Affections of the external skin consequent upon complaints of the genital organs being thus no less common in Ancient times than they are to-day, it follows that in inverse proportion forms of ulceration of the palate and nose, as well as complaints affecting the bones, must have fallen into the background and have been of more rare occurrence, just as is observed to be the case in the present day[189]. So, to combine all the varying forms under one generalisation, we may say that this represents a type of disease of an exceedingly mild and favourable character, particularly if attention is directed only to the external symptoms, as indeed was habitually done by the old pathologists. For even the skin-affection itself presents so little that is characteristic, or at any rate shows itself under such varying shapes, that even at the present day its diagnosis is extremely difficult, being very often based solely and entirely on the admission of the patient, whether voluntary or forced from him, of having suffered from gonorrhœa or chancre. But if the so-called secondary symptoms are more or less completely absent, or lack distinctness, what is there then left beyond the primary affections of the genitals and their succedanea? Full and sufficient descriptions of these are not lacking; we have already quoted numerous examples, and we shall find others yet clearer and more precise later on.
Before quitting the subject of the influence exerted by Climate, we are bound to return once more to the question, in what relation did contagion, if contagion there was, stand to this climatic influence? The existence of contagion in the case of gonorrhœa is certified by the passage of Galen already quoted by Naumann, which we propose later on to give in full, besides being implied long before by the law of purification of the Mosaic Books. So far as ulcerous formations, condylomata and skin-affections such as mentagra etc., are concerned, proof is supplied by the facts we have previously given. According to more modern experience all forms of contagion exhibit in Southern countries a more fugitive type than elsewhere and spread with proportionately greater readiness. Whereas in such as are naturally fugitive, the intensity may for that very reason be less injurious, fixed and stable forms of contagion on the contrary must obviously lose in strength, at any rate so far as their local effects go. They will be the less able to make good a lodgement in the organism, from the fact that, stimulating the latter as they do to a general activity, they are the more readily resisted and prevented by this very state of enhanced activity. For just as, speaking generally, chronic complaints, uncomplicated by fever, can only be removed by artificially setting up a feverish condition, that is to say by calling on the organism as a whole to share in the local manifestations of disease. Precisely the same is true of local affections set up by any fixed and stable contagion, and so the removal of the actual contagion can only be successfully brought about either by direct decomposition and destruction of the affected tissue or by metamorphosis into a fugitive form.
Now inasmuch as the contagion was rapidly thrown off from the point of first infection upon the cutaneous glands,—and this happened the more readily, the more fugitive its character was,—the affections there set up by it standing in such clear relation as they did with the primary symptoms, were necessarily bound also to exhibit a greater or less degree of the contagious character, as indeed is observed according to Jos. Frank, Biett and other authorities even in Europe to the present day. In Greece, where the transformation was less often to pustular and scurfy forms, more frequently merely to papillae or at worst little bladder-like risings, or blebs (Phlyctaenae), while at the same time the energy of the skin was not so pronounced, the interval between the appearance of the primary and secondary symptoms was greater, and the contagiousness of the skin-affections undoubtedly less prominent, it cost the organism in that climate much more strenuous effort to set in action the elimination of the disease by the skin. Consequently the nervous system as well was injuriously affected by sympathy to a greater extent, while the exanthematic forms showed themselves in more obvious conjunction with itch (psora!). This was partially the case in Italy too, though here the climate approximated more nearly to that of Lower Egypt, leading to a more frequent appearance of pustulous forms, as shown by the prevalence in that country of mentagra.
But just as climatic influence relaxed the intensity of contagion, and diminished concurrently the malignancy of disease-types, local as well as general, so on the contrary, in those cases where other influences tended to counteract its effect, while the organism was not strong enough to overmaster the assaults of the enemy by general or local activity, it sought to guard against the contagion rising to a higher degree of independence; it set up mortification of the ulcers, by which means the contagion itself was directly destroyed. From all this it may be concluded, that although climate must evidently be acknowledged to be an important factor favourable to the rise of affections of the genital organs in Antiquity as much as at the present day, yet on the other hand it tended by its own action to combat the mischief it had originated; and so, at any rate so far as the development of the morbid process is concerned, is to be regarded to an almost equal degree as a counteracting influence at the same time.
§ 32.
The experience of all ages has conclusively proved that a large proportion of such morbid phæenomena as occur in consequence of local climatic conditions are capable equally of being produced sooner or later in countries and neighbourhoods the climate of which is entirely different by help of the genius epidemicus; and that the readiness with which they are so produced varies in direct ratio with the degree in which the climate is associated with and seconds the favourable factors. It is indeed extremely difficult, in view of the low level of development to which the science of Epidemics, in general no less than in particular, has as yet attained, to show this as applicable in any given case, more especially if it is a question of the epidemic condition of some disease of which the pathological relations themselves are far from being as yet adequately known. Still this must not prevent us from making at any rate an attempt at investigation of the question, how much or how little effort has been manifested by such influence in the course of years.
