§ 39.
But for no small part of this reluctance on the part of patients the Physicians were themselves to blame. We have no wish in this place to enlarge upon the possibility of professional indiscretion in their case, though long ago the Hippocratic masters saw themselves constrained to guard their scholars against it.[281] Of far greater weight was the nature of the treatment, especially that applied to ulcers of all kinds, which was excellently adapted to fill sufferers with fear and trembling. Already Hippocrates[282] taught that ulcers with callous margins must be cauterized or else cut away with the knife. Galen[283] declares himself even more plainly in the same sense: “But if the margins of the ulcer merely are discoloured and callous, they must be removed right to where the healthy flesh begins. Supposing this condition to have extended more widely, then the question arises,—whether we ought to cut away all the diseased tissue, or prefer a more tedious method of cure. It is natural and necessary in this case to consult the inclination of the patient; for whereas some prefer to avoid the knife and submit to a more tedious treatment, others on the contrary are ready for anything, so long as they get cured.” The same procedure was adopted with ulcers of the genitals, especially gangrenous ulcers, as is proved at once by the passage already quoted on p. 176 of Vol. II above.
The Asiatic, for whom the genital organs were an object of veneration, was no doubt horrified, as the Turk is to this day,[284] at the idea of any such operation on himself; while the licentious Roman, who must have dreaded its very probable result in the entire loss of the further use and enjoyment of the parts in question,[285] sought any other means for choice, preferred to have recourse to Priapus or even resorted to suicide, like the Municeps of Pliny mentioned on p. 257, before he trusted himself to the physicians who ever since the Carnifex (Butcher) Archagathus had appeared at Rome, strove to rival one another in infatuation for cautery and amputation. In any case it was only the direst necessity[286] that drove the sufferer under such circumstances to the physician; while the latter had really and truly no reason for enquiring into the origin of the evil, as very often absolutely no alternative was left him but to grasp the knife or cauterizing iron. In this way medical procedure could not but have fallen into disrepute, while physicians were in most instances necessarily deprived of all opportunity of systematic observation.
Whether there were other factors as well to induce the old Physicians to apply the ordinary treatment of ulcers in general to those of the genital organs, we cannot indeed as yet for the time being determine. Certainly the conjecture is an obvious one that they may well have had an inkling of the specific nature of such ulcers, and that it was not merely the local mischief they sought to put a stop to by early application of cautery and knife. However it is only further and more careful investigations that must be allowed to decide the point,—the more so, as the general views as to the formation of ulcers held by the Ancients seem in many respects to tell against it. Thus Galen[287] says: “The mode in which these (ulcers involving destruction of substance) are set up however is twofold; they arise either by removal of surrounding tissue (ἐκ περιαιρέσεως) or by eating away (ἐξ ἀναβρώσεως). How the former acts is well known. As to the eating away, if it proceed from the inward parts of the organism, it is an outcome of the evil humours; but if it arise from outside, then it is a result of the physician’s remedial measures or of fire.” From this we gather that all ulcers of the genitals, as well as others, which did not result from the action either of remedial measures or of fire, were held as being necessarily an outcome of the evil humours of the body. Further, that this view was not in any way peculiar to the time of Galen, but was a direct and necessary consequence of the further development of the pathology of “humours,” follows from the circumstance that we find the same opinion expressed by Hippocrates.[288] Again Plato shared the latter author’s general doctrine of apostasis (suppurative inflammation taking off evil humours) in his “Timaeus”, where he derives from the white phlegm, striking outwards to the skin, cutaneous eruptions, rashes and the like maladies, from the acrid, salty phlegm on the other hand the fluxes of all types, bearing different names according to the different parts of the body affected.
If we do not choose to infer from this the proof of a then occurring, genuine and consistent genesis of the affections peculiar to the genitals, we are bound at any rate to admit that such a view must necessarily have debarred all thought of any specific character as belonging to ulcers of these organs,—the more so as to this very day we look in vain for any clear conception of really characteristic symptoms marking out Venereal ulcers in particular. Further, the knowledge that ulcers of the genitals were contracted through sexual intercourse, lacked entirely, so far as the ancient Physicians were concerned, the necessary confirmation and authority to induce them to make a special and distinctive class of morbid process to include them, because as a rule they paid no sort of attention to the occasioning cause, unless in virtue of its being still present and active, or else by the necessity for its elimination, it could afford some indication for therapeutic purposes. Galen brings this out best and most clearly in the following passage:[289] “Moreover it will be a fitting occasion now to make it clear that not one of the causes directly occasioning the diathesis, or particular condition of body, will give any indication as to treatment; guiding signs for the purpose must rather be gathered from the complaint itself. What is to be done in any individual case depends on the immediate purpose and the nature of the part attacked, on the predominant temperament and the like facts. For to put it shortly, in no case can an indication as to what is beneficial be taken from any one of the factors that are no longer existent,—i.e. in actual operation. But as it often happens that in order to diagnose some affection that cannot be recognized either by help of ratiocination or by the senses, we are obliged to inquire into the cause that occasioned it, laymen conclude the guiding signs for remedial treatment to be taken from the same source. But this is by no means so. This may be plainly seen in those instances where the diathesis is quite well known in all its details; for whether it be ecchymosis or ulceration or erysipelas or putrescent ulcer (σηπεδὼν) or phlegmonous affection in any organ, it is perfectly useless to trace out the cause that occasioned it (αἴτιον ποίησαν), if this latter is now no longer active. On the other hand for any affection, a clear insight into which is lacking, a knowledge of the occasioning cause is useful.”
