§ 40.
If we turn now from these discussions to the statements of the ancient Physicians themselves, there are two different ways in which we may regard them ourselves and present them to the reader’s eyes. Either we put down consecutively everything that has been said by one and the same Author and examine each single datum we owe to him by itself, or we bring together the data given by different writers on one and the same subject, and then compare these one with another. The first way, the one generally followed by historians of Venereal disease hitherto, gives us it is true the general results of the knowledge possessed by the several writers on the different forms of Venereal disease; but, seeing on the one hand we do not in most instances actually possess all the works of our Author, while on the other even when we do, we are not justified in looking upon his report as embodying a résumé of all the knowledge of his time, the advantages of such a way of dealing with the subject are on the whole but slight, while it has the disadvantage of rendering considerably more difficult the general survey of the information possessed by Antiquity as to Venereal disease, which nevertheless is really our immediate and capital concern, and cannot fail moreover to occasion a host of contradictions.
The second way not only relieves us from this disadvantage, but also ensures us that general Survey which is peculiarly necessary, and to the absence of which the circumstance is chiefly to be ascribed that it has been possible hitherto to convince the opponents of the antiquity of Venereal disease only in the most incomplete manner of its actual existence in those times at all, as the exposition of the contrary view, in itself incomplete, was bound in its fragmentary presentment to seem even more incomplete still. Of course, in following the second way of exposition, there is an unavoidable dislocation of the data communicated by each individual writer, but this is a thing of but little moment, more particularly as its inconvenience is minimised by our giving the passages, when quoted for the first time, in extenso, so as to have on subsequent occasions merely to refer back to them. Again the want of a clear marking of dates, a point undoubtedly of great importance in historical researches, is readily obviated by our laying down the available fixed points of our chronology in the general Survey that forms a necessary conclusion to our exposition.
No doubt Hensler and Alex. Simon had already struck out this second way of exposition; but the latter writer merely examined the data of the several Writers by themselves without making any effort to build them up into one whole. To do this was, it is true, a proceeding quite foreign to the method adopted by the Ancients, but for our own time, accustomed as we now are to demand a systematic exposition of a subject, it seems absolutely indispensible. Hensler on the other hand in his treatment of the question fixed his particular attention solely on the Middle Ages, and made it his immediate aim merely to prove that previously to the ninetieth year of the XVth Century local affections of the genital organs were already well known, and had been subjected to treatment.[297]
Now with regard to the actual exposition that follows, we shall refrain in it as much as possible from going into particulars, such as the text itself or the views of the Authors might seem to make obligatory, as the needful space fails us, at any rate for the present. Moreover the matter coming under review has been discussed already by many others, while as for critical elucidations, let them be as pressingly required as they may, we lack all the necessary apparatus criticus. In fact in the case of several Writers, the translation, let alone the original text, was with difficulty accessible, for which reason many a passage of those already known may perhaps have been passed by unregarded. A complete collection of all passages, including those still unknown,—for the harvest as was mentioned above has by no means been all reaped,—will certainly not be demanded by any reasonable reader from a Student of thirty, for hardly even a greybeard Enquirer surely could boast of having read all printed works of the ancient Physicians. For the rest, our present object is not at all to give an exhaustive exposition of all the ideas and observations of ancient Physicians as to affections of the genital organs; it only concerns us here to bring together what is true and directly available for our task. Under this head would certainly seem to come the following seven points:
1. Gonorrhœa (Clap).
Nimia profusio seminis,—excessive flow of seed (Celsus), γονόῤῥοια.
Gonorrhœa, the name of which is compounded of γονή (badly made semen) and ῥεῖν (to flow),[298] consists in an affection of the seminal vessels, not of the private parts themselves, which merely serve as the road for the excretion of the seed.[299] Two kinds of gonorrhœa must be distinguished, according as the malady is, or is not, combined with erection of the penis.[300]
Gonorrhœa with erection of the penis is called sometimes Satyriasis or Satyriasmus sometimes Priapism,[301] and is a species of cramp,[302] which however only attacks the penis, belongs to the category of the emphysemata, or inflations,[303] and is conditioned by an afflux of the humours, particularly of conspissated or badly compounded humours.[304] However this last phænomenon is only a symptom of that morbid lasciviousness which Paulus Aegineta entitles Priapism, while he designates the condition connected with it by the name of Satyriasis, this having its origin in an inflammatory affection of the seminal vessels.[305] No proof is needed that both these views are right so far as this, that gonorrhœa is both spasmodic and inflammatory, and in either case may be accompanied by priapism. Nothing, or only very little, is evacuated of a nature to make the patients experience relief; and if there is, they are again attacked by the evil, until the original cause of the erection is eliminated, on which the penis relaxes of itself and subsides.[306] According to Paulus Aegineta paresis of the spermatic vessels,—the second form of gonorrhœa,[307]—supervenes, if the disease is not relieved, or else general spasms. Patients attacked by such spasms succumb rapidly, suffering from cold sweats and tympanitic distension of the abdomen. Alexander of Tralles (IX. 10) saw the erection even continue after the death of the patient. This form is not a common one; it occurs pre-eminently among young people,[308] and according to Themison’s observations, who frequently saw the complaint in Crete, where however it was probably very often a result of pederastia, is subject to epidemic influence.
