423

apparatus for talipes varus (THE LANCET, vol. ii. 1850, p. 303);and Mr. Hilton’s tourniquet for the groin, (THE LANCET, vol. ii.,1852, p. 7). In this department (the surgical) we shall soonhave to give a short description of an improvement of Mr.Luke’s swinging apparatus for fracture of the leg, and of certain.modifications of lithotomy knives.A few words shall, in the meanwhile, be devoted to experiments

which have lately been instituted by several hospital surgeons, totest the efficacy of a peculiar preparation of copaiba and cubebs,proposed by M. Jozeau, a French pharmacien in London, underthe name of Copahine-Mège. M. Jozeau obtained the favour ofthese trials principally because he simply and frankly acquaintedevery surgeon with the different ingredients contained in thesesaccharated capsules, and with the manner in which these iu-

gredients are treated and prepared. This is as it shonld be, forthe drawback of all the specific preparations and solutions,&c., of copaiba, &c., is that the mode of preparing them is keptsecret.The peculiarity of M. Jozeau’s saccharated capsules was stated

to be that they were easy and agreeable to take, that they pro-duced no nausea, sickness, or unpleasant purging, and that, whencontinued for a sufficient period, they cured gonorrhoea in a shorttime. Considering the insuperable dislike of some patients forcopaiba, these, if verified by experience, are certainly most valu-able improvements.The following is the account given by M. Jozeau of the pre-

paration of the Copahine-Mège, and the pathological factswhich led to the peculiar manner of preparing this remedialagent :-

It was noticed that such patients as were purged by the copaibaevacuated per anum large quantities of this drug in an unalteredstate, their urine not containing any of it. These persons, thoughsometimes cured, generally had a relapse. Those, however, whowere not purged became well more slowly, and had no recurrenceof the disease ; their stools contained no copaiba, and their urinea great deal. From these facts it became evident that in orderto obtain regular and speedy effects, the copaiba should be madeto undergo such modifications as to insure its more complete ab-sorption into the system. Experiments were now institutedrespecting the effects of’ the two principal substances containedin the copaiba-viz , the oil and the resin. These were separatelytried. The oil produced a decidedly purgative effect; the resinpurged less; but no complete cure was obtained by either sub-stance taken separately.

It was now pretty clear that both the resin and essential oilwere indispensable for obtaining curative effects, and the questionarose how these could be modified so as to allow the stomach to

digest them completely. This end was attained in surchargingthe copaiba with oxygen, by means of nitric acid, the latter beingadded in proportions which varied according to the kind ofcopaiba acted upon. The nitric acid yields some of its oxygento the essential oil, and the nitrogen is given off in the forrn ofhyponitrous acid, by combining with the oxygen of the atmo-sphere. The copaiba thus treated is then well washed withwater, until it no longer reddens litmus paper, and to it are addedone tenth part of cubebs in fine powder, the same proportion ofcarbonate of soda, and one sixteenth part of calcined magnesia.The mixture is allowed to stand until it is quite solidified, and inthat state it is made into small masses. The latter are then care-fully covered with sugar, to which a pleasant pink colour (coccuscacti) is given, and they then look like very pretty sugar-plums.To these saccharated capsules the name of Copahine- Mege was

given, because the experiments had been made conjointly byM. Jozeau and M. Mege, and the latter had first thought ojmaking the saccharated capsules. For lymphatic patients anddelicate females a second mass was prepared, into which, besidesthe above-mentioned ingredients, some steel was made to enter.

This is then a sort of martial preparation of copaiba. The dosesare stated as follows:-When there is neither pa;n nor inflammation, five saccharatec

capsules are taken three times per diem. One capsule more ithen given with each dose every subsequent day, the doses beinthus increased until purging is produced. Where there is pairor inflammation, these should first be treated by the surgeon irthe manner he thinks the most advisable, and the copabine is t(be commenced when acute symptoms have abated. It has beernoticed that the martial capsules have effected a cure when th(simple preparation has failed.