This principle was equally applied to affections of the genitals, the antecedent act of coition being regarded as affording absolutely no help in diagnosis, as we see from the passage of Galen to be next discussed. In this passage the declaration of a gonorrhœal patient to the effect that the women with whom he had connection suffered no less than himself from the malady, was entirely without influence on our author in the way of inducing him to assume and lay down a specific type of gonorrhœa. Under these circumstances it is really a matter for no surprise[290] that the old Physicians in discussing affections of the genitals never allege sexual intercourse as an occasioning factor amongst others; and the conclusion drawn that such affections in Antiquity were not contracted by coition, because the ancient Writers do not definitely and in every single instance assign this as a cause, evidences really and truly merely the absence of any accurate study of their works and the knowledge of their views that is acquired as a result of such study. It is abundantly clear however that the neglect of the etiological factors referred to led eventually to their being completely overlooked; and it is no less obvious that this must needs have been a source of manifold mistakes, which degraded the physician in the eyes of the non-professional laity, very often made him ridiculous by reason of this ignorance, and brought down, as we have seen, many a cut of the satirist’s whip on his devoted shoulders. But how many of our colleagues are there not at the present day whom Venereal disease involves in the same doubts and difficulties?
However it may perhaps be suggested that, although the ancient Physicians did not feel themselves obliged to make any mention of sexual intercourse as cause of affections of the genitals, they cannot for all that have failed to notice the phænomena of infection. To say nothing of the fact that in no small proportion of instances affections of the genitals under the favouring conditions previously described did not as a matter of fact arise through infection, but actually in a sense spontaneously,[291] and further that to this day we possess absolutely no criterion to distinguish such diseases arising in this way,—for it is only superficial and indolent observers that deny the possibility of such origination altogether,—apart from all this, the view which the Ancients took as a whole of the general question of infection was one in the highest degree inadequate. For this state of things, as Heyne[292] long ago pointed out, the τὸ θεῖον (the divine element), or in other words the prevalent opinion that infectious diseases were an infliction of the offended deity, is mainly responsible. In these very diseases of the genitals, we have in fact seen how they were ascribed to the wrath of Dionysus and Priapus; and how long such ideas lasted, and how intimately they were interwoven with the life of the people, may be gauged by the circumstance that even the Christian Fathers themselves took every pains and used every effort to maintain them.
Now is it really in any way reasonable to expect the physicians of those times to have so completely extricated themselves from the predominant range of ideas? and have we any right to abuse them for their beliefs at the present moment, when in our own day there are to be found not a few physicians who deny absolutely the contagiousness of Venereal disease under its different forms? All the old practitioners could do was to draw attention to the fact that underlying the τὸ θεῖον there lurked some natural cause, and this view Hippocrates did actually maintain in his writings. As to the indicative signs of this cause perceptible by the senses, as to the material substance, whatever it may be, that communicates infection, into all this they could hardly be expected to initiate investigations,[293] deficient as they were in every sort of aid and assistance for the task. For I ask, have we, in spite of all our researches, thus far attained to any satisfactory and certain results? Could the Anti-Contagionists ever have come forward at all, if we had been successful in demonstrating the contagion to be perceptible to the senses?
Besides all this, we actually find to the present day that in the countries in question the contagion exhibits but a low degree of virulence, and only under epidemic influence, as at the epoch of the Athenian Plague, did it assume a virulent character at all,—a fact that will be made yet clearer in our Continuation of the History of Venereal Disease. But wherever the contagion did exhibit this virulence of character, the ulcers that were set up passed over as a rule into gangrenous mortification, or else the physicians either exterminated it altogether by the actual cautery or removed it along with the part in which it had established itself. Thus any further spread of the contagion in its original form was not to be expected, as in patients of the sort there can be no doubt all desire for coition must have been destroyed.
