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ST. BARTHOLOMEW'S, GUY'S, AND ST. THOMAS'S HOSPITALS.
422 the anterior aortic valve is especially broad, and is formed by anterior extremity of the upper border of the septum of the ventricles; and it is the corresponding portion of the aorta which is especially dilated; the posterior wall descending nearly verti. cally. The contrast is well shown in an antero-posterior vertical section of the vessel. This arrangement obtains in all three pulmonary valves, but as the walls of the right ventricle are con-_ siderably thinner th3ii those of the left, the muscular floor of these valves is much narrower thau in the anterior aortic valve. All this is of course much more plainiy seen in the hearts of the larger animals, as the horse and ox; and here, where the muscular floor of the valves, more especially the anterior aortic, is of very considerable breadth, the tendinous tissue of the valve may be traced over the muscular surface to join the wall of the vessel.
of the
(To be coneltided.)
A
Mirror
OF THE PRACTICE OF . Section of arterial coat.
2. Section of valve.
MEDICINE
3. Section of ventricle.
border before described; the consequence of which arrangement is, that the portion of valve adjacent to the vessel passes over, and rests upon the muscular substance-is supported upon the inner border of the free edge of the ventricles surrounding the arterial orifices. This arrangement, in consequence of the small size of the parts, is not so obvious at the first glance in the human heart, but can scarcely be overlooked in an examination of the heart of any one of the larger animals. Figures 4 and 5 are ac-
AND
SURGERY
IN THE
HOSPITALS OF LONDON. Nulla est alia pro certo noscendi via, nisi quam plurimas et morboram, et dissectionum historias, tum aliorum proprias, collectas habere et inter se comparare.-MORGAGNI. De Sed. et C(ii,6s. 41orb., lib.14. Prooemium.
ST. BARTHOLOMEW’S, GUY’S, AND ST. THOMAS’S HOSPITALS. Cases of Gonorrhœa treated by M. Jozeau’s Copahine-Mège; a Peculiar Mode of Administering Copaiba. Mr. LLOYD, Mr. POLAND, and Mr. LEGROS CLARK.)
(Under the care of
OUR readers have probably observed that we carefully put upon record the trials which are male in the hospitals of this melropolis, of the new therapeutical agents which are from time to offered to the profession. Among these we may mention the sumbal, which was first used at King’s College Hospital (THE LANCET, vol. i. 1850, p. 63). This root was recommended in cases of epilepsy and spasmodic diseases, and gave at first some satisfaction; but it has not kept its ground, and is, as far as nosocomial practice is concerned, put upon the shelf. It was in our columns that the wonderful effects obtained by kousso at King’s College Hospital, were first mentioned, (THE LANCET vol. i. 1850, pp. 339, 483.) As to this remedy, we are happy to say that it still continues to do much good, and that it may be procured at a much lower price than at the period when our reports were first published. It should not, however, be concealed that the head is not always expelled together with the rest of the tape-worm, and that relapses have occurred, (THE LANCET, vol. ii. 1851. p. 270.) Nor should it be passed under silence that the oil of male fern has been found extremely efficacious in procuring the expulsion of the taenia solium, (THE LANCET, vol. ii., 1850, p. 676). We likewise have mentioned experiments which were instituted with Warburg’s tincture for ague (THE LANCET, vol. i. 1851, p. 430,) the weak point in this remedy being the mystery which surrounds its composition. Another remedial agent has lately been tried at Guy’s Hospital-viz. the fruit of the Bengal quince, or Bael, which is said to be of some value in dysentery. The experiments have not, however, been sufficiently numerous to allow of a conclusion ; we shall revert to it, as well as to the good effects of sulphuric acid in diarrhoea, which have been largely recorded from private practice, and which we saw principally used at King’s College Hospital. In the surgical department, we have been careful in noting the new mechanical contrivances which are being introduced : among these was Mr. Luke’s elastic bed (THE, LANCET, vol. i. 1850. p. 154); Mr. Thomas ’ii’akley’s new stricture instruments, (THE Mr. John Wood’s improved splint LANCET, vol. i. 1851, p. for fracture of the femur (THE LANCET, vol. ii. 1850, p. 578); Mr. Bonjeaurd’s new belts for hernia, (THE LANCET, vol. ii. 1851, p. 33, and vol. i., 1852, p. 43). M. Boissonneau’s artificial eyes, (THE LANCET, vol. ii., 1851, p. 130); Mr. Hilton’s speculum ani, (THE LANCET, vol. i. 1850, p. 533); Mr. Clark’s
