by Hensler and Simon, from Bishop Palladius157, who128 relates of a certain Hero, how the Demon led him129 to Alexandria, how he there visited theatres and horse-races, and roamed round the taverns. “And130 thus, being by this time a glutton and a drunkard, he fell moreover into the mire of lust after women; and being now set upon sinning, he lived with a certain actress, (and had carnal intercourse with her?). Then when he had done all this, by a (Divine) providence he got an “anthrax” on the glans penis; and was so sick for six months that his (private) parts rotted away and dropped off of themselves. But subsequently recovering and getting off with the loss of these members, coming to a knowledge of God and a remembrance of the heavenly kingdom, and after confessing all that had befallen him, he fell asleep a few days afterwards, without having had the time to manifest works (of repentance).” In spite of the difficulties some of the expressions in the text exhibit, the main fact is perfectly plain, and admits of no doubt whatever, viz. that Hero had brought the ἄνθραξ on himself by carnal intercourse with an actress, and the moral reflections Palladius tags on to it cannot invalidate the fact. The objections Astruc raises against the conclusiveness of the passage have already been refuted by Hensler (Geschichte der Lustseuche,—History of Venereal Disease, I. pp. 317 sqq.), who while citing as parallel instances the passages adduced by Becket from the early XVth Century, very justly remarks: “What proof would they have, if this is not conclusive?”
Did the female genitals perhaps receive the names ἐσχάρα (scab) and ἄνθραξ (malignant pustule), because they very often made men a present of these things?!
In any case it is an interesting fact that to this day in India anthrax and chancrous ulcers are looked upon as akin, and both according to Sir William Jones (Asiatic Researches Vol. II.) are known by the name Nar Farsi or Ateshi Farsi (Ignis Persicus—Persian Fire) to the Cabirajas or Indian physicians. Now if we think of the great care taken131 by the Jews to ensure the multiplication of their race, the readiness with which various forms of ulceration pass over into mortification in hot localities,—as is shown by the examples of Apion and Hero,—and consequently the serious liability of the organs of generation to be destroyed, it will occasion less surprise when we read among the laws of Moses158 the following injunction: “And if a man shall lie with a woman having her sickness, and shall uncover her nakedness; he hath discovered her fountain, and she hath uncovered the fountain of her blood; and both of them shall be cut off from among their people.” Surely great and serious resulting injuries must in no inconsiderable number of instances have been before his eyes for a Lawgiver to feel himself constrained to assign the death penalty to the act of coition with women during menstruation,—and this in spite of the fact that he had already in a general way declared the woman at this time, as well as everything she touched, to be unclean. Again on the other hand coition with women in this condition must with the Jews have been amongst things practised with more than ordinary132 frequency, if only such an extreme punishment availed to check it; and so we cannot really be surprised to find that the Holy Books of that Nation perhaps earlier than the writings of any other People were acquainted only too well with diseases of the genital organs acquired by coition. The particular disease that broke out in consequence of the worship of Baal-Peor has been discussed above in §§ 8 and 9; while the fact that the Mosaic books contain the first traces of a knowledge of Gonorrhoea has long been regarded as proved beyond a doubt159.
If the Climate already exerted such an influence on the aboriginal inhabitants, how much greater must this have been where foreigners were concerned, on whom all endemic excitants of disease in a country notoriously work with augmented virulence. In Antiquity this fact must have been even more conspicuously true, inasmuch as at that period the Nations still remained much more unmixed than they subsequently became. It is a thing which always hitherto, speaking generally, has been far too little taken account of by Pathologists, but which is surely of vast importance in connection with the rise and spread of Venereal disease,—without its being in any way implied that we must necessarily therefore adopt the theory of its American origin160. If134 we are not much mistaken, this factor was operative also in the case of the Plague of Baal-Peor. Now what holds good for the Jews, must equally hold good for the other peoples of Asia and of Egypt, and even in an enhanced degree, since these, as we have seen above, gave way to vicious indulgence to a yet more excessive degree.
Nevertheless, then as now distinctions no doubt existed, and probably in Antiquity as at the present day there were districts, whose physical conditions of climate might be regarded as actually forming a counteracting factor, and where in spite of excesses the genital organs seldom became diseased. The evidence for this must be given by later investigations, for we must of necessity first possess a geographical Nosology of Venereal disease at the present day, if we are ever to succeed in finding and utilizing the materials for the same in Antiquity. What has been so far collected by the meritorious Schnurrer in his Geographical Nosology is too incomplete to justify us at present in drawing any certain conclusions, more particularly as the greatest part of the material contributed by him is drawn from the communications of non-medical enquirers.
The climate of Greece neither exercised any 135pre-eminently stimulating effect on the sexual activity of the genitals, nor yet did it afford a ground for the enhancement of their individual activity. Thus enjoying as it did in consequence of that happy combination of its seasons justly celebrated by ancient Writers161 the advantages, without the disadvantages, of the Tropics, and its inhabitants possessing all functions in a more vigorous proportion, the climate could not possibly have been directly favourable to the rise of affections of the genitals; and for this reason made unnecessary all precautionary measures aimed at them, such as were required in Asia. Italy exhibits but little analogy with the Greek climate; still it cannot certainly without considerable qualification be reckoned among factors favourable to maladies of the genital organs. From this we may at any rate partly explain why the physicians of Greece and Rome give so little satisfactory information on the diseases in question, though indeed, as we shall see presently, in this case other and quite distinct factors were at work.
We have now seen that Climate is ipso facto an important factor favourable to the rise of affections of the genital organs. How much more powerful an influence must it exert on such affections when136 already in existence. Thus the question, what influence did Climate manifest in Antiquity on the character and course of affections of the genitals, is one of the utmost moment in connection with a History of Venereal disease,—the more so as on a correct answer being given to it depends the correctness of our views as to the form taken in such cases by the morbid process in Ancient times. True such a question presupposes the existence of these affections, and ought therefore, strictly speaking, only to be raised after the conclusion of our present investigations. However we think enough evidence has already been adduced in the preceding pages to remove all possible doubt from the mind of an attentive reader as to such being the case. Besides, this appears to us the more convenient course,—to survey in its entirety the influence exerted by Climate, rather than to take up our investigation of the subject afresh in different places, and thus to a greater or less extent mangle the discussion of it.
Preponderance of the vegetative principle combined with a certain slackness of tissue is the character of all organisms coming under the influence of the climate of Southern lands. In these countries an extra-ordinary stimulus acts on the mucous membrane of the genitals, and the character described will find its expression here also. Reaction will proceed not so much from the arterial side, or show itself under the guise of sthenic inflammation, but rather take the form merely of intensified secretion. What this increased secretion aims at is the removal of the abnormal stimulus, and the flow of mucus so originating manifests itself as simple, so to speak merely catarrhal, blennorrhoea. This, where the atmosphere is not impregnated with moist vapours, readily disappears, if only somewhat greater care is bestowed on the maintenance of cleanliness,—and all the more so, as re-absorption, which in hot climates acts vigorously on all the mucous membranes generally, very soon gets the upper hand again in the case of137 that of the genital organs, seconded as it is by the activity of the external skin. The latter is always in a condition of enhanced action at the same time, while the extent of its surface of course markedly exceeds that of the mucous membrane of the genitals. On the other hand where the atmosphere is especially moist, the activity of the skin, as well as the process of re-absorption internally, appears to be less; and so under these circumstances the mucous flow will assume more of a chronic character, but at the same time to an even greater degree be free from inflammatory reaction.
All the more recent observations agree in one thing, viz. that in Southern countries the gonorrhoeal forms predominate, and speaking generally, almost always run a mild course that hardly calls for medical interference. There is no doubt Climatic conditions in Antiquity differed but little from those of to-day; so that we may safely assume that equally in Ancient times blennorrhoea showed the same general characteristics, a fact which existing traditions moreover prove beyond question. The frequency of blennorrhoea of the genital organs in Antiquity is shown at once by the just quoted passage from the Mosaic Books, while its mildness of character may be gathered amongst other things from the remedies employed by the old Physicians, who almost without exception followed the principle laid down by Celsus (VI. 18.), to treat gonorrhoea levibus medicamentis (with gentle remedial measures), if they were called upon to apply treatment at all. At least this is true of acute blennorrhoea; the chronic form of the complaint, with which alone as a general rule they had to do, of course required astringents. No doubt each failure of arterial reaction afforded yet another reason for the belief on the part of the Ancients that gonorrhoea was a result of weakness of the seed-secreting vessels, and their idea that the discharge was merely badly prepared semen. Supposing, as must have happened, that marks of increased activity appeared, these138 proceeded not so much from the circulatory system at all as from the nerves, and Galen162 was correct in referring Priapism under these conditions to spasmodic convulsion.
So much for mucous discharge. It was the same also with the various forms of ulceration of the genitals. The conditions to be enumerated presently in the next Section were already present to counteract their rise in any considerable proportion. Further, if they did appear in the high lands of Asia and in Upper Egypt more frequently than did blennorhoea,—this much is shown plainly at any rate by present-day experience,—still they lasted but a short time, as the preponderant activity of vegetative growth, seconded by extraneous assistance, soon mastered the disease, and quickly restored again the loss of tissue. The course of events was otherwise indeed on lower levels, as in Syria and Lower Egypt, districts which besides their high temperature also showed a considerable degree of moisture in the atmosphere and soil. Here accordingly the different forms of ulceration, unless careful precautions were taken, assumed a malignant character, and readily passed over into gangrene (ἄνθραξ), as we saw a little above happened in the cases of Apion and Hero. By this means it is true every specific characteristic of the morbid alteration was annihilated; but this only made the risk to the individual so much the greater, the patient being at best only too apt to lose the organ attacked
Again, though sometimes the part escaped destruction by gangrene, even then its cure was often difficult owing to the fact that, where the malady had been neglected, worms made their appearance in the ulcers163, and set up so profuse and so far140 spreading a suppuration that the patient eventually succumbed to it. Of this we have an example in the Emperor Galerius Maximianus, mentioned by Eusebius164, and to which allusion is made as early141 as in the Book of Ecclesiasticus (XIX. 2, 3.), when the Author, Jesus the son of Sirach, says: “Wine and women will make men of understanding to fall away: and he that cleaveth to harlots will become impudent. Moths (otherwise165—Rottenness and worms) shall have him to heritage, and a bold man shall be taken away.” The use of knife and actual cautery must naturally have played an important part under these circumstances in the treatment adopted; but these the patient often dreaded more than the malady itself, and chose suicide rather than submit to them, like the “Municeps” whose story Pliny tells in the passage quoted in a previous chapter. But now supposing suchlike ulcers to be142 situated in the mouth of a fellator or cunnilingue, then their course must have been all the more rapid, and the danger involved all the greater, if the patient lived in such a climate as described; and it was in this way the Αἰγύπτια καὶ Συριακὰ and Βουβαστικὰ ἕλκεα (Egyptian and Syrian sores, Bubastic sores) mentioned above acquired their evil repute. Still in the majority of cases these climatic influences could be counteracted by appropriate medical aid and dietetic measures, or at any rate their effect considerably reduced. Hence it was that cases of the sort only very rarely appeared in Antiquity, and for this very reason were noted by the Historians, when they did occur.
The human organism possessed in Southern lands yet another way of combating the enemy’s attacks, one which would seem to have escaped the notice of the Physicians of Antiquity, and which, though recognized in modern times, has yet never been at all adequately appreciated and utilized in the history of Venereal disease, viz. the reaction exhibited by the skin in diseases of the genital organs in hot climates. So long as authorities thought of the external skin as merely compacted of separate and distinct layers of tissue, there could not really be any question of an accurate knowledge of its functions whether under healthy or under morbid conditions. The investigations of Breschet and Roussel de Vauzène166 as confirmed and reinforced by Gurlt167, have now143 taught us to understand that the skin, over and above these layers, possesses as a matter of fact,—a fact formerly only conjectured,—special organs belonging to the same class as the glands, to wit the skin, hair and sweat glands. These share amongst them the function hitherto ascribed to the skin generally, and especially bring into correlation the sympathies of the different parts, so much so that they may be said to be almost the sole and only seat of the manifold forms of skin-diseases. All this we endeavoured first to demonstrate in the series of Articles on Skin-diseases in “Blasius’ Handwörterbuch der Chirurgie und Augenheilkunde” (Manual of Surgery and Ophthalmology), and so pave the way for a compendious Survey of our knowledge of the Skin-diseases up to the present time.
