If we would undertake to write the history of a Disease, the very first thing needful is to frame in one’s own mind a clear conception of what the History of a Disease in a general way is, for it is from a right preliminary conception, that the right conditions will follow which a Historian as such is bound to fulfil. Consult experience,—in other words enquire what has been usually understood under the name History of a Disease, and you find to be included in the idea,—first, a more or less complete chronological comparison of the different observations and views of different Physicians at different times on such or such a Disease, secondly, a survey of the course of the Disease in the individual case. The first is properly only a history of the opinions of Physicians, the History of the Literature so to speak of the Disease, which must come before theactualHistory, while the latter is nothing else than a history of a Disease in a single instance, that is to say the history of a particular case of disease, the history of individual patients; and this we have long been in the habit of reckoning a part of Clinics.
Nay, thesumof such clinical histories if takenall together will not help us to the actual history of a Disease, so long as they merely give an account of the visible symptoms by which the disease makes its presence known. By this means we shall be learning merely the ideal course of the Malady, getting a pictorial representation of it such as is demanded by Pathological specialists,—as it were theinternalhistory of the Disease. We cannot write the history of a single Man or of a single Nation so as to be a sufficient basis for the understanding and right appreciation of them, if we grasp only their inner history, that of theirinternaldevelopment, and consequently view them by themselves as a something separated off from all surroundings, instead of bearing in mind as we should the forms their relations take to environment, to the outer world generally,—in fact theirexternalhistory. Similarly we are just as little in a position to furnish the history of aDisease, if we include in the matter of our enquiry only the course of the disease and not its external relations as well.
It is only the inner genetic co-ordination of the two, viz. the internal and the external history (for Disease has also an external history) that can conduct to theactual Historyof the Disease. This may be defined asa genetic co-ordination and statement of the symptoms of a Disease under different conditions and in different individuals, from the first moment at which they arose and came under observation down to the time when the report is made; or, expressed more briefly, the History of a Disease isa genetic co-ordination and account of its development and progress in time(as conditioned by time). Supposing Time, Relations, and Number of individuals definitely limited, a Special History is the result; while the General History of a Disease properly speaking canneverbe viewed as isolated from its surroundings. In that case the conditions on which the generation and origin of the particular Disease depend would necessarily cease entirely and for ever to exist.
Now if we analyse the conception of the History of a Disease into its component parts, we shall get to know its specialcontents, the efficient factors of which it is compounded, and which the Historian has to comprehend and express. The function of History is to exhibit something that has happened; naturally therefore the first thing the Historian must do is to look out for the point of time at which the process of change began. But certain generating factors and influences are indispensable to every process of change, and their activity again is dependent on certain favourable external conditions; and so it becomes the next duty of the Historian to authenticate the existence of the said favourable influences as well as of the generating factors, and concurrently to determine in what manner they came into active operation. Inasmuch as it happens however sometimes that the interposing or favouring as well as the generative factors are known to be present, and yet no outbreak of disease occurs, so far as we see, or only an incompletely developed one, those influences also will require authentication which hindered or modified the potential activity of the factors.
Only after all this has been systematically and sufficiently analyzed, will it become possible to trace the development and course of the Disease itself and to mark the successive changes offered to observation from its first appearance to the time when its history was recorded. Now these changes are imposed upon it either by its own proper nature or from outside, and so the Historian must explain also the internal and external relations involved. Again in any individual case the various manifestations or signs of a Disease by no means appear all together at one time, but rather develope in a series; so in thegeneralcourse of a Disease, as recorded historically, a similar continuous series of symptoms will be more or less clearly noticeable, yet without implying that it is dependent solely on external conditions. Further, as every Disease is liable at any given time to comeinto conflict with another, the Historian will in this case also have to point out, what forms the relations of either took at the moment, whether the disease in question showed itself as determining the other or was itself determined by it, whether it consented to enter into combinations, whether it led to the annihilation of its adversary or was itself annihilated, or whether lastly both remained in a manner neutral. Finally account must be taken of the influence of medical aid, and generally of the relation of the Physician to the Disease.
These different points once successfully and in a competent manner co-ordinated into a kind of organic connexion, the resulting History of Disease, a clinical History, yet as wide as humanity itself, will supply the most momentous factor towards an insight into the nature and essence of Disease. It will not merely afford the theoretical enquirer the necessary materials for his speculations as to Disease in general and systems of treatment, but also teach the practical Physician the conditions of a rational method of Therapeutics; and will consequently be equally interesting, and what is more, equally needful to both. Such an organic connexion can only be established on the condition that the Historian calls to remembrance step by step, as he proceeds, the sciences of Physiology and Pathology. Only by their help is it possible always and everywhere to mark the inner necessity of the relation of cause and effect and to distinguish the essential from the accidental.
