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 diſ⯑eaſes, is but too often the ſad conſequence^* 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.

[6]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^*, 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 [7]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.

[8]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 [9]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 [10]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^* 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 [11]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^* 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^† 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 [12]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. Armoen. 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 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.

[13]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 [14]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^* 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.

[15]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^* 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,^† 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.

[16]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.