Part 2

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with excruciating pains, and the muscular tunic of the urethra so crispated, that the extremity of the glands was retracted inwards.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.