I have used the bark of the root of the elder very frequently. A fluid extract made with dilute Alcohol is as efficient as the decoction. The proportions I use are 10 ounces of the dried root bark to a pint of dilute Alcohol. Dose, 20 drops to 3j. in water 2 to 4 ounces, repeated every hour or two. I have often obtained excellent results from it in hepatic diseases, whether attended with dropsy or not.

Sambucus is a valuable remedy in Bright's disease, acting kindly as a diuretic without irritating the kidneys; in point of fact, it resembles Buchu in its action on the whole urinary apparatus. It is also valuable during pregnancy, when secretion of urine is growing less daily; the woman has headache; is nervous; feels ill at ease; loss of appetite; skin dry, white or muddy; pulse fast; and heart beats hard. These are often the signs of slowly-approaching puerperal covulsions. In these cases the old eclectics used Sambucus and Cimicifuga, infused in boiling water, kept hot an hour or two, about an ounce of each to a quart. Dose, one to three fluid ounces at intervals of one to two hours. The Elder acted as an alterative diuretic, bringing away deleterious material by way of the urine; the Black Snake-root acted as a nervous sedative, quieting the excited states of the cord and brain. Seldom did puerperal convulsions steal a march on those astute and vigilant practitioners. It would be well if eclectics of the present day would imitate the methods and means of treating many diseases their ancestors used with such eminent

success.

Sambucus and Apocynum go well yoked together. Both are liver tonics, as well as diuretics of high value, help each other, tone up the heart, depurate the blood through the liver and kidneys; both cause large excretion of waste nitrogenous compounds, remove dropsies of all kinds, promote assimilation and normal metabolism.

Polytrichium Juniperinum (Hair-cap Moss). This is a perennial moss growing in wet places. Polytrichium is a pronounced diuretic in all forms of liver disease attended with dropsy. It is a dropsy remedy par excellence, which has not obtained recognition of the liberal profession its merit deserves. It is an undoubted chologogue, as well as a diuretic. I have seen many brilliant

results obtained from its use in many desperate cases of liver disease. One case of cirrhosis-three physicians concurred in the diagnosis was cured with Fl. Ext. Hair-cap Moss. Some of the very rebellious cases of liver trouble, sequel of long-continued malarial poison, dirtiest yellow tinge of skin, constipation, enlarged abdomen and spleen, complete anorexia, and the peculiar cachexia attending these case, have yielded completely to this medicament; the crude moss decoction was used. I have cured several cases of this kind with it; the most striking effect of the medicament was diuresis; the bowels became regular; the appetite and assimilation much improved.

Eupatorium Purpureum (Queen of the Meadows).-This is a valuable diuretic, well suited to all catarrhal states of the urinary apparatus. On the kidney it acts as a decided diuretic, restores the flow of urine when it is diminished, acts as a sedative to the uriniferous tubules and the bladder. I have obtained excellent results from it in "gravel." Where urates form in insoluble particles in the urine, called "gravel," this remedy does finely; has cured many cases. In chronic cystitis it does much good, especially if combined with White Poplar Bark. This latter has very decided influence on the mucous membrane of the bladder; a real remedy in bladder catarrh, its value heightened combined with Queen of the Meadows. All parts of Eupatorium are valuable, but the root is mostly used. I have obtained fine results from the green leaves when the plant is in flower; used in infusion in large draughts. Too much will vomit and purge; in proper quantities it is a good diuretic.

Blatta Americana (American Cockroach)-The infusion or tincture of Cockroach is a fine and simple diuretic. This medicament will excite the kidneys to work when all else fails. It is the best-adapted remedy when the urine is suppressed through some peculiar influence on the nervous system. Have seen several cases of this kind of suppression, the cause of which could not be readily made out, cured by Tincture of Blatta. The same is true in many cases of kidney disease, even Bright's; urine suppressed, or nearly so; secretion has been brought about by Blatta in infusion. A dozen or more cockroaches may be infused in hot water for an hour or two; teaspoonful, repeated at intervals of one-half to two hours, according to the urgency of the case.

The tincture is made the same as that of the honey-bee; doses of equal sizes. I believe Tincture of Blatta will be found of inestimable value in nearly all cases where a positive diuretic is required. It is evident this medicament exercises some decided influence on some part of the nervous system, through which its remarkable diuretic influence is made manifest. It is true we know much less of the physiology of the kidneys than of other organs how certain medicaments act, through what special structure or centres the secretion of urine is carried on; we have much yet to learn; however, a clinical fact empirically learned is worth as much as any other way obtained.

