Secale 158.- Remarks on the preceding paragraph.
Putting all this testimony from authors of the Middle Ages regarding the phenomena on the sexual organs together, and considering that these authors ascribe all this morbid phenomena to intercourse with impure women, whose internal sexual organs contained impure humors, we cannot avoid the conclusion that the sexual disorders described by the above-named authors, were of a truly venereal character. In the next chapter, where we shall speak of the different venereal diseases and contagia, we shall endeavor to shed light on the question whether the phenomena related by those authors are identical with our modern chancre- syphilis. For the present, it may suffice to direct attention to the fact how little attention, in comparison with the authors of the 16th century, their predecessors attached to a more circumstantial description of their ulcers, pustules, excrescences, and phlegmata; and how these disorders were not only derived from impure intercourse, but likewise from other causes, among which Valescus de Tarenta mentions “unclean pantaloons,” an “acridity beneath the prepuce” and Lanfranc mentions “ulcers on the legs,” as a frequent cause of “buboes.” “What seems to be more strange, is that, in spite of the corrosive ulcers,” of which all make mention, and which seem to have been known to the Greeks and Romans, not one author seems to have directed attention to the consecutive phenomena that these ulcers may be followed by in the mouth and throat, and which would not have escaped the attention of those early authors any more than that of the physicians of the 16th century, more particularly since may of these consecutive phenomena, in the present chancre-syphilis, do not manifest themselves at such a remote period after the primary symptoms, but that every observer must be struck by their internal pathological connection. It is true that Rosenbaum quotes Aretaeus’ description of a kind of ulcers in the throat that might be mistaken for phagedaenic chancres in the throat, if Aretaeus did not explicitly state that these “aphthae,” which, on account of their lead-colored, white ulcers with their thick-scurfs, resemble our modern diphtheritis, occurred principally among children. If we add to this complete omission of all mention of consecutive phenomena, that, as some modern authors will have it, even at this day, some venereal ulcers (such as phagedaenic, and more specially gangrenous ulcers) but rarely occasion any consecutive phenomena-at least not in the degree as Hunterian chancres-we are certainly justified, if not in denying the identity of yonder ancient phenomena with the products of our modern chancre syphilis, at least in asserting that this identity is not by any means made out by nature of the facts; more particularly, since a good many of the corrosive ulcers described by ancient authors might have been a root of phagedaenic or serpiginous tetter, being one of the consequences or manifestations of lepra, which aged in the 15th or 16th century in this South of Europe, as well as in France and laity. What decides the matter, is the testimony of John de Vigo, living in the 16th century, who, after contrasting both the former venereal diseases and the phenomena of modern syphilis with each other, distinguishes both forms from each other; which is likewise done by Fallopius, and, among other characteristic signs of recent chancres, which he terms Caroti, not only mentions their lardaceous base and callous edges, but likewise mentions their livid, dark cooper color, that sometimes merges into a blackish tint.
Secale 159.- Appearance of Syphilis as an Epidemic.
According to the testimony of all authors living at that time, epidemic syphilis broke out in the last years of the 15th century. According to some, cases of the plague broke already out in the year 1492 in Italy and Spain, until in 1494-more particularly during the invasion of Italy by the French-the well known epidemic syphilis broke out, which soon spread from Italy over France and Spain, and likewise over England, as far as Westphalia, Pomerania, Prussia, and Saxony, and, on its passage, derived its name from the country it had visited last. In France, for instance, it was called the Nopolitan sickness; in Holland, the Spanish pox; in German, it was called the Franzosen, and in Poland, the Germen disease. It likewise derived its name from its locality. When attacking women, in whom it was chiefly located on the pudendum, it was called pudendagra; among men, in whom the face and chin were more strikingly affected, it was called mentagra, etc., until at a later period, on account of its being chiefly transmitted by sexual coit, it was generally termed venereal disease. All then living physicians and authors testify, that this was a new disease had not been known heretofore. They endeavored in vain to find a proper name for it among the then known diseases; some regarding it as a variety of lepra; others of elephantiasis, others again as a malignant form of small-pox (variolae aluhumatae). Finally, not knowing what to call it, they applied to it the name of the saints whom the people invoked to help them; for instance, morbus St. Rochi etc. Whether this plague was a specific venereal disease, or a combination of the tolerably general lepra and the former venereal disease, and by the creative power of circumstances had become and idiopathic, henceforth self