We have now seen that Climate is ipso facto an important factor favourable to the rise of affections of the genital organs. How much more powerful an influence must it exert on such affections when already in existence. Thus the question, what influence did Climate manifest in Antiquity on the character and course of affections of the genitals, is one of the utmost moment in connection with a History of Venereal disease,—the more so as on a correct answer being given to it depends the correctness of our views as to the form taken in such cases by the morbid process in Ancient times. True such a question presupposes the existence of these affections, and ought therefore, strictly speaking, only to be raised after the conclusion of our present investigations. However we think enough evidence has already been adduced in the preceding pages to remove all possible doubt from the mind of an attentive reader as to such being the case. Besides, this appears to us the more convenient course,—to survey in its entirety the influence exerted by Climate, rather than to take up our investigation of the subject afresh in different places, and thus to a greater or less extent mangle the discussion of it.
Preponderance of the vegetative principle combined with a certain slackness of tissue is the character of all organisms coming under the influence of the climate of Southern lands. In these countries an extra-ordinary stimulus acts on the mucous membrane of the genitals, and the character described will find its expression here also. Reaction will proceed not so much from the arterial side, or show itself under the guise of sthenic inflammation, but rather take the form merely of intensified secretion. What this increased secretion aims at is the removal of the abnormal stimulus, and the flow of mucus so originating manifests itself as simple, so to speak merely catarrhal, blennorrhoea. This, where the atmosphere is not impregnated with moist vapours, readily disappears, if only somewhat greater care is bestowed on the maintenance of cleanliness,—and all the more so, as re-absorption, which in hot climates acts vigorously on all the mucous membranes generally, very soon gets the upper hand again in the case of that of the genital organs, seconded as it is by the activity of the external skin. The latter is always in a condition of enhanced action at the same time, while the extent of its surface of course markedly exceeds that of the mucous membrane of the genitals. On the other hand where the atmosphere is especially moist, the activity of the skin, as well as the process of re-absorption internally, appears to be less; and so under these circumstances the mucous flow will assume more of a chronic character, but at the same time to an even greater degree be free from inflammatory reaction.
All the more recent observations agree in one thing, viz. that in Southern countries the gonorrhoeal forms predominate, and speaking generally, almost always run a mild course that hardly calls for medical interference. There is no doubt Climatic conditions in Antiquity differed but little from those of to-day; so that we may safely assume that equally in Ancient times blennorrhoea showed the same general characteristics, a fact which existing traditions moreover prove beyond question. The frequency of blennorrhoea of the genital organs in Antiquity is shown at once by the just quoted passage from the Mosaic Books, while its mildness of character may be gathered amongst other things from the remedies employed by the old Physicians, who almost without exception followed the principle laid down by Celsus (VI. 18.), to treat gonorrhoea levibus medicamentis (with gentle remedial measures), if they were called upon to apply treatment at all. At least this is true of acute blennorrhoea; the chronic form of the complaint, with which alone as a general rule they had to do, of course required astringents. No doubt each failure of arterial reaction afforded yet another reason for the belief on the part of the Ancients that gonorrhoea was a result of weakness of the seed-secreting vessels, and their idea that the discharge was merely badly prepared semen. Supposing, as must have happened, that marks of increased activity appeared, these proceeded not so much from the circulatory system at all as from the nerves, and Galen[162] was correct in referring Priapism under these conditions to spasmodic convulsion.
So much for mucous discharge. It was the same also with the various forms of ulceration of the genitals. The conditions to be enumerated presently in the next Section were already present to counteract their rise in any considerable proportion. Further, if they did appear in the high lands of Asia and in Upper Egypt more frequently than did blennorhoea,—this much is shown plainly at any rate by present-day experience,—still they lasted but a short time, as the preponderant activity of vegetative growth, seconded by extraneous assistance, soon mastered the disease, and quickly restored again the loss of tissue. The course of events was otherwise indeed on lower levels, as in Syria and Lower Egypt, districts which besides their high temperature also showed a considerable degree of moisture in the atmosphere and soil. Here accordingly the different forms of ulceration, unless careful precautions were taken, assumed a malignant character, and readily passed over into gangrene (ἄνθραξ), as we saw a little above happened in the cases of Apion and Hero. By this means it is true every specific characteristic of the morbid alteration was annihilated; but this only made the risk to the individual so much the greater, the patient being at best only too apt to lose the organ attacked
Again, though sometimes the part escaped destruction by gangrene, even then its cure was often difficult owing to the fact that, where the malady had been neglected, worms made their appearance in the ulcers[163], and set up so profuse and so far spreading a suppuration that the patient eventually succumbed to it. Of this we have an example in the Emperor Galerius Maximianus, mentioned by Eusebius[164], and to which allusion is made as early as in the Book of Ecclesiasticus (XIX. 2, 3.), when the Author, Jesus the son of Sirach, says: “Wine and women will make men of understanding to fall away: and he that cleaveth to harlots will become impudent. Moths (otherwise[165]—Rottenness and worms) shall have him to heritage, and a bold man shall be taken away.” The use of knife and actual cautery must naturally have played an important part under these circumstances in the treatment adopted; but these the patient often dreaded more than the malady itself, and chose suicide rather than submit to them, like the “Municeps” whose story Pliny tells in the passage quoted in a previous chapter. But now supposing suchlike ulcers to be situated in the mouth of a fellator or cunnilingue, then their course must have been all the more rapid, and the danger involved all the greater, if the patient lived in such a climate as described; and it was in this way the Αἰγύπτια καὶ Συριακὰ and Βουβαστικὰ ἕλκεα (Egyptian and Syrian sores, Bubastic sores) mentioned above acquired their evil repute. Still in the majority of cases these climatic influences could be counteracted by appropriate medical aid and dietetic measures, or at any rate their effect considerably reduced. Hence it was that cases of the sort only very rarely appeared in Antiquity, and for this very reason were noted by the Historians, when they did occur.
