Title: Reprint of Two Tracts
Author: Marat, Jean Paul
Language: English
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_This Edition consists of 84 copies, of which 75 copies are for sale._

                             _This is No._



                                  TWO

                            MEDICAL TRACTS

                                  BY
                           J. P. MARAT, M.D.



                         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 JEAN PAUL MARAT, M.D.

                      EDITED WITH AN INTRODUCTION

                                  BY

                          JAMES BLAKE BAILEY

         LIBRARIAN OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND

                 PRINTED FOR PRIVATE CIRCULATION ONLY

                                  BY

                            PERCIVAL & CO.

                                LONDON

                                 1891



INTRODUCTION


The two tracts here reprinted were written in English by Jean Paul Marat
during his residence in Church Street, Soho, where he practised as a
Physician.

Both of the tracts are exceedingly rare. Speaking of the former one, Mr.
Morse Stephens, in his article on “Marat” in the _Encyclopædia
Britannica_,[1] says, “no copy is to be found.” Since the date of Mr.
Stephens’s notice of Marat a copy has come to light, and is now in the
possession of Dr. J. F. Payne. Of the latter tract there is only one
known copy: this is in the Library of the Royal Medical and Chirurgical
Society of London. I have to thank the Council of the Society and Dr.
Payne for their kindness in allowing copies of the pamphlets to be made
for the purpose of publication.

The first tract is dedicated to the Worshipful Company of Surgeons in
London, and is dated November 1775. As the type is broken the day of the
month cannot be read with certainty in the copy from which this was
reprinted: there is no other known copy to which reference can be made.
The date is either the 21st or 24th: as regards the month and the year
there is no doubt. The second tract has an address to the Royal Society,
and is dated January 1st, 1776: as Marat returned to Paris in 1777 both
these works were issued towards the end of his residence in London.

A few months before the publication of the Essay on Gleets, Marat had
received an M.D. degree from the University of St. Andrews. The degree
was equivalent to an honorary one, and, as was the custom of the time,
was given on the recommendation of two medical men known to the Senate.
The two who recommended Marat were Hugh James and William Buchan,
doctors of medicine in Edinburgh. Marat passed no examination for the
degree, and probably did not even go to St. Andrews to receive it. At
that time it was customary to forward the Diploma on receipt of the
graduation fee. Mr. Morse Stephens[2] is of opinion that Marat received
degrees from other universities, because in 1777 on his appointment as
physician to the body-guard of the Comte d’Artois he is described as
“docteur en médecine de plusieurs facultés d’Angleterre.” It may,
however, be pointed out that at this date there were very few
universities or faculties granting an M.D. degree, and also that the
older universities did not give the Doctor of Medicine as an honorary
degree. It is known that Marat resided for some time at Edinburgh and at
Dublin, but there is no record of his having received a degree from
either of these Universities.

Although diligent search has been made by historians no record of any
other qualification has been found, and it may fairly be assumed that
the above description is an exaggeration of the St. Andrews degree.

There is evidence in both pamphlets that Marat practised medicine in
Paris before coming to London. In the Essay on Gleets[3] he speaks of
his “ten years practice”; this probably gives a clue to the actual date
of the beginning of his professional life. The duration of his practice
in France before his coming to England must have been short. He took up
his residence in England in 1766; the Essay is dated November 1775, and
Marat was born in 1742: allowing for the ten years he mentions, he would
have started practice about 1765, at which date he was twenty-three
years of age.

The “Gleet” Tract shows that Marat’s early work was not devoted entirely
to this department of practice. Mr. Morse Stephens[4] says, “from
Bordeaux he went to Paris, where he effected a remarkable cure of a
disease of the eyes, which had been abandoned as hopeless both by
physicians and quacks, by means of electricity.” This, no doubt, is the
case of _Charlotte Blondel_, described on page 34 of this reprint. Marat
himself says, speaking of the employment of bougies for the treatment of
gleet, “as it was not my province to treat venereal diseases, this
method had not engaged my attention.”

Marat evidently had in mind other medical works. In the Essay on
Gleets[5] he says, “If this essay should meet with approbation, I shall
offer to the public a new method of radically curing gonorrhœas in a
short time.” And again, in the tract on Diseases of the Eye,[6] speaking
of the action of mercury, “A complete Examination of them would swell
these Sheets beyond the proposed Size; I therefore reserve it for the
Subject of a future Publication.” It may, I think, be safely said that
these intentions were never carried out. Watt, in his _Bibliotheca
Britannica_, gives the titles of the two tracts here reprinted, but
makes no mention of the others; and, so far as I can find, they never
saw the light.

