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organic matter tend to become diarrhoea,! towns. And,lastly, in so far as soil is concerned, excessive wetness andcomplete dryness of soil appear both to be unfavourable todiarrhoea,. When there is habitual moisture which is not

sufficient to preclude free admission of air, that condition isvery favourable to diarrhcea, and it is well marked wherethe subsoil level is high enough to maintain by capillaryattraction a dampness of surface soil. Occasional floods

and leakages from sewers and drains operate in a similarlydetrimental way.As to density of population, there seems no question that

dense aggregations, while favouring high general infantmortality, are especially favourable to death from diarrhoeaamongst infants; and this is especially noticeable wheredensity of buildings on area restrict the movement of airabout dwellings-as, for example, where numerous smalldwellings are shut in amongst tall and large buildings, andwhere long lines of dwellings are so arranged that theycannot be benefited by the prevailing winds. The same lackof free movement of air within dwellings also operatesprejudicially. The absence of free domestic ventilation

tends to raise mortality generally; it very greatly andobviously increases the mortality from diarrhoea, and themost pernicious form in which it is usually operative formischief is in the cases of houses built "back-to-back." In

a somewhat similar way, fustiness and general dirtiness ofdwellings, together with the darkness which conduces tothose conditions, and also the accumulation of filth abouthouses, especially where there is stagnation of air, operateto raise diarrhcea mortality. As to social position, it doesaffect the question; but Dr. BALLARD finds, from certaintables included by Dr. GRIMSHAW in his paper on "ClassMortality Statistics," that this condition influences the

mortality from all other causes, even to a greater extentthan it does diarrhoeal mortality alone.As to articles of consumption, it has not been found that

the use of a polluted water operates to produce the specialform of summer diarrhoea under consideration. With respectto food, Dr. BALLARD is inclined to think that any con-

dition favouring diarrhoea depends not so much on theactual foods, proper or improper, as upon some extraneoussubstance in them which by itself is an efficient cause

of the malady. As to breast-fed as opposed to bottle-fedinfants, some valuable assistance was obtained in Liverpoolby Dr. HOPE; and, as the result of it, Dr. BALLARD con-cludes that, apart from race and social status, children fed

solely from the breast are remarkably exempt from fataldiarrhoea,; that infants suffer from diarrhoea just in pro-portion as artificial feeding takes the place of breast

milk ; and that of all forms of artificial feeding " thebottle" is the most dangerous. Maternal neglect, which,like artificial feeding, is necessitated by certain tradeoccupations, illegitimacy, &c., are generally unfavour-

able to infant life, but they tend specially to diarrhoealmortality.

In a further notice we propose to consider the pro-visional hypothesis as to causation of summer diar-

rhoea which Dr. BALLARD adopts as the outcome of

the evidence we have referred to, and also the practicalsuggestions which are submitted for the guidance of sani-tary authoiities.

Annotations."Ne quid nimis."

THE PHONOGRAPH AND MEDICINE.

A VISIT to the exhibition of Mr. Edison’s marvellous

phonographs in Bond-street shows very clearly that allmusical notes can be reproduced by them with sufficient powerfor a fairly large audience to hear them simultaneously. Allinflexions of the voice, from the loudest shout to a stagewhisper, can also be reproduced, and with the most strikingfidelity in pitch, sequence, and time. Any slurring of aword, or any impediment in its utterance, comes backexactly as it was first pronounced. It is very obviousthat the exact vocalisation of a general paralytic, or

anyone affected with any marked partial paralysis of theorgans of speech, could be reproduced to a class, andso far this valuable invention might be utilised in medicalteaching, for a faithful reproduction is in every way moresuited for purposes of instruction than the most successfulimitation. But this seems to be the limit of its use in,medicine at present. The ticking of a watch failed to makeany mark on the wax tablet, and cannot therefore yet bereproduced ; so that there is no possibility at present ofstoring up for all time a record of either normal or abnormalcardiac or pulmonary sounds. If this were possible, what anew era would be opened out in medical practice andscience. Disputed points in rhythm would no longer be opento discussion, and explanations of many of the debatable-sounds and bruits would be easily arrived at. Moreover,the exact condition of a heart or a lung at any given timecould then be indelibly recorded by the organ itself, and

stored up for reference at any future period, so that improve.ment or otherwise would pass from surmise to certainty.The phonogram might be used to instruct a class or be sent,to any other practitioner. Mr. Edison has, we believe, inLondon more recent phonographs than those now on exhi.bition, but these are not yet patented in England, andtherefore not shown. But even these will probably not besufficiently delicate to reproduce the sounds which it isthe daily province of the physician to study and interpret.Is such a desideratum unattainable ?

