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I ENTER in the subject without any preamble. A gleet, by the want of skill in those who undertake to cure venereal dis∣eases, is but too often the sad consequence* 1.1 of a virulent gonorrhoea.
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 in∣creases, it always proceeds, or from an inflammation of the muscular tunic, as happens after or freely enjoying the bottle and the company of women, or from a rarefaction of the fluids* 1.2, 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 suc∣cessful 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 pro∣vince 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 per∣mission.
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 circum∣stance. On this I said to him all that occurred to me just then for his consolation.
After I had lest him I could not help reflecting on his melan∣choly 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 rea∣sons of the frequent inefficacy of the usual practice, and soon was made sensible of them.
After mature consideration, I called upon my friend, and pro∣posed to attempt his cure. He readily agreed. The same day he took an apartment next to mine. I immediately began his treat∣ment, 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 enume∣rating 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 bou∣gies are made with. This is obvious from the structure of the af∣fected parts. The internal tunic of the urethra, although ever irritated in a virulent gonorrhoea, 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 sup∣purating bougies, made with a plaister, whose basis is lytargirium of lead and oil of olives; whilst, in order to conduct suppura∣tion 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, practi∣tioners 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 suppu∣ration, 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 con∣siderably 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 ab∣surd. 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 inflamma∣tion 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 conse∣quences, such as crispation, and afterwards relaxation of its fibres. How many patients have I not heard, complaining of hav∣ing
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 accompa∣nied 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 bou∣gies being employed in order to consolidate the ulcers, never fail to dry to an excess the parts they are in contact with; they there∣fore 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 sup∣puration, in order to cure gleets, is in some sort indicating the proper way to do it; but as there are many particulars to be ob∣served 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 mu∣cilage* 1.3 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 con∣sider 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 marsh∣mallows, and I introduce the bougie in the urethra, when I judge that the remedy is in contact with the ulcers, I bend back the ex∣ternal
extremity of the bougie; and to fasten it, nothing is want∣ing 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 na∣tural 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, re∣quires the skill of an able practitioner.
The caustic humours which an ulcer contains, vitiate the nu∣tritive 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* 1.4 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† 1.5l'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
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 ul∣cers 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 my∣self to the two following.
In 1762, J. A. Esq contracted a virulent gonorrhoea 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 disap∣pointments, 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 him∣self, he resolved to venture a last experiment.
When he applied* 1.6 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 sup∣purative 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* 1.7 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,† 1.8 having contracted a virulent gonorrhoea 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 fore-mentioned cases, there is no gleet incurable: nay, there is none which cannot easily and speedily be cured, if properly treated.
If this essay should meet with approbation, I shall offer to the public a new method of radically curing gonorrhoeas in a short time.
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.
I use the mucilage of marshmallows instead of oil, for it does not oppose the heal∣ing of ulcers as oily substances do.
Although the solution of sal ammoniac be a powerful dissolvent of callous substances, yet it does not injure sound parts.
This unguentum is but little, if at all, known in England. The formula of its composition is to be found in the Paris dispensatory.
In October, 1769.
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.
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.