The _Daran_ under whose care the cases described in the first tract were
before they came under Marat’s observation, was Jacques Daran
[1701-1784], a man who greatly distinguished himself whilst in the army
during an epidemic of the Plague at Messina: after travelling all over
Europe he lived at Marseilles, but finally settled in Paris. He was
chiefly celebrated for his bougies for the treatment of diseases of the
urethra: the composition of the bougie he kept a secret, and thus
amassed a very large fortune. He ultimately, however, died at Paris in
very poor circumstances.

The famous _T_***, under whose care the case described on page 17
was, I cannot identify with any degree of certainty.

The “ingenious Mr. _Miller_, Oculist,” mentioned on page 44, was
probably John Miller, an optician, who died at Edinburgh in 1815, having
occupied for forty-eight years a leading position in that city. He was
originally in business at 7 Parliament Close, and afterwards was in
company as Miller and Adie in Nicolson Street.

The original tracts are printed in 4to without any running title; the
top of each page simply having the pagination in square brackets. The
reprints follow the originals exactly as regards orthography,
punctuation, etc. Obvious errors have not been corrected: the pamphlets
are reproduced exactly as Marat wrote them.

Marat’s nationality comes out very strongly in more than one passage,
where, whilst using English words, he has kept entirely to the French
idiom. In the preface to the first tract he apologises for his imperfect
knowledge of the language in which he is writing.

The tract on the Eye is printed with that prodigality of capitals so
common in books of that date: curiously enough the one on Gleets is
entirely free from this lavish use of capitals, and only has them where
absolutely necessary. There is no note (_b_) in the original of the
“Eye” tract: the letters have been followed exactly.

In the second tract the word “Gentlemen” both at the beginning and end
of the address to the Royal Society is in MS. The writing is undoubtedly
that of a foreigner: Mr. Stephens thinks that in all probability it is
in the handwriting of Marat himself,[7] and that this copy is the
presentation one. There being no other known copy it is impossible to
see if the words were added to the whole of the tracts issued for sale,
or whether they exist only in this copy. “Gentlemen” is printed in the
earlier tract, and it certainly looks as though it were an omission in
this case, not noticed until too late to have the word inserted in
print. If this were the “presentation copy,” its proper home would be at
the Royal Society, but there is no mark of its ever having belonged to
that Library.



                                  AN

                                 ESSAY

                                  ON

                                GLEETS;

                                WHEREIN

             The DEFECTS of the ACTUAL METHOD of treating
           those Complaints of the URETHRA are pointed out,

                                  AND

              An EFFECTUAL WAY of CURING them indicated.

                         By J. P. MARAT, M.D.

                                LONDON:

        Printed for W. NICOLL, in _St. Paul’s Church-Yard_, and
                    J. WILLIAMS, in _Fleet-Street_.

                      [Price ONE SHILLING Sewed.]



TO THE READER.


The candour of the public will need no solicitation, when acquainted of
the following sheets being written by a foreigner, not sufficiently
conversant in the language to avoid faults against it: which may
likewise be the more easily forgiven, for the fashioning of the stile
being less an object of attention, than the importance of matter to the
human health.



          _To the Worshipful Company of SURGEONS in LONDON._


     GENTLEMEN,

Long since Surgeons both in _London_ and _Paris_ have assumed to
themselves the treatment of Venereal Diseases, and Physicians generally
decline it.

I cannot conceive what makes it your exclusive province the treating of
those diseases, since in most cases the whole frame of the body is
affected, and in very few the hand of an operator is wanted. But as the
custom prevails, I do not pretend to strive against the torrent, and
content myself with offering to you the most effectual method of curing
Gleets--- a method which I at first discovered, by reflecting on the
deplorable situation of a bosom friend, and which I afterwards put in
practice at the earnest request of several acquaintances, and have ever
since followed with constant success.

       *       *       *       *       *

A man of mercenary principles would, no doubt, keep it a secret; but a
liberal mind is above such interested procedures. To promote the good of
society is the duty of all its members; besides, what an exquisite
pleasure it is for a benevolent heart to lessen, as much as possible,
the number of those unfortunate victims, who, without hope of relief,
labour under the many evils to which human nature is subject. Thus, not
satisfied with relieving the patients who apply to me, I wish I could
relieve many more by your hands. Happy, if in this respect, the fruit of
my labour is not lost!

                                                             GENTLEMEN,

                                     Your most obedient humble Servant,

                                                           J. P. MARAT.


_Church Street, Soho.

Nov. 21. 1775._



AN ESSAY ON GLEETS, &c.


I enter in the subject without any preamble.