time
curate sketches from preparations in the Museum of St. Bartholomew’s Hospital, exhibiting vertical sections of’ the anterior aortic and pulmonary valves of the ox. Any doubt as to the nature of this disposition of parts in the human heart, is at once removed by an examination of the same parts on a larger scale. This arrangement appears of importance when viewed in connexion with the functions of the valves. Dr. Reid* describes the reflux as sustained in part by the festooned rings at the base of the valves, but in fact they are thinnest at this very part, corresponding to the central portion of the convexity of the valve; and if the description previously given of the formation of the tendinous festooned rings be a correct one, it is obvious why it is so-the thicker portions being the projecting angle at the junction of two valves, to which points the tendinous fibres of the valves converge. Probably this arrangement will be better understood from the accompanying sketches than from any lengthened verbal description. Now, inasmuch as the posterior portion of the aortic orifice is continuous with the left auriculo-ventricular ring, no muscular tissue of the ventricle existing in this part, the posterior aortic valve and a portion of the adjacent one have no support of this kind, and here, indeed, "the force of the reflux is (entirely) sustained by the stouter and more tendinous part of the arterial valve ;"’)- but the muscular floor *
t A.
of Anatomy and Physiology, art. " Heart." Muller’s Archtv.: Mr. Paget’s Reports, 1843, p. 1-1.
Cyclopaedia
Retzius.
178);
423 It might also be feared that the form given to the remedy, being extremely elegant and new, out-patients of 1852, p. 7). In this department (the surgical) we shall soon hospitals might probably not sufficiently appreciate the importhave to give a short description of an improvement of Mr. ance of the capsules. Still it would appear that M. Jozeau Luke’s swinging apparatus for fracture of the leg, and of certain was anxious to obtain the approval of the surgeons of this .modifications of lithotomy knives. metropolis, as the preparation had already been pronounced A few words shall, in the meanwhile, be devoted to experiments as extremely valuable by the Academy of Medicine of Paris, a report of Messrs. Boulay, Begin, and the former surgeon which have lately been instituted by several hospital surgeons, to test the efficacy of a peculiar preparation of copaiba and cubebs, of the Venereal Hospital, M. Cullerier. We here subjoin some proposed by M. Jozeau, a French pharmacien in London, under of the results obtained. the name of Copahine-Mège. M. Jozeau obtained the favour of these trials principally because he simply and frankly acquainted ST. BARTHOLOMEW’S HOSPITAL. every surgeon with the different ingredients contained in these Cases of Gonorrhœa Treated by M. Jozeau’s Copahine-Mège. saccharated capsules, and with the manner in which these iu(Under the care of Mr. LLOYD.) gredients are treated and prepared. This is as it shonld be, for The three cases were noted by Mr. Stretton, Mr. of all following the drawback the specific preparations and solutions, &c., of copaiba, &c., is that the mode of preparing them is kept Lloyd’s house-surgeon :CASE 1.