Having learned the Conception and proper Contents of the History of a Disease, we naturally proceed to another closely connected question,—do all Diseases admit of such a historical exposition? It may betaken for granted at the outset with tolerable certainty that the answer to this question will be affirmative for the majority of actual Diseases; at any rate hardly an objection can be alleged from the theoretical stand-point. At the same time practical Experience must be allowed a voice on this point.
Unhappily we gain but little that is comforting from experience. It can scarcely be said that even a beginning has been made so far towards writing the History of a Disease in the indicated sense; and besides this, diseases have been primarily selected for consideration in which the historical factor obtrudes itself, as it were, on the attention, to wit the epidemic diseases. For the rest hardly anything at all has been done, excepting only in the case of Leprosy and the Venereal Disease, for which with singular unanimity an epidemic character has always been claimed. The Proteus-like character of these Maladies hindered every attempt of speculation to penetrate their nature, and so enquirers saw themselves forced to consult History. But the merest superficial glance at the treatment of Venereal disease by its Historians (and this applies equally to Leprosy) will show that little more than an insufficient collection of materials towards an actual History of the disease has thus far seen the light; and this in spite of the fact that no contemptible number of the most distinguished Scholars have devoted time and trouble to the subject, in many cases making it their life’s work.
However, if the matter is looked into more closely, it will be evident that a large proportion of these scholars directed their attention to one single point only, viz. the antiquity and time of origin of the Disease; and regarded all the other factors only in so far as they supported one or other of the views they had formulated. Besides the co-ordination of these factors is seen to be so loose that no general result of any stringency could ever be obtained. The few men whose definite purpose it was to arrive atsuch a result, failed, in view of the difficulty of collecting the material, to reach the completeness they had proposed, and so deferred working up what they had accumulated till death put an end to their enterprise. In especial this was the case withHensler, and the non-appearance of the Second Part of his History of the Venereal Disease must doubtless long continue to be mourned as an irreparable loss.
The Past, on which all experience must draw, affords us so little assistance here that it is to the Future we must look for everything. The Present cannot show us in existence any history of Venereal disease as we understand it, but this in no way entitles it to deny the possibility of such a History. Thus it is of the highest importance to make the attempt to arrange and sift the material now ready and accessible, so far as it concerns the Venereal Disease, on principles conformable to the Conception and proper Contents as indicated above of the History of a Disease, and for this a relative completeness of the collected materials suffices. If in this way we are successful in sketching the history of Venereal Disease at any rate in its general outlines, it can quite well be left to the continued efforts of other Investigators to fill in the individual lines of the picture, especially as then and then only is the particular point ascertained by anticipation, at which later accessions must be worked in.
In every History, what comes first and foremost is to get to know the original Authorities from which the material for its treatment can be drawn, and this forms the proper Contents of theLiteraryhistory of the Disease. Accordingly our first duty will be to give a general survey of the literary helps lying ready to hand for the use of the Historian of Venereal Disease, and at the same time to specify how far these were accessible to ourselves. Thus the reader will be enabled at the very outset to form a judgement as to the completeness of theinformation supplied; and succeeding Enquirers will learn the gaps that are left remaining for them to fill up.
This will conclude a Survey of the historical results so far obtained in connection with the antiquity and time of origin of the Disease; and it will then be possible to indicate the special Scheme we propose to follow in our treatment of the task before us.
The different Opinions advanced at various periods on the question of the Antiquity and Origin of the Venereal Disease may at the outset be brought under two main divisions, according as the disease is supposed to have been already known to the Ancients and from their time onwards to have been continuously observed,oron the other hand regarded as having first arisen in the ninetieth year of the XVth. Century. Both views were framed much about the same time, and depended largely on the position and education of the person delivering judgement. The former may be styled the view of the learned, the latter the popular view, though indeed at their first inception it was not so much scientific reasons in either case as men’s prejudices that formed their basis.
The few really learned Physicians of the end of XVth. Century and beginning of the XVIth. took as the theme of their study not Nature but rather the medical Writings of the Greeks and Arabians, a field that had long been left unappropriated by them, and all were far too firmly convinced, thatHippocrates, and still moreGalenandAvicennahad already included in their Works everything that couldever be the subject of scientific treatment at any given time.
Attention was concentrated upon the Skin Affection that was the predominant form at first, and this was naturally enough taken for a kind of Leprosy, and called sometimes Elephantiasis (Seb. Aquilanus,Phil. Beroaldus), sometimes “Formica” (Schellig,Cumanus,Gilinus,Leonicenus,Steber), by others “Saphat” (J. Widmann,Nat. Montesaurus,Jul. Tanus,Jo. de Fogueda,Sim. Pistor). Hence the view advanced subsequently bySydenham,Haller,Plenk,Thierry,Haward, and held for a time bySprengel, that the original form of the Venereal Disease was the “Yaws” or “Piana”, and consequently that Africa must be assigned as the original home of the disease; and in this way the Moors also were brought in as part of the concatenation. Later on, when the conviction grew up that the beginning of the Disease consists in local affections of the genital organs, it was easy to show that these had always been in existence from the most ancient times. But as no direct information on the relation between affections of the Genitals and Skin-disease was to be found in the earlier Writers, enquirers were driven to the supposition, that Syphilitic affections of the Skin had been confounded by the Ancients with Leprosy.