A gleet, by the want of skill in those who undertake to cure venereal
diseases, is but too often the sad consequence[8] of a virulent
gonorrhœa.

The running is ever more or less coloured, often of a green tint, more
often of a pale yellow, and sometimes of a dark brown, a little blood
being mixed with it.

The matter discharged comes from the ulcerated glands of the internal
tunic of the urethra: but when the running suddenly increases, it always
proceeds, or from an inflammation of the muscular tunic, as happens
after too freely enjoying the bottle and the company of women, or from a
rarefaction of the fluids[9], caused by the expansion of the internal
air; as happens in spring and autumn, two seasons where the atmosphere,
being less elastic, does not oppose so great a resistance to the action
of the internal air.

Formerly the running was attributed to a relaxation of the affected
parts, an opinion still in credit among the ignorant; but by introducing
a probe in the urethra, every one may be convinced that it is wholly
caused by ulcers. _Daran_, who first made this discovery, attempted to
cure gleets by suppurative bougies. His method was soon adopted as the
most rational, and ever since followed by the best practitioners.
Undoubtedly it proved successful in many cases; but in many others
proved abortive, even in the hands of _Daran_ himself.

Long I had not seen bougies employed for curing gleets, without finding
them often ineffectual: however, as it was not my province to treat
venereal diseases, this method had not engaged my attention. Mere chance
afterwards obliged me to turn my thoughts to the subject, as I shall
now relate with the reader’s permission.

Calling one morning on an intimate friend of mine at _Paris_, I found
him involved in the deepest melancholy. On enquiring into the cause, he
acquainted me, that having been so long in the hands of _Daran_ for the
cure of a gleet, he at last thought himself free of it, when, on a
sudden, he was cruelly disappointed. Upon which he begged of me to give
him any advice in my power, his situation being extremely critical on
the point of marriage with a young lady of fortune whom he loved, and
with whom he could not bear the thought of engaging, while under so
cruel a circumstance. On this I said to him all that occurred to me just
then for his consolation.

After I had left him I could not help reflecting on his melancholy
condition, and thinking how possibly he could be extricated out of it.
The best way that offered to my mind was his cure.

I indeed considered suppuration as the only method to effect it. But not
accustomed indiscriminately to adopt a method as soon as it is extolled,
much less to follow it blindly, I enquired into the reasons of the
frequent inefficacy of the usual practice, and soon was made sensible of
them.

After mature consideration, I called upon my friend, and proposed to
attempt his cure. He readily agreed. The same day he took an apartment
next to mine. I immediately began his treatment, attended him closely,
and by suppuration properly conducted, was radically cured in seven
weeks.

Some months after, two of his acquaintances left incurable by _Daran_,
applied to me, requesting my assistance, and both were cured in eleven
weeks time. But here is not the place for enumerating cures performed by
my method; I therefore proceed to point out the defects of the actual
practice of preparing and using bougies to cure gleets, and shall
communicate the proper way to improve it, so as never to fail the
intention.

The actual method of treating gleets is frequently unsuccessful, because
defective.

The first defect is the hardiness of the suppurative, common bougies are
made with. This is obvious from the structure of the affected parts. The
internal tunic of the urethra, although ever irritated in a virulent
gonorrhœa, is seldom the seat of the disease. Its seat is commonly the
glandular tunic beneath the muscular, as is shewn by the abundance of
the suppuration, and more plainly by dissecting. In such case, it is
evident, that a common bougie introduced in the urethra, acting
immediately on the internal tunic alone, cannot cause but an imperfect
suppuration of the ulcerated parts, and consequently cannot perfect the
cure.

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 præ-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[10] 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.

Thus having used diachilum cum gummis, I employ four times a day
injections made with a weak solution[11] of sal ammoniac in common
water, and order the injection to be kept in the urethra five minutes
every time. Mean while I make use of a weaker suppurative, such as[12]
_l’onguent de la Mer_.

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           ʒ jv.
        Venet. turpentine    ʒ ji.
        Bol. Armœn           ʒ 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.

In 1762 _J. A._ Esq; contracted a virulent gonorrhœa at _Naples_. There
he applied to the famous _T_***. Having been some months in his
hands, without receiving any benefit, he went to Rome, where affairs of
importance called for his presence; and there likewise he was attended
for a long while by some reputed practitioner, but with no better
success.

From _Rome_ he went to _Florence_, where he was also under the hands of
the best surgeons.

Two years were already wasted in fruitless attempts, when the patient
set off for _Paris_, and there was for two years together under the care
of the celebrated _Daran_. During that time he underwent a long course
of remedies. The running indeed disappeared, when dissicative bougies
were made use of, but returned soon after.