-John B-,aged twenty-eight, has had gonorrhoea secret. The peculiarity of M. Jozeau’s saccharated capsules was stated four days, and has not tried any remedies. He commenced taking to be that they were easy and agreeable to take, that they pro- the capsules October 17th, 1851, the dose being five of these duced no nausea, sickness, or unpleasant purging, and that, when thrice a day. Six days afterwards, there was no improvement; continued for a sufficient period, they cured gonorrhoea in a short bowels open regularly twice a day; no nausea, but slight scalding time. Considering the insuperable dislike of some patients for in passing urine. Take six capsules three times a day. Two copaiba, these, if verified by experience, are certainly most valu- days after this increase of the dose, the patient was found better; the discharge had considerably lessened, the scalding had ceased, able improvements. The following is the account given by M. Jozeau of the pre- and the bowels were opened three or four times daily. No paration of the Copahine-Mège, and the pathological facts nausea ; take seven capsules three times a day. October 30th, thirteen days after the commencement of the which led to the peculiar manner of preparing this remedial treatment, the discharge had nearly ceased. Bowels open four agent :It was noticed that such patients as were purged by the copaiba times a day. Take twenty-four capsules per diem. Five days evacuated per anum large quantities of this drug in an unaltered after this, the discharge had entirely disappeared. On Nov. 9th, state, their urine not containing any of it. These persons, though being four days after the complete cessation of the discharge, the sometimes cured, generally had a relapse. Those, however, who latter slightly recurred. The capsules were resumed, and in four were not purged became well more slowly, and had no recurrence days, no appearance of the affection was left. CASE 2.-Edward L-,aged eighteen. Gonorrhoea three of the disease ; their stools contained no copaiba, and their urine From these facts it became evident that in order days; a small sore on the prepuce. Commenced taking five a great deal. to obtain regular and speedy effects, the copaiba should be made capsules three times a day, on October 17th, 1851, and continued to undergo such modifications as to insure its more complete ab- using them for six days, when he was taking twenty-one per sorption into the system. Experiments were now instituted diem. The patient was soon purged three times a day, and the respecting the effects of’ the two principal substances contained bowels continued freely open several times daily, until the eighth in the copaiba-viz , the oil and the resin. These were separately day of the treatment, when the discharge ceased. There was no tried. The oil produced a decidedly purgative effect; the resin nausea during the use of the capsules. CASE 3.-Sarah A--, aged twenty, has been affected with purged less; but no complete cure was obtained by either substance taken separately. gonorrhoea, for one week. She began to take five capsules three It was now pretty clear that both the resin and essential oil times daily, on the 17th of October, 1851, and continued them for four days, increasing the dose to twenty-four per diem, when were indispensable for obtaining curative effects, and the question the discharge entirely ceased. On November the 10th she left arose how these could be modified so as to allow the stomach to digest them completely. This end was attained in surcharging the hospital quite cured. After using the capsules for two or the copaiba with oxygen, by means of nitric acid, the latter being three days, the bowels were freely acted upon, but no nausea or added in proportions which varied according to the kind of sickness ever occurred during their use. copaiba acted upon. The nitric acid yields some of its oxygen to the essential oil, and the nitrogen is given off in the forrn of GUY’S HOSPITAL. hyponitrous acid, by combining with the oxygen of the atmoGonorrhœa Cases Treated by the Copahine-Mège. of The thus treated is then well washed with copaiba sphere. water, until it no longer reddens litmus paper, and to it are added (Under the care of Mr. POLAND.) one tenth part of cubebs in fine powder, the same proportion of CASE 1.-A. B-; gonorrhcea for the first time; duration carbonate of soda, and one sixteenth part of calcined magnesia. three weeks ; inflammatory symptoms subsiding. Patient took The mixture is allowed to stand until it is quite solidified, and in the for sixteen days, increasing from five, three times a capsules that state it is made into small masses. The latter are then careday, to eight, and became completely well. fully covered with sugar, to which a pleasant pink colour (coccus CASE 2.