Now while the sweat-glands stand in a special connection of sympathy and antagonism with the lungs, the same correlation exists in a peculiar degree between the glands of the mucous membrane of the intestinal canal and of the genital organs on the one hand and the cutaneous glands on the other which secrete the sebum or sebaceous humour. It would take us too far a-field, if we undertook in this place to enter upon a detailed explanation of this circumstance, which however is still in sore need of further clearing up. We shall content ourselves with recalling the fact that Onanists (Masturbators) not only often betray themselves by having a nose with a shiny, tallowy looking surface that comes from excessive secretion of sebum, but also not less frequently by their face being covered with acne pustulus. One more fact we must mention is that the outbreak of acne very often with girls heralds the approach of each period of menstruation, and accompanies it168. These are signs clearly pointing144 to the conclusion that stimulations of the genitals are reflected back on the glands of the skin, for acne is nothing else but an affection of these glands, as we have demonstrated in the Work just mentioned.
But indeed there are proofs of this antagonism still nearer to hand. How frequently have our physicians observed an eruption169 resembling roseola or urticaria in character, at the—very often sudden—appearance of which the gonorrhoeal symptoms have much decreased in severity or disappeared altogether! These skin affections have been ascribed to the balsam of Copaiva or the Cubebs pepper administered in these cases, which are supposed to have stimulated the intestinal mucous membrane and so sympathetically excited the skin. This may very possibly sometimes be the case; but it could not but occur much more frequently, if the remedial agents mentioned are to bear the sole and entire blame. No doubt in some patients a particular idiosyncrasy may have145 given rise to sympathetic action stimulative of the intestinal canal, but in the majority the reaction of the mucous membrane of the genitals on the cutaneous glands has undoubtedly been a chief contributory factor under epidemic influences, while the drugs exhibited have played only a subordinate part in producing the result. There are cases where the gonorrhœa has been treated simply and solely by mere antiphlogistic methods, and yet such an eruption has been observed.
But it is not in gonorrhœa only that these phænomena appear; they have been noted as well in chancre, being then ascribed to the sublimate of mercury and looked upon as affording a criterion that the drug had exercised its full effect on the original complaint. In most cases this was without doubt a mistake, for Biett, Rayer and other authorities have noted the most widely divergent forms of skin-disease to appear concurrently with the existence of chancre, and in consequence have come to regard them as primitive symptoms. In fact cases have actually been observed, where these were the sole primary symptoms of contagion after indulgence in unclean coition. At the same time it is only fair to say that this has been doubted in many quarters, observers trying to explain the fact of the absence of other symptoms by saying the ulcers, which are frequently very minute, may have been overlooked. At least experience has sufficiently taught us this much, that the so-called secondary symptoms, and therefore the skin-affections as well, appear the more readily in proportion as the ulcers of the genitals are smaller and more superficial; and we ourselves believe that never without local reaction on the genital organs from coition do so-called secondary appearances arise,—only it is not invariably ulcers that are to looked for.
Now when even in our temperate climate the cutaneous glands play a not unimportant part in the morbid processes of Venereal disease, how much146 more must this be the case in Asia and Egypt, where the activity of the skin generally and that of the cutaneous glands in particular is even under normal conditions far more conspicuously energetic, as may be seen from the constant oily state of the skin, more particularly in Negroes. This oily grease on the skin is in fact nothing more nor less than the product of the action of the cutaneous glands. These glands are peculiarly apt to become morbidly affected in travellers visiting the South during their acclimatisation; though natives too are yearly attacked in the Summer months by complaints of the skin-glands.170 The fact has long been recognized171 that147 in Southern countries not only the greater number of skin-diseases, but even Venereal disease itself in an especial degree, appear as an exanthema of the skin, and for this reason it there displays far less destructive effects; but as a rule enquirers have contented themselves with the general habit, without (as pointed out before) adequately turning the fact to advantage in connection with the History and Theory of Venereal disease.
This preponderating bias towards the external skin148 must obviously manifest itself equally in other diseases of the mucous membranes, and so too in those of the genital organs. Reabsorption in particular, acting with increased vigour on the mucous surfaces, will prove its beneficial presence also in the diseases affecting them. The foreign matter that comes in contact with these surfaces is assimilated to a less degree by the mucous glands and by those of the glans penis, and no time is allowed it to exert a destructive influence on the small surface receiving it; on the other hand it is quickly thrown back on the much more extensive surface of the external skin, and there dealt with by the cutaneous glands with their powerful secretive and assimilatory action, being either assimilated or expelled externally.
In particular localities this quickly happens without any striking symptoms being locally perceptible in the skin, as e.g. in Numidia, Libya172 and the Northern part of Peru173, where the disease is said to cure itself without extraneous medical aid, and among the inhabitants generally to be practically149 non-existent(?). Though this is not the case in other countries, still the cutaneous glands become involved in the morbid process of the disease, and secrete with augmented copiousness, and the secretion being simultaneously altered in character, it fails to be driven out externally, inasmuch as external elimination is at once stopped owing to the fact that the cutaneous glands, like the uterus in pregnancy, close their orifice, so as to be enabled to carry out their function in their recesses. For this reason the glands swell, and manifest themselves in the form of papillae or tubercles (very often as little bladders, or blebs), changing later either into pustules, if the morbid products are eventually expelled174, or else gradually150 disappear, if the process of assimilation and re-absorption has been sufficiently vigorous. Supposing damp, cold or other unfavourable influences to be at work, suppuration may very well supervene, or degenerative processes commence, and so on, and the disease pass over into leprosy and elephantiasis. This is above all the case in Egypt, where from the first, chancres on the genitals would seem to possess a marked tendency towards scurfy and scabby formations175.
If these are the facts at the present day,—and no one doubts they are,—there only remains the question: were they so in Ancient times as well? Here we come face to face with the difficult problem as to the relation of leprosy with Venereal disease,—a problem which for Centuries has been the subject of dispute, and in spite of the very careful enquiries of a Hensler and of other investigators, cannot by any means be regarded as solved. Our own investigations on the Leprosy of the Ancients are as yet too incomplete, and the nature of the subject demands such far-reaching inquisition into the most widely different individual phænomena, that we are compelled, in order to economise our space, to renounce all idea of submitting the subject to any more detailed examination in the present Work. Besides, in our Second Part we shall be coming back to it again, when we have under investigation the question as to whether or no the Venereal disease of the XVth Century was developed from leprosy.
For our present purpose the following statement must suffice: The Climate of Asia and Egypt was in Antiquity, as mentioned already, undoubtedly but little different from what it is to-day, and the influence it exerted therefore must have shared in this resemblance176.
As to mentagra, we have already proved a little above that it was a consequence of the vice of the cunnilingue, and as according to Pliny’s report the latter claimed Egypt for its fatherland, obviously the climate of that country must have been in part responsible for its origination. Now affections of the genital organs being found in Antiquity as the result of sexual intercourse, it follows that in this direction also Climate must have exerted its influence, and that in the very same way as we have just above seen it do,—in other words manifold affections of the skin must have originated in consequence of irritation and other morbid effects on the genital organs. True the Ancient physicians say not a word of this; but then they derive the greater proportion of the skin-diseases, which they mass all together in the most admired confusion, from internal mischief of various sorts, and regard them all as apostases (suppurative inflammations carrying off the effect of fevers, etc.),—at any rate a proof they were not entirely unacquainted with the antagonistic relations existing between the skin and other organs.
So far as the genitals are concerned, they seem to have adequately realized only the consensus between the uterus and the skin177, whereas in male subjects they appear to have put down most of the effects observed to the liver. But on these points we shall have something further to say later on. Still the assertion to the effect that Eunuchs are not attacked by calvities (baldness) (Hippocrates, I. 400; Galen, XVIII. A. 40., also p. 42., where mention is made of the excesses in Baccho et Venere—in Wine and Love—peculiarly prevalent at his epoch), which was a frequent consequence of vice in Antiquity178, points to the consensus between genitals and skin having been already noted. Even more is the fact, vouched for by Archigenes179, that153 castration was recommended by some Physicians as a cure for elephantiasis, such as to arouse the suspicion that the physicians of Antiquity knew perfectly well what influence affections of the genital organs exerted on diseases of the skin. This is made all the more likely by Archigenes (ch. 120.) not only speaking of the disease as being contagious, but also describing the skin-affection as secondary in character. He further declares its cause to be unknown, puts on record the extreme lubricity of the patients (Satyriasis pp. 74, 133, 269.), and even says in so many words that such as were castrated did not contract elephantiasis!
We have seen how mentagra attacked the154 cunnilingue, and afterwards passed over into psora; in just the same way might elephantiasis,—a complaint indeed which the Gloss of the Pseudo-Galen actually puts in connection with the Morbus Phoeniceus (Phoenician Disease),—be brought on by indulgence in coition. This is in no way contradicted by the preference the disease exhibits for first making its appearance in the face, inasmuch as the cutaneous glands of the face are in a relation of special sympathy with the genital organs. That leprosy too no less than elephantiasis was communicated and contracted by coition is shown by a host of examples given in the Mediæval Historians180; in fact, a large number of Physicians held Venereal disease to be a species of leprosy or elephantiasis, while some made it actually originate in the act of coition with leprous persons; yet for all that we do not, according to Hensler, (“Vom Aussatz”,—On Leprosy, p. 396.), find it anywhere recorded that the genital organs were first affected,—apart that is from what Astruc has brought forward on purpose to support his own view. As everybody knows, he refers all local evils existing prior to the end of the XVth Century to Leprosy.
But what would follow supposing traces were actually to be found proving that what was known in Asia as leprosy did as a matter of fact first show itself in the genitals? Before we enter upon the closer examination of reasons for this supposition, we must quote a passage from the Work of Von Roeser already several times mentioned, a passage equally important for the pathology of Venereal disease as for its History. Von Roeser, (p. 68.) writes thus: “Primary syphilis manifests itself in Egypt in the very rarest cases on the prepuce or glans of the verge; the chancres are more commonly found on the outer skin of the penis nearer the mons Veneris,155 or actually on this in the hairy parts which among Egyptians and Arabs are generally kept shaved, or else on the scrotum. Pruner181 told me that the occurrence of a chancre on the prepuce, which indeed is absent in Mohammedans owing to circumcision, or on the glans penis is in the ratio of 1: 3 to chancres on the last mentioned parts, hence in that country Astruc’s opinion that syphilitic ulcers hardly ever formed on the exterior of the verge, is strongly contradicted,—as is no less true amongst ourselves. That circumcision is not the sole cause of this phænomenon is manifest from the fact that in Smyrna and Constantinople I saw plenty of chancres on the glans, as well as amongst Jews at home, though I am not going to deny that circumcision may have some share in causing the rarity of the appearance of a chancre on the glans,—but this does not in any way explain the frequency of their appearance on the scrotum and the mons Veneris. A tendency to take the exanthematic type, a tendency which makes itself known also by the fact of many chancres commonly appearing at once and showing in a marked degree a preference for scurfy and scabby forms, might very possibly afford a better explanation of the phænomenon in question.”
Now as to the supposition just expressed, this is based on a repeated examination of a passage of the very utmost importance in the history of leprosy, viz. Ch. XIII. of Leviticus—a chapter which has exercised Theologians no less than Physicians for Centuries, but without our being enabled to regard the investigations it has given rise to as in any way concluded. However it is no intention of ours to provide in this place a commentary on this Chapter, more particularly as we do not possess the philological acquirements necessary for a critical appreciation of the results so far obtained. Neither, speaking in general terms, has anything like156 sufficient progress in the study of original sources for the history of leprosy as yet been made to enable an adequate judgement to be formed; we much prefer to limit our efforts at present to contributing sundry observations, which stand in close connection with our immediate object, and at the same time may afford readers, whether scientific or philological authorities, an opportunity of favouring us with their judgement as specialists.
