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

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In several of them, I have even seen the fibres of this membrane so corrugated, as that the præ-eminence of the glands was retracted within, and this retraction was ever accompanied with excruciating pains at the time of erections; however, the most fatal consequences attending the actual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.