It is true of course that at the period of universal degradation of morals Physicians must have found no lack of opportunities for observation; but the great majority of them were incapable of utilizing these, actually blocked the way of set purpose, as we shall see presently, that led in the direction of more accurate investigation, or else troubled their heads little about the cultivation of Science or the systematic record of observations. The latter, if they had published them, whether in writing or orally, could only have been detrimental, particularly in the case of physicians of the character of Charidemus’ medical attendant,[277] to their own interests. In fact they were bound to call all their subtlety into play for the express purpose of concealing the true cause of diseases of this type, a circumstance which no doubt we have to thank for a large number of the extravagant and often more than ludicrous statements regarding the origin of Venereal disease in the XVth. and XVIth. Centuries.

But as a matter of fact the public itself was no less careful to guard the secret, as we gather from Martial,[278] as well as from the fact that Galen felt himself constrained even in his day to compose a special Treatise on dissimulated diseases. This sort of intentional deception on the part of patients was so much the easier, as Physicians in those times, as said above, in virtue of their pathological views,—some of which indeed may very well have originated in this way,—were little accessible to the truth. For these reasons they deserved, at any rate to some degree, the satiric lash of Martial; and were very generally ridiculed by the more discerning of the laity. This comes out in the important words of Appuleius (Metamorph. X. 211.) as follows: “Crederes et illam fluctuare tantum vaporibus febrium: nisi quod et flebat: Heu medicorum ignavae mentes! Quid venae pulsus, quid caloris intemperantia, quid fatigatus anhelitus et utrimque secus iactatae crebriter laterum mutuae vicissitudines? Dii boni! Quam facilis, licet non artifici medico, cuivis tamen docto venereae cupidinis comprehensio, cum videas aliquem sine corporis calore flagrantem.” (Could you imagine her so tempest-tossed by the vapours of mere fever,—not to mention that she kept forever crying: “Oh! the sorry wits of doctors!” What means the throbbing vein, the excessive temperature, the labouring breath, and the hurried interchange of heaving flank, panting now on one side now on the other? Great heavens! how easy the diagnosis, not of course for a medical expert, but for any one learned in the symptoms of love, when you see a person burning, yet without bodily fever-heat).

But does all this justify us in casting a stone at our medical colleagues of Ancient times? For the last three hundred years we imagine ourselves clearly acquainted with Venereal disease and all its forms; yet how many a bubo has been mistaken for a strangulated hernia, anal callosity, or the like, how many a case of vaginal gonorrhœa for simple fluor albus (white discharge, leucorrhœa), how many a condyloma on the posteriors for hæmorrhoidal swellings, and accordingly not treated as the physician in Juvenal, medico ridente (the physician grinning the while), treated them,—that is duly cut away or ligatured?

Lastly to all these reasons was added further the mildness and absence of danger characterizing the disease itself, at any rate in the majority of instances,—as proved in our earlier investigations. To our own day genuine amateurs of Love, thanks to those who supply “advice, direction and information” on these subjects, endeavour as a rule, at any rate in the earlier stages, to cure without assistance the wounds received in the fight. This was equally so in Antiquity, as the following significant passage of Galen[279] shows: “This is pretty well all I have to say at present as to ephemeral fevers. For patients who have contracted fever consequent upon a bubo, do not consult physicians as to what they must do; but after first treating the ulcer which occasioned the bubo and then the bubo itself, bathe after the abatement of the severity of the attack. After that if any one says a word as to the “diatriton” (fast till the third day), all laugh and declare him a precisian: I suppose because they are of the opinion that nothing must be resigned to nature that is not invariably there.”

We know quite well that the Ancients called all glandular swellings buboes, and that they were perfectly well acquainted[280] with those glandular swellings in the arm-pits and the groin which follow upon ulcers of the fingers and toes; but this in no way justifies us in referring the above passage, which is certainly written in a general sense, solely to suchlike buboes and not equally to those in the soft tissues; more particularly as Galen, in the place where he is dealing expressly with the treatment of buboes and the phlegmonous affections preceding them and occasioning ulcers (loco citato p. 881), explicitly mentions phlegmonous symptoms as κατὰ αἰδοῖον (affecting the privates) and γυναικὶ κατὰ μήτραν ἢ αἰδοῖον (in women affecting womb and privates),—loco citato p. 893. Hence we think ourselves justified in drawing attention to the passage as containing an indication of the reason why ulcers of the genital organs pursued a milder course and admitted of an easier cure in Antiquity, because the ephemera evidently facilitated the assimilation and elimination of the contagion, this taking place either at the point primarily attacked, or else occurring because it (the ephemeral fever) led to an enhanced activity of the cutaneous glands by provoking an exanthematous eruption.

§ 39.