The correct understanding of the whole passage appears to us to depend in the first place on the success of the endeavour to find a certain and definite explanation of the expression בְּעוֹר בְּשָׂרוֹ (b’ôr b’sarô,—“skin of the flesh” in English Authorized Version). Luther rendered this by: on the skin of his flesh; the Septuagint translators give it as ἐν δέρματι χρωτὸς αὐτοῦ (in the skin of the surface); while de Wette (whose Translation of the passage generally we hereby ask the reader to consult, space not allowing us to quote the whole Chapter) translates it on the skin of his body, and understands by the expression every part of the external skin.
Supposing this translation the correct one, it will be a hard matter to explain how it was the hair should simultaneously have turned white, a circumstance which strangely enough caused even Hensler no surprise. Rosenmüller in his Scholia on the passage says: Schilling (De lepra p. 7.) observat, in lepra alba pilos albescere, (Schilling, On Leprosy p. 7. notes that in white leprosy the hair grows white); but it is only the partes pilosae aut capillatae (hairy parts, parts covered with long hair) that are here intended, and these are to be understood as including merely the head, eye-brows, chin, armpits and pubic region. Obviously the hair on other parts of the body cannot be taken here into consideration, as it is specifically almost colourless, and though it is true it may have had a stronger coloration in many Jews, surely they did not all belong to the race of Esau. Again all writers on leprosy, when this mischief affecting157 the hair is in question, speak solely of the hair of the parts named182. So when Haly Abbas in a passage quoted by Hensler (Excerpta p. 9.), in which he is treating of Allopitia and Tyria (forms of leprosy), says, Nonnunquam totius accidit pilis corporis (Sometimes this happens to all the hair of the body), this also is to be understood merely of the parts above named. Indeed Hensler himself (Vom Aussatz,—On Leprosy, p. 304.) assumes this when, after speaking of the hair of the head and beard, he goes on: “But this mischief may also attack other hairy parts of the body. Haly Abbas says, (Excerpta p. 9.) At times this affects also the hair of the whole body. True the passage of Hippocrates, in view of the erroneous punctuation, seems to belong more properly to what follows, still even by itself it would be probable enough, as the preliminary symptoms are found particularly in the arm-pit and the groin, and might of course extend their ravages there, just as much as on the head.” However should anyone wish to understand here all the hairy parts of the body mentioned, and suppose the Author to be speaking in the first instance in a general sense, then158 what follows will not agree, for the hair of the head and beard was not changed into white, but into yellow ( צָהֹב ), as V. 30 states. There are left therefore only the eye-brows, arm-pits and the pubic region, to which the transformation to white can apply.
Granting these considerations to be correct, it is impossible to understand the b’ôr b’sarô as signifying the whole exterior surface of the skin; it must imply a local limitation. But the limited area intended can be nothing but the genitals, and this agrees best at once with the facts and with the usages of Biblical phraseology. In more than one passage, in fact, of the Old Testament basar, like σάρξ (flesh) in the New, has the meaning of “sexual parts”; and even in English the word flesh, particularly in ecclesiastical language, is consecrated by custom in this sense. So Luther was perfectly justified in the passage under discussion in translating as he did: on the skin of his flesh, that is to say, of his genitals. The particular combination of b’ôr b’sarô we have not it is true been able to find used generally in the books of the Old Testament, but we must not therefore conclude absolutely that it is unique and peculiar to this XIIIth. Chapter; though indeed, if such were the case, it would merely be an additional confirmation of the explanation we have given.
So far as the matter of fact goes, such an assumption offers no difficulties,—indeed it actually removes several, as e.g. that connected with the coloration of the skin, and not only proves that already at that date pustules on the genitals had been observed that were free from any suspicion of malignant character, but further that along with a suspicious pustule or similar symptom (scurf, ulcer) there went a simultaneous general affection of the skin as a whole, which was held to be diagnostic for the local malady, and accordingly proclaimed even the suspected leper free from taint after his recovery from it. For evidently we must take verses 12 and 13 as indicating159 this, where it is stated in so many words: “And if the leprosy break out ( פָּרַח, —blossom) abroad in the skin, and the leprosy cover all the skin of him that hath the plague from his head even to his feet, as far as appeareth to the priest; then the priest shall look: and behold, if the leprosy have covered all his flesh, he shall pronounce him clean that hath the plague; it is all turned white: he is clean.” (English Revised Version). The last words have been wrongly referred by some Interpreters to the “Bohak” (bright spot), which is mentioned in verse 39., but really nothing more than this is intended:—after the eruption is dried up, and the skin has returned to its natural white colour, then the hitherto sick man is to be declared clean183.
This diagnostic eruption again points to another fact, viz. that the leprosy must have had its seat in a part of the body, the cutaneous glands of which stand in a relation of lively sympathy with those of the skin generally, and this according to modern experience can only be the cutaneous glands of the genital organs. Sometimes inoculation with cow-pox lymph brings out a general eruption of the whole skin, but this circumstance cannot well be made pertinent here, as really and truly the lymph is a resultant product of a feverish affection, and therefore its innate tendency is towards a reproduction of160 itself under circumstances of feverish stimulation, and to set the whole organism, and consequently the whole cutaneous glandular system, in a state of enhanced activity. How the diagnostic eruption comes about may be gathered from the statement of the case given just above; while the passage quoted from von Roeser’s Work will explain the rest. Still for the present this much may suffice to put the expert reader in a position to test our conjecture,—for indeed so far it makes no profession to be more than a conjecture. Supposing it found tenable, then the further consequences that cannot but grow from it for the elucidation of the Chapter in discussion may be readily developed. On the other hand, if it is devoid of justification, it would be quite useless further to elaborate a hypothesis, plunging a subject obscure enough without this in even deeper darkness. Further than this we only need to mention that Hensler and others hold mentagra to be indicated in the bald chin and scurfy (scall) chin of Leviticus (XIII. 29 sqq.), which if they are right would merely be another point in favour of our view.
Finally there can hardly be any need for us to observe that we have no idea of holding leprosy in general to be a consequence of excesses; on the contrary we believe, to return to the problem we started with at the beginning of this Section, that we are bound to agree to the opinion first explicitly laid down by Becket184, viz. that under the widely comprehensive notion of Leprosy were included other forms of skin-diseases owing their existence to some previous affection of the genital organs,—in precisely the same way as this happened in the Middle Ages, and as may be the case occasionally even at the present day.
What precise influence Climate exerted on the form taken and course run by affections of the genital organs in Greece and Italy, can be only approximately laid down, as the information supplied by Physicians, though ample in quantity, mostly leaves the point indefinite as to where the observations were made, whether in Asia Minor and Egypt (Alexandria), or in Greece and Italy. The last named country indeed was, as is well known, almost entirely devoid of independent native medical Writers.
The mild, genial sky of Greece and Italy impressed on all forms of disease, including diseases of the genitals, a mild character. There, on the confines of East and West, we find, it is true, the same natural tendencies prevailing as in Asia, but always on a less exaggerated scale. Von Roeser (loco citato p. 70.) says: “In conclusion we should note further that in Egypt gonorrhœa is a complaint of very rare occurrence, in Greece and Turkey a very common one. That the exanthematic character taken by syphilis is not(?) responsible for the fact of its not manifesting itself as gonorrhœa is confirmed by the circumstance that it occurs much more frequently in Greece than amongst ourselves, whereas syphilis in that country has (though not in an identical form) the exanthematic type to an even greater degree than in our own.” D. Hennen185 found Venereal disease rare in Cephalonia, but on the contrary gonorrhœa quite common.
No doubt the tendency to determine towards the skin is clearly noticeable in Greece as well, but not to such an extent as to outweigh the local affection. The latter accordingly takes a more independent162 form than is the case in Asia, and for this reason, though making its appearance more frequently, neither follows so rapid a course nor shows so destructive a character,—if only the organism is seconded to some extent in the efforts to combat the malady. This is shown by the statements Galen has left as to gonorrhœa and ulcers occurring in connection with bubonic swellings,—a matter we shall have occasion to speak of later. While in Asia the skin affection is manifested by the formation of pustules and scurf, in Greece and neighbouring countries of the South it rather takes the shape of papillae and small blisters or blebs, and only in obstinate cases breaks out in tubercles. Hence lepra, psora, lichen, and elephantiasis are the forms under which we must look for it in the medical Writers of Antiquity, who however say nothing as to the origin of these diseases, or else, as we have seen before, refer them all to deficiency of the moist humours186.
We have never yet succeeded, though we have before now expended much time on the effort, in getting a clear grasp of the ideas the Ancient physicians intended to express by the different designations they gave to the various skin-diseases. So we are constrained to postpone deeper investigation of the question to a subsequent occasion, or wait to see whether meantime some other enquirer, better163 equipped for the work, may not throw light on the chaos. Only so far as Scabies (Scab) is concerned, it would seem allowable to assume allusions to be intended to vicious living as a cause of the malady. It cannot be without a reason that for centuries this one above all other skin diseases seems to have fallen under special disrepute; and the term to have been used by poets, by Martial187 for example, to indicate that sensual indulgence had been at work. In fact, several of the earliest Writers on Venereal disease hold it to be a sort of scabies, and even at a later period there is for long frequent mention made of Venereal scars or scabs. Possibly also in Greece lepra (leprosy) was looked upon as a form of skin-disease that was come by in no reputable way, and commonly regarded as an inheritance of the debauchees188, just as we saw to be the case with mentagra at Rome.
Affections of the external skin consequent upon complaints of the genital organs being thus no less common in Ancient times than they are to-day, it follows that in inverse proportion forms of ulceration of the palate and nose, as well as complaints affecting the bones, must have fallen into the background and have been of more rare occurrence, just as is observed to be the case in the present day189. So, to combine all the varying forms under one generalisation, we may say that this represents a type of disease of an exceedingly mild and favourable character, particularly if attention is directed only to the external symptoms, as indeed was habitually done by the old pathologists. For even the skin-affection itself presents so little that is characteristic, or at any rate shows itself165 under such varying shapes, that even at the present day its diagnosis is extremely difficult, being very often based solely and entirely on the admission of the patient, whether voluntary or forced from him, of having suffered from gonorrhœa or chancre. But if the so-called secondary symptoms are more or less completely absent, or lack distinctness, what is there then left beyond the primary affections of the genitals and their succedanea? Full and sufficient descriptions of these are not lacking; we have already quoted numerous examples, and we shall find others yet clearer and more precise later on.
Before quitting the subject of the influence exerted by Climate, we are bound to return once more to the question, in what relation did contagion, if contagion there was, stand to this climatic influence? The existence of contagion in the case of gonorrhœa is certified by the passage of Galen already quoted by Naumann, which we propose later on to give in full, besides being implied long before by the law of purification of the Mosaic Books. So far as ulcerous formations, condylomata and skin-affections such as mentagra etc., are concerned, proof is supplied by the facts we have previously given. According to more modern experience all forms of contagion exhibit in Southern countries a more fugitive type than elsewhere and spread with proportionately greater readiness. Whereas in such as are naturally fugitive, the intensity may for that very reason be less injurious, fixed and stable forms of contagion on the contrary must obviously lose in strength, at any rate so far as their local effects go. They will be the less able to make good a lodgement in the organism, from the fact that, stimulating the latter as they do to a general activity, they are the more readily resisted and prevented by this very state of enhanced activity. For just as, speaking generally, chronic complaints, uncomplicated by fever, can only be removed by artificially setting up a feverish condition, that is to say by calling on the organism166 as a whole to share in the local manifestations of disease. Precisely the same is true of local affections set up by any fixed and stable contagion, and so the removal of the actual contagion can only be successfully brought about either by direct decomposition and destruction of the affected tissue or by metamorphosis into a fugitive form.
