Part 1
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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.