But be this as it may, it is not my wish to ascribe to the copaiba the whole credit of the cure in the case last described. The remedies previously employed, aided by proper regimen, had evidently produced much good; they might perhaps ⚫ have sufficed, in time, to effect the desired object, and had in all probability placed the patient in a situation to get well more readily than he would otherwise have done. But from what we know of the effects of the copaiba in mucous inflammations generally, and particularly in the disease before us-from the known protracted nature of such cases when treated by other means or when left to the powers of nature, we may reasonably presume that it was instrumental in shortening the duration of the disease or even effecting the cure.

CASE 3.-A young female, about twenty two years of age, applied to me for advice, in November 1834, for the cure of diarrhoea. The disease was of four months' standing. The patient was somewhat emaciated-her complexion was sallow, skin dry and husky, pulse weak and frequent. Her appetite was capricious, and thirst troublesome. The abdomen was a little tender to the touch, and the evacuations were very frequent, particularly towards morning and evening, and were attended with severe griping pain, and often with tenesmus. The matter discharged consisted of a small quantity of thin, unhealthy feculent matter, mixed with pieces of undigested food, and a large portion of mucus; the whole generally tinged with blood.

The patient had been on different occasions under regular medical treatment, and had besides made use of a number of family and popular medicines; but without more than temporary relief.

Cups were ordered to be applied along the arch of the colon, and over the right iliac region, and blue pill, followed by rhubarb and magnesia, prescribed. To these succeeded small doses of ipecacuanha and opium, lime water and milk; while boiled milk and water crackers were allowed for nourishment. From the local depletion some advantage was obtained; the tenderness and tenseness of the abdomen being a little mitigated. But so far from any benefit being produced by the other remedies, the disease in a few days appeared rather aggravated than otherwise the stools being more frequent, and attended with more griping, and considerable nausea. The ipecacuanha was discontinued ; and, as soon as the gastric distress had subsided, recourse was had to the copaiba, which was administered three times a day in doses of fifteen drops, with five of laudanum, in a glassful of camomile tea; the patient being at the same time allowed at her own repeated solicitation, water crackers, and boiled flour mixed with milk and water for nourishment, and cold toast and water for drink. The evacuations being still attended with pain, and the abdomen tender and tense, the local depletion was directed to be repeated; but this being objected to by the patient, a flannel roller and emollient injections were substituted.

From this plan a sensible amendment was obtained before the end of a week. The stools were reduced from ten or twelve, to four or five in the twenty-four hours, and the griping, though still troublesome was lessened in degree. The copaiba was increased to twenty-five drops three times a day; and at the end of another week the patient reported that the evacuations were reduced to two or three in the twenty-four hours, and were attended with less pain; that the matter discharged was of a firmer consistence and healthier appearance; and

that her appetite was good and her thirst less troublesome. The remedies were directed to be continued; but in diminished doses.

The disease continued with but little further abatement until about the 1st of December, when the intestinal derangement appeared to yield; the appetite became better, the stools were reduced to two, at most, in the twenty-four hours; the matter evacuated assumed a nearly natural appearance. The copaiba and laudanam were still farther reduced in quantity, and more nourishing food prescribed. On the seventh of the month, in consequence of exposure to cold and humidity, the disease was of a sudden considerably aggravated, and was attended with pain and fever; but after a few days it gave way to proper remedies. The copaiba was resumed; animal jelly was allowed; and this was followed, on the twenty-second, by solid food. The medicine was in a day or two discontinued, and on the 2d January, the patient reported that she was now perfectly well.

The agent in the cure of this case is, I think, easily recognized. The quantity of laudanum added to each dose was very small, too much so to exert a decisive effect on the disease, and only sufficient to place the stomach in a condition to support the other medicine. Besides, previous to the time the copaiba was prescribed, opium was administered, in substance and in various of its preparations, by those who preceded me in the management of the case; and the patient had, of her own accord, taken, for several days, repeated doses of laudanum, and never with more than temporary relief. It is not probable, that if of no service as a curative means,—if only beneficial as a palliative, when thus prescribed freely, it can have had the principal agency in the removal of the disease when administered in minute doses conjointly with another medicine. As regards the articles of nourishment that were allowed, it may fairly be doubted whether they could be sufficient to effect a cure in a case of this kind. In mild attacks of diarrhea unattended with signs of severe irritation, there is little doubt that a proper regimen will often be sufficient to enable us to attain the object in view. But when the disease assumes a severe character-when it proves obstinate, it is in general found that other and more active means are required. Considering, indeed, the presence of griping, of tenderness of the abdomen, and other symptoms of the kind, it is probable that more physicians will be disposed to censure the use of such articles as were allowed in the case before us, than to approve of them; and that, therefore, few will refuse to coincide with me in denying to them the principal agency in the cure.