Now inasmuch as the contagion was rapidly thrown off from the point of first infection upon the cutaneous glands,—and this happened the more readily, the more fugitive its character was,—the affections there set up by it standing in such clear relation as they did with the primary symptoms, were necessarily bound also to exhibit a greater or less degree of the contagious character, as indeed is observed according to Jos. Frank, Biett and other authorities even in Europe to the present day. In Greece, where the transformation was less often to pustular and scurfy forms, more frequently merely to papillae or at worst little bladder-like risings, or blebs (Phlyctaenae), while at the same time the energy of the skin was not so pronounced, the interval between the appearance of the primary and secondary symptoms was greater, and the contagiousness of the skin-affections undoubtedly less prominent, it cost the organism in that climate much more strenuous effort to set in action the elimination of the disease by the skin. Consequently the nervous system as well was injuriously affected by sympathy to a greater extent, while the exanthematic forms showed themselves in more obvious conjunction with itch (psora!). This was partially the case in Italy too, though here the climate approximated more nearly to that of Lower Egypt, leading to a more frequent appearance of pustulous forms, as shown by the prevalence in that country of mentagra.
But just as climatic influence relaxed the intensity of contagion, and diminished concurrently the malignancy of disease-types, local as well as general, so167 on the contrary, in those cases where other influences tended to counteract its effect, while the organism was not strong enough to overmaster the assaults of the enemy by general or local activity, it sought to guard against the contagion rising to a higher degree of independence; it set up mortification of the ulcers, by which means the contagion itself was directly destroyed. From all this it may be concluded, that although climate must evidently be acknowledged to be an important factor favourable to the rise of affections of the genital organs in Antiquity as much as at the present day, yet on the other hand it tended by its own action to combat the mischief it had originated; and so, at any rate so far as the development of the morbid process is concerned, is to be regarded to an almost equal degree as a counteracting influence at the same time.
The experience of all ages has conclusively proved that a large proportion of such morbid phæenomena as occur in consequence of local climatic conditions are capable equally of being produced sooner or later in countries and neighbourhoods the climate of which is entirely different by help of the genius epidemicus; and that the readiness with which they are so produced varies in direct ratio with the degree in which the climate is associated with and seconds the favourable factors. It is indeed extremely difficult, in view of the low level of development to which the science of Epidemics, in general no less than in particular, has as yet attained, to show this as applicable in any given case, more especially if it is a question of the epidemic condition of some disease of which the pathological relations themselves are far from being as yet adequately known. Still this must not prevent us from making at any rate168 an attempt at investigation of the question, how much or how little effort has been manifested by such influence in the course of years.
But the influence of the genius epidemicus on diseases in general is a twofold one. Either it supplies the capital, most essential external circumstances conditioning the production of a disease, in fact is related to it as cause to effect. In virtue of it the disease is an epidemic disease, coming into existence for the first time concurrently with the development of the genius epidemicus, disappearing again with the cessation of its prevalence, and once again springing up if and when the genius epidemicus makes a second re-appearance. Or else the most essential external conditioning circumstances are specifically independent of the genius epidemicus; while the latter takes merely a remote share in the way of favouring or counteracting the production of the disease, manifesting its influence rather in modifying the form and direction of such morbid reactions as have arisen in the organism without its intervention at all,—in other words the disease is subject to epidemic influence.
Unfortunately hitherto these two kinds of influence exerted by the genius epidemicus have been only too often confounded, and no adequate distinction drawn between epidemic diseases on the one hand and diseases subject to epidemic influence on the other. This has been especially so with regard to Venereal disease, the epidemic character of which curiously enough enquirers have felt bound to vindicate, as well at the beginning of the XVth. Century as here and there even at the present day. The baselessness of such an opinion is so perfectly obvious to anyone who weighs the matter with any care, that we really do not think it necessary to devote more pains now to proving the point, particularly as we propose to treat it more fully in another place. On the other hand Venereal disease is subject to epidemic influence, in fact it is so169 perhaps to a greater extent than many other forms of sickness, as will be clearly shown in the course of our historical investigations. Accordingly the only question still wanting an answer is, how far such influence may have been effectual in Antiquity. This question of course presupposes the existence already of a number of diseases appearing in consequence of Venereal excesses; still we possess sufficient proof, as previously stated in the course of our enquiries into the influence of climate, to justify a provisional assumption of their existence for our immediate purpose. For openly admitting as we do our ignorance in relation to the influence of the genius epidemicus on sexual activity generally and on the individual activity of the genital organs in particular, and noting the problem to be one that can only be solved in the future, there is nothing else left us to investigate here but this, viz. the influence of the genius epidemicus in reference to the forms taken and course followed by diseases occurring in consequence of Venereal excesses.
It may be collected from later experience and observation that there are three clearly marked forms of the genius epidemicus or epidemic condition, that exercise a preponderating influence on affections of the genitals and Venereal disease, and condition the frequency of the occurrence of one or the other type of these, viz. catarrhal, conditioning blennorrhœal affections, the exanthematic, conditioning complaints of the cutaneous glands, and the typhoïdal, conditioning various forms of chancre and their malignancy.
With regard to the influence of the genius epidemicus catarrhalis and exanthematicus, it would seem to be difficult to arrive at any definite conclusion as to what precisely this was in Asia and the South of Europe, since the Climate was ipso facto, as already shown, pre-eminently favourable to blennorrhœal and cutaneous affections; nevertheless the rise and spread of mentagra as well as of elephantiasis170 in the time of Pompey the Great does afford some indication at any rate so far as Italy is concerned. No doubt the Hippocratic writers several times mention the prevalence of skin affections at particular periods; but the expressions they employ are too general to make it possible for us to take these into special consideration in this place. However there is one passage we must make an exception of,—a passage of the greatest importance for our purpose, even though in all probability it refers to the commencement of a combined erysipelas-typhoïdal condition, to which we shall have occasion to return again later. In it Hippocrates relates how after a dry Summer with Southerly winds and frequent rain there followed a mild, wet Winter, next cold and even snow-storms succeeded in the Spring with much rain, and finally a very hot Summer again. In the Spring began inflammatory fevers and erysipelas, and190 “in many cases aphthae and ulcerations formed in the mouth, many rheums occurred in the genitals taking the form of ulcers and abscesses on the external and internal surface of the sexual parts; also eye troubles, with discharge, obstinate, persistent and painful; also growths, which are called σῦκα (figs) on the inner and outer surface of the eye-lids, causing many to lose their sight; besides they frequently occurred on other parts liable to ulceration and particularly on the genital organs.” In this passage the expressions ἑλκώματα, φύματα, ἔξωθεν ἔσωθεν τὰ περὶ βουβῶνας (ulcers and abscesses on the external and internal surface of the sexual parts) is as a rule misunderstood by the annotators. But171 really ἔξωθεν (on the outside) evidently refers to ἑλκώματα (ulcers), while ἔσωθεν (on the inside) goes with φύματα (abscesses), and signifies a swelling and inflammation of a mucous gland resulting in suppuration, as may be seen from the next quoted Aphorism191. “Such patients as have φύματα (abscesses) in the urethra find relief, so soon as these have suppurated and broken.” That this relief (λύσις) consisted in the cessation of pain and of the retention of urine may be gathered not only from Galen’s commentary on the first passage, and from the λύεται ὁ πόνος (the suffering is relieved) in the172 repetition of the same Aphorism, but Hippocrates actually says so distinctly in a third passage192.
Supposing the view, still generally held even in the last Century, that regards gonorrhœa as a result of an ulcer in the urethra, to have been already adopted in Hippocrates’time,—and inasmuch as the expression γονοῤῥοία, so far as we know, never occurs in his writings, the assumption would not only not be absurd, but such a view would really be preferable to that which makes out the discharge to be badly made semen,—we shall find in this passage an expression of the fact of the more common occurrence of gonorrhœa, the most troublesome symptom of which, viz. the pain suffered during micturition (πόνος, δυσουρία, ἰσχουρία, suffering, difficulty in micturition, retention of urine), disappears, as is well known, concurrently with the commencement of the discharge (πύου ῥαγέντος, φυμάτων ῥαγέντων,—when the pus has broken out, when the abscess has broken), or if it does not entirely disappear, is at any rate sensibly diminished. But it is not really needful to accept this as having been the ruling opinion; the facts may very well be accounted for by supposing that in virtue of the epidemic condition a strongly marked tendency was set up on the part of the glandular organs to inflammatory and suppurative action, by which not merely the glands of the external skin (ἑλκώματα ἔξωθεν),—ulcerations on the outside, Moses’שְׁחִין ,שְׂאֵת but also those of the mucous membrane of the urethra (φύματα ἔσωθεν,—abscesses on the inside) were affected,173 exactly as is observed at the present day, especially in the chronic forms of gonorrhœa.
The gonorrhœa then in this case would seem to have been of a more malignant type and to have been combined with ulceration. This best agrees with the general delineation of the epidemic condition as a whole, the exanthematic character of which declared itself in the fig-like growths or tumours,—the σῦκα αἰδοίοισιν (figs on the genitals). Grimm (Vol. I. p. 490.) already remarks on this passage of Hippocrates: “One might be tempted in this case to regard the ulcerations of the genital parts and their consequences, the fig-like tumours, as being the first signs of disease due to incontinence. Indeed what was there to hinder an evil of the sort in those times and under a warm climate from signalizing itself,—then subsequently so far losing its malignant character that its nature was completely misunderstood? Something of the same kind actually happens under our own eyes in connection with this very disease.”
Still more important were the effects of these meteorological conditions on ulcers of the genitals already in existence. We read (loco citato p. 482.): “Even before the beginning of Spring, concurrently with the commencement of the cold time, erysipelas made frequent appearances sometimes with, sometimes without, visible cause; it showed itself highly malignant in type, and carried off many. Many again suffered from painful affections of the pharynx (anginae,—sore throats), loss of voice (affections of the wind-pipe), inflammatory fevers with delirium, aphthae in the mouth, φύματα (abscesses) in the genital organs, ophthalmias, ἄνθρακες (malignant pustules), etc.—Also many got erysipelas from external causes, at such spots as these had happened to affect them,174 even after the smallest injuries193, and in all parts of the body. Above all sexagenarians suffered in this way in the head, if they were treated in the smallest degree carelessly. Even under careful and scientific treatment wide-spread phlegmonous affections frequently occurred, while the erysipelas spread to a serious extent and with great rapidity in all directions. In most of the patients so affected the metamorphosis that succeeded was to ulcerations, whilst muscles, sinews and bones fell away to a serious degree. But the morbid product that collected did not resemble ordinary matter (pus), but was a sort of putrid sanies, occurring equally in combination and by itself194. Such as were attacked in the head, became bald over the whole head and chin, the bones were laid bare and fell away, and such ῥεύματα (morbid discharges) as described occurred frequently, whether with or without fever. Symptoms of the kind however were more terrifying than really destructive195,175 for among patients in whom these (ῥεύματα) came to maturity and resulted in suppuration, the majority were saved; on the contrary many died among those in whom the phlegmonous affections and the erysipelas disappeared, without undergoing any such metamorphosis into other forms of disease. Moreover the same thing happened to those in whose case (the morbid product) attacked some other part of the body. For with many of them the whole upper and fore arm fell away; while in some patients the disease attacked the ribs, the sole difference being176 whether some destruction was wrought on their anterior or posterior aspect; in others again the whole thigh or the lower leg or the whole foot was laid bare. But the most dangerous of all was, when this or the like happened in the neighbourhood of the private parts or to the private parts themselves, and the mischief manifested itself in the form of ulcers, and as the result of external causes. In many patients suchlike symptoms occurred during, before, as well as after the fever”196.
Galen, who has left us a Commentary on this passage (Vol. XVII. A.) mentions in the first place that aphthae, φύματα (abscesses) of the genitals, etc. specifically possessed (p. 661.) nothing of κακοηθεία (malignity), but only when as in this case they occurred in conjunction with a putrid general condition. “The putrid character easily arises even without a pestilential general condition, if the parts are attacked by phlegmonous affections or erysipelas, and spreads likewise over the neighbouring parts lying uppermost; hence it is we are compelled after cutting away the decayed tissues to cauterize the place. It is no wonder then, when such a condition has arisen that upper and fore-arm, thigh and lower leg, ribs and head are attacked, if the private parts suffer above all others.—So far the author has discussed those affections of a kind akin to erysipelas which associate themselves with ulcerations or other comparatively177 insignificant external cause; in what follows he speaks of such attacks as occurred without any such occasioning cause”197.