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.

From _Paris_ the patient came over to _London_, his place of abode.
Anxious to be cured, he applied to an eminent surgeon, (whom it would
not be candid to name) who for eighteen months attended him with great
assiduity. Various were the remedies employed to subdue the running.
Among them the suppuration was again tried, and again did the running
stop by the use of dissicative bougies. When stopt the patient was
assured of his being cured, and to remove every doubt about it, was
advised to drink punch pretty freely. So he did; but no sooner was the
tryal made, than the running returned with greater violence. Vexed at so
many disappointments, the patient was determined to resign his fate to
Nature alone, and for a while did not alter his resolution, till hearing
(from a friend) of some striking cures of similar complaints I had
performed, that he might not have any reproach to make to himself, he
resolved to venture a last experiment.

When he applied[13] 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[14] 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.

Mr. J. G. a celebrated artist,[15] having contracted a virulent
gonorrhœa at _Milan_, was for several months in the hands of a surgeon
in that town, and left uncured. From _Milan_ he went to _Spain_, and
there was the space of twenty-five years under the hands of all those
who had any repute for curing venereal diseases.

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.

As the seat of the disease was the _fossa navicularis_, the urine was
always pretty free; but all the other cruel symptoms attending gleets
were felt.

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.

I shall conclude with this observation, that, since a radical cure was
effected in the two forementioned cases, _there is no gleet incurable:
nay, there is none which cannot easily and speedily be cured if properly
treated_.


                                FINIS.



                                  AN
                                ENQUIRY
                               INTO THE
                        NATURE, CAUSE and CURE
                                 OF A
                           SINGULAR DISEASE
                                OF THE
                                 EYES,
                   Hitherto UNKNOWN, and yet COMMON,
                        Produced by the Use of
                    CERTAIN MERCURIAL PREPARATIONS.

                         By J. P. MARAT, M.D.

                                LONDON:

        Printed for W. NICOLL, in _St. Paul’s Church-Yard_, and
                    J. WILLIAMS, in _Fleet Street_.

                     (Price ONE SHILLING, Sewed.)



                                TO THE

                            ROYAL SOCIETY.


_Gentlemen_,

This is not a Dedication: such a Matter of Form I have ever thought
beneath the Dignity of Philosophy. My Idea hereby is purely (after the
Example of communicative Naturalists, proud of contributing to the
Cabinets of the Curious any rare Fossil, or Article of the Study of
Nature) 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 Phænomenon in the Animal Oeconomy: a
singular Phænomenon, 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,

                                      _Gentlemen_      Your most humble

                                             And most obedient Servant,

                                                           J. P. MARAT.

Church-Street, Soho,

January 1st, 1776.



AN ENQUIRY, &c.


Among the various Diseases affecting the EYES, there is one still[16]
unknown, which Practitioners have hitherto confounded with the _Gutta
Serena_.

These are its characteristic Symptoms:--The Eye (when touched) 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.

This singular Affection of the Eye, which has yet no Name, but which may
be termed _Accidental Presbytopia_[17] or Long-sightedness, is ever the
fatal Consequence of taking prepared Mercury without proper Care.

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.

As it circulates, it unites with the _Mucus_, with which it has a more
intimate Affinity than with any other of our Humours. Afterwards it is
carried into the glandular Organs, there to be[18] secreted.

Whilst not yet united with the _Mucus_, if any of its Particles are of
too large a Bulk to pass freely through the minute capillary Vessels,
which it will have entered, it irritates their Coats with its sharp
Angles: the Vessels contract; their Diameter being diminished thereby,
the Lymph no longer permeates them freely; but, its Afflux continuing
the same, distends their Cavity. The distended Vessels soon compress
other minute adjacent ones; and these being obstructed and distended in
their Turn, the whole Texture of the Organ they form is tumefied.[19]

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 Œconomy 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
Phænomena 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[20] Choroïdes, 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 Choroïdes 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.

Thus, when the Motion of these Muscles is obstructed by their swelling,
it is plain that there is no being able to see clearly Objects at
several Distances.

When viewing remote Objects, the Eye is retracted towards the Bottom of
the Orbit by the Contraction of its strait Muscles; for as they
contract, these Muscles bring back the anterior Hemisphere of the Globe
(to which their Apponevroses are adhering) to the posterior one; they
thereby approach the Choroïdes to the Crystaline.

