Supposing the view, still generally held even in the last Century, that regards gonorrhœa as a result of an ulcer in the urethra, to have been already adopted in Hippocrates’time,—and inasmuch as the expression γονοῤῥοία, so far as we know, never occurs in his writings, the assumption would not only not be absurd, but such a view would really be preferable to that which makes out the discharge to be badly made semen,—we shall find in this passage an expression of the fact of the more common occurrence of gonorrhœa, the most troublesome symptom of which, viz. the pain suffered during micturition (πόνος, δυσουρία, ἰσχουρία, suffering, difficulty in micturition, retention of urine), disappears, as is well known, concurrently with the commencement of the discharge (πύου ῥαγέντος, φυμάτων ῥαγέντων,—when the pus has broken out, when the abscess has broken), or if it does not entirely disappear, is at any rate sensibly diminished. But it is not really needful to accept this as having been the ruling opinion; the facts may very well be accounted for by supposing that in virtue of the epidemic condition a strongly marked tendency was set up on the part of the glandular organs to inflammatory and suppurative action, by which not merely the glands of the external skin (ἑλκώματα ἔξωθεν),—ulcerations on the outside, Moses’שְׁחִין ,שְׂאֵת but also those of the mucous membrane of the urethra (φύματα ἔσωθεν,—abscesses on the inside) were affected, exactly as is observed at the present day, especially in the chronic forms of gonorrhœa.
The gonorrhœa then in this case would seem to have been of a more malignant type and to have been combined with ulceration. This best agrees with the general delineation of the epidemic condition as a whole, the exanthematic character of which declared itself in the fig-like growths or tumours,—the σῦκα αἰδοίοισιν (figs on the genitals). Grimm (Vol. I. p. 490.) already remarks on this passage of Hippocrates: “One might be tempted in this case to regard the ulcerations of the genital parts and their consequences, the fig-like tumours, as being the first signs of disease due to incontinence. Indeed what was there to hinder an evil of the sort in those times and under a warm climate from signalizing itself,—then subsequently so far losing its malignant character that its nature was completely misunderstood? Something of the same kind actually happens under our own eyes in connection with this very disease.”
§ 33.
Still more important were the effects of these meteorological conditions on ulcers of the genitals already in existence. We read (loco citato p. 482.): “Even before the beginning of Spring, concurrently with the commencement of the cold time, erysipelas made frequent appearances sometimes with, sometimes without, visible cause; it showed itself highly malignant in type, and carried off many. Many again suffered from painful affections of the pharynx (anginae,—sore throats), loss of voice (affections of the wind-pipe), inflammatory fevers with delirium, aphthae in the mouth, φύματα (abscesses) in the genital organs, ophthalmias, ἄνθρακες (malignant pustules), etc.—Also many got erysipelas from external causes, at such spots as these had happened to affect them, even after the smallest injuries[193], and in all parts of the body. Above all sexagenarians suffered in this way in the head, if they were treated in the smallest degree carelessly. Even under careful and scientific treatment wide-spread phlegmonous affections frequently occurred, while the erysipelas spread to a serious extent and with great rapidity in all directions. In most of the patients so affected the metamorphosis that succeeded was to ulcerations, whilst muscles, sinews and bones fell away to a serious degree. But the morbid product that collected did not resemble ordinary matter (pus), but was a sort of putrid sanies, occurring equally in combination and by itself[194]. Such as were attacked in the head, became bald over the whole head and chin, the bones were laid bare and fell away, and such ῥεύματα (morbid discharges) as described occurred frequently, whether with or without fever. Symptoms of the kind however were more terrifying than really destructive[195], for among patients in whom these (ῥεύματα) came to maturity and resulted in suppuration, the majority were saved; on the contrary many died among those in whom the phlegmonous affections and the erysipelas disappeared, without undergoing any such metamorphosis into other forms of disease. Moreover the same thing happened to those in whose case (the morbid product) attacked some other part of the body. For with many of them the whole upper and fore arm fell away; while in some patients the disease attacked the ribs, the sole difference being whether some destruction was wrought on their anterior or posterior aspect; in others again the whole thigh or the lower leg or the whole foot was laid bare. But the most dangerous of all was, when this or the like happened in the neighbourhood of the private parts or to the private parts themselves, and the mischief manifested itself in the form of ulcers, and as the result of external causes. In many patients suchlike symptoms occurred during, before, as well as after the fever”[196].
Galen, who has left us a Commentary on this passage (Vol. XVII. A.) mentions in the first place that aphthae, φύματα (abscesses) of the genitals, etc. specifically possessed (p. 661.) nothing of κακοηθεία (malignity), but only when as in this case they occurred in conjunction with a putrid general condition. “The putrid character easily arises even without a pestilential general condition, if the parts are attacked by phlegmonous affections or erysipelas, and spreads likewise over the neighbouring parts lying uppermost; hence it is we are compelled after cutting away the decayed tissues to cauterize the place. It is no wonder then, when such a condition has arisen that upper and fore-arm, thigh and lower leg, ribs and head are attacked, if the private parts suffer above all others.—So far the author has discussed those affections of a kind akin to erysipelas which associate themselves with ulcerations or other comparatively insignificant external cause; in what follows he speaks of such attacks as occurred without any such occasioning cause”[197].
Now if we examine these statements, so far as they are of immediate interest in view of our object, we may unhesitatingly conclude from them, that in Hippocrates’time a large number of patients suffered from ulcers of the genitals. These it seems under the influence of the prevailing typhoïdal conditions were assailed by inflammation of an erysipelas-like type, rapidly passing over into humid gangrene, which latter destroyed the parts attacked, readily extended its ravages, and eventually killed the patient. This is an observation which Galen likewise had frequent occasion to make (so probably under the head of Influence of the Climate of Asia, pp. 318, 326, 329.), without any exactly definite typhoïdal conditions having been prevalent[198], and even saw himself under these circumstances very generally constrained, in order to put a stop to the spread of the mortification, to amputate the gangrenous tissue, and afterwards cauterize the wound. What was the origin of these ulcers of the genitals is indeed not stated; but it is certain they were not invariably conditioned by the prevailing genius epidemicus. Besides, since Hippocrates several times mentions them without giving the cause that produced them, it is a more likely conjecture to suppose that this cause was one universally familiar (it consisted in an act of unclean intercourse with women), than to assume it to have been absolutely unknown to physicians generally[199].
Again the result of this investigation is of still more especial interest in so far as it enables us to properly appreciate Thucydides’notice of the so-called Plague of Athens.[200] This has been discussed by very many writers, and has given occasion to the most widely different explanations. He relates as follows: “For the disease which at first had its stronghold in the head, beginning from above downwards traversed by degrees the whole body; and even supposing a patient to have escaped the worst, yet a seizure of the extremities put its mark upon him. For it attacked the genitals and the extremities of the hands and feet; and many escaped death, but with the loss of these parts.” Even more clearly does the poet Lucretius[201] paint the disease, when he says:
Profluvium porro qui tetri sanguinis acre
Exierat; tamen in nervos huic morbus et artus
Ibat et in partes genitales corporis ipsas,