Read Ebook: Reprint of Two Tracts 1. An essay on gleets. 2. An enquiry into the nature cause and cure of a singular disease of the eyes by Marat Jean Paul Bailey James Blake Editor

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If so, when the ulcers of the glandular tunic lie at the entrance of the lacunes in the internal tunic; how much more when the corroding virus has extended its seat, and produced a kind of sinusses, as is always the case in inveterate gleets!

Another defect in common bougies is a want of degradation in their suppurative virtue.

It is well known, that practitioners employ but one kind of suppurating bougies, made with a plaister, whose basis is lytargirium of lead and oil of olives; whilst, in order to conduct suppuration properly, bougies should be more or less suppurative, according to the stages of the disease.

Having for a long while made use of suppurative bougies, practitioners use dessicative ones, even when suppuration is still abundant. But to those who have the least notion of the means employed by nature in the reproduction of fleshy substance, it is evident, that such a sudden passage from active suppurative remedies to dessicative ones, never can produce the desired effect. After a forced suppuration, kept so for a long while, far from being incarnated, the cavity of the ulcers is widened, and all the fibres around it have lost their natural elasticity.

Thus dissicative bougies employed immediately afterwards, being all of an astringent quality, and acting on the part alone they are in contact with, can only dry and crisp the edges of the ulcers, and cause them to become callous. The running is therefore stopt for a time, and never fails to break out again, when circulation is considerably increased by any accidental cause.

The use of common bougies, as they are actually made, is not only defective, but unrational and hurtful.

In common bougies, the suppurative plaister is spread over their whole superficies. Now, to apply the remedy in every point of the urethra, in order to cure some ulcerated parts, is certainly very absurd. What is commonly alledged in support of such a practice is, that it is only by giving to the medicament this extension, that it can be sure of reaching and acting on the diseased parts; but the seat of the distemper can easily be found, by gently introducing a probe into the urethra, and there only may the remedy be applied.

Absurd did I say this method was; it would be well if it was no worse, notwithstanding it is but too common for practitioners to assert each, that bougies of his own making are not irritating; it is a fact, that as being such only they can act, for without inflammation no suppuration is to be expected. It is plain therefore, that the long standing application of an irritating remedy over the whole membrane of the urethra, must be attended with fatal consequences, such as crispation, and afterwards relaxation of its fibres. How many patients have I not heard, complaining of having nearly lost their virility by the use of those bougies continued for some months. In several of them, I have even seen the fibres of this membrane so corrugated, as that the prae-eminence of the glands was retracted within, and this retraction was ever accompanied with excruciating pains at the time of erections; however, the most fatal consequences attending the actual practice of curing gleets, is a permanent difficulty of making water. Dissicating bougies being employed in order to consolidate the ulcers, never fail to dry to an excess the parts they are in contact with; they therefore produce too hard a cicatrice. This makes a more or less strong stricture in the urethra, which always reduce the stream of the urine.

Pointing out the defects of the actual way of conducting suppuration, in order to cure gleets, is in some sort indicating the proper way to do it; but as there are many particulars to be observed in the effectual method of curing those diseases, I shall lay down its whole process.

My first care is to inspect the parts. I take a bougie made of white wax, rendered flexible with a little turpentine. I make round and smooth one of its extremities, which I dip in the mucilage of marshmallows, and then I introduce it gently into the urethra up to the urine bladder, carefully observing the parts where the patient feels any acute pain, which parts I consider as the seat of the disease. Being thus made sure where the ulcers are situated, I take another similar bougie, upon it I mark places corresponding to the ulcers, there spread all round a little of a suppurative plaister, which I make smooth, rolling it between the fingers, anointed it with mucilage of marshmallows, and I introduce the bougie in the urethra, when I judge that the remedy is in contact with the ulcers, I bend back the external extremity of the bougie; and to fasten it, nothing is wanting but to pinch it a little.

The suppurative I use at first is diachilum cum gummis, rendered softer than usual; in order that being further dissolved by the natural heat, it may penetrate into the cavity of the ulcers.

The space of time I continue using it, is proportionate to the inveteracy of the disease; and to fix it between proper limits, requires the skill of an able practitioner.

The caustic humours which an ulcer contains, vitiate the nutritive lymph, and prevent its assimilation to the substance of the corroded fibres; and besides adhering to these fibres, they keep them in a state of rigidity, and oppose their extension. The first reason therefore, showing the necessity of suppuration in order to cure ulcers, is to evacuate these humours. The next is to dissolve the callous edges of the ulcers, and to aid the corroded fibres to discharge the viscid fluids with which they are filled.

The time the injection and suppurative are to be continued, is likewise to be proportionate to the inveteracy of the disease, and must be longer if any astringent injection has been made use of, or any callous had been discovered in the urethra by passing the probe up to it.

When the use of this suppurative is discontinued, I employ another made with

Gold lytharge ? vj. Oil of olives ? xji. Yellow wax ? jv. Venet. turpentine ? ji. Bol. Armoen ? ji.

Every day I render it less suppurative by mixing with it a few drops of Peruvian balsam, and continue its use till the ulcers are consolidated.

The space of time necessary to perfect the cure of slight gleets, is generally from twenty-five to thirty days; and of stubborn ones, seldom exceeds ten weeks.

But to these observations I must add a few others very material.

Sometimes patients who labour under these complaints, are of a habit of body scorbutic, or infected with the venereal taint; in such cases the humours ought to be purified, before the cure of the ulcers is attempted.