From this it follows that, if the favourable termination of the case cannot be ascribed to the opiates, or to the articles of nourishment employed, we must necessarily refer it to the remedial agency of the copaiba; particularly as its beneficial effects in other instances of a similar or kindred kind have been well ascertained. While the local depletion produced relief but of one symptom only; the purgatives and other remedies employed, if they did not aggravate, at any rate did not arrest the disease; and the flannel roller and emollient injections, though excellent adjuvants or palliatives, are not by themselves adequate to the task of eradicating the cause upon which such diseases depend.

In conclusion, it may be proper to remark, that other remedies, often employed successfully in the treatment of severe and protracted diarrhoea, were not resorted

to, partly because the patient objected to them, but principally because it was desired to make a fair trial of the copaiba, the efficacy of which was already well known. Whether this plan was judicious or justifiable; and whether a cure might have been more speedily obtained by other means, can only be decided by those who have made trial of the remedy in question, and compared the results with those obtained from other modes of treatment.

CASE 4. In a case of feculent diarrhea which came under my notice in the Autumn of 1833, the balsam of copaiba, though it did not effect a cure, was sufficiently serviceable to justify an account of its effects. The patient, Mr. J. B., about sixty five years of age, had been for a long while subject to attacks of hemorrhages from the bowels. These came on at irregular periods, and generally continued with longer or shorter remissions during a day or two. They were considered in the light of a salutary effort of nature to unload the vessels of a superabundant quantity of blood; particularly those of the brain, which had a tendency to fulness, and they were unconnected with intestinal disease. In August 1833, this gentleman was attacked with hemiplegia, and palsy of the tongue; both of which, however, together with the cerebral inflammation which supervened, were removed by active antiphlogistic and revulsive means, and mercurial ptyalism. A short time after this Mr. B. was seized with febrile symptoms attended with considerable determination of blood to the head, which gave way in a few days to depletion and mild purgatives. From this period, however, he remained subject to frequent attacks of bowel complaint, preceded by confusion in the head, and occasionally severe vertigo. The diarrhoea generally continued three or four or even more days, and had the effect of relieving the cerebral derangement. In this respect it may have been salutary; but as the discharges, which consisted of thin feculent matter, mixed occasionally with a large portion of blood, were at times frequent and copious, they finally produced considerable emaciation and debility. In consequence of this it became necessary to restrain these attacks within safe limits, without, however, putting a stop to their return, and thereby losing the advantage of the derivative action they occasioned. For this purpose the balsam of copaiba was prescribed, after an ineffectual trial of other means, and was used alone during the intervals of the attacks, and in combination with laudanum when the discharges were carried too far. From this plan, aided by restricted and appropriate diet, the desired effect was obtained. The bowels were kept in a soluble state; and though Mr. B. continued subject to attacks of diarrhoea, these gradually lost much of their former severity, and came on at longer intervals; while, the cerebral derangement was lessened in force, and the patient improved in flesh and strength.*

As the relief in this case (in which, for the reasons assigned a complete cure was not attempted) followed immediately after the copaiba was resorted to, and as other means had failed, it cannot be improper to ascribe it to that remedy.

• Mr. B. adhered with good effect to this plan for some months. Gradually, however, he relaxed in his attention to his health. He indulged in the luxuries of the table; ate copiously, and finally abandoned the use of the copaiba. He refused to resort to the active means required to relieve his attacks of cerebral irritation; which increased in frequency and violence, and produeed considerable emaciation. His bowel complaint became very troublesome, and he died in March 1835.

But whatever may be the opinion of others on this subject, there cannot be any doubt as to the efficacy of the copaiba in the following case.

CASE 5.-Miss Isabel D—, aged thirteen years, was attacked, while travelling during the summer of 1832, with looseness of the bowels. The discharges were at times frequent and copious, and attended with some griping pain. But, as the friends of Miss D. were of opinion that the disease arose from, and was kept up by change of water and inattention to regimen, and that it would give way as soon as the subsidence of the cholera, (which then prevailed in this city,) would allow them to return home, nothing of importance was done to check it. In this expectation, however, they were disappointed; for although the patient was placed under medical treatment soon after her arrival, the disease continued with short intervals of respite until the commencement of the following year. Various remedial means-local depletion, revulsives, opiates, alteratives, astringents, chalybeates, tonics, aided by proper regimen, were successively resorted to; but to little purpose. The disease was, it is true, occasionally mitigated for two or three days, or even for a week or more at a time; but it invariably returned with renewed violence-sometimes from imprudence in diet, at others without any assignable cause. The longest interval of relief was of five weeks continuance; and was apparently obtained through the agency of colombo powder. But as, during the whole of that period the patient was strictly kept on small quantities of cold roasted fowl and stale bread a regimen which experience had shown to agree with her better than any other; and as her other symptoms were little amended, and as she relapsed whenever a change of diet was allowed, or the medicine was omitted, it may be doubted whether any substantial amendment was obtained of the morbid state of the intestinal tissue, upon which the diarrhoea depended. But, however this may be, after the recurrence of the disease, the remedy above mentioned no longer produced any beneficial effect.