existing disease, is not clearly made out by the documents that have been left to us by the authors of that period. It is true, that as described by them, this disease was characteristically pustulous disease, distinguished by the breaking out of large ugly, purulent, pocks, and accompanied by horrid bone-pains; and more particularly communicated by intercourse with women who were attacked by the disease. Those authors, however, do not state, and yet it would have been of great importance for us to know, whether these pustules first broke out on the pudendum, or in the face, or on the whole body; nor do they state whether the first signs of a recent infection were first seen on the sexual organs. If this was not the case, and if, according to the universal testimony of contemporaries, the infection was caught by simply touching the epidermis, or by inhaling the breath of an infected individual, such a cause must have operated much more powerfully during the act of coition, which, if true, true, would not by any means justify the idea that this plague was venereal. In addition to this we have a right to argue, that, if this plague had been, strictly speaking, a venereal disease, the sexual organs ought to have shown the first symptoms of a recent infection, whereas, at Grunbeck justly observes, they only became affected incidentally, in consequence of the general spreading of the pustules over the surface of the body. It is only in the case of women that the pudendum seems to have been principally affected, as we may judge from the name pudendagra. Nevertheless, if this has been a general characteristic, instead of being an accidental occurrence, males likewise would have perceived the first signs of the infection on their private parts, for the reason, that the syphilitic virus first affects these parts, when coming in contact with them, as their favorite site. Hence it is incredible that modern authors of repute, even such a man as Schoenlein, can take the statements of the writers of that epoch for granted and, without any further critical examination, simply because the disease has been handed down to us under the name of Morbus venereus, assign to it a place in their text-books as epidemic syphilis.
Secale 160.- Development of Chancrous Syphilis.
Whatever similarity of form may have existed between that epidemic and more recent syphilitic phenomena, it is evident that it may likewise have been a malignant small-pox epidemic. If so, the infection must have necessarily been more rapidly communicated during the act of coition, where the two parties are placed in the most immediate contact with each other. This, however, does not authorize the inference that the disease was venereal, any more than we would be authorized to call the itch a venereal disease, for the simple reason that it is more readily caught during sexual proximity, or by sleeping in the same bed with an infected person. Nevertheless, there are other circumstances prevailing in the history of this epidemic, that must have exerted an undoubted influence upon the subsequent form of the syphilitic disease. If we read, for instance, what Fernel, who wrote not long after that epidemic, says of the diagnostic differences between morbus gallious and the venereal disease, which, according to him, is no longer characterized by ulcers, buboes and purulent discharges, but by secondary phenomena, such as: pustules, pains, falling off of the hair; etc.; and if we add to these statements the constant mentioned in No. 158, which had never had never been before made by any author previous to that epidemic, and which De Vigo established between the more ancient ulcers and those that were known at his time, in the 16th century, of which he says that they lardaceous base, and callous livid, and almost blackish (dark copper-brown) edges; we witness, subsequent to this epidemic, the sudden appearance of a new venereal form, resembling in all essential particulars our modern chancre-syphilis, and which drove the lepra that had been prevailing until then out of Europe, as if by magic. If this fact were to be trust before us, as an argument in favor of the remote origin of syphilis, back to the time of Job and Moses, the true character of the disease never having been recognized, but mistaken for lepra: all we have to reply to a suggestion of this kind is, that, when a disease not only changes its name, but at the same time its whole character, as when a chrysalis becomes transformed into a butterfly, we regard this produces at least as a metamorphosis, if nothing more. At all events, whatever may have been the pathological nature of that remarkable epidemic, it is certain that, at a period when the world was shaken by the mighty invention of a Guttenberg, and the old creeds and institutions began to totter to their foundations, the nations of Europe were visited by a terrible febrile convulsion, that swallowed up one of the most ancient plagues, as by a volcanic eruption, and substituted in its place a new and desolating disease. In the next chapter we shall se in what manner a correct appreciation of the historic origin of our modern syphilis influences the solution of the question concerning the unity or plurality of the different venereal viruses; in order that this point may be settled so much more fully, we shall have to premise a few words concerning the circumstances and forms under which the new disease was brought into life.