Now if we examine these statements, so far as they are of immediate interest in view of our object, we may unhesitatingly conclude from them, that in Hippocrates’time a large number of patients suffered from ulcers of the genitals. These it seems under the influence of the prevailing typhoïdal conditions were assailed by inflammation of an erysipelas-like type, rapidly passing over into humid gangrene, which latter destroyed the parts attacked, readily extended its ravages, and eventually killed the patient. This is an observation which Galen likewise had frequent occasion to make (so probably under the head of Influence of the Climate of Asia, pp. 318, 326, 329.), without any exactly definite typhoïdal conditions having been prevalent198, and even saw himself under these circumstances very generally constrained, in order to put a stop to the spread of the mortification, to amputate the gangrenous tissue, and afterwards cauterize the wound. What was the origin of these ulcers of the genitals178 is indeed not stated; but it is certain they were not invariably conditioned by the prevailing genius epidemicus. Besides, since Hippocrates several times mentions them without giving the cause that produced them, it is a more likely conjecture to suppose that this cause was one universally familiar (it consisted in an act of unclean intercourse with women), than to assume it to have been absolutely unknown to physicians generally199.
Again the result of this investigation is of still more especial interest in so far as it enables us to179 properly appreciate Thucydides’notice of the so-called Plague of Athens.200 This has been discussed180 by very many writers, and has given occasion to the most widely different explanations. He relates as follows: “For the disease which at first had its stronghold in the head, beginning from above downwards traversed by degrees the whole body; and even supposing a patient to have escaped the worst, yet a seizure of the extremities put its mark upon him. For it attacked the genitals and the extremities of the hands and feet; and many escaped death, but with the loss of these parts.” Even more clearly does the poet Lucretius201 paint the disease, when he says:
Profluvium porro qui tetri sanguinis acre
Exierat; tamen in nervos huic morbus et artus
Ibat et in partes genitales corporis ipsas,
Et graviter partim metuentes limina leti
Vivebant ferro privati virili.
(Then too if any one had escaped the acrid discharge of noisome blood, the disease would yet pass into his sinews and joints and onward even into the sexual organs of the body; and some from excessive dread of the gates of death would live bereaved of these parts by the knife. Munro’s translation).
Though we really are concerned only with the last words of Thucydides, so far as they relate to the genitals, yet what precedes has given occasion to such extraordinary interpretations that we feel bound to devote some attention to this as well. The whole passage proved itself an especial stone of stumbling to those writers who endeavoured to identify the Athenian plague with scarlet-fever, as Malfatti did, or with small-pox, like Scuderi and Kraus. In fact this is why the last named says as he does202: “The loss of the private parts and the extremities (στερισκομενοι τουτων,—being deprived181 of these, with the loss of these) would certainly seem to point merely to the loss of the free use of these parts, in consequence of ulcerations, swellings of the joints, lesions and contractions, for the entire members are not likely to have been destroyed by mortification or amputated by the surgeon? Indeed it is only in deference to the verses of Lucretius that the latter opinion has become the one generally held; but even Ancient commentators203 have felt that the Roman poet may very possibly have mistaken Thucydides’meaning. Moreover I feel myself disposed to agree with them particularly on this ground, that the mortification of the whole of any of the greater limbs, though it has been observed in pestilential fevers, in Typhus contagiosus putridus (putrid infectious Typhus) amongst others, yet makes a comparatively rare symptom of the disease, and at the same time so dangerous a one that it can hardly be, as Thucydides alleges it was, that many (πολλοὶ) after such a serious affection escaped death, while on the contrary some (εἰσὶ δ’οἵ) only did so with the loss of the eyes.” Any one who will compare the just quoted passages of Hippocrates and Galen with the account of Thucydides, will want no further proof that as a matter of fact mortification of the extremities did supervene, an occurrence that even in later times204 is not of the182 extreme rarity that Kraus and others believe. Again the fact that many of those attacked escaped with their lives is the less surprising when one remembers that Thucydides is not speaking of entire arms and feet as having fallen off, but only of ἄκρας χεῖρας καὶ πόδας, that is to say, fingers and toes. However supposing any one to prefer not to supply ἄκρων with τούτων, but take it as used in its full extent, maintaining that hands and feet as well as genitals were entirely destroyed, even this would not belong to the category of extremely rare phenomena, for Hippocrates actually saw the extremities entirely fall off in similar circumstances, while if only the ῥεύματα (morbid discharges) came duly to maturity and maturation supervened, the major part (οἱ πλεῖστοι τούτων ἐσώζοντο,—the majority of these were saved) escaped with their life.
Finally the passage of Thucydides gives no sort of evidence to prove that the ἀκρωτηρίων ἀντίληψις (seizure of extremities) occurred solely in those attacked by the fever as metastasis and so on. For the first sentence quoted, to the effect that the disease traversed the whole body, evidently refers back to the preceding clause ἐπικατιόντος τοῦ νοσήματος ἐς τὴν κοιλίαν (when the disease descends into the abdomen), and for this reason is183 connected with it by the conjunction γὰρ—“for”. The succeeding words καὶ εἴ τις ἐκ τῶν μεγίστων περιγένοιτο (and even supposing a patient to have escaped the worst) may very well be taken in this way; μεγίστων (the greatest, worst things) is made not a Neuter absolute, like τὰ ἔσχατα (last extremities) and such like phrases in other places, but κακῶν (evils) is supplied to go with it, and the whole translated: “even supposing a patient escaped the greatest evils”, that is to say if he were not attacked by the λοῖμος (Plague) in the forms of head and abdominal affections, “yet it marked him”, that is it made its existence manifest by gangrene of the extremities supervening205. This Thucydides, a layman writing on a medical subject, supposes to be a mere manifestation of the λοῖμος (Plague), while Hippocrates regarded it as the proof of the erysipelas-putrid condition, which caused the already previously existing ulcers etc. to assume this character.
We have already mentioned the fact that at Athens ulcers of the feet were of frequent occurrence; and these must, no less than the ulcers of the genitals previously existing in any case, have necessarily been likewise assailed by the general unhealthy condition of things, and when this happened, have passed over into gangrene. Thucydides in fact says expressly at the beginning of his delineation of the disease (ch. 49.): τὸ μὲν γὰρ ἔτος, ὡς ὡμολογεῖτο, ἐκ πάντων μάλιστα δὴ ἐκεῖνο ἄνοσον ἐς τὰς ἄλλας ἀσθενείας ἐτύγχανεν ὄν. εἰ δέ τις καὶ προέκαμνέ τι, ἐς τοῦτο πάντα ἀπεκρίθη. (For indeed that year, as was universally admitted, chanced to be of all years one especially free from other diseases in general; and indeed if any 184one suffered previously from any complaint, all ended in this, the plague.)” We have seen how Hippocrates observed the prevalence of ulcers of the genitals at the period of the special meteorological conditions he drew attention to, and without doubt in the same way such existed at Athens as well, and were subsequently dominated by the prevailing erysipelas-typhoïdal conditions. This was manifested in one of two ways; either the ulcers became gangrenous, or the patient was attacked by typhus, precisely as is noted to be the case at the present day206. But under either eventuality the existing contagion was annihilated, in the one case by the general feverish reaction of the organism207. But in those cases where neither fever nor mortification supervened, the contagion undoubtedly assumed a more strongly effective character, was more readily infectious, set up more deeply penetrating ulcerations,185 and the tendency towards the skin being the predominating one, exanthematic eruptions with an inclination to ulcerative forms (ἐκθύματα μεγάλα, ἕρπητες πολλοῖσιν μεγάλοι,—great pustules, extensive creeping eruptions in many cases) were observed by Hippocrates to be set up in Summer, (loco citato p. 487.). All these are factors of the highest importance for the history of Venereal disease, as it is only by them that we shall be enabled to solve the great riddle of the origin of Venereal disease in the XVth. Century,—a riddle to which the answer would long ago have been found, if only enquirers had not been in the habit almost down to our own days of persistently looking upon Venereal disease as an isolated phænomenon.
True it is impossible from the passage of Thucydides to decide with any certainty whether the extremities, hands, feet and genitals, fell off of their own accord or were removed by the knife; but our own opinion is that both was the case, for of course there were Physicians at Athens, and until they had learned their powerlessness against the prevailing sickness, they no doubt employed the remedial means at their disposal, and these consisted according to Hippocrates solely and simply in the use of scalpel and cauterizing iron, all other measures having proved unavailing. That these were equally resorted to in ulcerations of the genitals we see from the passage of Galen quoted above, and the Poem of the Priapeia, p. 74, confirms the same in the most convincing way.
Enough has been alleged to prove how far the view expressed in many different forms, to the effect that, in the Athenian Plague as well as in the meteorological conditions and their results as laid down by Hippocrates, it is a question of Venereal disease, is justified by facts, and to show that even in Antiquity materials are to be found to demonstrate conclusively that the genius epidemicus exercised a not unimportant influence on the rise, form and course186 of the ulcerations of the genital organs. In what way this influence acted on the complaints consequent on paederastia and the vices of the cunnilingue and the fellator and affecting the posterior and mouth, we cannot at any rate at the moment demonstrate historically, but it seems only probable that previously existing ulcerations in the mouth and throat must under an erysipelas-typhoïdal general condition have proved themselves in the highest degree dangerous to the sufferers.
Influences which served to hinder to a greater or less degree the inception of Diseases consequent upon the Use or Misuse of the Genital Organs.
It has been fully proved in the course of our previous investigations that Asia and Egypt must be regarded as the two focus-points of exaggerated sensual licence, the conditions of climate being most favourable in those regions for the generation of affections consequent upon sexual excesses. So it may be fairly concluded without further proof that in the same parts of the world attention was early devoted to the problem how to render such influences,—no mere passing ones, be it observed, but continuously operative,—as little harmful as possible. Now in what way could this end be more adequately attained than by cleanliness carried out to the highest possible degree? As a matter of history, the merest superficial acquaintance with the customs and usages of Antiquity clearly shows that equally in Asia and in Egypt concern for bodily cleanliness had occupied the particular attention of both political and sacerdotal Legislators from the most remote period. More than this, it had come to be looked upon by the people as so entirely necessary, as to be all but inextricably blended with their very life and188 being. Any idea of vexatious compulsion entirely disappeared, and the laws and ordinances directed to this object are in force to this day as fully as they were thousands of years ago.
Inhabitants of the temperate zone who visited these lands were bound to think,—unless they gave more careful consideration to the subject than most were likely to do,—such almost universal and such scrupulous care for cleanliness exaggerated; and so we find, e.g. the Greek writers, who cite many of the usages of this description, invariably referring to them merely as a sort of curiosity. In later times, e.g. in St. Athanasius,208 they are even condemned as being prompted by the Devil, in order to diminish the amount of time to be devoted to pious exercises. It may well be that in course of time a too scrupulously precise dependence on ancestral custom had brought many of these usages into ridicule, especially when they were practised in countries where in some cases the reasons for their observance altogether cease to be operative. Yet anyone who considers with due care the conditions under which they were originally introduced, will find himself constrained to admit that the Lawgiver was only obeying a behest of necessity.
If the different customs and usages of the Ancients in connection with their careful attention to cleanliness are examined more minutely, they are found to be divisible into two classes, according as (1.) their object was to prevent uncleanliness, or (2.) to banish it, when once admitted. All measures connected with sanitary police supervision, the enforcement of which in modern civilized States leads to such endless difficulties, were almost entirely in the hands of the Priests, to whom the People were accustomed to accord an unquestioning obedience. It was an easy matter therefore to prevent any189 injurious contamination from extending over a wide area; it sufficed simply to declare unclean whatever might prove injurious to health to ensure its being avoided in practice,—and in the majority of instances with the most scrupulous care. This is a factor in the problem that appears never to have been properly appreciated by our Historical Pathologists; otherwise they must long ago have abandoned many prejudices regarding the knowledge possessed by the Ancients as to contagious matter. For how could practical observations be collected on infection and the liability to infection, when every possible chance of infection was carefully and generally avoided? Most of the Peoples of Antiquity considered contact with a dead body a pollution, more than this, they thought even the neighbourhood of a corpse to have the same effect. They hung up notices to warn the passers-by, and placed vessels of water (ἀδάνιον, ὄστρακον, γάστρα—water-stoup, earthen vessel, water-pot) before the house where a dead man lay, that those who came in and out might be able to purify themselves again on the spot209. Of course all did not go so far as the Persians, who declared every sick person unclean. Still it is a fact, and this most certainly not merely among the Jews, that all the various infectious skin-diseases that were massed together under the name of Leprosy210, and190 also Gonorrhœa (Clap), made the sufferer, and also everything he touched, unclean, and caused them to be set apart where no one should come in contact with them; and this continued so long as the sickness lasted.