A view, whichBecketfirst sought to establish on precise grounds, appeared on the contrary too bold to other investigators, who thought to find some way of evading it. This was to the effect that Leprosy under favourable conditions had changed into Venereal Disease, and the increased rarity of the former seemed to speak for this opinion. Supporters of this last view are in especialSprengelandChoulantin his Preface to Fracastori’s “Syphilis”. Whilst the particular home of the Disease was fixed in this way by some authors,SwediaurandBeckmanthought to find it in the East Indies, and held that the “Dschossam”, a familiar Indian disease, or else the“Persian Fire” must be looked upon as the original form of the Complaint.Schaufusagreed with them in part; he believed Venereal disease to have been brought by the Gypsies from India to Europe.Dr. Wizmann3made the disease arise in the IInd. Century in Dacia, which at that date was transformed into a Roman Colony and had to welcome the licentious Roman soldiery. The excesses of these colonists, in a strange climate, and seconded by a combination of conditions favourable to epidemic sickness, produced the disease, which he says is generated to this day in its genuine form in Turkey. AccordinglyWizmann, as alsoSprengelandChoulant, and to some extentGruner, who considered the Moors to be the parents of the Venereal disease, may be regarded as taking up an intermediate position between the two extreme views, and as making a sort of transition to the opinions of those who look upon the Disease as a new one.
The special supporters of this view were, as mentioned above, the non-medical, though a considerable number of men calling themselves Physicians agreed with them, though on other grounds, differing only as to the mode in which the Disease arose. The prevailing astrological views found the original cause of the Disease in the Conjunction of the Planets, a conjunction declared beforehand by prophecy to bode disaster. With this were included as contributing to the effect Inundations, the oppressed condition of Nations, Famine and the like. The disease was called an epidemic, or what at that period was practically synonymous, a pestilential disease, a Plague, and ascribed of course to the wrath of God. There were other accounts given,that still carry some show of probability; the Disease was referred to the poisoning of wells and of wine (Caesalpinus), to the admixture of gypsum with the flour (Fallopia), or actually to indulgence in human flesh.
When coition could no longer be denied as an interposing factor, rumour resorted to all sorts of wild tales, the copulation of a courtesan with a Leper, copulation with animals, and particularly with asses, and finally with the voluptuous Indian women of America. From the latter story grew up by degrees the theory of the American origin of Venereal Disease, which found its chief supporters inAstrucandGirtanner, and in spite of Hensler’s exertions seems even yet not absolutely forgotten.
It now becomes important to consider more closely these various views, as well as the reasons advanced for them, and to subject them to examination. But as the result of this examination will cover to some extent the same ground as the formal History, it will be expedient to treat the two as far as possible in connection with one another. By this method it willipso factoappear how far the individual views are tenable, and how far the grounds alleged in their favour valid. And this is all the more necessary for two reasons, first because by this means a host of repetitions is avoided, secondly because only in this way are such gaps as still remain clearly recognised and made tangible.
All the different views fall, as already stated, into two groups, according as they maintain the antiquity or the modernness of the Venereal Disease. In conformity with this division we must separate our investigation from the outset into two parts, of which Part I is to comprise the Venereal Disease in Antiquity, Part II the Venereal Disease to the end of theXVth. Century. To this will be added further as a Third Part, the History of the Disease down to our own day.
Each of the two earlier Parts will open, in accordance with the views declared above, with a statement and examination of the Authorities.
After that will follow an investigation of the influences that evoked diseases as a consequence of the use or misuse of the Genital organs and are favourable to their genesis, as well as those influences capable of staying, or in the case of diseases already established, modifying their progress. The difficulty of such an investigation is as striking as is its necessity; for on this subject there is an almost total lack of previous Works of any use to consult; and yet it is only by their help we can possibly win a deeper insight into the history of Venereal Disease.
The attitude of medical Science in face of these influences and their consequences will next claim our attention, so far as it is competent to exert a determining and modifying effect on the form and character of the Disease. In this connection it is especially important to determine whether the Physicians correctly diagnosed these diseases for what they are, or generally speaking had any opportunity of doing so.
Having come to a clear understanding, as far as is possible, on all these points, we shall then be in a position to give a genetic exposition of the development of the Disease itself. This will form the conclusion of each separate part, as well as of the whole Work; and then and then only we shall be able to say our task is fulfilled.