But for no small part of this reluctance on the part of patients the Physicians were themselves to blame. We have no wish in this place to enlarge upon the possibility of professional indiscretion in their case, though long ago the Hippocratic masters saw themselves constrained to guard their scholars against it.[281] Of far greater weight was the nature of the treatment, especially that applied to ulcers of all kinds, which was excellently adapted to fill sufferers with fear and trembling. Already Hippocrates[282] taught that ulcers with callous margins must be cauterized or else cut away with the knife. Galen[283] declares himself even more plainly in the same sense: “But if the margins of the ulcer merely are discoloured and callous, they must be removed right to where the healthy flesh begins. Supposing this condition to have extended more widely, then the question arises,—whether we ought to cut away all the diseased tissue, or prefer a more tedious method of cure. It is natural and necessary in this case to consult the inclination of the patient; for whereas some prefer to avoid the knife and submit to a more tedious treatment, others on the contrary are ready for anything, so long as they get cured.” The same procedure was adopted with ulcers of the genitals, especially gangrenous ulcers, as is proved at once by the passage already quoted on p. 176 of Vol. II above.

The Asiatic, for whom the genital organs were an object of veneration, was no doubt horrified, as the Turk is to this day,[284] at the idea of any such operation on himself; while the licentious Roman, who must have dreaded its very probable result in the entire loss of the further use and enjoyment of the parts in question,[285] sought any other means for choice, preferred to have recourse to Priapus or even resorted to suicide, like the Municeps of Pliny mentioned on p. 257, before he trusted himself to the physicians who ever since the Carnifex (Butcher) Archagathus had appeared at Rome, strove to rival one another in infatuation for cautery and amputation. In any case it was only the direst necessity[286] that drove the sufferer under such circumstances to the physician; while the latter had really and truly no reason for enquiring into the origin of the evil, as very often absolutely no alternative was left him but to grasp the knife or cauterizing iron. In this way medical procedure could not but have fallen into disrepute, while physicians were in most instances necessarily deprived of all opportunity of systematic observation.

Whether there were other factors as well to induce the old Physicians to apply the ordinary treatment of ulcers in general to those of the genital organs, we cannot indeed as yet for the time being determine. Certainly the conjecture is an obvious one that they may well have had an inkling of the specific nature of such ulcers, and that it was not merely the local mischief they sought to put a stop to by early application of cautery and knife. However it is only further and more careful investigations that must be allowed to decide the point,—the more so, as the general views as to the formation of ulcers held by the Ancients seem in many respects to tell against it. Thus Galen[287] says: “The mode in which these (ulcers involving destruction of substance) are set up however is twofold; they arise either by removal of surrounding tissue (ἐκ περιαιρέσεως) or by eating away (ἐξ ἀναβρώσεως). How the former acts is well known. As to the eating away, if it proceed from the inward parts of the organism, it is an outcome of the evil humours; but if it arise from outside, then it is a result of the physician’s remedial measures or of fire.” From this we gather that all ulcers of the genitals, as well as others, which did not result from the action either of remedial measures or of fire, were held as being necessarily an outcome of the evil humours of the body. Further, that this view was not in any way peculiar to the time of Galen, but was a direct and necessary consequence of the further development of the pathology of “humours,” follows from the circumstance that we find the same opinion expressed by Hippocrates.[288] Again Plato shared the latter author’s general doctrine of apostasis (suppurative inflammation taking off evil humours) in his “Timaeus”, where he derives from the white phlegm, striking outwards to the skin, cutaneous eruptions, rashes and the like maladies, from the acrid, salty phlegm on the other hand the fluxes of all types, bearing different names according to the different parts of the body affected.

If we do not choose to infer from this the proof of a then occurring, genuine and consistent genesis of the affections peculiar to the genitals, we are bound at any rate to admit that such a view must necessarily have debarred all thought of any specific character as belonging to ulcers of these organs,—the more so as to this very day we look in vain for any clear conception of really characteristic symptoms marking out Venereal ulcers in particular. Further, the knowledge that ulcers of the genitals were contracted through sexual intercourse, lacked entirely, so far as the ancient Physicians were concerned, the necessary confirmation and authority to induce them to make a special and distinctive class of morbid process to include them, because as a rule they paid no sort of attention to the occasioning cause, unless in virtue of its being still present and active, or else by the necessity for its elimination, it could afford some indication for therapeutic purposes. Galen brings this out best and most clearly in the following passage:[289] “Moreover it will be a fitting occasion now to make it clear that not one of the causes directly occasioning the diathesis, or particular condition of body, will give any indication as to treatment; guiding signs for the purpose must rather be gathered from the complaint itself. What is to be done in any individual case depends on the immediate purpose and the nature of the part attacked, on the predominant temperament and the like facts. For to put it shortly, in no case can an indication as to what is beneficial be taken from any one of the factors that are no longer existent,—i.e. in actual operation. But as it often happens that in order to diagnose some affection that cannot be recognized either by help of ratiocination or by the senses, we are obliged to inquire into the cause that occasioned it, laymen conclude the guiding signs for remedial treatment to be taken from the same source. But this is by no means so. This may be plainly seen in those instances where the diathesis is quite well known in all its details; for whether it be ecchymosis or ulceration or erysipelas or putrescent ulcer (σηπεδὼν) or phlegmonous affection in any organ, it is perfectly useless to trace out the cause that occasioned it (αἴτιον ποίησαν), if this latter is now no longer active. On the other hand for any affection, a clear insight into which is lacking, a knowledge of the occasioning cause is useful.”