Thus the strait Muscles of the Eye being swelled and contracted by
irritating Mercurial Particles, Objects cannot be distinguished but at
one particular Distance.[21]

When viewing near Objects, the Eye, laterally compressed by its oblique
Muscles, seems to be forced out of the Orbit. Its Globe being thereby
lengthened, the Choroïdes is more distant from the Crystaline. But as
the Eye has only two oblique Muscles to four strait ones, when its
Muscles are all swelled to the same Degree, the Choroïdes is more
retracted towards the Crystaline by the former, than it is retracted
from by the latter.

Thus near situated Objects cannot be so clearly distinguished as the
remote.

When the oblique Muscles are not equally swelled in their whole Extent,
the Bottom of the Eye, pressed towards its Axis, forms no longer a
regular Circumference, whose Points are each equally distant from the
Lens. Therefore, of the Rays which fall on the Choroïdes, Part only have
thereon their Focus; the other are yet too divergent to express a
distinct Image.

Thus even remote Objects cannot be distinguished but imperfectly.

So far for the Investigation of the Nature and Cause of this Disease.

Having been hitherto mistaken for a _Gutta Serena_ by Practitioners, it
has accordingly been treated as such. Issues, Vomiting, Purging,
Salivation, have all, occasionally, been tried; but every Method yet
attempted to remove this Disorder, has been to no better Purpose than to
confirm it.

A rational Treatment of this Disease, I should imagine, cannot but be
acceptable to the Public; I therefore proceed to point it out.

The Indications for a radical Cure are three, relaxing, deobstructing,
and restoring to their due Tone the ocular Muscles.

In order that they may be relaxed, the Patient must avoid spirituous
Liquors, Tea, Coffee, Chocolate, Aromatics, great Exercise, and violent
Passions. He also must observe a low Diet; his only Drink, for a while,
ought to be either Barley-water, Whey, Marsh-mallows Infusion, or
Orgeate.

Regimen being prescribed, the Cure is to be attempted by a moderate
Bleeding at the Foot, which is to be repeated once every Week.

Every Day (except those of Bleeding) the Patient should take, for a
whole Month, two, three, or four Drachms of Cassia, according to the
Strength of his Constitution.

When his Fluids are well diluted, antispasmodic Suffumigations[22] are
to be conveyed to the Eyes by a proper Instrument. Emollient[23]
Pultises are likewise to be applied to the temporal Regions.

These being made Use of, the Swelling of the ocular Muscles gives Way by
Degrees, the obtuse Pain vanishes, the Globe of the Eye collapses, and
Vision begins to be restored.

Then some electrical[24]Sparks are to be drawn from the Canthi of the
Eyes, Morning and Evening, during a few Weeks. Mean while, a Plaister of
_Tacamahaca_ is to be worn on the Temples. These Remedies being
calculated to remove all Obstruction of the affected Parts, promote the
restoring of the Sight, and complete the second Indication.

When Vision is nearly[25] in its former State, there remains only a
Weakness of Sight, which is gradually removed by often washing the Eyes
with fresh Water alone.

Such is the Method I have pursued to perform the following Cures, being
the only ones of the Kind I ever attempted.

_Charlotte Blondel_ (the only Daughter of a Merchant in _Paris_,) a girl
of about Eleven Years of Age, and of a delicate Constitution, being
troubled with Worms, Mercurial Cakes were prescribed to her; and
although she had been purged, now and then, during the Course of this
Remedy, a Salivation came on. Soon after her Head swelled, and her Sight
was altered in such a Manner that she could hardly distinguish any
Object.

In order to conquer Salivation, purging was repeated every Day. It
indeed soon diminished; so likewise did the Swelling of the Head: The
Sight also was somewhat better. By following the Use of the same
Laxative, every Symptom at last disappeared, except the Alteration of
Vision; for she could only see Objects at a Distance.

The Parents, uneasy on their Daughter’s Account, applied to a famous
Oculist, who declined undertaking the Cure.

Afterwards Application was made to a Fryar, of some Repute for curing
Diseases of the Eyes. He gave it as his Advice, that the Patient was
afflicted with a _Gutta Serena_, and attended her for Seven Months
together, prescribing at first sudorific Drinkings, and at last ammoniac
Suffumigations, which produced no other Effect but to inflame the Eyes.

The Patient was already given over, when I undertook her Cure. As I was
not unversed in Optics, and had seen several People affected in the same
Manner, I soon was made sensible her Case had not been understood.

Considering the Swelling of the ocular Muscles as the true Cause of this
Disease, I was convinced that the only Remedies to be employed at first
were Laxatives and Emollients. Accordingly, having fixed upon a cooling
Diet, I prescribed two Drachms of Cassia to be taken fasting every
Morning, for three Weeks together, and Infusion of Marsh-mallows for her
Diet-drink. Seeing that the Patient had a Disgust to this Infusion, Whey
was substituted to it.