The number of stools was seldom less than six or seven daily; and they consisted generally of dark, thin, offensive, and frothy feculent matter, mixed often with portions of undigested food. In the progress of the disease, the skin became dry and harsh to the feel, and of a waxy appearance; emaciation and debility gradually supervened, attended with thirst, and a feeble and accelerated pulse. The appetite continued notwithstanding nearly as before the attack, and although the patient was usually disturbed once, and sometimes twice in the night, unless she took opiates the evening before, her sleep was quiet and refreshing.

Such was the condition of Miss D. when my attention was more particularly called to her case. Finding that none of the remedies heretofore employed had produced permanent relief, and recollecting the salutary effects obtained from the balsam of copaiba in similar complaints, it was prescribed in doses of twenty drops, with three of laudanum, three times a day. The benefit derived from itexceeding my warmest expectation;-the discharges soon diminishing in frequency and improved in appearance. The medicine was increased in quantity, and the laudanum gradually omitted. The patient, who had been kept on the diet already mentioned, was allowed to resume gradually her ordinary food, and experienced no ill effects from the change. She gained strength and flesh; her skin resumed its natural appearance, and in the course of some weeks she was enabled to discontinue the use of the medicine.

When we bear in mind the long standing and obstinacy of the disease in the foregoing case;-the failure of all the remedies employed; the relief obtained soon after recourse was had to the copaiba, and the permanency of that relief;-when, besides, we compare this result with that obtained from the same remedy in the cases already described in the present communication, and in affections of other portions of the mucous membrane, it appears evident that the credit of the case is ascribable to that agent and to no other. The conclusion is the more natural, as no other remedy likely to produce the effect was employed in conjunction with the copaiba, except laudanum. But as this had failed before being used with the former, though administered in large doses; and as it was laid aside before a cure was obtained, it is impossible to lay much 'stress on its operation. As regards the regimen, it will be sufficient to remark, that it was similar to that which had been allowed from the time Miss D. was first placed under treatment; and that as it did not succeed in curing the disease before recourse was had to the copaiba, it is not probable it was more effectual at a subsequent period of the attack.

CASE 6.-Chronic Enteritis. In speaking in another place of the efficacy of the balsam of copaiba in disease of the urinary organs, I stated that that remedy could be employed usefully, not only in cases characterised by an increased mucous, or by suppurative secretion; but also in certain varieties of irritation of the lining membrane of the bladder, unattended by either of these changes. The following case will serve to show, that in complaints of the alimentary canal dependent upon chronic inflammation, but unconnected with symptoms of dysentery, or of diarrhoea properly speaking, the copaiba will be found, at least sometimes, highly useful.

Miss M., aged about twenty-five years, of a bilious and nervous temperament, had been subject for a long period to attacks of gastro-intestinal irritation. Late in the autumn of 1825, she exposed herself during her catamenial period, to a current of air, immediately after coming out of a warm bath. The consequences of this imprudent act were soon manifest: she was attacked with chill, followed by hot fever and acute pain in the left iliac region; and the menstrual discharge was suppressed. The pain was aggravated by pressure and the least change of position, and was accompanied by a sensation of weight in the uterine region, frequent desire to urinate, constipation of the bowels, thirst, &c. Presuming, from this assemblage of phenomena, that the patient laboured under peritoneal inflammation; and that the left ovary and the neck of the bladder were probably implicated in the morbid state, recourse was had to active depletion, general and local, emollient applications, diluent drinks, enemata, mild purgatives, and finally to a blister over the parts affected. By these means Miss M. was so effectually relieved, that in the course of a few days she was allowed light nourishment; and soon after was enabled to leave her bed. She did not remain long, however, in this favourable situation; for in a few days she experienced, in consequence of inattention to diet, a return of the disease. This attack was more alarming than the preceding one, inasmuch as, independently of the morbid state already described, she now suffered from an inflammation of the lining membrane of the digestive tube and of the vagina;

• American Journal of the Medical Sciences.