Appendix — Venereal Diseases in the Homosexual
It is an old belief, shared by the homosexual themselves, that venereal infections are extremely rare among them. If male homosexual persons had sexual intercourse only with one another, this assumption would be in some degree plausible. For the principal focus of venereal infection is feminine prostitution, by which venereal diseases are transmitted to heterosexual men. But since these homosexual men often undertake sexual acts with heterosexual men—apart from occasional sexual intercourse with women—a priori there is a possibility of infection in their case, and such infection is, in fact, observed. Above all, many male prostitutes also indulge in intercourse with women, and thus diffuse venereal troubles among homosexual men.
It is obvious that syphilis can be diffused among the homosexual as easily as among the heterosexual, for syphilis is transmitted by many varieties of contact—by kisses, other caresses, etc. But how is it as regards gonorrhœa?
In the case of heterosexual men and women gonorrhœa is almost exclusively transmitted by the sexual act, by the introduction of the male penis into the female vagina. The analogous act between men—that is to say, pæderasty, immissio penis in anum—is unquestionably far rarer than the ordinary sexual act between men and women; it is commonly replaced by mutual onanism, by kisses and other caresses, and quite frequently by coitus in os. This last is much commoner than genuine pædication. Of gonorrhœa of the rectum produced by pædication when the active man is suffering from gonorrhœa, we very rarely hear. But is there, in the case of homosexual men, any possibility of gonorrhœal infection due to coitus in os?
There can be no doubt that typical gonorrhœa of the mouth occurs. The observations of Kuttler, Atkinson, Rosinski, Dohrn, and Kast, have proved it.328 Horand and Cazenave have even observed gonorrhœal infection of the urethra as a result of oral coitus!329 A homosexual patient told me that some years before, after coitus in os with a man, he had for several weeks had a discharge from the urethra, which spontaneously ceased, and therefore cannot have been genuine gonorrhœa, but only urethritis resulting from infection by contagious angina. In the case in question, the urethral catarrh was certainly due to the coitus in os, since any other sources of infection could be excluded.
On the other hand, in a second case an apparently gonorrhœal infection of the oral cavity was transmitted from the urethra.
A homosexual man, forty-five years of age, one day allowed a heterosexual man to perform coitus in os on him. Some days afterwards he experienced difficulty in swallowing, was feverish, and saw in the looking-glass that the uvula was swollen. A specialist for throat troubles diagnosed merely a catarrhal infection. The illness became worse, and a second throat specialist detected the presence of a purulent angina of both tonsils, ordered painting with argentamin, also vapour baths, and an astringent gargle, whereupon the affection gradually subsided. Six weeks later the patient had swelling and pain in the joints of the right knee and foot; under cold compresses these swellings subsided after a fortnight. Of the whole trouble nothing now remains.
This description, on the part of a patient who is thoroughly trustworthy, aroused strong suspicion of a gonorrhœal angina, with a consecutive gonorrhœal arthritis. Unfortunately, the purulent discharge from the tonsils was not examined for gonococci by either of the physicians in attendance. The case remains, anyhow, very remarkable.
In the case of homosexual women, it is obvious that syphilis, and also gonorrhœa, can be transmitted, the latter by mutual friction of the genital organs. I do not know what actually occurs in practice.
[321, 322] According to English experience, the congenitally syphilitic child rarely exhibits any sign of syphilis when born. Thus, Hutchinson writes (“Syphilis,” p. 73): “At the time of birth, the congenitally syphilitic infant almost invariably has a clear skin, and appears to be in perfect health.” According to Osler also (“Medicine,” sixth edition, p. 269): “The child may be born healthy-looking or with well-marked evidence of the disease. In the majority of instances the former is the case, and within the first month or two the signs of the disease appear.”—Translator.
Notes
312 Cf. Iwan Bloch, “Schopenhauer’s Illness in the Year 1823. A Contribution to Pathography based upon an Unpublished Document.” Published in Medizinische Klinik, 1906, Nos. 25 and 26. (This gives an account of all Schopenhauer’s utterances regarding syphilis.)
313 At a meeting of the Société d’Anthropologie de Paris, held on April 19, 1906, I read a paper on “La Syphilis Prétendue Préhistorique,” in which I discussed this question. The important question of ancient bones is further considered in the second volume of my work on “The Origin of Syphilis,” pp. 317-364 (now in the press).