My Patient received no Change in her Vision for Fourteen Nights, but
afterwards found a little Benefit. In order to ascertain it in Future,
I framed a Scale, whereon I marked the nearest Distance she could tell
the Hour by a Watch. The Distance was Eight-and-Twenty Inches.

Judging the Use of Cassia had been continued long enough, I advised
Marsh-mallows Suffumigations to be taken twice a Day, and a soft Pultis
of the _Quatre Farines_ to be applied to her Temples. These were used
for a whole Month, at the latter End of which the Scale was reduced to
Twenty-two Inches; that is, the Patient could tell the Hour by the same
Watch at Twenty-two Inches Distance.

As her Humours appeared well diluted, in order to remove the Obstruction
of the ocular Muscles, and promote the reducing of their Bulk, I desired
to have some Sparks drawn from the Canthi of her Eyes, but was opposed
by her Mother, who having imbibed a strong Prejudice against such
Remedy, never would consent to it. Here I took Leave of my Patient.

Ten Days after I was sent for by her Father, who, after a short Apology,
told me, “if I was still of Opinion that Electrization would be of any
Service to his Daughter, my Advice should be followed.” I answered in
the Affirmative.

The next Morning a few Sparks were drawn accordingly. However, to
estimate the Effect of the electrical Fluid in this Case, I previously
repeated the Observation with the Watch, and found no Alteration in my
Patient’s Sight, since I had discontinued to attend her.

In the Evening a few Sparks likewise were drawn. The same was repeated
for many a Day, having Care, at every Time, to increase the Number of
Sparks.

She advanced but slowly towards her Recovery; for at the Beginning of
the fourth Week the Scale was reduced only to 18 Inches.

Astonished at so inconsiderable a Progress, I allowed some Intermission
to my Patient. During that Time, enquiring into what could have checked
the Efficacy of a Remedy I so much relied upon, I made the following
Reflection:--That since electrical Sparks acted only as stimulating,
they possibly could neither deobstruct nor reduce swelled Parts, as long
as there was a Redundancy of Blood. To diminish its Mass, I therefore
had Recourse to Bleeding, and the next Day Electrization was re-assumed.

The Event justified my Expectation; for drawing Sparks had not been
continued eight Days, but the Scale was reduced to 13 Inches.

I had then a Mind to repeat Bleeding, but was obliged to postpone it, on
Account of the Weakness of my Patient.

Having been bled a second Time, a Plaister of _Tacamahaca_ was applied
to both her Temples, and Electrization continued. A few Days after the
Scale was reduced to Nine Inches.

These Remedies were made Use of three Weeks longer; but, seeing no
farther Reduction of the Scale, I judged the Vision to be nearly
restored to its original State. The stimulating Plaister and
Electrization were then left off.

For a while there remained to the Patient an Incapacity of fixing
Objects. As this was entirely dependant on the Weakness of the ocular
Muscles, I prescribed Lotions with cold Water mixed with a few[26] Drops
of HOFFMAN’S _Balsam Vitæ_, which at last perfected the Cure.

_D. B._ a Merchant in _London_, having contracted a virulent Gonorrhœa
and Bubo, applied to a Surgeon of Repute, who (suspecting the whole Mass
of Humours infected with the Venereal Taint) administered to him
corrosive Sublimate in Spirits of Wine.

In order to keep his Body open, a Dose of Jalap indeed was given now and
then: But as this Purgative is of a drastic[27] Kind, and as the Patient
observed no Sort of Regimen (enjoying his Bottle as freely as before) a
violent Salivation came on; which however, by timely Assistance, was
soon conquered.

The Use of corrosive Sublimate had been re-assumed but a few Days, when
the Patient having made an Excess in Drinking, his Running suddenly
disappeared, and in Four-and-Twenty Hours broke out in the small Canthus
of the Left Eye: both Eyes became inflamed, and the whole Face swelled.

The next Day the Opthalmia was such as the Patient could not bear Day’s
Light. For a while he kept his Eyes shut; and when he did open them, it
was only to be sensible that his Sight was nearly lost.

It was long before the Opthalmia was entirely discussed; but when it was
so, the Vision was much affected, for the Patient could see no Objects
except at a Distance; and those only partially, their Image being
incompleat.

In his Vexation at this, he discharged the Surgeon who attended him, and
applied to another.

In order to restore his Sight, Purges with Calomel were frequently
given, and a Blister kept open on the Neck; but to no Effect.