By way of digression I may observe, in Russia Blatta is a very popular diuretic, and stands high with the learned medical profession. In India Cockroach Tea is a standing and much-prized remedy in asthma. I know of one case in particular-the attacks were violent and seriously distressing; often sudden, and at night; would last twenty-four hours; in fact, the patient often wished he would die in one of them, and thus end the cruel agonies he so often suffered was made remarkably comfortable; the attacks were only one-fourth as frequent, lasted but a short time, and not by any means as severe, after he took ten drops of a tincture of Cockroach, made by filling a wide-mouth bottle with cockroaches, filling up with good corn whiskey. This remedy made the attacks much less frequent, shortened their duration, and bereft them of their agonizing severity. It is equally as good in cardiac asthma, is a heart-tonic, and some insist it is a valuable uterine tonic. I advise my readers to begin their studies of the therapeutic properties of cockroach as soon as circumstances permit. The medicament is no more objectionable than cantharides or honey-bees.

Phosphate of Ammonia.-I have often found Phosphate of Ammonia an excellent diuretic, of value in many forms of dropsy caused by kidney and liver diseases. I prepare it by saturating strong Water of Ammonia with strong Phosphoric Acid. The dose is between 20 drops and 3ss., well diluted. It. is a nervetonic; acts as a stimulant in shock, collapse during acute disease, loss of nerve energy in chronic disease. I often administer it as a tonic along with the Fl. Ext. Cinchona. I think my readers will be pleased with it when a nerve-tonic is required; the secretion of urine is always augmented.

OTOLOGY: DISEASES OF THE AUDITORY CANAL.

BY PITTS EDWIN HOWES, M.D., BOSTON, MASS.

V.

Close examination is necessary for the proper treatment of diseases situated in the auditory canal. This can be most satisfactorily conducted by the aid of the concave forehead mirror, which can be manipulated so as to thoroughly illuminate the parts exterior to the tympanic membrane. As the passage way is almost universally oval in section, the specula, which we use for inspection, should be shaped in like manner.

Where the tissues are much swollen, the conical speculum of Wilde aids, materially, in pressing to one side what would otherwise interfere with vision. Careful cleansing of all instruments used in the ear must be insisted upon, even if the case is not regarded as infectious. Hot, boiling water affords the best and at the same time the most convenient method of disinfection.

The speculum should be cautiously introduced under complete illumination, and a thorough search should be made at the primary examination, if possible, of all parts of the canal and tympanum-a search which should result in finding and dislodging every particle of foreign substance, of any description, which might hide an unsuspected lesion.

Extreme carefulness is necessary in inspecting the deeper portion of the canal, as many times troubles are thus unearthed, which otherwise would be overlooked.

A few careful observations, closely compared with the statements of normal and pathological anatomy of the ear, will quickly enable the persevering student to make a correct diagnosis in the larger proportion of cases brought to his attention.

The oblique position of the tympanic membrane, which is so difficult to comprehend in the pictured plates, should be studied. until thoroughly understood. The combined use of the eye and hand will aid very materially in attaining the desired end.

Granted that a large number of ear troubles find their origin in a diseased condition of the naso-pharynx, and will only respond to treatment directed to these parts, yet there are many diseased conditions in the auditory canal which can be skillfully relieved by delicate manipulation, keen sight, and correct medication.

The person who aspires to treat these cases, must be willing to train all his faculties in the most scrupulous manner, if he expects to secure any great degree of success.

Within the auditory canal, three conditions demand attention, viz. Impacted cerumen, eczematous or diffuse, and furuncular or circumscribed inflammation. These embrace those most frequently brought to our notice.

Impacted Cerumen.-The cerumen is an excretion of modified sweat-glands that are situated almost entirely upon the outer twothirds of the canal; hence, the wax will seldom he found in the deeper part of the meatus, or pressing upon the drum-membrane, unless it has been forced there by meddlesome interference.

There is a wonderful activity of growth of the epidermis at the center of the tympanic membrane, which has a tendency to force the entire lining of the meatus to the external orifice.

Accumulations at this point are normally extended since the hairs, situated in the outer part of the canal, prevent their return, and may even act with an expulsive force, thus throwing cerumen pellets out of the external meatus.

The normal ear will secrete quite large amounts of viscid, yellowish wax, which dries and is passed out of the ear without attracting much attention.

Inflammatory conditions of the meatus and tympanum usually cause a decrease, or suspension, in this secretion; but, at the same time, so change its characteristics as to cause it to adhere, and remain within the walls of the cavity.

The shedding of hairs in the outer part, adds another element to the mass, which, acting as a foreign body, causes an increase of exfoliation of the epidermis, and thus forms large obstructions, composed of dark wax, hairs, and epidermic particles.

Vigorous efforts to remove these accumulations, or over-cleanly interference with a secretion that should not be disturbed, are almost sure to push the mass inward until, by their own enlargement, complete closure occurs.

Generally, this takes place at the narrow portion of the canal; rarely is the mass in contact with the tympanum, and so long as this membrane is not conscious of pressure, the clogging of the canal may not cause any disturbance.