As argument and ridicule seem alike incapable of arresting this influx of novelties, we may expect to hear of the cure of gonorrhoea by injections of sulphuric acid, or the introduction of a hot wire down the urethra; this would, doubtless, have the effect of checking the gonorrhoea, as well as of incapacitating the patient from contracting any fresh attack. -Med. Times and Gazette, Aug. 21, 1852, p. 197.

109.-CASES OF GONORRHOEA TREATED BY M. JOZEAU'S

COPAHINE-MEGE;

(A PECULIAR MODE OF ADMINISTERING COPAIBA.)

Under the care of Messrs. LLOYD and POLAND.

[M. Jozeau deserves great praise for the frankness with which he has stated the different ingredients contained in these capsules, and the way in which they are treated and prepared.]

The peculiarity of M. Jozeau's saccharated capsules was stated to be that they were easy and agreeable to take, that they produced no nausea, sickness, or unpleasant purging, and that, when continued for a sufficient period, they cured gonorrhoea in a short time. Considering the insuperable dislike of some patients for copaiba, these, if verified by experience, are certainly most valuable improvements.

The following is the account given by M. Jozeau of the preparation of the Copahine-Mège, and the pathological facts which led to the peculiar manner of preparing this remedial agent:

It was noticed that such patients as were purged by the copaiba evacuated per anum large quantities of this drug in an unaltered state, their urine not containing any of it. These persons, though sometimes cured, generally had a relapse. Those, however, who were not purged became well more slowly, and had no recurrence of the disease; their stools contained no copaiba, and their urine a great deal. From these facts it became evident that in order to obtain regular and speedy effects, the copaiba should be made to undergo such modifications as to insure its more complete absorption into the system. Experiments were now instituted respecting the effects of the two principal substances contained in the copaiba-viz., the oil and the resin. These were separately tried. The oil produced a decidedly purgative effect; the resin purged less; but no complete cure was obtained by either substance taken separately.

It was now pretty clear that both the resin and essential oil were indispensable for obtaining curative effects, and the question arose how these could be modified so as to allow the stomach to digest them completely. This end was attained in surcharging the copaiba with oxygen, by means of nitric acid, the latter being added in proportions which varied according to the kind of copaiba acted upon. The nitric acid yields some of its oxygen to the essential oil, and the nitrogen is given off in the form of hyponitrous acid, by combining with the oxygen of the atmosphere. The copaiba thus treated is then well washed with water,

until it no longer reddens litmus paper, and to it are added one tenth part of cubebs in fine powder, the same proportion of carbonate of soda, and one sixteenth part of calcined magnesia. The mixture is allowed to stand until it is quite solidified, and in that state it is made into small masses. The latter are then carefully covered with sugar, to which a pleasant pink colour (coccus cacti) is given, and they then look like very pretty sugar-plums.

To these saccharated capsules the name of Copahine-Mège was given, because the experiments had been made conjointly by M. Jozeau and M. Mège, and the latter had first thought of making the saccharated capsules. For lymphatic patients and delicate females a second mass was prepared, into which, besides the above-mentioned ingredients, some steel was made to enter. This is then a sort of martial preparation of copaiba. The doses are stated as follows:

When there is neither pain nor inflammation, five saccharated capsules are taken three times per diem. One capsule more is then given with each dose every subsequent day, the doses being thus increased until purging is produced. Where there is pain or inflammation, these should first be treated by the surgeon in the manner he thinks the most advisable, and the copahine is to be commenced when acute symptoms have abated. It has been noticed that the martial capsules have effected a cure when the simple preparation has failed.

Such being the explanations given by M. Jozeau, several hospital surgeons agreed to give the capsules a trial, but this proved somewhat difficult, as far as public practice is concerned, since persons affected with gonorrhoea are not in general admitted as in-patients into these institutions. It was, moreover, evident that upon out-patients the effects could not be so conveniently watched, and the value of the remedial agent ascertained. It might also be feared that the form given to the remedy, being extremely elegant and new, out-patients of hospitals might probably not sufficiently appreciate the importance of the capsules. Still it would appear that M. Jozeau was anxious to obtain the approval of the surgeons of this metropolis, as the preparation had already been pronounced as extremely valuable by the Academy of Medicine of Paris, upon a report of Messrs. Boulay, Bégin, and the former surgeon of the Venereal Hospital, M. Cullérier. We here subjoin some of the results obtained.