-W. H- ; gonorrhoea for the third time ; discharge cacti) is given, and they then look like very pretty sugar-plums. profuse. Took the capsules for four days, and left off from a To these saccharated capsules the name of Copahine- Mege was dislike to the mode of taking the drug, as he allowed the sugar given, because the experiments had been made conjointly by to melt away too completely before swallowing, and therefore M. Jozeau and M. Mege, and the latter had first thought oj experienced the unpleasant taste of the copaiba in the mouth. making the saccharated capsules. For lymphatic patients and CASE 3.-Male patient; gonorrhcea three weeks. Took the delicate females a second mass was prepared, into which, besides for a week, without any trouble; but having slightly capsules the above-mentioned ingredients, some steel was made to enter. he did not present himself again. improved, This is then a sort of martial preparation of copaiba. The doses CASE 4.-W. B-;gonorrhoea for the second time; copious are stated as follows:which had lasted ten weks. Took the capsules with When there is neither pa;n nor inflammation, five saccharatec discharge, a little inconvenience, increasing from five to ten three times capsules are taken three times per diem. One capsule more i daily. The drug acted very well, there was slight purging, and then given with each dose every subsequent day, the doses bein the In this patient the capsules were was checked. thus increased until purging is produced. Where there is pair not discharge continued long enough after the discharge had ceased, for it or inflammation, these should first be treated by the surgeon ir returned to a certaiù extent. the manner he thinks the most advisable, and the copabine is t( CASE 5.-Male patient ; gonorrhoea second time ; copious disbe commenced when acute symptoms have abated. It has beer charge. Took the capsules, from five to twelve, three times daily, noticed that the martial capsules have effected a cure when th( for eight days, without any effect, and did not continue them. It simple preparation has failed. should be noticed that no injections were used in any of the Such being the explanations given by M. Jozeau, severa cases. hospital surgeons agreed to give the capsules a trial, but thi: foregoing somewhat as as is far concerned proved difficult, public practice ST. THOMAS’S HOSPITAL. since persons affected with gonorrhoea are not in general ad under the care of Mr. LE GROS CLARK.) (Cases mitted as in-patients into these institutions. It was, moreover evident that upon out-patients the effects could not be so con. Mr. CLARK has treated three patients affected with gonorrhoea the Copahine-Mège capsules. The effect has generally been wiently watched, and the value of the remedial agent ascer-
apparatus for talipes varus (THE LANCET, vol. ii. 1850, p. 303); and Mr. Hilton’s tourniquet for the groin, (THE LANCET, vol. ii.,
tained.
upon
,
with
of the
(To be coneltided.)
A
Mirror
OF THE PRACTICE OF . Section of arterial coat.
2. Section of valve.
MEDICINE
3. Section of ventricle.
border before described; the consequence of which arrangement is, that the portion of valve adjacent to the vessel passes over, and rests upon the muscular substance-is supported upon the inner border of the free edge of the ventricles surrounding the arterial orifices. This arrangement, in consequence of the small size of the parts, is not so obvious at the first glance in the human heart, but can scarcely be overlooked in an examination of the heart of any one of the larger animals. Figures 4 and 5 are ac-
AND
SURGERY
IN THE
HOSPITALS OF LONDON. Nulla est alia pro certo noscendi via, nisi quam plurimas et morboram, et dissectionum historias, tum aliorum proprias, collectas habere et inter se comparare.-MORGAGNI. De Sed. et C(ii,6s. 41orb., lib.14. Prooemium.
ST. BARTHOLOMEW’S, GUY’S, AND ST. THOMAS’S HOSPITALS. Cases of Gonorrhœa treated by M. Jozeau’s Copahine-Mège; a Peculiar Mode of Administering Copaiba. Mr. LLOYD, Mr. POLAND, and Mr. LEGROS CLARK.)
