APPENDIX
VENEREAL DISEASES IN THE HOMOSEXUAL
It is an old belief, shared by the homosexual themselves, that venereal infections are extremely rare among them. If male homosexual persons had sexual intercourse only with one another, this assumption would be in some degree plausible. For the principal focus of venereal infection is feminine prostitution, by which venereal diseases are transmitted to heterosexual men. But since these homosexual men often undertake sexual acts with heterosexual men—apart from occasional sexual intercourse with women—a priori there is a possibility of infection in their case, and such infection is, in fact, observed. Above all, many male prostitutes also indulge in intercourse with women, and thus diffuse venereal troubles among homosexual men.
It is obvious that syphilis can be diffused among the homosexual as easily as among the heterosexual, for syphilis is transmitted by many varieties of contact—by kisses, other caresses, etc. But how is it as regards gonorrhœa?
In the case of heterosexual men and women gonorrhœa is almost exclusively transmitted by the sexual act, by the introduction of the male penis into the female vagina. The analogous act between men—that is to say, pæderasty, immissio penis in anum—is unquestionably far rarer than the ordinary sexual act between men and women; it is commonly replaced by mutual onanism, by kisses and other caresses, and quite frequently by coitus in os. This last is much commoner than genuine pædication. Of gonorrhœa of the rectum produced by pædication when the active man is suffering from gonorrhœa, we very rarely hear. But is there, in the case of homosexual men, any possibility of gonorrhœal infection due to coitus in os?
There can be no doubt that typical gonorrhœa of the mouth occurs. The observations of Kuttler, Atkinson, Rosinski, Dohrn, and Kast, have proved it.[328] Horand and Cazenave have even observed gonorrhœal infection of the urethra as a result of oral coitus![329] A homosexual patient told me that some years before, after coitus in os with a man, he had for several weeks had a discharge from the urethra, which spontaneously ceased, and therefore cannot have been genuine gonorrhœa, but only urethritis resulting from infection by contagious angina. In the case in question, the urethral catarrh was certainly due to the coitus in os, since any other sources of infection could be excluded.
On the other hand, in a second case an apparently gonorrhœal infection of the oral cavity was transmitted from the urethra.
A homosexual man, forty-five years of age, one day allowed a heterosexual man to perform coitus in os on him. Some days afterwards he experienced difficulty in swallowing, was feverish, and saw in the looking-glass that the uvula was swollen. A specialist for throat troubles diagnosed merely a catarrhal infection. The illness became worse, and a second throat specialist detected the presence of a purulent angina of both tonsils, ordered painting with argentamin, also vapour baths, and an astringent gargle, whereupon the affection gradually subsided. Six weeks later the patient had swelling and pain in the joints of the right knee and foot; under cold compresses these swellings subsided after a fortnight. Of the whole trouble nothing now remains.
This description, on the part of a patient who is thoroughly trustworthy, aroused strong suspicion of a gonorrhœal angina, with a consecutive gonorrhœal arthritis. Unfortunately, the purulent discharge from the tonsils was not examined for gonococci by either of the physicians in attendance. The case remains, anyhow, very remarkable.
In the case of homosexual women, it is obvious that syphilis, and also gonorrhœa, can be transmitted, the latter by mutual friction of the genital organs. I do not know what actually occurs in practice.