[The following case occurred at St. Bartholomew's, under Mr. Lloyd:] Case 1. John B., aged 28, has had gonorrhoea four days, and has not tried any remedies. He commenced taking the capsules October 17th, 1851, the dose being five of these thrice a day. Six days afterwards, there was no improvement; bowels open regularly twice a day; no nausea, but slight scalding in passing urine. Take six capsules three times a day. Two days 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. No nausea; take seven capsules three times a day.

October 30th, thirteen days after the commencement of the treatment, the discharge had nearly ceased. Bowels open four times a day. Take

twenty-four capsules per diem. Five days after this, the discharge had entirely disappeared. On Nov. 9th, being four days after the complete cessation of the discharge, the latter slightly recurred. The capsules were resumed, and in four days no appearance of the affection was left. Case 2. Edward L., aged eighteen. Gonorrhoea three days; a small sore on the prepuce. Commenced taking five capsules three times a day, on October 17th, 1851, and continued using them for six days, when he was taking twenty-one per diem. The patient was soon purged three times a day, and the bowels continued freely open several times daily, until the eighth day of the treatment, when the discharge ceased. There was no nausea during the use of the capsules.

Case 3. Sarah A., aged 20, has been affected with gonorrhoea for one week. She began to take five capsules three times daily, on the 17th Oct., 1851, and continued them for four days, increasing the dose to twentyfour per diem, when the discharge entirely ceased. On November 10th she left the hospital quite cured. After using the capsules for two or three days, the bowels were freely acted upon, but no nausea or sickness ever occurred during their use.

[The next cases were under Mr. Poland, of Guy's Hospital.]

Case 1. A. B.; gonorrhoea for the first time; duration three weeks; imflammatory symptoms subsiding. Patient took the capsules for sixteen days, increasing from five, three times a day, 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 a dislike to the mode of taking the drug, as he allowed the sugar to melt away too completely before swallowing, and therefore experienced the unpleasant taste of the copaiba in the mouth.

Case 3. Male patient; gonorrhoea three weeks. Took the capsules for a week, without any trouble; but having slightly improved, he did not present himself again.

Case 4. W. B.; gonorrhoea for the second time; copious discharge, which had lasted ten weeks. Took the capsules with a little inconvenience, increasing from five to ten three times daily. The drug acted very well, there was slight purging, and the discharge was checked. In this patient the capsules were not continued long enough after the discharge had ceased, for it returned to a certain extent.

Case 5. Male patient; gonorrhoea second time; copious discharge. Took the capsules, from five to twelve, three times daily, for eight days, without any effect, and did not continue them. It should be noticed that no injections were used in any of the foregoing cases.— -Lancet, November 6, 1852, p. 423.

110.-On the Employment of Aluminized Bougies. By M.JOBERT.When the stricture is combined with chronic inflammation, M. Jobert finds a preliminary treatment by means of aluminized bougies of great service in procuring dégorgement of the mucous membrane,-the alum not acting as a caustic substance, but producing a modifying influence

similar to that induced by nitrate of silver in ocular inflammations. He warms the end of a wax bougie, and then incorporates with it some powdered alum, so as to form a kind of magma of the wax and alum. If the latter were lying at the surface of the bougie, it might induce ulceration in place of mere modification of the mucous surface, and the inodular tissue left by this, on healing, would only aggravate the patient's condition. When the dégorgement is accomplished-usually in from seven to twelve days-the dilatation of the stricture is proceeded with.-L'Union Médicale; Medico-Chirurgical Review, Oct. 1852, p. 544.

DISEASES OF THE SKIN.

111.-ON THE PRESENT METHOD OF TREATING DISEASES OF THE SKIN.

By J. S. TYLOR, Esq.

[In the first of the following cases of lepra, the patient, Emma Collinson, aged 12, was first attacked with the disease six years ago, beginning upon her knees and extending to the lower parts of her legs. At present (Sept. 5, 1851) firmly adherent patches of lepra are scattered over nearly the whole of the loins, back, and abdomen.]