Such being the explanations given by M. Jozeau, severa

hospital surgeons agreed to give the capsules a trial, but thi:proved somewhat difficult, as far as public practice is concernedsince persons affected with gonorrhoea are not in general admitted as in-patients into these institutions. It was, moreoverevident that upon out-patients the effects could not be so con.

wiently watched, and the value of the remedial agent ascer-

tained. It might also be feared that the form given to theremedy, being extremely elegant and new, out-patients ofhospitals might probably not sufficiently appreciate the import-ance of the capsules. Still it would appear that M. Jozeauwas anxious to obtain the approval of the surgeons of thismetropolis, as the preparation had already been pronouncedas extremely valuable by the Academy of Medicine of Paris,upon a report of Messrs. Boulay, Begin, and the former surgeonof the Venereal Hospital, M. Cullerier. We here subjoin someof the results obtained.

ST. BARTHOLOMEW’S HOSPITAL.Cases of Gonorrhœa Treated by M. Jozeau’s Copahine-Mège.

(Under the care of Mr. LLOYD.)The three following cases were noted by Mr. Stretton, Mr.

Lloyd’s house-surgeon :-CASE 1.-John B-, aged twenty-eight, has had gonorrhoea

four days, and has not tried any remedies. He commenced takingthe capsules October 17th, 1851, the dose being five of thesethrice a day. Six days afterwards, there was no improvement;bowels open regularly twice a day; no nausea, but slight scaldingin passing urine. Take six capsules three times a day. Twodays after this increase of the dose, the patient was found better;the discharge had considerably lessened, the scalding had ceased,and the bowels were opened three or four times daily. Nonausea ; take seven capsules three times a day.

October 30th, thirteen days after the commencement of the

treatment, the discharge had nearly ceased. Bowels open fourtimes a day. Take twenty-four capsules per diem. Five daysafter this, the discharge had entirely disappeared. On Nov. 9th,being four days after the complete cessation of the discharge, thelatter slightly recurred. The capsules were resumed, and in fourdays, no appearance of the affection was left.CASE 2.-Edward L-, aged eighteen. Gonorrhoea three

days; a small sore on the prepuce. Commenced taking fivecapsules three times a day, on October 17th, 1851, and continuedusing them for six days, when he was taking twenty-one perdiem. The patient was soon purged three times a day, and thebowels continued freely open several times daily, until the eighthday of the treatment, when the discharge ceased. There was nonausea during the use of the capsules.CASE 3.-Sarah A--, aged twenty, has been affected with

gonorrhoea, for one week. She began to take five capsules threetimes daily, on the 17th of October, 1851, and continued themfor four days, increasing the dose to twenty-four per diem, whenthe discharge entirely ceased. On November the 10th she leftthe hospital quite cured. After using the capsules for two orthree days, the bowels were freely acted upon, but no nausea orsickness ever occurred during their use.

GUY’S HOSPITAL.Cases of Gonorrhœa Treated by the Copahine-Mège.

(Under the care of Mr. POLAND.)CASE 1.-A. B-; gonorrhcea for the first time; duration

three weeks ; inflammatory symptoms subsiding. Patient tookthe capsules for sixteen days, increasing from five, three times aday, to eight, and became completely well.

, CASE 2.-W. H- ; gonorrhoea for the third time ; discharge

profuse. Took the capsules for four days, and left off from adislike to the mode of taking the drug, as he allowed the sugarto melt away too completely before swallowing, and thereforeexperienced the unpleasant taste of the copaiba in the mouth.CASE 3.-Male patient; gonorrhcea three weeks. Took the

capsules for a week, without any trouble; but having slightlyimproved, he did not present himself again.CASE 4.-W. B-; gonorrhoea for the second time; copious

discharge, which had lasted ten weks. Took the capsules witha little inconvenience, increasing from five to ten three timesdaily. The drug acted very well, there was slight purging, andthe discharge was checked. In this patient the capsules werenot continued long enough after the discharge had ceased, for itreturned to a certaiù extent.CASE 5.-Male patient ; gonorrhoea second time ; copious dis-

charge. Took the capsules, from five to twelve, three times daily,for eight days, without any effect, and did not continue them. Itshould be noticed that no injections were used in any of theforegoing cases.

ST. THOMAS’S HOSPITAL.

