§ 31.
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. Hennen[185] 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 independent 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 humours[186].
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, better 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 Martial[187] 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 debauchees[188], 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 day[189]. 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 itself 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 organism 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, so 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.
§ 32.
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 rate 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 so 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 elephantiasis 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, and[190] “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. But 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 Aphorism[191]. “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 the repetition of the same Aphorism, but Hippocrates actually says so distinctly in a third passage[192].
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, 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.”
§ 33.
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, even after the smallest injuries[193], 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 itself[194]. 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 destructive[195], 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 being 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 comparatively 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 prevalent[198], 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 genitals 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 generally[199].
Again the result of this investigation is of still more especial interest in so far as it enables us to properly appreciate Thucydides’notice of the so-called Plague of Athens.[200] This has been discussed 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 Lucretius[201] 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 does[202]: “The loss of the private parts and the extremities (στερισκομενοι τουτων,—being deprived 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 commentators[203] 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 times[204] is not of the 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 is 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 supervening[205]. 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 one 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 day[206]. But under either eventuality the existing contagion was annihilated, in the one case by the general feverish reaction of the organism[207]. 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, 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 course 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.