The treatment of this form of gonorrhœa demands according to Paulus Aegineta (loco citato) immediate general blood-letting,—this Galen[309] also recommends, and practised with advantage,—local cupping or leeching, simple clysters, cooling and composing embrocations and poultices of solanum (nightshade) or cicuta (hemlock) in the lumbar region, of litharge, Cimolian earth, psymithium (white-lead) with vinegar, water or sweet wine, on the perineum. Internal remedies are a decoction of mallows, mercury and birch-bark, sap of rue, decoction from the root of the iris, nymphaea (water-lily) and adianthum (maidenhair). Diuretics are injurious. Patients should at the same time be put upon a low, vegetable diet, and the supine posture avoided. Galen (loco citato) recommended in addition emetics, but not purgatives, also embrocations of ceratum rosaceum, friction and subsequently gymnastic exercises. Alexander of Tralles insists particularly on the patient avoiding[310] all wanton scenes and thoughts, and forbids the use of any cold, specially astringent things, whereby the resolution of the contraction is made more difficult (πάθος δυσδιαφόρητον γενέσθαι,—the affection is rendered hard to be resolved).
Gonorrhœa without erection of the penis, that is to say gonorrhœa proper, exhibits a persistent, involuntary discharge of the seed,[311] has some analogy with incontinentia urinae, and usually depends like the latter on weakness or failure in the retentive power of the spermatic vessels.[312] Very often an inflammatory stage supervenes, making the complaint approximate to the first form; patients secrete copious and hot semen, which provokes them to ejaculation,—an ejaculation however that is followed by great exhaustion. If they avoid copulation, headache is established, pains in the stomach and nausea, while nocturnal pollutions cause them similar inconveniences to those they incur from coition. The ejaculation is accompanied by heat and smarting pain,—and this not solely among men but with women as well; for one of these patients, Galen writes,[313] told me that not only himself, but also the women with whom he had accomplished coition, experienced during the discharge a biting, burning pain. On the contrary, according to Aretaeus,[314] it would seem the only symptoms found in conjunction with the complaint are itching of the privates, a voluptuous feeling and a violent inclination to sexual intercourse. This datum admits of ready explanation if we consider the fact that in southern countries the inflammatory stage that makes its appearance is very brief and as a rule hardly noticeable, provided,—though no doubt this condition was pretty often broken,—coition was not indulged in during its course.
As a matter of fact in the great majority of instances the Physician had only the chronic form to treat. Generally speaking a patient first notices the complaint, when the discharge begins; and then the latter, when once the inflammatory stage is over, proceeds day and night undisturbed and without special voluptuous feeling, without wanton dreams,[315] often without any particular sensation at all. The actual discharge is a thin, cold, pale, sterile flux. Towards the end of the illness it becomes thicker, assumes an acrid quality, and eventually ceases altogether to flow.[316] But if the malady persists, especially in young people, then according to Aretaeus, the whole visage of the sufferers assumes a greyish look; they grow sluggish, atonic, spiritless, faint-hearted, indolent, dull, weak, emaciated, incapable of effort, unhealthy-looking,[317] pale, womanish, have no appetite, feel chilly, complain of heaviness in the limbs, are weak-loined, feeble and unfit for anything. According to Galen, the abdomen falls in, besides all the rest of the body collapsing more or less and withering; while patients become lean, of a yellowish pale complexion and hollow-eyed. In this way the complaint not unfrequently paves the road to paralysis, or else sufferers die of tabes or wasting.[318] Specifically and in itself the disease is not dangerous, but it provokes various other complaints, and represents a highly disagreeable, ill-reputed affection (Aretaeus),[319] that almost always follows a chronic course,[320]—for which reason Aretaeus and Caelius Aurelianus actually treat of it under the head of chronic diseases.
Gonorrhœal pus is infectious, as is implied by the Mosaic Laws of Purification (Leviticus Ch. XV.), and the malady is communicated by coition, as is seen from the words of Galen,—p. 428. But as early as the Fourth Century the idea was prevalent that the conjunction of the stars was not devoid of influence, as such or such a conjunction might from a man’s very birth determine that the individual was to die of gonorrhœa. This at any rate is maintained by Julius Firmicus Maternus,[321] who lived in the time of Constantine the Great. The disease has to be carefully distinguished from the nocturnal pollutions,[322] that are at times one of the sequelae of gonorrhœa.