(Under the care of
OUR readers have probably observed that we carefully put upon record the trials which are male in the hospitals of this melropolis, of the new therapeutical agents which are from time to offered to the profession. Among these we may mention the sumbal, which was first used at King’s College Hospital (THE LANCET, vol. i. 1850, p. 63). This root was recommended in cases of epilepsy and spasmodic diseases, and gave at first some satisfaction; but it has not kept its ground, and is, as far as nosocomial practice is concerned, put upon the shelf. It was in our columns that the wonderful effects obtained by kousso at King’s College Hospital, were first mentioned, (THE LANCET vol. i. 1850, pp. 339, 483.) As to this remedy, we are happy to say that it still continues to do much good, and that it may be procured at a much lower price than at the period when our reports were first published. It should not, however, be concealed that the head is not always expelled together with the rest of the tape-worm, and that relapses have occurred, (THE LANCET, vol. ii. 1851. p. 270.) Nor should it be passed under silence that the oil of male fern has been found extremely efficacious in procuring the expulsion of the taenia solium, (THE LANCET, vol. ii., 1850, p. 676). We likewise have mentioned experiments which were instituted with Warburg’s tincture for ague (THE LANCET, vol. i. 1851, p. 430,) the weak point in this remedy being the mystery which surrounds its composition. Another remedial agent has lately been tried at Guy’s Hospital-viz. the fruit of the Bengal quince, or Bael, which is said to be of some value in dysentery. The experiments have not, however, been sufficiently numerous to allow of a conclusion ; we shall revert to it, as well as to the good effects of sulphuric acid in diarrhoea, which have been largely recorded from private practice, and which we saw principally used at King’s College Hospital. In the surgical department, we have been careful in noting the new mechanical contrivances which are being introduced : among these was Mr. Luke’s elastic bed (THE, LANCET, vol. i. 1850. p. 154); Mr. Thomas ’ii’akley’s new stricture instruments, (THE Mr. John Wood’s improved splint LANCET, vol. i. 1851, p. for fracture of the femur (THE LANCET, vol. ii. 1850, p. 578); Mr. Bonjeaurd’s new belts for hernia, (THE LANCET, vol. ii. 1851, p. 33, and vol. i., 1852, p. 43). M. Boissonneau’s artificial eyes, (THE LANCET, vol. ii., 1851, p. 130); Mr. Hilton’s speculum ani, (THE LANCET, vol. i. 1850, p. 533); Mr. Clark’s
time
curate sketches from preparations in the Museum of St. Bartholomew’s Hospital, exhibiting vertical sections of’ the anterior aortic and pulmonary valves of the ox. Any doubt as to the nature of this disposition of parts in the human heart, is at once removed by an examination of the same parts on a larger scale. This arrangement appears of importance when viewed in connexion with the functions of the valves. Dr. Reid* describes the reflux as sustained in part by the festooned rings at the base of the valves, but in fact they are thinnest at this very part, corresponding to the central portion of the convexity of the valve; and if the description previously given of the formation of the tendinous festooned rings be a correct one, it is obvious why it is so-the thicker portions being the projecting angle at the junction of two valves, to which points the tendinous fibres of the valves converge. Probably this arrangement will be better understood from the accompanying sketches than from any lengthened verbal description. Now, inasmuch as the posterior portion of the aortic orifice is continuous with the left auriculo-ventricular ring, no muscular tissue of the ventricle existing in this part, the posterior aortic valve and a portion of the adjacent one have no support of this kind, and here, indeed, "the force of the reflux is (entirely) sustained by the stouter and more tendinous part of the arterial valve ;"’)- but the muscular floor *
t A.
of Anatomy and Physiology, art. " Heart." Muller’s Archtv.: Mr. Paget’s Reports, 1843, p. 1-1.
Cyclopaedia
Retzius.
