Induration of the testicles is mentioned by Galen,[346] who assigns it as one cause of sterility. The same author[347] likewise speaks of the testicles being affected with aphthae (διδύμους ἀφθῶντας), which he says should be treated with terra cimolia (Cimolian chalk) and myrtle-berries.
[§ 41.]
3. Ulcers of the Genitals.
φθινάς, ἄνθραξ, ἔσχαρα,—robigo, cancer. (Wasting ulcer, malignant pustule, scab,—ulcerous sore, eating, suppurating ulcer).
Though we cannot exactly subscribe to Alexander Simon’s declaration to the effect that it would fill whole volumes, if we wished to cite systematically and in full all that has been said by the oldest and earlier medical Writers on ulcerous affections that attack the sexual parts from the points of view of pathology and therapeutics, still the number of such passages is no doubt sufficiently imposing. Unfortunately their contents cannot be described as equally important; for the pathological side is sacrificed to the therapeutic,—in fact the great majority give nothing more than the general names ἕλκος (ulcer) or φλεγμονὴ αἰδοίου (inflamed tumour of the privates), and then at once pass on to discuss the remedial measures expedient. This mode of procedure is indeed quite consistent with the general character of medical science in those days, for it is always the case that the more medicine declines, the more practitioners think themselves bound to look for remedial means nowhere but in the prescription-books. Curiously enough we find that almost every thing given by the later physicians already has a place in the pages of Celsus; the latter probably utilized the Alexandrian physicians, on whose knowledge the later Writers appear to have made little advance.
Now with regard to ulcers of the genitals in general,—these are of frequent occurrence, as to begin with the parts are from their very constitution prone to putrefactive changes, as well owing to their moist nature, possessing as they do so many glands that draw moisture together, and being covered with hair, as because they are at the same time excretory organs[348]. The time of year exerts an influence on the appearance of such ulcers, for they show themselves chiefly in the summer,[349] particularly when a South wind is blowing,[350] a wind that is moist and warm and fosters a tendency towards the resolution of fluid and solid parts alike. Thus ulcers of the genitals are likewise subject to epidemic influence, as has been clearly demonstrated on previous pages. They are acquired by coition, and that equally by natural coition, as the instance of Hero mentioned on a previous page shows without a shadow of doubt, as by the unnatural forms, and particularly by paederastia, which last caused the malady of Naevolus’slave also referred to in an earlier passage. Moreover in the hot regions of Asia and Africa want of cleanliness also, especially when men were uncircumcised, gave occasion, as in Apion’s case, to the establishment of ulcers of the genitals. These were looked upon by the Ancient physicians in most instances as an outcome of the evil humours of the body,—an opinion which need cause us less surprise as even in much more modern times a large number of physicians have endeavoured to explain the origin of chancres by an antecedent general infection, that manifested itself in this way, viz. by the appearance of these sores. Ulcers not unfrequently took the form of aphthae, particularly in women,[351] being in that case more superficial, but for that very reason readily eating their way over adjacent parts,—(cancer, eating ulcer). In many instances inflammation (φλεγμονὴ, ἐρυσίπελας—phlegmonous inflammation, erysipelas) and swelling of the parts affected were accompanying circumstances. They were often painful,—sometimes moist, sometimes dry. In the majority of cases they assumed under favouring conditions a putrefactive character (φαγέδαινα,—phagedenic or eating ulcer), under which circumstances worms actually bred in the sores, or else they manifested from the very first a marked tendency to pass over into gangrene (ἄνθραξ, carbunculus,—malignant pustule, carbuncle), where as a rule merely an ulcer developing from a minute bladder (bleb) or φύμα existed in the first instance. On the other hand its course was often very chronic, without phlegmonous ulcers at all, or if these were present, either they were callous, or else condylomatous outgrowths sprung from them.
