This preponderating bias towards the external skin must obviously manifest itself equally in other diseases of the mucous membranes, and so too in those of the genital organs. Reabsorption in particular, acting with increased vigour on the mucous surfaces, will prove its beneficial presence also in the diseases affecting them. The foreign matter that comes in contact with these surfaces is assimilated to a less degree by the mucous glands and by those of the glans penis, and no time is allowed it to exert a destructive influence on the small surface receiving it; on the other hand it is quickly thrown back on the much more extensive surface of the external skin, and there dealt with by the cutaneous glands with their powerful secretive and assimilatory action, being either assimilated or expelled externally.
In particular localities this quickly happens without any striking symptoms being locally perceptible in the skin, as e.g. in Numidia, Libya[172] and the Northern part of Peru[173], where the disease is said to cure itself without extraneous medical aid, and among the inhabitants generally to be practically non-existent(?). Though this is not the case in other countries, still the cutaneous glands become involved in the morbid process of the disease, and secrete with augmented copiousness, and the secretion being simultaneously altered in character, it fails to be driven out externally, inasmuch as external elimination is at once stopped owing to the fact that the cutaneous glands, like the uterus in pregnancy, close their orifice, so as to be enabled to carry out their function in their recesses. For this reason the glands swell, and manifest themselves in the form of papillae or tubercles (very often as little bladders, or blebs), changing later either into pustules, if the morbid products are eventually expelled[174], or else gradually disappear, if the process of assimilation and re-absorption has been sufficiently vigorous. Supposing damp, cold or other unfavourable influences to be at work, suppuration may very well supervene, or degenerative processes commence, and so on, and the disease pass over into leprosy and elephantiasis. This is above all the case in Egypt, where from the first, chancres on the genitals would seem to possess a marked tendency towards scurfy and scabby formations[175].
If these are the facts at the present day,—and no one doubts they are,—there only remains the question: were they so in Ancient times as well? Here we come face to face with the difficult problem as to the relation of leprosy with Venereal disease,—a problem which for Centuries has been the subject of dispute, and in spite of the very careful enquiries of a Hensler and of other investigators, cannot by any means be regarded as solved. Our own investigations on the Leprosy of the Ancients are as yet too incomplete, and the nature of the subject demands such far-reaching inquisition into the most widely different individual phænomena, that we are compelled, in order to economise our space, to renounce all idea of submitting the subject to any more detailed examination in the present Work. Besides, in our Second Part we shall be coming back to it again, when we have under investigation the question as to whether or no the Venereal disease of the XVth Century was developed from leprosy.
For our present purpose the following statement must suffice: The Climate of Asia and Egypt was in Antiquity, as mentioned already, undoubtedly but little different from what it is to-day, and the influence it exerted therefore must have shared in this resemblance[176].
As to mentagra, we have already proved a little above that it was a consequence of the vice of the cunnilingue, and as according to Pliny’s report the latter claimed Egypt for its fatherland, obviously the climate of that country must have been in part responsible for its origination. Now affections of the genital organs being found in Antiquity as the result of sexual intercourse, it follows that in this direction also Climate must have exerted its influence, and that in the very same way as we have just above seen it do,—in other words manifold affections of the skin must have originated in consequence of irritation and other morbid effects on the genital organs. True the Ancient physicians say not a word of this; but then they derive the greater proportion of the skin-diseases, which they mass all together in the most admired confusion, from internal mischief of various sorts, and regard them all as apostases (suppurative inflammations carrying off the effect of fevers, etc.),—at any rate a proof they were not entirely unacquainted with the antagonistic relations existing between the skin and other organs.
So far as the genitals are concerned, they seem to have adequately realized only the consensus between the uterus and the skin[177], whereas in male subjects they appear to have put down most of the effects observed to the liver. But on these points we shall have something further to say later on. Still the assertion to the effect that Eunuchs are not attacked by calvities (baldness) (Hippocrates, I. 400; Galen, XVIII. A. 40., also p. 42., where mention is made of the excesses in Baccho et Venere—in Wine and Love—peculiarly prevalent at his epoch), which was a frequent consequence of vice in Antiquity[178], points to the consensus between genitals and skin having been already noted. Even more is the fact, vouched for by Archigenes[179], that castration was recommended by some Physicians as a cure for elephantiasis, such as to arouse the suspicion that the physicians of Antiquity knew perfectly well what influence affections of the genital organs exerted on diseases of the skin. This is made all the more likely by Archigenes (ch. 120.) not only speaking of the disease as being contagious, but also describing the skin-affection as secondary in character. He further declares its cause to be unknown, puts on record the extreme lubricity of the patients (Satyriasis pp. 74, 133, 269.), and even says in so many words that such as were castrated did not contract elephantiasis!
