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