178);
423 It might also be feared that the form given to the remedy, being extremely elegant and new, out-patients of 1852, p. 7). In this department (the surgical) we shall soon hospitals might probably not sufficiently appreciate the importhave to give a short description of an improvement of Mr. ance of the capsules. Still it would appear that M. Jozeau Luke’s swinging apparatus for fracture of the leg, and of certain was anxious to obtain the approval of the surgeons of this .modifications of lithotomy knives. metropolis, as the preparation had already been pronounced A few words shall, in the meanwhile, be devoted to experiments as extremely valuable by the Academy of Medicine of Paris, a report of Messrs. Boulay, Begin, and the former surgeon which have lately been instituted by several hospital surgeons, to test the efficacy of a peculiar preparation of copaiba and cubebs, of the Venereal Hospital, M. Cullerier. We here subjoin some proposed by M. Jozeau, a French pharmacien in London, under of the results obtained. the name of Copahine-Mège. M. Jozeau obtained the favour of these trials principally because he simply and frankly acquainted ST. BARTHOLOMEW’S HOSPITAL. every surgeon with the different ingredients contained in these Cases of Gonorrhœa Treated by M. Jozeau’s Copahine-Mège. saccharated capsules, and with the manner in which these iu(Under the care of Mr. LLOYD.) gredients are treated and prepared. This is as it shonld be, for The three cases were noted by Mr. Stretton, Mr. of all following the drawback the specific preparations and solutions, &c., of copaiba, &c., is that the mode of preparing them is kept Lloyd’s house-surgeon :CASE 1.-John B-,aged twenty-eight, has had gonorrhoea secret. The peculiarity of M. Jozeau’s saccharated capsules was stated four days, and has not tried any remedies. He commenced taking to be that they were easy and agreeable to take, that they pro- the capsules October 17th, 1851, the dose being five of these duced no nausea, sickness, or unpleasant purging, and that, when thrice a day. Six days afterwards, there was no improvement; continued for a sufficient period, they cured gonorrhoea in a short bowels open regularly twice a day; no nausea, but slight scalding time. Considering the insuperable dislike of some patients for in passing urine. Take six capsules three times a day. Two copaiba, these, if verified by experience, are certainly most valu- days after this increase of the dose, the patient was found better; the discharge had considerably lessened, the scalding had ceased, able improvements. The following is the account given by M. Jozeau of the pre- and the bowels were opened three or four times daily. No paration of the Copahine-Mège, and the pathological facts nausea ; take seven capsules three times a day. October 30th, thirteen days after the commencement of the which led to the peculiar manner of preparing this remedial treatment, the discharge had nearly ceased. Bowels open four agent :It was noticed that such patients as were purged by the copaiba times a day. Take twenty-four capsules per diem. Five days evacuated per anum large quantities of this drug in an unaltered after this, the discharge had entirely disappeared. On Nov. 9th, state, their urine not containing any of it. These persons, though being four days after the complete cessation of the discharge, the sometimes cured, generally had a relapse. Those, however, who latter slightly recurred. The capsules were resumed, and in four were not purged became well more slowly, and had no recurrence days, no appearance of the affection was left. CASE 2.-Edward L-,aged eighteen. Gonorrhoea three of the disease ; their stools contained no copaiba, and their urine From these facts it became evident that in order days; a small sore on the prepuce. Commenced taking five a great deal. to obtain regular and speedy effects, the copaiba should be made capsules three times a day, on October 17th, 1851, and continued to undergo such modifications as to insure its more complete ab- using them for six days, when he was taking twenty-one per sorption into the system. Experiments were now instituted diem. The patient was soon purged three times a day, and the respecting the effects of’ the two principal substances contained bowels continued freely open several times daily, until the eighth in the copaiba-viz , the oil and the resin. These were separately day of the treatment, when the discharge ceased. There was no tried. The oil produced a decidedly purgative effect; the resin nausea during the use of the capsules. CASE 3.