*Treatment.-Meat was allowed once a day; but a milk and farinaceous diet was chiefly enjoined. Thin oatmeal gruel was directed to be used instead of soap. Malt liquors were forbidden. An alkaline bath was ordered once a week. Half grain doses of the iodide of potassium, combined with three minims of Fowler's solution, were given three times a-day; and an ointment, composed of the nitric oxide of mercury and lard, with a few drops of creosote, was to be applied night and morning to the parts affected. She persevered in the use of these measures for six weeks; and it was very interesting to observe, from time to time, the gradual detachment of the larger and thicker leprous scales, and the healing of the patches from the centre outwards.

Discharged cured, October 17, 1851.

Case 2. Lepra Vulgaris.-George Totz, a German, aged 50, Old St. Pickford-square, admitted June 18, 1851. Is a skin-dresser by trade, and much exposed to dirt, and contact with certain chemical substances. Has been affected with lepra for fifteen years. Up to the age of thirtyfive, he was robust and healthy. At this time, he was attacked by a scaly eruption which first came on his left elbow, and his health began to decline. He is now weakly, though suffering from no specific complaint but that of the skin. The pruritus is at times extreme, and distresses him greatly. Has been a patient at several hospitals and dispensaries. Irregular patches of lepra are scattered over nearly the whole of this patient's body. The shin bones and arms are also occupied by orbicular patches and spots, slightly depressed in the centre, and many of them are covered with white shining imbricated scales. Some of the

patches are inflamed and indurated, and some irregular in shape resem bling those of psoriasis. The knees and elbows are coated with thick, closely-adherent scales, of a dirty white colour. Diet, &c., the same as in the last case.

Treatment.-An alkaline bath. Iodide of potassium, with a few minims of Fowler's solution; and creasote ointment.

This patient was discharged cured, October 8, 1851, with his general health much improved.

Case 3. Lepra Vulgaris. - Anna Campkin, aged 9, Perry-street, Chiselhurst, Kent, admitted March 17, 1851. A stout, fresh-looking girl, in good general health. She first observed small squamous spots on her arms and legs two years ago. Her father was affected with a scaly disease for some years before she was born. Large circular patches of lepra are symmetrically placed upon the neck, body, and legs. The largest, from two to three inches in diameter, are situated upon the hips, and below the patellæ. The arms and elbows are free from disease: a few spots are developed on the scalp. The disease produces no constitutional disturbance. The itching only troublesome when warm in bed. The complaint gradually increases, but does not vary with the seasons of the year. Rules given with respect to diet, &c. Alkaline bath as usual.

Treatment.-Doses of one-twelfth of a grain of bichloride of mercury, with a few drops of laudanum, three times a-day. An ointment, containing a small quantity of both the nitric oxide and the ammoniochloride of mercury, to be applied night and morning. On the 7th of April, Fowler's solution was added to the medicine, and creasote ointment was substituted for the mercurial.

On the 30th of April, as she did not make rapid progress, the iodide of potassium, with liq. arsenicalis, was prescribed, which was persisted in till she got well.

June 20.-Quite well. Skin everywhere perfectly clear and sound. This patient did not leave the hospital till the 28th of August, during which time she experienced no relapse, and took no medicine.

Case 4. Lepra Vulgaris.-Elizabeth Maunder, aged 22, unmarried, Blue Anchor-road, Bermondsey, admitted December 20, 1850; a healthy young woman. Six years ago a few red spots appeared on both elbows at the same time, which shortly became covered with white filmy scales. Parents both healthy; neither has ever suffered from any cutaneous disease. She can assign no cause for the attack. Over some parts of this patient's body the spots represented the appearance of lepra alphos, being small, raised, and coated with very white scales. On the limbs the patches are of considerable size, mostly depressed in the centre, and covered with shining metallic-looking scales. The parts chiefly affected are the fore-arms, and the legs from the knees to the ankles. Diet and bath as usual.

Treatment.-Half-grain doses of the iodide of iron, with Fowler's solution, and the creasote ointment; but as the arsenic, even in very small doses, disagreed with the stomach, the bi-chloride of mercury was prescribed on the 3rd of January, with a few drops of the tinctures of opium and cantharides. This patient disliked medicine, and not being