(Cases under the care of Mr. LE GROS CLARK.)Mr. CLARK has treated three patients affected with gonorrhoeawith the Copahine-Mège capsules. The effect has generally been

424

favourable for the time they continued taking them ; but, as

stated above, the treatment was not submitted to with sufficientregularity to follow up the cases in a completely satisfactorymanner. No vomiting, eructation, or unpleasant gastric symp-toms occurred in any of the cases.

From the foregoing cases, it seems clear that when thispeculiar preparation is administered regularly, and that patientsadhere completely to the instructions given, good results maybe obtained; but it is just as plain, that without great attention toquantity, regularity, and perseverance, failures will occur as withany other medicine imperfectly taken. Several surgeons, inorder to give the preparation a fair trial, have used it in privatepractice, where all circumstances for such a purpose are by farmore favourable than with out-patients of hospitals. Very satisfac-tory results have thus been obtained. Among the number we maycite Mr. Gay, of the Roval Free Hospital, and Mr. Callaway, ofGuy’s Hospital. It would appear that the great point in theadministering of copaiba is to disguise its very unpleasant taste,and to prevent, as far as possible, sickness and vomiting. !rtten-tion has thus for nearly a quarter of a century been directed toprevent, by various means, these untoward effects. Dr. Christison,s,ys on this head:-

"Among the inconveniences attending the use of copaiba,sickness and vomiting are the most frequent. This effect maysometimes be prevented by multiplying and at the same time di-minishing the doses, by altering the form, especially to that ofsolution, by uniting an aromatic water with it, or by directingthe patient to chew a piece of cinnamon or nutmeg after eachdose."

M. Jozeau’s capsules are likely to preclude the necessity ofhaving recourse to the various devices which have been pro-posed for facilitating the administration of copaiba, for they pro-duce no impression on the mouth, and are well borne by thestomach. If they keep their ground, they will cause the

following passage of Mr. Druitt’s " Surgical Vade-Mecum" to bemodified :-

" Young, irritable people, with light complexions, can seldomtake these medicines (preparations of copaiba) without sufferingfrom sickness or diarrhoea, or sometimes even from fever anda rash; and every combination of aromatic and opiate that can bedevised, will not enable the stomach to tolerate them."We find, also, that Mr. Curling, in his work on the Rectum,

despairs of making patients take the copaiba. The author says,p. 32 ° In cases where there is much irritation about the rectum,great relief may be derived from the balsam of copaiba, whichoperates as a mild aperient at the same time that it allays irrita-tion. It may be given in doses of half a drachm, with aboutfifteen minims of liquor potassae, three times a-day, in a mixtureto disguise the taste. This remedy is so nauseous to many per-sons that it is not desirable to press their taking it."

It is principally in France that combinations have been triedto disguise the nauseous taste of the copaiba. There is, for in-stance, Choppart’s mixture, composed of copaiba, alcohol, syrupoftolu, mint water, orange-flower water, and nitric sether. Thisis a kind of solution of the copaiba in alcohol, but as water isadded in too large a proportion, the copaiba separates from it tosuch an extent, that the mixture must be well shaken before use.The removal of this defect has been attempted by making an ’,emulsion, but this does not keep; and both preparations have, Ibesides, a most unpleasant taste. Calcined magnesia has, bysome, been combined with the copaiba, and the mass given in the Ishape of boluses, covered with wafer paste, these being sometimesmixed with opium or almond paste. The copaiba has been,finally,administered in capsules made either of gelatine (Mothes) or ofgluten (Raquin). But of the latter it should be noticed, that thecapsules served only to keep the taste of the copaiba from themouth, and that the gelatine, when acted upon by the stomach,swelled to five or six times its size before the bursting of the cap-sules. The digestive powers, being weakened by this circum-stance, had hardly any action on the drug ; hence arose eructa-tions, nausea, cramps, &c., of a more unpleasant nature than wherethe copaiba is taken in a simple mixture. It has also been noticedthat eructations are very frequent with the gelatine capsules, asthe latter cannot be completely filled with the copaiba, the bubbleof air contained within them invariably reascending the oesophaguscharged with the taste of the copaiba.The sugar capsules which are mentioned above seem to be

free from these defects, as sugar rather favours and strengthensthe digestive vigour. As soon as they are placed in the mouth,the sugar begins to melt, which process is quickly completed inthe stomach. The capsules are thus gradually diminishing insize, and reach the intestinal canal without occasioning anyfatigue or distress to the stomach. To these advantages must be

added the fact, that sugar rather excites secretion of the fluidsnecessary for a good digestion, and that therefore neither nauseanor eructations ever occur by the use of the saccharated capsules,which may, without the slightest harm ever occurring, be takenin pretty large quantities.