-Sarah A--, aged twenty, has been affected with purged less; but no complete cure was obtained by either substance taken separately. gonorrhoea, for one week. She began to take five capsules three It was now pretty clear that both the resin and essential oil times daily, on the 17th of October, 1851, and continued them for four days, increasing the dose to twenty-four per diem, when were indispensable for obtaining curative effects, and the question the discharge entirely ceased. On November the 10th she left arose how these could be modified so as to allow the stomach to digest them completely. This end was attained in surcharging the hospital quite cured. After using the capsules for two or the copaiba with oxygen, by means of nitric acid, the latter being three days, the bowels were freely acted upon, but no nausea or added in proportions which varied according to the kind of sickness ever occurred during their use. copaiba acted upon. The nitric acid yields some of its oxygen to the essential oil, and the nitrogen is given off in the forrn of GUY’S HOSPITAL. hyponitrous acid, by combining with the oxygen of the atmoGonorrhœa Cases Treated by the Copahine-Mège. of The thus treated is then well washed with copaiba sphere. water, until it no longer reddens litmus paper, and to it are added (Under the care of Mr. POLAND.) one tenth part of cubebs in fine powder, the same proportion of CASE 1.-A. B-; gonorrhcea for the first time; duration carbonate of soda, and one sixteenth part of calcined magnesia. three weeks ; inflammatory symptoms subsiding. Patient took The mixture is allowed to stand until it is quite solidified, and in the for sixteen days, increasing from five, three times a capsules that state it is made into small masses. The latter are then careday, to eight, and became completely well. fully covered with sugar, to which a pleasant pink colour (coccus CASE 2.-W. H- ; gonorrhoea for the third time ; discharge cacti) is given, and they then look like very pretty sugar-plums. profuse. Took the capsules for four days, and left off from a To these saccharated capsules the name of Copahine- Mege was dislike to the mode of taking the drug, as he allowed the sugar given, because the experiments had been made conjointly by to melt away too completely before swallowing, and therefore M. Jozeau and M. Mege, and the latter had first thought oj experienced the unpleasant taste of the copaiba in the mouth. making the saccharated capsules. For lymphatic patients and CASE 3.-Male patient; gonorrhcea three weeks. Took the delicate females a second mass was prepared, into which, besides for a week, without any trouble; but having slightly capsules the above-mentioned ingredients, some steel was made to enter. he did not present himself again. improved, This is then a sort of martial preparation of copaiba. The doses CASE 4.-W. B-;gonorrhoea for the second time; copious are stated as follows:which had lasted ten weks. Took the capsules with When there is neither pa;n nor inflammation, five saccharatec discharge, a little inconvenience, increasing from five to ten three times capsules are taken three times per diem. One capsule more i daily. The drug acted very well, there was slight purging, and then given with each dose every subsequent day, the doses bein the In this patient the capsules were was checked. thus increased until purging is produced. Where there is pair not discharge continued long enough after the discharge had ceased, for it or inflammation, these should first be treated by the surgeon ir returned to a certaiù extent. the manner he thinks the most advisable, and the copabine is t( CASE 5.-Male patient ; gonorrhoea second time ; copious disbe commenced when acute symptoms have abated. It has beer charge. Took the capsules, from five to twelve, three times daily, noticed that the martial capsules have effected a cure when th( for eight days, without any effect, and did not continue them. It simple preparation has failed. should be noticed that no injections were used in any of the Such being the explanations given by M. Jozeau, severa cases. hospital surgeons agreed to give the capsules a trial, but thi: foregoing somewhat as as is far concerned proved difficult, public practice ST. THOMAS’S HOSPITAL. since persons affected with gonorrhoea are not in general ad under the care of Mr. LE GROS CLARK.) (Cases mitted as in-patients into these institutions. It was, moreover evident that upon out-patients the effects could not be so con. Mr. CLARK has treated three patients affected with gonorrhoea the Copahine-Mège capsules. The effect has generally been wiently watched, and the value of the remedial agent ascer-
apparatus for talipes varus (THE LANCET, vol. ii. 1850, p. 303); and Mr. Hilton’s tourniquet for the groin, (THE LANCET, vol. ii.,
tained.
upon
,
with