In accordance with these varying factors did the treatment of ulcers of the genitals vary, though without any universally recognized special distinction from that adopted for ulcers in general. Speaking generally, purgings by the rectum are not indicated; but preferably in affections of the genitals revulsory treatment by emetics is employed.[352] If blood-letting is resorted to, it must be either in the hollow of the knee or at the ankle.[353] As to local measures, fatty matters according to Antyllus are not good for the genitals,[354] whereas astringents and desiccatives are beneficial, if that is to say the phlegmonous condition is absent.[355] On the contrary if the latter is found, this must in the first place be combated, then a mixture applied consisting of sifted resin and pounded cumin, or alternatively a poultice of barley-meal, hydromel and vine-leaves reduced to a pulp, or else cumin with butter and tree-resin.[356] Above all Galen[357] recommended in the early stages before the appearance of an eating or phagedenic ulcer (κατὰ τῶν ἐν αἰδοίοις φλεγμονῶν ἐν ἀρχῇ, πρὶν ὑποφαίνεσθαι τινα νομώδη σηπέδονα,—in phlegmonous affections of the privates at the commencement, before any eating ulceration appear) a ceratum rosaceum (wax-salve of roses), the preparation of which he gives in extenso, and Aëtius copying from him; its activity is enhanced by the addition of a little oleum sabinum (Sabine oil). If the ulcers are complicated with swelling, a compound of white-lead (ψιμύθιον) and triturated vine-leaves is applied,[358] sea-water compresses,[359] or poultices of boiled lentils and pomegranate rind.[360] For painful ulcers pompholyx (flowers of zinc)[361] was particularly recommended, or a decoction of linseed with the addition of myrrh; also woman’s milk may be advantageously used as well,[362] especially with the addition of anodynes, and above all pompholyx or flowers of zinc. Paulus Aegineta (loco citato) prescribed the application of butter and resin melted together in equal parts, or linseed ground up with myrrh and resin. In raw and dry ulcers of the genitals the aloe was very generally prescribed; it was powdered and sprinkled over the sore,[363] or if a phlegmonous condition was already established, dissolved in water.[364] In the second case Oribasius[365] prescribed likewise the use of lead,—and indeed it was a usual recommendation with regard to most of the recognized remedies that they should be pounded and triturated in leaden mortars with leaden pestles.
Superficial ulcers of an aphthae-like character were treated as early as in Hippocrates’ time and indeed by him[366] with a decoction of myrtle-berries boiled in wine. As a remedy against moist ulcers a certain mixture of Crito’s, compounded of frankincense and myrrh boiled in sweet wine, had a great reputation;[367] but above all the powder of charta usta (papyrus ash), anise and cucurbita (gourd)[368] was employed, after the ulcer had been washed with urine; further the cortex pinus (cork-tree), lapis haematites (bloodstone, haematite iron-ore),[369] to which frankincense was added in the case of more deep-seated ulcers,[370] also cadmium ustum (burnt calamine) (Paulus Aegineta); likewise washing with urine proved beneficial.[371] In spreading or eating ulcers (νομῶδες ἕλκος) a poultice was applied of lentils, pomegranates and oxymel[372] reduced to a pulp; but a still more usual remedy was to sprinkle verdigris over the sore,[373] and especially verdigris in conjunction with a salve made of charta usta (papyrus ash), sulphur, lead-slag, honey and ceratum rosaceum (wax-salve of roses); another remedy highly thought of was the pastillus corax (corax cake), the ingredients of which were verdigris, chalk, gallnut, frankincense, turpentine, wax, oil of myrtles and beef-tallow; this was particularly beneficial in combating the carbunculous form of the disease. Very often however recourse to the cauterizing iron and the knife was unavoidable, especially if gangrene supervened, or if the callosity of the edges of the ulcer made cicatrisation impossible.
Such were the general methods of treatment employed for ulcers of the genital organs, but these naturally varied according to the various distinctions between the several sorts conditional on the situation of the sore. Thus it becomes our next business to indicate on what parts of the body ulcers were observed:—
A. Ulcers on the male Genital Organs.
It is invariably the case that forms of ulceration affecting the male genitals are the most familiar and best known, and this was equally true in Antiquity. Whatever information the Ancient physicians deemed it necessary to record on the subject is found as early as Celsus laid down with something approaching to completeness in his writings (VI. 18.).