The treatment is, according to Aretaeus, at the commencement that for an ordinary rheum or flux, by keeping the parts affected cool, in order to counteract the flow of the humours to them; by degrees going on to a heating and at the same time desiccating procedure, then the application of fresh wool to the part, the employment of friction, embrocations of ceratum rosaceum or oinanthinum with white wine, olive oil with melilot, marjoram, rosemary, poultices of barley-meal, saltpetre and dyll, but above all rue, with the addition of honey or, according to Celsus, vinegar; as further treatment, stimulating cataplasms, of a strength to redden the skin or even to bring out pustules on it, so as to draw off the afflux of the humours, or else as an alternative, plasters of the nature of the emplastrum viride (green plaster), of baccae lauri (laurel berries). As for internal treatment, the patient should drink decoctions of: semen lactucae (lettuce juice), cannabis (hemp), rad. orcheos (orchis root), nymphaeae (waterlily), halicacabi (bladder-wort), etc.; and take castoreum (beaver oil), or the antidotes of Symphon, Philo, or Bestinus, which are prepared from viper’s flesh. In case of very profuse discharge, the patient should be directed to drink hard red wine; if he is acrid with bile (χολωδέστερον καὶ δριμύτερον,—over-bilious and acrid), lukewarm baths are brought into requisition (Alexander of Tralles). On one point all authorities are agreed, that the main thing to depend on is diet. Both food and drink, says Celsus, must be cold, a precaution Themison also recommended in satyriasis, whereas Caelius Aurelianus denounces it. The patient must not indulge in semen-forming matters, such as cause flatulency, but take nourishing food, flesh of animals but not fish, a little light wine with it, for the constant ejaculation is weakening; he should be careful as to resting,[323] lie on a cool bed, either on the right side or the left (Paulus Aegineta), not on the back (Celsus).
Where the complaint is of longer continuance, exercise in the open air and the use of cold baths is to be recommended, which latter Celsus[324] it appears prefers to see resorted to, as well as cold aspersions, almost at the very commencement; a mode of treatment that is even now coming into fashion again among ourselves, as the water-cure mania makes further and further progress. Galen[325] recommended, besides diet and medicine, that with a view to retarding the preparation of semen, gymnastic exercises, particularly such as bring the upper part of the body into activity, e.g. ball-playing both with great and little balls and the casting of leaden disks, be resorted to. After bathing, patients must rub and wash over the hips with desiccative ointments, oil expressed from red, coarse olives, roses or quinces, wax-salves with the juices of sempervivum (evergreen house-leek), solanum (nightshade), umbilicus Veneris (navelwort), portulaca (purslain), linseed boiled in water, etc. I once saw, he says, the Intendant of a Gymnasium Athletes lay a leaden disk on the lumbar region of an athlete as a measure against nocturnal pollution,—a means Caelius Aurelianus prescribed also for gonorrhœal patients,—and afterwards recommended the same treatment to another sufferer from these, who was thankful for the advice. Others again found lying on the agnus castus beneficial to them, as well as the taking of its juice along with rue. Violently active refrigerants in the form of ointments, prepared from poppy and atropa mandragora should not be employed, and this equally applies to sleeping on these plants when they are in bloom, for they act injuriously on the kidneys. On the other hand sleeping on roses was advantageous,—Caelius Aurelianus added to the list the leaves and flowers of vitex (agnus castus, Abraham’s balm). “Besides these I have excogitated many other specifics for patients of the sort, and found their utility confirmed in practice. For instance those afflicted with such a condition of body should pay particular attention to this. When the accumulation of semen that has to be ejaculated is at its greatest, they should during the day take a nourishing yet moderate meal, and then when they lie down to sleep accomplish sexual intercourse.[326] But on the following day, after taking their fill of sleep, they should on rising chafe themselves till the skin is reddened. Next they should rub the body all over with oil; then soon after take some well-leavened, pure bread, baked in the baking-pan, and mixed with wine, after which they may then go about their customary business. Between the rubbing with oil and the meal of bread patients may go for a walk, if there is a spot convenient for the purpose in the neighbourhood, except in the colder time of the year, for at that season it is better for them to stay indoors.”
With regard to gonorrhœa in women, it is all but impossible to arrive at any accurate knowledge of what the Ancient Physicians knew concerning it. The reason of this is that the views held as to the effect of deteriorated menstrual blood and of the ῥοῦς γυναικεῖος (female discharge), by means of which the whole body was supposed to purge itself of evil humours,[327] absolutely precluded the possibility of any unprejudiced observation, in precisely the same way as down to quite modern times the fluor albus (white flux, blennorrhœa) conditioned the extremely imperfect knowledge possessed by the faculty of female gonorrhœa. We purpose to leave over the inquiry into the points which differentiate the two (male and female gonorrhœa) to another opportunity; and will only note here that gonorrhœa in women, strictly so called, was by no means utterly unknown,—in fact there is no doubt whatever as to its being distinguished from the ῥοῦς γυναικεῖος (female discharge), as is shown by the passage of Galen quoted above, and still more clearly by Aretaeus,[328] who speaks of γονόῤῥοια γυναικεῖα (female gonorrhœa) distinctly as ἄλλος ῥόος λευκὸς, another species of white flux. Whether perhaps this knowledge was first accumulated at the epoch of Tiberius and his fellows cannot indeed be positively determined; but certainly the word ἐλέξαμεν (we have named it) of the text of Aretaeus may very well leave room for such a conjecture, and as a matter of fact Aretaeus would appear to have lived under Domitian, and was therefore a contemporary of Martial’s!