A Discharge at the Nose was at last promoted by Powders _Errhynes_ and
Volatile Salts: These excited a fresh inflammation, and rendered the
Disease worse.

The Patient had laboured Seven Months under these disagreeable
Circumstances, when he put himself under my Care.

As he was of a sanguine Habit, I had him bled twice the first Day:
Afterwards I prescribed a cooling Diet, and kept his Body open with
gentle Laxatives.

For Fourteen Nights together no other Benefit was received, except that
the Eyes were less painful when touched; but during the Course of the
third Week, the affected Parts were quite easy: Objects indeed were not
distinguished at a nearer Distance, but their image was not so much
mutilated.

I then had the Patient bled again, and employed emollient Suffumigations
and Pultises. These being continued for Fourteen Nights, a great Change
was produced in Vision; the image of Objects was no longer mutilated.

Bleeding was repeated. The next Day the Patient re-assumed his
Laxatives, which he continued for a whole Week. Afterwards he was
electrified in the Manner already described, and a Plaister of
_Tacamahaca_ was applied to his Temples.

Stimulating Plaisters, drawing Sparks, and diluting Infusions, removed
in Five Weeks all Obstruction and Swelling of the ocular Muscles. The
Sight being thus restored, frequent Lotions with cold Water alone soon
compleated his Cure.

In _January 1773, J. P._ Esq; took Sublimate Corrosive dissolved in
Spirit of Wine, with a view of eradicating a stubborn Gleet. As no Care
had been taken to keep his Body open, a Salivation came on. When under
this Circumstance, he inconsiderately took a Morning Ride, in a sharp
Northerly Wind. At his Return Home he was seized with a sort of Quinsey:
His face swelled to a monstrous Size, and his Eyes were inflamed.

To relieve him, frequent Doses of Jalap were given.

As the Patient could bear no vivid Light, and was in Danger to be
suffocated whilst lying in Bed, he passed Night and Day on an elbow
Chair, in a darkened Room.

When the dreadful Symptoms disappeared, on again admitting Light into
his Room, he was apprehensive of having lost his Sight, but was soon
made sensible that it was only altered, for there was left to him a
Sensation of Objects at a certain Distance.

Too long and tedious would be the Narration of the various Remedies,
which were vainly employed in order to restore the Organ of Vision. I
shall only observe that, when I was applied to, the Patient had laboured
nearly Two Years under that cruel Disorder; and so weak was the
Impression of Objects on his Left Eye, that I looked upon the Success of
my Attempt as at best very doubtful.

Upon examining how far the natural Focus of the Rays of Light had been
changed, I found that my Patient could not possibly see the Hour on a
Watch, clearly, at any Distance whatever; but that he saw it less
imperfectly when the Watch was at Thirty-two Inches Distance:--An
Alteration of Vision the greatest I have ever known.

To add to his Misfortune, the Patient was of a scorbutic Habit; so I had
two Diseases to attack instead of one.

The first Thing to be done in this Case was, undoubtedly, diluting and
purifying the Humours; but among the antiscorbutic Remedies, such were
to be carefully avoided as were impregnated with acrid principles; for
Example, Water-cresses, bitter Plants, Tar-water, _Harrowgate_ Water,
Chalybeate Water, Elixir of Vitriol, Spirit of Sea Salt, &c. being all
diametrically opposite to the aimed-at Relaxation of the rigid Parts.
Accordingly I prescribed Whey and Apple-water for the sole Diet-drink,
with Milk and fresh Vegetables for Food.

Not daring to venture even a small Bleeding, on Account of my Patient’s
emaciated state of Health, I judged it proper to diminish the Mass of
Blood, by keeping his Body open with Cassia and Tamarinds.

This Method had the desired Effect. Not only the scorbutic symptoms
disappeared in Five Weeks, but one Eye was somewhat better.

No Alteration was made in the Diet; but, as the Patient’s Constitution
was then not so much debilitated, I prescribed Laxatives more
frequently: I likewise begun using emollient Suffumigations and
Pultises. They proved so effectual as to reduce the Scale to
Twenty-three Inches in Fourteen Nights.

The Patient daily gathering strength, I was no longer apprehensive of
any bad Effect from Bleeding, and accordingly had him bled.
Suffumigations and Pultises were continued three Weeks more, and during
the interval the Scale was reduced to Sixteen Inches.

I had him bled again, and afterwards electrified. The twelfth Day the
Scale was reduced to Ten Inches.

By continuing Electrization, Laxatives and _Tacamahaca_ Plaister a
Month longer, the Scale was further reduced One Inch and a Half.