314 The results of this study I have briefly epitomized in an address given before the Social Science Congress in Berlin, entitled “The First Appearance of Syphilis in Europe” (Jena, 1904).
315 Regarding the gradual acquirement (by means of natural selection) of immunity to epidemic diseases, the works of Archdall Reid may be most profitably consulted (“The Present Evolution of Man,” London, 1896; “The Principles of Heredity,” London, 1905). Dr. Reid’s views on the part played in human history by the transference of diseases from immunized to non-immunized races are of especial interest. Unfortunately, as regards syphilis, he accepts Hirsch’s erroneous statements relative to the antiquity of that disease, and its origin in the eastern hemisphere (see also p. 384, note 346).—Translator.
316 Cf. A. Neisser, “The Experimental Investigation of Syphilis as it Stands at the Present Day” (Berlin, 1906).
317 Cf. Erich Hoffmann, “The Etiology of Syphilis” (Berlin, 1906); Hans Hübner, “Recent Researches into the Nature of Syphilis,” published in the Journal for the Suppression of Venereal Diseases, 1906, vol. v., pp. 468-481.
318 I must not omit allusion to some recent admirable works on venereal diseases: A. Blaschko, “Venereal Diseases”—a popular exposition—(Berlin, 1904); Paul Zweifel, “Venereal Diseases and their Importance to Health” (Leipzig, 1902); Alfred Fournier, “Syphilis a Social Danger”; Karl Ries, “Blameless Sexual Infection” (Stuttgart, 1904); O. Burwinkel, “Venereal Diseases” (Leipzig, 1905); Waldvogel, “The Dangers of Venereal Diseases and their Prevention” (Stuttgart, 1905). In view of the large number of popular works on venereal diseases, those without professional knowledge should confine themselves to the best names, because in this province trashy literature is extraordinarily abundant, and by the false and erroneous views it diffuses, it does much more harm than good. The writings mentioned in this note I am able to recommend as thoroughly scientific and trustworthy.
319 Galewsky, “The Transmission of Venereal Diseases in the Suckling of Children,” published in the Journal for the Suppression of Venereal Diseases, 1906, vol. v., pp. 365-371.
320 It is true that such a hardening may also occur in other non-syphilitic affections of the genital organs—for example, when they are peculiarly situated or as a result of cauterization. Only the physician can determine whether in such a case syphilitic infection has actually occurred.
323 Cf. the recently published admirable work of Edmond Fournier, “Recherches et Diagnostic de l’Hérédo-Syphilis Tardive” (Paris, 1907).
324 Parrot regarded rickets as a manifestation of congenital syphilis, but this view has never found acceptance in England. Hutchinson remarks (“Syphilis,” p. 408): “The typical forms of rickets are constantly met with in conditions which do not lend the slightest support to the suggestion of syphilis.” As Cheadle remarks: “Syphilis modifies rickets; it does not create it.”—Translator.
325 This view must be accepted with reserve. See, for instance, Osler’s “Medicine,” sixth edition, p. 271: “Is syphilis transmitted to the third generation? The general opinion is opposed to this view. Occasionally, however, cases of pronounced congenital syphilis are met with in the children of parents who are perfectly healthy, and who have not, so far as is known, had syphilis, and yet, as remarked by Coutts, who reported such a group of cases, they do not bear careful scrutiny. The existing difference of opinion is well illustrated in the account by G. Boeck (Berl. Klin. Wochenschrift, September 12, 1904) of four instances of hereditary lues in the second generation, while in the same journal Jonathan Hutchinson expresses his belief that syphilis is not transmitted to the third generation.”—Translator.
326 As more important scientific works on syphilis I must mention that of Isidor Neumann (Vienna, 1899, second edition), containing the entire bibliography of the subject; that of Joseph Lang (Wiesbaden, 1896, second edition); but, above all, the epoch-making work of Alfred Fournier, “Traité de Syphilis” (Paris, 1898)—English translation, Fournier, “The Treatment and Prophylaxis of Syphilis” (Rebman Ltd., London, 1906).
327 The most important scientific work on gonorrhœa is that of Ernest Finger, “Blennorrhœa of the Sexual Organs,” fifth edition (Leipzig and Vienna, 1901).
328 Cf. M. von Zeissl, “Diagnosis and Treatment of Venereal Diseases,” third edition, pp. 171, 172 (Berlin and Vienna, 1905).
329 Op cit., p. 172.