If we now bring together the results of our discussion so far, we shall find reason to believe that, speaking generally, the ancient physicians,—that is physicians properly so called,—possessed but scanty opportunities, especially in the case of women,[294] of observing with any precision the origin and course of affections of the genital organs, for it was mostly only the malignant forms of these that came under their notice, and these were of their very nature, except when epidemic conditions were at work, necessarily of infrequent occurrence. Their pathological views stood in the way of unprejudiced observation, conspicuous characteristic symptoms were as little to be found then as they are nowadays, any adequate knowledge of the material substrata of contagions was lacking to them in these as in other forms of disease, and thus they felt no direct inducement to class the primary affections of the genitals as forming a special category of disease.
Then again with regard to the secondary symptoms, the ancient practitioners in the cases treated by them made the occurrence of such all but impossible, for scalpel and cauterizing iron either entirely eradicated the contagion along with its material substratum, or else removed it with all speed before it could be reabsorbed into the system. Even when these did nevertheless appear, in some instances too great an interval of time intervened, in others the parts attacked were too remote from the spot primarily affected for it to have been possible for them to be referred to any direct inter-communication. Indeed this was made an actual impossibility in most cases, as it was just those very spots that are the usual seat of the secondary affections which were attacked primarily in consequence of the different modes of Venus illegitima (abnormal love) with such extreme frequency as to make it barely practicable for the keenest eye at a diagnosis to discover any actual distinction between the two,—and this without taking into account the circumstance that in view of the pronounced tendency conditioned by climatic causes for the morbid process to strike outwards to the external skin, mischief in the mucous membranes and bones must necessarily have fallen to a considerable extent into the background.
If circumstances put it out of the power of the ancient Physicians to unite under one whole the separate forms of Venereal disease, to look at the morbid process in its entirety, it is no less self-evident that for the same reasons they could have found no occasion to invent a special name for a thing that was simply invisible to them. Hence the conclusion drawn that, because no such special name is found, therefore Venereal disease cannot have existed, strictly speaking requires no further consideration. Still, granting for the sake of argument that they had recognized at any rate the generic difference of the primary affections, were they therefore bound to introduce a special name for them? Galen shall supply the answer. He says, mentioning[295] 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 place[296] he finds fault with the different designations given to ulcers, and then proceeds: “If I consented to enumerate all the names, I should be running the risk of deliberately teaching what I recommend others to avoid, when I say that the true searcher after truth must needs withdraw his attention from the nomenclature that has grown up, and fix his eyes on the actual fact.”
While these expressions of opinion demonstrate the uselessness of the names, they show at the same time that no inconsiderable number of such names must no doubt have been in existence. So far as affections of the genitals are concerned, not only is this indicated by the Greek φθινὰς,—wasting disease and the Latin robigo,—ulcerous sore, not to mention the ambiguous ἄνθραξ,—carbuncle, malignant pustule, but Celsus expressly declares the fact, saying (Bk. VI ch. 18) at the beginning of his description of Diseases of the sexual parts: “Proxima sunt ea, quae ad partes obscoenas pertinent, quarum apud Graecos vocabula et tolerabilius se habent et accepta iam usu sunt, cum omni fere medicorum volumine atque sermone iactentur, apud nos foediora verba, ne consuetudine quidem aliqua verecundius loquentium commendata sunt.” (Next come such words as apply to the parts of shame, the Greek names for which are at once less offensive and are now sanctioned by usage, as they are constantly occurring in every medical book and medical discussion, whereas our native (Latin) names are coarser and are not even recommended by any custom on the part of those who speak with some regard to modesty). Celsus himself communicates but few of these words, for he wrote simul et pudorem et artis praecepta servans, (observing at once the laws of modesty and the rules of his art); while between him and the writers of the Hippocratic school medical Literature is all but a blank to us. The same is the case between Celsus and Galen; and of a period so important for our purpose as that of the licentious Emperors, likewise not a single independent medical Writer has come down to us. In fact even the Fragments of the Compiler Oribasius, lately made known to the world by Mai, contain, alas! nothing more than the headings of the Chapters most interesting to us.
In such a condition of things it is really verging on the borders of folly to hope to give a dogmatic and decisive judgement as to the knowledge of Venereal disease possessed by the Physicians of Antiquity,—the more so as the extant medical Works have never once been adequately ransacked, as Naumann only the other day proved in the case of Galen. But of a surety it is easier to maintain the Ancients knew nothing of Venereal disease, than to devote the best part of a man’s life-time to the investigation, how much the Ancients did actually know about it!