Now does it really need any further proof that these diseases developed a perfectly well-known form of contagious matter: or is an arbitrary and imaginary theory to be adopted by preference, to the effect that injunctions of the sort owed their existence merely to the caprice of the Legislator, and were not based on any actual experience of real detriment resulting from their neglect in favour of others? At any rate it is certain that, where these laws were in force and where each individual followed them out exactly, a disease that is communicable only by close contact could not possibly be disseminated over any wide area. This could not take place under such circumstances, even though it had been engendered in its original form and continued prevalent for a long period of time.
However it was not only the sick that were avoided, but all possible causes as well that might lead to the disease. It was not only the effort required and the pain, but most likely the possibility also of injury resulting, that made the weakly Asiatic forgo the Jus primae noctis (Right of the first night), and declare unclean the supposed211 injurious191 effects of the vaginal blood that flowed on the rupture of the hymen, as well as the act of defloration itself. Pollution was guarded against in this case, as it was by the regulation banishing women during the time of menstruation from the neighbourhood of men, a regulation that had the binding force of law amongst almost all the Nations of Antiquity. The same held good for the time of purification of women who had been lying-in,212 a condition which was supposed in some unexplained way to be able to exert a possibly injurious influence on the genital organs of the husband.
In spite of all this it might yet happen that contact with a sick person could not be avoided, and all possible causes of the diseases in question escaped. Attention therefore was naturally directed to the effort to make the admission of the contagion and of matters having deleterious effects as difficult as might be. There were two means for attaining this end held to be especially effective,—depilation and circumcision.
The hair as is well known is particularly apt to attract and retain all kinds of moisture; and it will of course do this in the case of the genital secretions, whether healthy or morbid, if they come in contact with it. These secretions will the more readily exert an injurious effect, as each hair is accompanied by at least two cutaneous glands, possessing an excretory duct or pore, and in those192 parts of the body where a thicker and stronger growth of hair is found, develop a considerably increased degree of activity,—an increased activity which they exhibit in any case in hot countries. “Hence too the Priests in Egypt shave the body carefully; for there is something collects under the hair, that must be removed,” Philo says in a passage cited above, and a fragment of Theopompus preserved by Athenaeus213 also tells us, that193 this habit existed also among the Greeks, as well as among different peoples of Italy.
In later times however the habit gradually disappeared in these countries; and is only found again at the period of greatest luxury, when the Pathics endeavoured by the removal of hair from all parts of the body, except the head, to assimilate their outward appearance to the feminine type214. Especially were they bound to rid the posteriors215 of hair, as one penetrating into the anus during unnatural connexion might easily cause small cuts at the orifice, and produce chafings of the penis. For the same reason paederasts, as indeed was the case with all amateurs of Love, invariably took care to remove all hair from the genitals216, to avoid endangering194 the posterior and the private parts of their mistresses. Even more than men, did women seek to remove the hair from their private parts, as they do to this day in the East. This appears never to have been the case among the Jews; but in Asia and in Egypt the custom was observed by all classes of the people, and probably from those lands first spread into Greece and Italy. It seems to have been adopted very generally by Greek women;217 but it was especially hetaerae and “filles de joie”218 who practised local as well as general depilation. A similar state195 of things must have existed at Rome219, where older women resorted to the removal of hair from the genitals as a means of concealing their age220. In196 any case whether in Greece or in Italy the purpose and special object of depilation seems to have been soon lost sight of, and the practice to have been still to some extent kept up merely as a matter of fashion. Nevertheless it is a fact that the habit has continued even down to modern times in these197 countries, and is actually followed there to some extent on the ground of cleanliness221.
Depilation is completed by the polishing of the skin with pumice, etc., a treatment that made it very much less liable to take up dirt of all kinds. This and the anointing of the body, that commonly followed it, as it did the bath (see later), guarded against the introduction of foreign matter into the tissues to an important extent, yet without interfering with transpiration, which in southern countries takes place more by the cutaneous glands than by the sweat-pores. This fact goes some way to explain how it was that the contagious plagues of Antiquity, generally of a transient character, never properly speaking acquired any wide extension, unless they were carried along with the Genius epidemicus at the same time; and that even the latter, as is the case at the present day, could seldom master and reverse198 endemic predispositions. This last consideration merits the particular attention of the Historical Pathologist, as giving him a partial indication why Antiquity comes so far behind later times in regard to startling epidemics, at the same time teaching him to regard Asia as the home of Endemic, Europe of Epidemic Diseases. This ought to safeguard him against many over-hasty conclusions in his views of the progressive developement and evolution of disease in general. At the same time it will undoubtedly destroy not a few agreeable dreams, where he has allowed imagination to outrun reality.
Herodotus himself represents circumcision as a very ancient usage even in his time, as to which it is a moot point whether the Egyptians or Ethiopians first199 practised it. From the Egyptians it would seem to have passed on to the Phoenicians and Syrians in Palestine, from the Colchians to the Syrians living on the banks of the river Thermodon and Parthenius and to the Macronians223. To the present day we find Circumcision practised, as all the world knows, among the Mohammedans, Persians and Jews, among the Kaffirs on the South-East Coast of Africa, the Abyssinian Christians224, the inhabitants of the Pacific Islands225, as well on the mainland of America,—and this not merely among the coast dwellers, but also in several inland districts of South America226.
Without in this place going into the different reasons that have been alleged to account for the original introduction of Circumcision, especially among the Jews, we may yet say, looking back to our previous exposition in § 29., that we hold ourselves bound to see in Circumcision originally a religious-hygienic measure, intended to guard a part of the body already in the earliest times held in such high honour among the Egyptians, Indians etc. as was the penis, against any probable chance of defilement by uncleanliness (sebaceous smegma on the glans penis); for it was found that the uncurtailed prepuce made the maintenance of a clean glans penis much more difficult, favouring as it did the collection of the smegma resulting from the sebaceous secretions, and thus gave occasion for the formation of pustules and ulcers and the like inconveniences. These were referred not to the natural cause, but rather looked upon as a deserved punishment due to the anger of the offended deity to whom the penis was sacred, the deity being himself defiled and made unclean by the uncleanliness of the organ. To escape such anger men were ready enough to remove a part, the direct utility of which was as little obvious at the first glance as that of the hair that grew in its neighbourhood,—a proceeding they were the more willing to agree to, as the mischief the uncurtailed prepuce occasioned was often enough manifested.
At first only the Priests, who of course were at the same time the Physicians of primitive Peoples, were allowed to undertake the performance of this operation; subsequently it devolved upon the people generally as well, either by direct command or because they were now convinced of the utility of circumcision. This utility however must have grown less and less frequently visible in proportion as fewer uncircumcised individuals were left in evidence; and so in the same degree the hygienic motive fell more and more into the background. Thus only the religious was left, and this was now taken as the201 sole reason and sufficient explanation of the universal custom. Circumcision accordingly came to be a symbol signifying adoption among such as were initiated into the Egyptian Mysteries, and similarly adoption among the initiated of the Lord, adoption into the peculiar People of God. It is in this fashion the various discordant views as to the origin of circumcision, all of which proceeded in the first instance from a more or less one-sided point of view, may most satisfactorily be brought into agreement. True the motive for the operation was supplied by a pathological factor, but one which owed its force to a religious idea, and thus at first the knife was regarded not so much from the physician’s point of view as from the religious side.
But again later, when religious ideas of the sort were more and more disappearing before a cool examination of actual nature, when the tale of diseases originating in the anger of a deity was growing every day fewer, belief became impossible in the religious meaning of circumcision, or indeed such belief was deliberately rejected, now that a clear and natural explanation of the rite was to be found. The religious motive in turn made way for the medical-hygienic, as in Philo in the passage quoted above, and even Our Lord seems to have held no other view of the rite, when he says227: “If a man received circumcision on the sabbath, that the law of Moses may not be broken; are ye wroth with me, because I made a man every whit whole on the sabbath?” De Wette in his Translation adds: “that is to say, not simply, as in circumcision, in one member, but in the whole body.” In fact the question is here of the healing of the man “which had been thirty and eight years in his infirmity” (Ch. V.), whom Christ had made whole at the Pool202 of Bethesda on the Sabbath, for which reason the Jews wished to put him to death. The sick man was afflicted in his whole body, i. e. in every limb, for without help he could not leave his bed and go down into the Pool. Thus Christ we see contrasts the healing of all the members with circumcision, making it plain that in his view the latter makes whole merely a single member, the penis, or at least puts it in such a condition that it cannot become sick (ὑγιῆ ἐποίησα,—I made whole); accordingly the rite possessed for him only a purely medico-hygienic aim.
As to the introduction of Circumcision among the Jews, this may very likely, as we have already pointed, have taken place in the following mode: Evidently the Jews when in Egypt were not yet circumcised, as the speech of the lord Joshua clearly implies, “This day have I taken the reproach of Egypt from off you;” for in the eyes of the Egyptians the uncircumcised condition of the Jews was a reproach, just as in later times “Uncircumcised” was the strongest word of abuse with the Jews themselves.228 Moses brought up by the Egyptian Priests, initiated into their secret wisdom, must necessarily have been circumcised, and so have known the hygienic as well as religious point of view. Convinced of its expediency, he determined to introduce it among the Jews, in order to make203 them by outward sign in some sort a holy and pure priestly Nation.229 For this reason we find the command to circumcise on the eighth day after birth specified among the Laws of Purification,230 yet without any further supplemental addition,—which would certainly not have been omitted, if it had at that time been regarded as a symbolic sign of covenant. Circumcision did not yet possess its purely symbolic meaning; and so it is not yet included among the laws given at Sinai, where the blood of the Burnt Offerings seals the covenant with God.
But subsequently when the Jews at Shittim gave themselves to the licentious worship of Baal Peor, not merely the expediency stood out in glaring conspicuousness, but the positive necessity of observing the laws of purity in general, including that of circumcision in particular. Thus the long conceived idea of Moses came to maturity, to enjoin upon the People the rite of circumcision as special symbol of unity with Jehovah; though he could not hope to bring about its universal adoption by adults, until these were on the point of actually setting foot on the Promised Land. This could only be after the death of Moses; consequently it was Joshua at Arolath who first circumcised all those who had been born in the Wilderness. Now all the sufferings of the march were forgotten, the land flowing with milk and honey, that was to content all their highest wishes, lay before their eyes, and so they were willing enough to consent to purchase its everlasting possession at the cost of what is certainly a painful, but at the same time on the whole only a trifling, operation. But then when every male was circumcised, there was no longer any evidence, as explained above, to convince people of the necessity of the observance, and thus for the future Circumcision appeared in the guise of a purely religious204 symbol, as the sacramental outward and visible sign of adoption into sonship with Jehovah,—a point of view subsequently consistently kept to throughout the Old Testament.
Finally with regard to the notion, expressed in many different forms, that Circumcision was originally introduced on behalf of increased fruitfulness on the part of the Sons of Abraham,231—an idea found as early as in the pages of Philo Judaeus, it would appear not to be so much the greater length of the foreskin that came into question, but rather the same general reasons that ensured a condition of cleanliness in the procreative organs; for the alleged interruption of the ejaculation of the semen owing to the excessive length of the foreskin can after all only occur, if the latter is at the same time unduly contracted at its orifice in such a way that during the act of coition it cannot be drawn back over the glans. Supposing, as we have seen to be the case, complaints affecting the glans penis when covered with the normal prepuce to be readily set up through climatic influences, the free use of the organ of procreation must of course in this way have been interfered with, or even in extreme cases, completely prevented. But inasmuch as the Jew, in this resembling most of the Nations of Antiquity, made a numerous posterity his highest glory,232 and as this could only be obtained on the condition of205 a healthy procreative member, every endeavour must obviously have been made to remove anything likely to be prejudicial to the part so profoundly reverenced, anything capable of disturbing, or even altogether frustrating, the due performance of its functions.