If the patient is of a phlegmatic or plethoric habit of body, the ulcers are always difficult to heal. A drachm of bark in powder should therefore be prescribed to be taken in a glass of red wine, every day during the treatment.

Such is my method of curing gleets; and if ten years practice attended with constant success, may be allowed a sufficient time to convince of its efficacy, I may confidently offer this my idea to the sensible practitioners, and flatter myself that every one who shall adopt it, will find the greatest satisfaction in this respect.

Among the great number of instances I could quote to evince its superiority over all other methods hitherto in vogue, I confine myself to the two following.

A circumstance, however, which must appear strange at first sight is, that the return of the flux was periodical. It regularly broke out every year at the beginning of spring and autumn.

When he applied to me, his running was just coming upon him; it was of a deep green, both scalding and abundant. The erection of the penis was accompanied with excruciating pains, and the muscular tunic of the urethra so crispated, that the extremity of the glands was retracted inwards. The urine spouted out in a small stream, slowly and with difficulty. Some time he experienced a sort of retention, and never could eject it without passing a bougie in the neck of the bladder once a day.

My first care was to relax the contracted parts; which I did by mucilaginous injections. In a week's time no pain was felt in erections; the summit of the glands again became proeminous, and the scalding was considerably abated.

Suspecting the whole mass of the lymph to be infected, as the patient was rather of a plethoric complexion, I made him for a long while go through a course of sudorific draughts.

When his humours were judged well purified, I employed suppurative remedies, as I have explained before, and in about three months time the ulcers were consolidated.

There are now nearly five years that this gentleman has found himself perfectly cured. Ever since the difficulty of making water has diminished every day; and these eighteen months past he did not need the introducing of a bougie in the neck of the bladder.

Such is the first case I was speaking of: the second is somewhat more surprizing.

At first, all sorts of remedies were tried in turn, by every one of them, and at last astringents rashly made use of to stop the running, in order to have a pretence for payment.

The running once disappeared for eleven months, but returned, without any apparent cause, more violently than ever; and ever since, till a few years ago, broke out again after indulging too freely in drinking.

Having laboured twenty-seven years under these complaints, and being left incurable, the patient applied to me. His disease was so inveterate, that I entertained indeed some doubts of his recovery: I however ventured a fair tryal, and, to my great surprize, after he had undergone a regular treatment for eleven weeks, he found himself entirely cured; at least he has perceived, these two years past, no appearance of a relapse, although he has indulged his bottle. And I may boldly assert, that, the running being not possibly stopt by suppuration, the ulcers are certainly healed, when they for a long space of time furnish no matter.

FINIS.

LONDON:

TO THE

ROYAL SOCIETY.

This is not a Dedication: such a Matter of Form I have ever thought beneath the Dignity of Philosophy. My Idea hereby is purely to intreat that, in your immense Collection of Facts, Experiments and Researches, you will permit me to ask of you a small Nook for an Observation of a Phaenomenon in the Animal Oeconomy: a singular Phaenomenon, which has hitherto escaped the Attention of Physiologers, and which, I presume, is too curious not to excite your Attention. If, when the Occasion may present itself, any of the Members of your Society would be pleased to amuse themselves with verifying, by Dissections, the Elucidation of it, which is offered in the following Sheets, it might not, perhaps, be a regrettable Employ of Time.

I am, with the most perfect Respect,

And most obedient Servant,

J. P. MARAT.

Church-Street, Soho,

January 1st, 1776.

AN ENQUIRY, &c.

These are its characteristic Symptoms:--The Eye becomes somewhat painful, without any apparent Cause; a Pression or Stiffness is felt inwardly; the lateral Motions of its Globe are performed with Difficulty; near situated Objects can no longer be seen; remote ones alone are distinguished at a fixed Distance, and even these imperfectly.

When Calomel, Panacea, Sublimate corrosive, or any other Mercurial Preparation in a saline Form, has been unseasonably administered, if not immediately evacuated by Purgatives, it passes with the Chyle into the Blood.

Where nervous Fibres and Blood Vessels concur to the Constitution of the Organ, the Tumor is ever accompanied with a painful Inflammation.

Such being the Operation of prepared Mercury, it is capable of disordering the Animal OEconomy in many Ways, according to the Functions of the affected Parts. A complete Examination of them would swell these Sheets beyond the proposed Size; I therefore reserve it for the Subject of a future Publication. Here I confine myself to the Effects of Mercurial Salts on the Organs of Vision, in Order to account for the Phaenomena of the Disease about which I am treating.

Mercurial Particles, carried into the minute Vessels of the ocular Muscles, irritate them: Irritation is soon followed by Contraction and Obstruction; thus the whole Substance of the Muscles becomes inflamed, and their Bulk swelled. Hence from the inward Pression, Stiffness and obtuse Pain, which are felt in this Disease.

That the Light's Rays, which fall on the Eye, may express a distinct Image on the Choro?des, they are to have their Focus thereon. This cannot be effected, except when this Membrane is at a certain Distance from the Lens; and this Distance is ever relative to the Position of Objects.

Rays reflected by proximate Objects, being less refrangible, have their Focus more distant from the Lens, than Rays reflected by remote ones. In order to distinguish Objects at various Distances, the Soul therefore approaches the Choro?des to, or remove it from, the Crystaline; that is to say, the Soul alters the Figure of the Eye:--An Alteration ever effected by the Motions of ocular Muscles.

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