But the influence of the genius epidemicus on diseases in general is a twofold one. Either it supplies the capital, most essential external circumstances conditioning the production of a disease, in fact is related to it as cause to effect. In virtue of it the disease is an epidemic disease, coming into existence for the first time concurrently with the development of the genius epidemicus, disappearing again with the cessation of its prevalence, and once again springing up if and when the genius epidemicus makes a second re-appearance. Or else the most essential external conditioning circumstances are specifically independent of the genius epidemicus; while the latter takes merely a remote share in the way of favouring or counteracting the production of the disease, manifesting its influence rather in modifying the form and direction of such morbid reactions as have arisen in the organism without its intervention at all,—in other words the disease is subject to epidemic influence.
Unfortunately hitherto these two kinds of influence exerted by the genius epidemicus have been only too often confounded, and no adequate distinction drawn between epidemic diseases on the one hand and diseases subject to epidemic influence on the other. This has been especially so with regard to Venereal disease, the epidemic character of which curiously enough enquirers have felt bound to vindicate, as well at the beginning of the XVth. Century as here and there even at the present day. The baselessness of such an opinion is so perfectly obvious to anyone who weighs the matter with any care, that we really do not think it necessary to devote more pains now to proving the point, particularly as we propose to treat it more fully in another place. On the other hand Venereal disease is subject to epidemic influence, in fact it is so perhaps to a greater extent than many other forms of sickness, as will be clearly shown in the course of our historical investigations. Accordingly the only question still wanting an answer is, how far such influence may have been effectual in Antiquity. This question of course presupposes the existence already of a number of diseases appearing in consequence of Venereal excesses; still we possess sufficient proof, as previously stated in the course of our enquiries into the influence of climate, to justify a provisional assumption of their existence for our immediate purpose. For openly admitting as we do our ignorance in relation to the influence of the genius epidemicus on sexual activity generally and on the individual activity of the genital organs in particular, and noting the problem to be one that can only be solved in the future, there is nothing else left us to investigate here but this, viz. the influence of the genius epidemicus in reference to the forms taken and course followed by diseases occurring in consequence of Venereal excesses.
It may be collected from later experience and observation that there are three clearly marked forms of the genius epidemicus or epidemic condition, that exercise a preponderating influence on affections of the genitals and Venereal disease, and condition the frequency of the occurrence of one or the other type of these, viz. catarrhal, conditioning blennorrhœal affections, the exanthematic, conditioning complaints of the cutaneous glands, and the typhoïdal, conditioning various forms of chancre and their malignancy.
With regard to the influence of the genius epidemicus catarrhalis and exanthematicus, it would seem to be difficult to arrive at any definite conclusion as to what precisely this was in Asia and the South of Europe, since the Climate was ipso facto, as already shown, pre-eminently favourable to blennorrhœal and cutaneous affections; nevertheless the rise and spread of mentagra as well as of elephantiasis in the time of Pompey the Great does afford some indication at any rate so far as Italy is concerned. No doubt the Hippocratic writers several times mention the prevalence of skin affections at particular periods; but the expressions they employ are too general to make it possible for us to take these into special consideration in this place. However there is one passage we must make an exception of,—a passage of the greatest importance for our purpose, even though in all probability it refers to the commencement of a combined erysipelas-typhoïdal condition, to which we shall have occasion to return again later. In it Hippocrates relates how after a dry Summer with Southerly winds and frequent rain there followed a mild, wet Winter, next cold and even snow-storms succeeded in the Spring with much rain, and finally a very hot Summer again. In the Spring began inflammatory fevers and erysipelas, and[190] “in many cases aphthae and ulcerations formed in the mouth, many rheums occurred in the genitals taking the form of ulcers and abscesses on the external and internal surface of the sexual parts; also eye troubles, with discharge, obstinate, persistent and painful; also growths, which are called σῦκα (figs) on the inner and outer surface of the eye-lids, causing many to lose their sight; besides they frequently occurred on other parts liable to ulceration and particularly on the genital organs.” In this passage the expressions ἑλκώματα, φύματα, ἔξωθεν ἔσωθεν τὰ περὶ βουβῶνας (ulcers and abscesses on the external and internal surface of the sexual parts) is as a rule misunderstood by the annotators. But really ἔξωθεν (on the outside) evidently refers to ἑλκώματα (ulcers), while ἔσωθεν (on the inside) goes with φύματα (abscesses), and signifies a swelling and inflammation of a mucous gland resulting in suppuration, as may be seen from the next quoted Aphorism[191]. “Such patients as have φύματα (abscesses) in the urethra find relief, so soon as these have suppurated and broken.” That this relief (λύσις) consisted in the cessation of pain and of the retention of urine may be gathered not only from Galen’s commentary on the first passage, and from the λύεται ὁ πόνος (the suffering is relieved) in the repetition of the same Aphorism, but Hippocrates actually says so distinctly in a third passage[192].