But just as this removal of a part of the prepuce, and the consequent increased possibilities of cleanliness of the glans, more or less counteracted the injurious effects of Climate tending to set up diseases of the glans penis in general, it must have equally exercised as against possible affections of this part resulting from coition a certain prophylactic influence,—though undoubtedly this was not so great as it has been in some quarters represented to be, as we intend to explain more fully elsewhere. Hence to some extent, but only to a limited extent, can the practice of circumcision be regarded as a proof of the existence of Venereal disease in Antiquity; but at the same time to refer it to this as sole motive, as Stoll233 does, is quite inadmissible.
What has here been said of the Circumcision of men, holds good also in the main of that of maids and women. This consists in the removal of the praeputium clitoridis; but neither the amputation of the Clitoris itself in so-called Tribads must be confounded with it, nor yet the operation on the exaggerated nymphae or inner labia, of women. The Arabs, among whom this practice,—female circumcision,—is especially rife at the present day as it was of old,234 call the part that is subjected to circumcision
نوي (nava), the circumcision itself خفض (battar)
or خفض (chaphad), and what is cut away in circumcision
207بظر (bätr). Usually the circumcision of maids
is first performed on the completion of the tenth year by women who make it their special business and who are known as مبظّرة (mobatterat). These women perambulate the streets and openly call out, “Any maids to circumcise?”235 Besides the Arabs, Circumcision of maids is to be found among the Copts or modern Egyptians,236 the Ethiopians,237 in some districts of Persia,238 among the Negroes in Bambuk239 and the Panos in the province of Maynas in South America, the latter actually restricting the practice to the women.240
Baths and Bathing.
In spite of all precautions adopted it was impossible to keep away everything unclean from the body, while this latter by its own excrements was208 constantly making itself more or less unclean;241 hence209 it was only natural that from the most primitive times men’s attention was directed towards means of removing the uncleanliness so contracted. But the defilement was never more than an external one; it concerned merely the skin and the orifices of the mucous membrane, while the matter requiring removal was of a sort soluble in water, and thus water was always the chief and foremost means employed to secure cleanliness. Doctrines of Cosmogony further confirmed the practice; these made water the origin of all things, a direct effluence of the deity and therefore itself divine,—a means not only of purification, but of sanctification as well.
Θάλασσα κλύζει πάντα τἀνθρώπων κακά,
(The sea washes away all evils of mankind) was the refrain, one that resounds to this day in our ears from the East; so that we cannot wonder that baths and bathing formed a capital factor both in the public and private life of the Ancients. Whatever view might be taken of sexual intercourse, all agreed in this, that a certain defilement was connected with it, which (as follows indeed from our exposition on earlier pages) might easily become injurious to the organs brought into activity, and could only be obviated by dint of baths and a system of bathing.242
Thus we read in Herodotus:243 “But as often as a Babylonian has had intercourse with his wife, he sits down beside a lighted censer, and his wife does the same on the opposite side; then when morning has come, both bathe themselves, for they will touch no vessel until they have washed. The same practice is followed by the Arabians too.” Whether bathing after each act of coition was a national custom of the Egyptians, we have been unable to discover, but Clement of Alexandria244 states that they were forbidden, as was almost everywhere the case in Antiquity, to enter the temple without having washed or bathed themselves after sexual intercourse; while the Priests were bound to bathe after every nocturnal pollution.245 This was equally an ordinance of the Jews, who at the same time were rendered by such pollution unclean till the evening. The last named People were also obliged to wash after every act of coition; at any rate Josephus246 and Philo247211 declare it to have been so, for in the Old Testament it is nowhere enjoined. As is generally known, this custom has been kept up in the East down to the present day, even among the Christian populations,—affording a concurrent testimony to the necessity for its observance in these countries.
Whether the Greeks deliberately and with intention made use of baths and bathing immediately after sexual intercourse, it is difficult to ascertain quite for certain; but it seems probable, as not only does Mythology more than once248 make express mention of the bath after coition, but the phrase ὅσιος ἀπ’ εὐνᾶς ὤν (being holy, purified, after the couch) points to the same conclusion. Moreover there is a passage in Lucian,249—though it is quite true he212 often describes Roman customs,—that might be thought to prove the same.
Clearer indications are forthcoming in the case of the Romans, who not only must not undertake any sacred function or enter a Temple, if they had failed to bathe after carrying out coition,250 but were also bound generally after every act of cohabitation to wash the parts brought into use. At any rate this holds good of the women, and so applies to the Roman matron (comp. the passage of Suetonius quoted213 in § 27) as to Atia, the mother of Augustus, as well as in an even greater degree to the amica (mistress) or courtesan. The regular name for this was aquam sumere (to take water).251 Indeed there were actually special attendants aquarioli (water-boys),252 whose business it214 was not merely to fetch water for this purpose, but also in particular to bathe and cleanse the “filles de215 joie” after sexual intercourse. For this reason Lampridius says of the Emperor Commodus (ch. 2), aquam gessit, ut lenonum ministeriis probrosis natum magis, quam in loco crederes, ad quem fortuna pervexit (he fetched water, so that you would more readily suppose him born to perform the shameful offices of pandars than in the station whereto fortune raised him). Such cleanliness was especially obligatory on those who had to do with the preparation of food and drink, such as bakers, cooks and butlers;253 and if we do not find it directly enjoined among many ancient Peoples, the only reason of this is that they were already accustomed to wash and bathe every morning254 immediately on leaving their bed.
In the same way as after natural coition the parts brought into use were bathed and washed, this was also done after unnatural, and so we read in the Collection of Priapeia (Carm. 40.):
Falce minax et parte tui maiore, Priape,
Ad fontem, quaeso, dic mihi qua sit iter?
Vade per has vites, quarum si carpseris uvas
Quas aliter sumas, hospes, habebis aquas—
(Standing in threatening attitude with my bristling pruning-knife and your better part, Priapus, I enquire: “Pri’thee tell me, which is my way to the fountain?” “Go through yonder vines, but if you dare to pluck the grapes, you will find, stranger, water you must take elsewhere”). Clearly this is to be taken as meaning paederastia or irrumation looked upon as punishments inflicted for the theft contemplated; and shows us at the same time it was not without a “double entendre” that Priapus was set up as a direction-post to fountains, a point that Lomeier255 has already brought out with perfect correctness. Again the fellator after his work used to cleanse the mouth with water, as we learn from several passages in Martial; thus amongst other places we read in one, of Lesbia,256
Quod fellas et aquam potes, nil Lesbia peccas,
Qua tibi parte opus est, Lesbia, sumis aquam.
(You fellate and then drink water; you do no wrong in this, Lesbia; where lies your work, there Lesbia you take water).
If we further add to this scrupulous cleanliness the quiet life led by the women of Antiquity, who spent most of their time, as women still do in the East, reclining, it is evident that in spite of the predisposing influence of Climate, injurious secretions from the vagina and uterus, or indeed ulcerations of these parts, must—speaking generally, and in proportion—have occurred but rarely. Moreover such maladies of the sort as were contracted were quickly got rid of again spontaneously, for very often even at the present day rest and cleanliness suffice by themselves for the removal of primary affections of the genitals. On the other hand it cannot be denied that a careless non-observance of these primeval laws of cleanliness must have then avenged itself all the more severely on the offending individual, and given occasion for the setting up of incurable diseases.
But great as the counteracting effect of the frequent use of baths in Antiquity was on the rise of diseases in general, and of those resulting from sexual excesses in particular, none the less in other ways did these same baths, directly or indirectly, give occasion for their rise and spread. As to their direct effect in this direction,—we certainly find but scanty evidence of any in the authorities, and even such as are forthcoming may very possibly be referred to the head of general want of cleanliness257. Still in view of the fact that at the present day the cellar baths of the Jews contribute to some degree to the spread of disease, and especially of skin-disease of different218 types, as did baths generally in the Middle Ages, the conjecture is surely justified that similar results followed in Antiquity, especially at Rome under the Emperors.
Indirectly maladies consequent upon sexual excesses were helped on by the mere fact that the ancient Baths afforded manifold opportunities for such excesses. The bath-attendants, or aquarioli (water-boys), who fetched the water for bathing, not only carried on vicious practices with the women frequenting the place themselves, but also made a business of procuration, as already pointed out just above, p. 214. The lascivious Roman Ladies took their own slaves with them to the Baths, that they might attend upon their mistresses.258 At first the same bathing Establishments were used equally by both sexes, but not at the same time; and according to Dio Cassius,259 Agrippa would appear to have first, 721 A. U. C., established the public Baths at Rome for men and women, from which place later on Baths open to both sexes were introduced into Greece, as Plutarch260219 states. The Greeks called these Establishments ἀνδρόγυνα λούτρα (men-women, male-female, baths), and used to set up an image of Hermaphroditus in front of them.261 In the Imperial period, when all shame was laid aside and Heliogabalus himself in balneis semper cum mulieribus fuit (always visited the Baths in company of the women) (Lampridius ch. 2), the use of the Baths both by men and women, and this at the same time, had become an established custom, as may be seen from several passages of Martial;262 and it was in vain the220 Emperors Hadrian,263 Marcus Antoninus264 and Alexander Severus265 endeavoured to restrain the abuse by enactments. These were just as unavailing as were the invectives of the Fathers of the Church.266
The Bathing Apartments, from which antique Roman modesty had excluded almost every glimmer of external light, were now patent to the eyes of the passer-by. Fitted up with every device of the most refined luxury,267 they were transformed into222 regular brothels;268 and accordingly were not allowed to open their doors earlier than one hour before the ordinary establishments of this nature.
The same opportunities which the Baths gave for vice with women, they afforded no less for vice between men,—for paederastia. There it was that amateurs looked about for bene vasatos and καλλιπύγους, (men with fine instruments, men with handsome buttocks), and this among the Greeks as well as among the Romans,269 though the latter in this as in other things beat the record of all other nations.
Relation of the Physician to Diseases consequent upon the Use or Misuse of the Genital Organs.
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 it225 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 and226 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 divine227 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 modern228 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 parts272229 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 Sparta274,230 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):
Nec mihi sit crimen, quod mentula semper operta est.
(Nor let it be laid as a crime against me, that my member is ever covered up.) If with this is compared231 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.232 This comes out in the following passage of Plato,275 where he says:233 “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:
Diis me legitimis nimisque magnis
Ut Phoebo puta, filioque Phoebi
Curatum dare mentulam verebar.
(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 how234 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 Charidemu235s’ 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 was236 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 the237 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 consult238 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 ourselves239 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.
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 question240 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 of241 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 the242 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 must243 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 or244 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 obvious245 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,246 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 the247 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. Thus248 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 primarily249 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 different250 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 a251 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!
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 such252 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 treatment253 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 directly254 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 of256 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.305257 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 not258 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 of259 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 analogy260 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,313261 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 would262 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 of263 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, have264 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),319265 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 of266 Constantine the Great. The disease has to be carefully distinguished from the nocturnal pollutions,322267 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 and268 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 makes269 further and further progress. Galen325 recommended,270 besides diet and medicine, that with a view to retarding271 the preparation of semen, gymnastic exercises, particularly272 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 Gymnasium273 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).274 “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 possibility275 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 γυναικεῖ276α (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 to277 an extension of the ulcer to the spermatic cords278 (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 urethra331279 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 anticipation280 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 the281 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 For282 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 preparing283 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 pounded284 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 information285 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 affected286 with aphthae (διδύμους ἀφθῶντας), which he says should be treated with terra cimolia (Cimolian chalk) and myrtle-berries.
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 procedure287 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 on288 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 large289 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-letting290 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 Galen357291 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.364292 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 especially293 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, necessitating294 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 or295 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 φαγέδαιν296α (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 same297 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.298 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,299 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,300 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 pruritus302 (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 of303 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.
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 equally304 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 favoured305 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 persevered306 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 wearing307 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 when308 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.) However309 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 shape310 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 male311 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,312 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, then313 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.
