a. Ulcers of the Prepuce.
According to Leonidas[374] fissures and cracks in the prepuce frequently occurred, in all cases of the latter being too tight and being forcibly drawn back. On these supervened pain and phlegmonous inflammation; and then if a cure were not speedily effected, the edges assumed a condition of callosity, necessitating the use of the knife for its removal. However, more often than not the wound broke out again, because as was noted as early as by Hippocrates,[375] wounds of the prepuce are as a rule obstinate in healing. To meet this eventuality Galen[376] provides an entirely suitable procedure. While ulcers of the glans penis demand desiccative remedies, those of the prepuce rather call for epilotics,[377] especially anise. Supposing the prepuce to become gangrenous, it must be cut away circularly, and the bleeding stopped by cauterization; if this treatment is not needful, a mixture of verdigris with honey, or pomegranate and vetch is applied.[378] Ulcers on the inner fold of the prepuce, as also on the skin of the penis generally, are mentioned by Celsus (VI. 18.), the latter likewise by Galen.[379] Such ulcers on the inner fold of the prepuce, Celsus states, not unfrequently give occasion to the setting up of phimosis and paraphimosis; and yet another consequence, a morbid growing together of glans and prepuce was observed by Oribasius (loco citato, 5.) and Paulus Aegineta (VI. 56.), for which these authors prescribe appropriate medical and surgical treatment. Under the name of cancer (eating ulcer) of the prepuce Celsus, it would seem, describes the νομὴ (spreading ulcer) of the Greek physicians, which commences by the ulcer turning black. Occasionally too the ulcers developed out of themselves morbid growths, excrescences or condylomata, particularly the form known as thymion (warty excrescence).
b. Ulcers of the Glans Penis.
These are, as pointed out by Celsus (VI. 18.), best described by taking their pathological and therapeutic aspects together; but it would serve no useful purpose to quote once more in this place the passages dealing with this part of the subject, which have been so often printed already. He makes a distinction, as does Galen,[380] between dry and clean, moist and suppurative, ulcers, the latter of which readily lead to phimosis and paraphimosis. The discharge is sometimes thin and watery, sometimes purulent, and on occasion becomes evil-smelling; the ulcerations both spread superficially and penetrate inwards, and may actually destroy the glans underneath the prepuce, so that it perishes altogether. When this happens, Paulus Aegineta (VI. 57.) has a leaden pipette inserted in the orifice of the urethra, to enable the patient to pass water. In other cases the prepuce grows into one with the ulcerated glans penis (Celsus, Paulus Aegineta, Oribasius). Ulcers circa coronam glandis (round the crown of the glans penis) are mentioned by Aëtius.[381]
A special kind is the cancer colis (eating ulcer of the member), probably the same as the νομὴ (spreading ulcer) of the Greeks, which Aëtius[382] delineates as a spreading, flaccid ulcer, which on pressure emits a thin bloody discharge, that subsequently becomes feculent. Hemorrhage is apt to supervene according to Celsus on the shedding of a cicatrix artificially produced by operation or the cauterizing iron. Another species of cancer is the φαγέδαινα (phagedenic, eating ulcer) of the Greeks, which extends rapidly and penetrates to the bladder. It appears to be identical with ἄνθραξ (malignant pustule), though Celsus mentions the carbunculus colis (carbuncle of the member) in a special category; for the description he gives, bk. V. ch. 28., of carbuncle is equally applicable to the phagedaena.[383] Ἄνθραξ (malignant pustule) begins with itching, later on a pustule, or else a number of little bladders or blebs resembling millet-seeds appear, which burst in much the same way as a blister due to burning does, leaving behind an ulcus crustaceum (scab-encrusted ulcer), resembling the cicatrix of a burn; this is firmly adherent and black in colour. The surrounding tissue is likewise black and violently inflamed, the inflammation not unfrequently having an erysipelas-like character. Galen[384] designates the process ἀνθράκωσις, and declares that buboes are an accompanying feature. He holds the ulcers of the genitals occurring under the special climatic conditions laid down by Hippocrates above to have been partly ἄνθραξ,[385] the disease to which Hero succumbed.
Another kind of ulcer affecting the male genitals is mentioned by Pollux[386] under the name of θηρίωμα (malignant sore), which Celsus (V. 28.) likewise speaks of, but without particularizing its situation. The same fact applies to ulcers of the glans penis as to those of the prepuce, viz. that many forms of morbid outgrowths arise from them; in other instances callosities on the edges of the ulcers are built up, leaving behind a callous protuberance, which the Greeks appear to have called ἥλος (a nail), the Romans clavus (a nail).[387] The proper treatment to be followed in each of these special cases is given by Celsus and the Writers he cites.
B. Ulcers of the Female Genital Organs.
In this connection, as indeed in the discussion of the female genital organs generally, we once again meet with the difficulty due to the indefiniteness of the names given to the several parts. Not only do the Greeks constantly make use of the general expression αἰδοία, μόρια (privates, parts), but they likewise employ ὑστέρον and μήτρα (the womb) sometimes as meaning the vagina, sometimes the uterus, though it is true the later Writers like Galen[388] designate the vagina ἡ ὑστέρα, the uterus ὁ ὑστέρος, yet without keeping consistently to the distinction. The same applies to the use in Latin of locus (place), pars (part), and vulva (womb), which last word stands for the uterus in Celsus, Pliny and most of the later Writers.
Passing over the indefinite expressions dolores (pains), inflammatio or phlegmoné (inflammation) of the genitals, although the treatment prescribed for them clearly implies that very often ulceration was concurrently present, we find the various kinds of ulcers of the female genitals most fully and systematically described by Aretaeus,[389] Paulus Aegineta (III. 65-68.) and Aëtius[390] following Archigenes, Soranus and Aspasia.[391][392]
Abscesses Aëtius says (loco citato, ch. 110.) occur on the female labia; if these extend in the direction of the anus, they must not be opened with the knife, as fistulas are liable to be set up, but there is no fear of this when they extend towards the urethra. The same author (p. 109.) speaks of pustulae scabrae (scabrous, scurfy pustules) in the vagina and orifice of the womb, which throw off bran-like scales, as also (ch. 108.) of tubercula miliaria (miliary tubercles) in the same localities. These may no doubt be recognized by touch, but are better diagnosed by means of the uterine speculum, or Dioptra, and ex coitus affrictu (in consequence of friction in coition) interfere with menstruation and conception. Obviously what is here pointed to is the swollen mucous glands, which in our modern practice likewise are frequently observed in gonorrhœal cases. Often the ulcers take a form characterized by fissures (ῥαγάδες, fissurae,—fissures, rimae,—cracks), particularly at the orifice of the uterus.[393] Sometimes they become callous, at others give rise to morbid outgrowths; as a rule the discharge is a thin watery juice, and pain is felt during coition.[394]