Judging that Vision was almost restored to its pristine state, I advised
him, for the bracing it, Lotions with cold Water alone. I must confess,
however, that ever since the Left Eye has remained weak.

These are the Cures[28] performed by my Method. They indeed are not
numerous, but are sufficient to prove the Attempt as safe as it is
rational: And whenever this Method shall be employed with Judgment, I
have no Doubt but it will be attended with the same Success. But even
allowing there is still much Room for Improvement, was the Question put
to me, _Why I offer it now to the Public?_ my Answer is plain--_Because
the actual Practise of treating this Disease is evidently wrong._--Thus
pursuing a wrong Plan, not only the Hopes of the Patient are frustrated,
but his Case becomes desperate.

If one cannot always be the happy instrument of alleviating the Misery
of the Unfortunate, it is, however, a sort of service tendered to them,
to prevent their being made worse. On this Consideration I claim the
indulgence of the Public.


                                 FINIS


FOOTNOTES:

[1] Ninth edition, vol. xv. p. 526.

[2] _Academy_, September 23, 1882.

[3] Page 17 of reprint.

[4] _History of French Revolution_, vol. i. p. 216.

[5] Page 7 of reprint.

[6] Page 29 of reprint.

[7] _Academy_, _loc. cit._

[8] If this essay should meet with approbation, I shall offer to the
public a new method of radically curing gonorrhœas in a short time.

[9] A proof of it is, that in this case the running is ever accompanied
with a sensation of scalding, which is not felt in the other case.

[10] I use the mucilage of marshmallows instead of oil, for it does not
oppose the healing of ulcers as oily substances do.

[11] Although the solution of sal ammoniac be a powerful dissolvent of
callous substances, yet it does not injure sound parts.

[12] This unguentum is but little, if at all, known in England. The
formula of its composition is to be found in the _Paris_ dispensatory.

[13] In _October 1769_.

[14] When the difficulty of making water, which generally attends
gleets, comes from any other cause but an irritation of the urethra;
the removing of it requires a particular method.

[15] Discretion is a part of the duty of a physician: But although
ever so reluctant to see their names in public print, the gentlemen in
question will not decline to appear in support of truth, if a private
interview was desired by patients. I have their word for it.

[16] Nor is this to be wondered at, considering how few Oculists,
if any, are acquainted with Optics; a Science, however, absolutely
necessary to investigate the Causes of Defects in Vision. Nay, since
curing the Diseases of the Eye became a peculiar Branch of the Medical
Art, it is wholly left to Operators, who in general do not know the
Functions of the several Parts which constitute the Organ of Seeing,
but are even ignorant of its Structure.

[17] This Disease is more common than one would readily imagine, since
it is a predominant Custom, both among Surgeons and Physicians, to
prescribe Mercury in almost every Case. And I dare assert, that out of
Ten Patients whom they give out as afflicted with a _Gutta Serena_,
Seven are affected with an accidental _Presbytopia_.

[18] Such is the Reason why Mercury, when taken, does not excite a
Salivation immediately.

[19] It is well known that not only Arteries, but Veins, are
susceptible of Irritability.

[20] On this Membrane is the Image of Objects painted.

[21] As ocular Muscles are seldom swelled, or all equally so at the
same Time, the taking of Mercurial Preparations neither does affect the
Sight of every Individual, nor equally both Eyes of the same Individual.

[22] I confine myself to the Indication of general Remedies, without
entering into Particulars: as to the judicious Physician, it is left to
select such as most agree with the Patient’s Constitution.

[23] I confine myself to the Indication of general Remedies, without
entering into Particulars: as to the judicious Physician, it is left to
select such as most agree with the Patient’s Constitution.

[24] It is a material Point to know when Recourse to Electricity is to
be had; for, if unseasonably employed, it only proves hurtful.

[25] As lasting Swelling, or Tension, is ever followed by a
proportionate Relaxation, the ocular Muscles cannot suddenly recover
their former Strength, so as to give the Eye a proper Figure to see
clearly at various Distances.

[26] I have since experienced that fresh Water does better alone than
mixed with Spirits.

[27] Drastic Purges produce momentaneous Dejections, and are all
followed by Costiveness.

[28] The last _August_, being at _Edinburgh_, I (under the Eyes of
the ingenious Mr. _Miller_, Oculist) treated an _American_ Gentleman
afflicted with this Disease. During the few Weeks he was under my Care,
the Scale of Vision was reduced more than one third Part. Affairs
calling me back to _London_, I left him in the Hands of Mr. _Miller_,
with proper Directions how to proceed in the Treatment. Since I have
heard that the Patient could not continue at _Edinburgh_ long enough to
perform his Cure.





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