Ἀκροχορδὸν432 is a smooth, circular, fleshy protuberance, having a slender circular base, so that it looks as though it hung on a string, whence the name. It is painless and callous, usually has the same colour as the skin, while its dimensions seldom exceed those of a bean. As a rule several occur together, but disappear again of their own accord, especially if they are only small, though on occasion they get inflamed and suppuration follows; they leave no root behind on amputation. According to Galen and Aëtius they occur on the fundament, according to Philumenes, as given in the latter author, likewise on the female genitals. They are removed either by means of a thread or with the lancet, though escharotics and other acrid remedies are also employed.
A highly inveterate form is the μυρμήκια, or formica (ant) of later Writers, which is almost always314 discussed by medical Authors concurrently with ἀκροχορδόν. It is, Celsus tells us, less prominent and harder than the θύμιον, has deeper roots, is more painful, broad at the bass and slender at the top, less suffused with blood and seldom larger than a lupin-bean. The colour according to Aëtius is blackish. On its being touched, the patient has the sensation of having been bitten by an ant. As an exactly similar growth appears on the hands, most Writers, e.g. Celsus and Oribasius, speak only of this latter; but Aëtius describes it expressly as occurring on the fundament and on the female genitals; and it was observed in the latter situation by Philumenes, or Aëtius (loco citato, ch. 105.) in the case of his own wife, whom he cured by three days’fumigation with origanum, (wild-marjoram). Not to mention the usual escharotic remedies, for which Aëtius in especial gives several formulæ, the following modes of treatment recommended by the medical Writers evidently apply to warts on the hands only,—by extirpation with a myrtle-leaf shaped scalpel called a scolopomachaerion (small pointed surgical knife), squeezing off by means of a quill or metal pipette, and above all sucking with the lips and gnawing off. This last was in Galen’s time especially433 a very fashionable treatment and is described by him as a new discovery made at Rome.
If we now turn back again and make a brief survey of the various forms of affections of the genitals described on preceding pages, comparing them with those of the present day, such as we have opportunity to observe in modern times, we think every unprejudiced reader will be found ready to315 admit that they agree with these latter in very nearly every respect whatever, and that every doubt would be removed, if only the medical Writers had appended to the records of their observations in each case the words, “got by infection in coition.” But to what cause do we refer such cases as a matter of fact, notwithstanding the denial on the part of the patient that he has exposed himself to any infection? Do we not take it for granted as a certainty that such infection did actually precede? Are we in the habit of noting down in every instance in our day-book of cases the antecedent act of coition that occasioned the chancre or what not; and does this omission in any way imply that this did not first occur? To our mind at any rate the fact suffices that non-professional observers and even a professional one like Galen have supplied irrefutable evidence that some of these affections were acquired by coition. Amongst others, morbid outgrowths for example are manifestly shown to have been so set up by the statement that they occurred on the fundament of pathics; and it needs no great perspicacity to draw the conclusion that if (unnatural) coition produced them in the pederast, the same maladies occurring on the genital organs owed their origin to the same cause.
But granting these maladies originated in coition, there must necessarily have been some other factors active as well, besides the mere act. Thus when patients are found explaining to the physician (Galen) that the women with whom they had accomplished coition suffered from the same evil as themselves (gonorrhœa), no one surely can suppose anything but that a transmission of the disease took place in virtue of a contagion. Such affections of the genitals as are transmitted in coition by contagion we are wont to regard as primary forms of Venereal disease; and those acquired and disseminated in the same way in Antiquity must accordingly be designated by the same name. But these primary forms extended not316 only to the genitals; they were equally and in the same way acquired through the various modes of Venus illegitima (abnormal Love) in the anus and the mouth, localities where we are accustomed nowadays to see the secondary symptoms chiefly appear. Consequently it was impossible for the Ancients,—and is really and truly no less so down to the present moment for the Moderns,—to make a definite distinction between primary and secondary forms. It is equally impossible to deny outright the former existence of the latter in these localities, the more so as, however wide the dissemination of vicious practices of various sorts, no very large number of men suffering from a diseased member are likely to have misused mouth or anus.
But if we are forced in considering the secondary forms to leave mouth and anus almost entirely out of the question,434 then only cutaneous diseases and those affecting the bones are left us, for ozaena (fetid polypus), which was regarded as incurable by the Ancient physicians,435 cannot any more than the317 others be taken into account in connection with primary affections of the mouth, unless indeed we are prepared to look upon the ῥέγχειν (snorting) of the men of Tarsus as a secondary complaint of pathics.
With regard to cutaneous affections, we have seen how the forms of lichen and mentagra passed over into psora and lepra (§§ 23, 25), and how the conclusion to be drawn from this is plain, viz. that the secondary cutaneous forms of Venereal disease were formerly assigned as belonging to leprosy. This seems to be confirmed by a passage of Johannes Moschus436 that has only just been brought under our notice, in which it is related how a monk of the Monastery of Penthula could no longer master the appeals of the flesh, travelled to Jericho to get relief from the “superfluity of his naughtiness” in a brothel in that318 place; how when he had entered the house, he was suddenly attacked by leprosy, whereupon he speedily returned to his Monastery. How much Venereal disease has in common with elephantiasis must be determined by later investigations. At any rate it is worth while to note its frequent occurrence in Egypt, its establishment in Italy along with the various forms of lichen, its infectiousness, as well as the statement of Celsus (III. 25.), who calls it an ignotus paene in Italia morbus (a disease almost unknown in Italy), and that even the bones would appear to be affected by it.
Lastly, inasmuch as the tendency of the morbid process to strike outwards to the skin was conditioned by the influence of climate, while cutaneous forms of Venereal disease were amongst the most common of occurrences, it follows that not only were affections of the mucous membranes bound to fall proportionally into the background and appear with less frequency, but those of the bones as well. Still the mucous membranes were sometimes attacked, and affections of the bones did also undoubtedly occur, though with incomparably greater rarity,—such affections being, as is well known, at the present day of rare occurrence, and especially so in hot climates. Corrosion of the tibia is mentioned by Plutarch, and peculiar pains of the periosteum, which are so deep-seated and stable as to make the patient believe the bones themselves to be the seat of the mischief, are spoken of as early as by Archigenes cited by Galen,437 the latter adding that319 these pains were commonly known as οστοκοποι (racking the bones). If further we ought to count in this connection those forms of exostosis (morbid excrescence) of the bones of the skull described above in § 26, which it seems were so prevalent among the inhabitants of Cyprus as to have gained for the island according to some authorities its name of Κεραστία (horned),438 we should actually have to hand320 proofs of the existence in Antiquity of all the symptoms that at the present day constitute Venereal disease. All we need to do is to unite these into one general picture and give the name that is now sanctioned by custom, in order to arrive at the final result,—that Venereal Disease, though not recognized and described as such by the Ancient Physicians, was as a matter of fact existent in Antiquity.
Having reached this general result at the conclusion of the first Part of our Investigations, we would now seem only to have to co-ordinate the various pieces of evidence thus far brought together without reference to time and place, but merely on the principle of similarity of contents, under local and temporal conditions, in order to obtain a general exposition of the development of Venereal Disease in Antiquity. Willing as we may be to undertake the task, and necessary as its performance is,—for it is precisely this that constitutes the History properly so called of the Disease,—still we must freely admit that for the present the fixed data indispensable for the work are too few to enable us to do more than offer suggestive hints. At the same time to supply these missing data by hypotheses that must necessarily lack all positive grounds, is not, at any rate in our opinion, consistent with the dignity and duty of a Historian.
As to the local determinations, those defining the places, to which such or such information given us belongs, are extremely scanty, and such as they are, we owe them mainly to the non-professional Authors. Among the Physicians, who from the nature of the case must be chiefly considered here, they are all but entirely wanting; true they are almost all Greek instances, still in the majority of cases it is left322 absolutely undetermined whether the observations, the mere results of which moreover are given us, were made in Greece, at Rome or in Asia Minor. But even supposing knowledge amounting to certainty were available on this point, yet the local range as compared with the whole Ancient world is too limited to entitle us to use it successfully as evidence in drawing up a general History of the Disease.
The temporal determinations are in no better case. This is especially so where the Physicians are concerned; not to mention the general uncertainty as to the epoch at which most of them lived and made their observations, they are for the most part bad witnesses for this reason if for no other, that they have obviously copied one from another, or at any rate so far as their works are extant for our examination, utilized,—with the possible exception of Galen,—certain common sources of information, which unfortunately have been completely lost. The loss is the more to be deplored as the authorities in question belonged just to the most flourishing period of scientific Medicine, that of the Alexandrian physicians.
Yet another drawback is that up to the present we are entirely without information as to the consecutive order of the series of epidemics in Antiquity, by the indirect help of which alone do the historical factors conditioning Venereal disease become discernible; while so far as appears, there is no reasonable hope of our ever attaining any clearer light on the point. Nay! even if we did possess the information, it could only apply to Greece, Rome and Asia Minor, for as previously pointed out, in countries situated in the hot Zone the genius epidemicus (general consensus of epidemic conditions) is but rarely as a rule strong enough to override the genius endemicus (general consensus of endemic conditions). As much therefore as can in such a state of things be predicated with some basis of reason as not entirely hypothetical may be pretty well summed up as follows:—
Diseases of the genital organs developed little by little among nearly all the Peoples of Antiquity known to us at all intimately under the favouring conditions detailed in preceding pages. At the same time in virtue of the large number of counteracting influences they seldom attained to any high degree of intensity, and remained mostly local, taking the form of mucous discharges and superficial ulcers, without provoking any general reaction of the organism. Even when such reaction did occur, it was the skin that felt it, in such a way as to throw off the effects of morbid activity in the form of cutaneous maladies. These conditions lasted usually as long as the different Peoples continued to cultivate mutual exclusiveness; directly they abandoned this, and individual members of different foreign stocks began to combine to gratify an unbridled licentiousness, affections of the genitals not only increased in frequency, but over and above this a malignant character was stamped upon them, with which both the development and the intensity of any particular contagion stood in direct ratio.
Examples are to be found in the Plague of Baal Peor among the Jews at Shittim (§§ 8. and 9. above), in the introduction of the cult of Dionysus at Athens (§ 98.) and of Priapus at Lampsacus (§ 7.), both of which latter are connected with the March of Bacchus to and from India, as well as lastly in the introduction of the Lingam-worship in India itself (§ 6.). All these phænomena point to the conclusion that a remarkable frequency and malignity of affections of the genitals was connected with influences conditioned from without, amongst which we have to reckon the general epidemic conditions. This becomes the more interesting and important from the fact that we meet with the same thing again in the XVth. Century, a period when the incorrect view taken of the circumstances led to the most contradictory opinions being held. However both influences and effects were merely transitory, as324 is proved by the unanimous consensus of authorities that the phænomena provoked by the conditions disappeared again after a certain interval of time, an interval that seems among the Jews only to have lasted somewhat longer under endemic influence.
Still under no circumstances does this justify us in arguing to a total absence of all affections of the genital organs,—as is proved, no doubt after an interval of more than a thousand years, (if indeed we are to admit the occurrences just mentioned to count at all as actual historical facts), by (1) the general weather conditions laid down by Hippocrates and their consequences, and (2) an event that probably was connected with the same conditions, the Plague of Athens described by Thucydides. Here we find indisputable proof given us that affections of the genitals, as also most likely the contagion conditioning them, increased under favourable epidemic influence in frequency, malignity and intensity, while concurrently the secondary forms manifested themselves pre-eminently by symptoms of an exanthematic type.
For close on five hundred years onwards we are again left without information; but the statements contributed by Celsus show that meantime there had been ample opportunities of observing and treating affections of the genitals. In the time of Pompey the Great, when Themison made his observations on the wide prevalence of satyriasis in Crete, there was developed, it would appear, though from what causes is not known, a general consensus of predominantly exanthematic conditions, that seems to have continued for a long period of time, no doubt as was to be expected with sundry interruptions intervening. Under favour of these conditions was developed in the first instance elephantiasis, and later on under the Emperor Claudius mentagra, which above all in Martial’s time afflicted the Romans, while caricous tumours (ficus) became an every-day complaint. From that epoch onwards, direct325 historical evidences more and more tend to disappear, till eventually it is only in the prescription-books of Physicians that we gather any inkling of the continued necessity for medical aid and concurrently of the existence of Venereal Disease.