LONDON HOSPITAL.Fibrous Tumour of the Lower Jaw; Removal of the Portion of

Bone involved in the Disease; Recovery.(Under the care of Mr. ADAMS.)

OPERATIONS are now-a-days performed with such care andaccuracy, the lines of incision are so well calculated, and themargins of the wounds so neatly brought together, that someof the most formidable operative proceedings, especially uponthe face, hardly leave any mark or difformity. There is nodoubt that great strides have, in this respect, been madewithin the last twenty years, and it is extremely gratifying,both to the surgeon and to ourselves, when we see patientspresenting themselves several months after the operation withfaintly-marked cicatrices, and freed at the same time fromtroublesome or dangerous tumours.These favourable results could, however, be rendered still

more satisfactory if surgeons would now and then resort, whenoperating upon the face, to a little contrivance which wouldrender exact apposition of parts almost certain. This con.trivance is nothing more than tracing with black pigment ornitrate of silver certain lines, which would, after the divisionof the soft parts and removal of morbid growths, point to theexact spot where the margins of the wound should meet. Thisapplies to all operations on the face, not excluding hare-lip orectropium, for in both of these cases lines or dots would con-siderably aid the symmetrical union of the edges of the wounds.Every one who sees many of these operations will readilyacknowledge that they are in general extremely well per-formed without lines, dots, and marks; but this circumstancecan hardly make us neglect additional precautions, especiallywhen outward appearance is at stake. In rhinoplasty, forinstance, the tracing is always done, and we presume that thepractice might, with advantage, be extended to other opera-tions upon the face. We saw, some time ago, Mr. Erihsenremove, at University College Hospital, the whole of the lowerlip for cancer; and there can be no doubt that he was muchassisted in the operation by the lines which were madea shorttime before commencing. We shall soon bring this case

under the notice of our readers, with two others nearlv of thesame kind, by Mr. Lawrence at St. Bartholomew’s Hospital,and Mr. Tatum at St. George’s Hospital, in which the resourcesof autoplasty were beautifully illustrated.We have indulged in these remarks because Mr. Adams’s

patient, from whom a pretty large portion of the lower jawwas removed, recovered with no difformity whatever, the linealcicatrix, which will, with time, become more and more faint,being hardly perceptible. It must be confessed that much ofthis favourable result is owing to the care taken not to dividethe prolabium, or red portion of the lip. In this manner themouth retains its pristine form; and we can confidently state,after closely watching the operation, that there is ample roomfor the manipulations with a longitudinal incision which doesnot include the red part of the lip.The tumour in this case was of the fibrous kind, and as with

these recurrence is the exception, attention to the formationof a becoming appearance of the parts after cicatrization isthe more incumbent upon the surgeon. Those who see muchhospital practice will agree with Mr. Paget, who says, in hisvaluable 11 lectures on Tumours," p. 49, "The favourite seatsof the fibrous tumours of bone and periosteum are about thejaws; en the other bones they are rare." Many cases of thekind present themselves in our charitable institutions: Mr.Hancock removed a fibrous tumour from the upper jaw, at theCharing-cross Hospital, a short time ago, and we hope soonto give an account of the case. Mr. Lawrence had, somemonths since, at St. Bartholomew’s Hospital, an extremelyfavourable case of the same sort; and in all the development ofthe tumour had taken place in either of the two ways thus de-scribed by Mr. Paget (loc. cit.): " As to situation and connexion,the fibrous tumours of the jaws may be found isolated and cir-cumscribed, growing within the jaw, divorcing and expandingits walls, and capable of enucleation; but, in the large majorityof these tumours, the periosteum, with or without the boneitself, is involved and included." Let us now turn to Mr.Adams’s case.The patient, a woman, twenty-nine years of age, of a deli-

cate constitution, pale, with great want of power, married,