The human organism possessed in Southern lands yet another way of combating the enemy’s attacks, one which would seem to have escaped the notice of the Physicians of Antiquity, and which, though recognized in modern times, has yet never been at all adequately appreciated and utilized in the history of Venereal disease, viz. the reaction exhibited by the skin in diseases of the genital organs in hot climates. So long as authorities thought of the external skin as merely compacted of separate and distinct layers of tissue, there could not really be any question of an accurate knowledge of its functions whether under healthy or under morbid conditions. The investigations of Breschet and Roussel de Vauzène[166] as confirmed and reinforced by Gurlt[167], have now taught us to understand that the skin, over and above these layers, possesses as a matter of fact,—a fact formerly only conjectured,—special organs belonging to the same class as the glands, to wit the skin, hair and sweat glands. These share amongst them the function hitherto ascribed to the skin generally, and especially bring into correlation the sympathies of the different parts, so much so that they may be said to be almost the sole and only seat of the manifold forms of skin-diseases. All this we endeavoured first to demonstrate in the series of Articles on Skin-diseases in “Blasius’ Handwörterbuch der Chirurgie und Augenheilkunde” (Manual of Surgery and Ophthalmology), and so pave the way for a compendious Survey of our knowledge of the Skin-diseases up to the present time.
Now while the sweat-glands stand in a special connection of sympathy and antagonism with the lungs, the same correlation exists in a peculiar degree between the glands of the mucous membrane of the intestinal canal and of the genital organs on the one hand and the cutaneous glands on the other which secrete the sebum or sebaceous humour. It would take us too far a-field, if we undertook in this place to enter upon a detailed explanation of this circumstance, which however is still in sore need of further clearing up. We shall content ourselves with recalling the fact that Onanists (Masturbators) not only often betray themselves by having a nose with a shiny, tallowy looking surface that comes from excessive secretion of sebum, but also not less frequently by their face being covered with acne pustulus. One more fact we must mention is that the outbreak of acne very often with girls heralds the approach of each period of menstruation, and accompanies it[168]. These are signs clearly pointing to the conclusion that stimulations of the genitals are reflected back on the glands of the skin, for acne is nothing else but an affection of these glands, as we have demonstrated in the Work just mentioned.
But indeed there are proofs of this antagonism still nearer to hand. How frequently have our physicians observed an eruption[169] resembling roseola or urticaria in character, at the—very often sudden—appearance of which the gonorrhoeal symptoms have much decreased in severity or disappeared altogether! These skin affections have been ascribed to the balsam of Copaiva or the Cubebs pepper administered in these cases, which are supposed to have stimulated the intestinal mucous membrane and so sympathetically excited the skin. This may very possibly sometimes be the case; but it could not but occur much more frequently, if the remedial agents mentioned are to bear the sole and entire blame. No doubt in some patients a particular idiosyncrasy may have given rise to sympathetic action stimulative of the intestinal canal, but in the majority the reaction of the mucous membrane of the genitals on the cutaneous glands has undoubtedly been a chief contributory factor under epidemic influences, while the drugs exhibited have played only a subordinate part in producing the result. There are cases where the gonorrhœa has been treated simply and solely by mere antiphlogistic methods, and yet such an eruption has been observed.
But it is not in gonorrhœa only that these phænomena appear; they have been noted as well in chancre, being then ascribed to the sublimate of mercury and looked upon as affording a criterion that the drug had exercised its full effect on the original complaint. In most cases this was without doubt a mistake, for Biett, Rayer and other authorities have noted the most widely divergent forms of skin-disease to appear concurrently with the existence of chancre, and in consequence have come to regard them as primitive symptoms. In fact cases have actually been observed, where these were the sole primary symptoms of contagion after indulgence in unclean coition. At the same time it is only fair to say that this has been doubted in many quarters, observers trying to explain the fact of the absence of other symptoms by saying the ulcers, which are frequently very minute, may have been overlooked. At least experience has sufficiently taught us this much, that the so-called secondary symptoms, and therefore the skin-affections as well, appear the more readily in proportion as the ulcers of the genitals are smaller and more superficial; and we ourselves believe that never without local reaction on the genital organs from coition do so-called secondary appearances arise,—only it is not invariably ulcers that are to looked for.
Now when even in our temperate climate the cutaneous glands play a not unimportant part in the morbid processes of Venereal disease, how much more must this be the case in Asia and Egypt, where the activity of the skin generally and that of the cutaneous glands in particular is even under normal conditions far more conspicuously energetic, as may be seen from the constant oily state of the skin, more particularly in Negroes. This oily grease on the skin is in fact nothing more nor less than the product of the action of the cutaneous glands. These glands are peculiarly apt to become morbidly affected in travellers visiting the South during their acclimatisation; though natives too are yearly attacked in the Summer months by complaints of the skin-glands.[170] The fact has long been recognized[171] that in Southern countries not only the greater number of skin-diseases, but even Venereal disease itself in an especial degree, appear as an exanthema of the skin, and for this reason it there displays far less destructive effects; but as a rule enquirers have contented themselves with the general habit, without (as pointed out before) adequately turning the fact to advantage in connection with the History and Theory of Venereal disease.