We have seen how mentagra attacked the cunnilingue, and afterwards passed over into psora; in just the same way might elephantiasis,—a complaint indeed which the Gloss of the Pseudo-Galen actually puts in connection with the Morbus Phoeniceus (Phoenician Disease),—be brought on by indulgence in coition. This is in no way contradicted by the preference the disease exhibits for first making its appearance in the face, inasmuch as the cutaneous glands of the face are in a relation of special sympathy with the genital organs. That leprosy too no less than elephantiasis was communicated and contracted by coition is shown by a host of examples given in the Mediæval Historians[180]; in fact, a large number of Physicians held Venereal disease to be a species of leprosy or elephantiasis, while some made it actually originate in the act of coition with leprous persons; yet for all that we do not, according to Hensler, (“Vom Aussatz”,—On Leprosy, p. 396.), find it anywhere recorded that the genital organs were first affected,—apart that is from what Astruc has brought forward on purpose to support his own view. As everybody knows, he refers all local evils existing prior to the end of the XVth Century to Leprosy.
But what would follow supposing traces were actually to be found proving that what was known in Asia as leprosy did as a matter of fact first show itself in the genitals? Before we enter upon the closer examination of reasons for this supposition, we must quote a passage from the Work of Von Roeser already several times mentioned, a passage equally important for the pathology of Venereal disease as for its History. Von Roeser, (p. 68.) writes thus: “Primary syphilis manifests itself in Egypt in the very rarest cases on the prepuce or glans of the verge; the chancres are more commonly found on the outer skin of the penis nearer the mons Veneris, or actually on this in the hairy parts which among Egyptians and Arabs are generally kept shaved, or else on the scrotum. Pruner[181] told me that the occurrence of a chancre on the prepuce, which indeed is absent in Mohammedans owing to circumcision, or on the glans penis is in the ratio of 1: 3 to chancres on the last mentioned parts, hence in that country Astruc’s opinion that syphilitic ulcers hardly ever formed on the exterior of the verge, is strongly contradicted,—as is no less true amongst ourselves. That circumcision is not the sole cause of this phænomenon is manifest from the fact that in Smyrna and Constantinople I saw plenty of chancres on the glans, as well as amongst Jews at home, though I am not going to deny that circumcision may have some share in causing the rarity of the appearance of a chancre on the glans,—but this does not in any way explain the frequency of their appearance on the scrotum and the mons Veneris. A tendency to take the exanthematic type, a tendency which makes itself known also by the fact of many chancres commonly appearing at once and showing in a marked degree a preference for scurfy and scabby forms, might very possibly afford a better explanation of the phænomenon in question.”
Now as to the supposition just expressed, this is based on a repeated examination of a passage of the very utmost importance in the history of leprosy, viz. Ch. XIII. of Leviticus—a chapter which has exercised Theologians no less than Physicians for Centuries, but without our being enabled to regard the investigations it has given rise to as in any way concluded. However it is no intention of ours to provide in this place a commentary on this Chapter, more particularly as we do not possess the philological acquirements necessary for a critical appreciation of the results so far obtained. Neither, speaking in general terms, has anything like sufficient progress in the study of original sources for the history of leprosy as yet been made to enable an adequate judgement to be formed; we much prefer to limit our efforts at present to contributing sundry observations, which stand in close connection with our immediate object, and at the same time may afford readers, whether scientific or philological authorities, an opportunity of favouring us with their judgement as specialists.
The correct understanding of the whole passage appears to us to depend in the first place on the success of the endeavour to find a certain and definite explanation of the expression בְּעוֹר בְּשָׂרוֹ (b’ôr b’sarô,—“skin of the flesh” in English Authorized Version). Luther rendered this by: on the skin of his flesh; the Septuagint translators give it as ἐν δέρματι χρωτὸς αὐτοῦ (in the skin of the surface); while de Wette (whose Translation of the passage generally we hereby ask the reader to consult, space not allowing us to quote the whole Chapter) translates it on the skin of his body, and understands by the expression every part of the external skin.