OVERWORK ON RAILWAYS.

THE practice of working overtime constitutes, we mayalmost say, a standing rule with railway companies. In

spite of complaints, remonstrances and accidents, some ofwhich, at least, are fairly attributable to this cause, over-work is the order of the day, confirmed by custom and pro-tected by the power of the dividend. The inquiry latelyinstituted in Parliament respecting the death of a plate-layer on the Brighton and South Coast Railway, with thecorrespondence arising out of it, affords a fair illustration ofthe arguments adduced both for and against the system,while it is equally suggestive of the ease with which a.

question of this kind may be shelved and forgotten. Thedeceased had been employed in signalling for twenty-one-hours out of twenty-four. After an interval of six hours hewas again on duty, and was killed by a passing train two’hours later. Excessive work was in this case admitted bythe general manager in a letter to the Board of Trade. It

was pleaded in defence that the circumstances were of ex-ceptional necessity, that a limited number of trained menwere alone qualified for the work in question, that theywere supplied with all needful comforts, and that the onlyalternative to such occasional over-pressure of enplo7c intimes of emergency was a temporary suspension of traffic.The obvious objection to this line of argument was that putforward on behalf of the Board-namely, that, in a city

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liable to annual visitations of fog, experience mighthave taught the greater necessity for a sufficiently numerousand qualified signalling staff. In the meantime the matterhas merely been officially registered, so to speak, by thisremonstrance on the part of the Board of Trade, and ageneral promise on that of the company to try what can bedone to meet the views of the Board in future. Whetherthe accident above mentioned was more properly due to theweariness and inattention of the unfortunate workman orto the mere density of the fog may be open to question. It

is clear that we have reason to believe in the former as wellas the latter cause. Certainly the habit of over-pressurewhich is characteristic of almost every branch of the rail-

way service will not incline the public mind to undue

sympathy with the difficulties and efforts of companies.Though the responsibility for accident were altogether setaside-and this cannot be,-it is evident that mere good work,without mention of health, requires at least enough of goodworking material-that is, of capable workmen. We trust,therefore, that the censure of the Board of Trade will notprove to be the grave of its objections; but that it is

prophetic of such further judicious interference as will giveto its injunctions a fuller meaning than that, of mere dis-approbation.

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EXCISION OF A TUBERCULAR TUMOUR FROM

THE BRAIN.

IN the Boston Medical and Surgical Journal (April 4th)Dr. Knapp and Dr. Bradford record a case of tumour of thebrain removed by operation. The patient was thirty-twoyears of age, and his symptoms commenced in the summerof 1886 with nausea, vomiting, and headache. In March,1887, he had a convulsion followed by paresis of the leftarm and leg, with exaggerated reflexes and slight contrac-ture of the left arm. His sight then began to fail, and theconvulsions recurred at intervals of about three months. In

March, 1888, he consulted Dr. Putnam, and in the followingJune he took to his bed, suffering from severe pain in theback of the head, failing vision, numbness in the left arm,and weakness of the leg. Dr. Knapp saw him in November,and found double optic neuritis, impaired sensibility of theleft side of the face, drawing up of the right angle of themouth, slightly more marked when laughing or talking, Iand diminished tactile sensibility over the left side, mostmarked in the forearm. With the eyes shut he was uncertainas to the position of either the left arm or left leg. The armwas in the position of post-hemiplegic contracture and rigid.The arm could be abducted and slightly rotated at theshoulder voluntarily, and flexed a little at the elbow, butthe wrist and fingers could not be moved. The left legcould be moved in every direction, but it was rather

stiff, and noticeably weak. The superficial reflexes weremostly absent on the left side, but the deep reflexeswere exaggerated. A cerebral tumour was diagnosed, its

locality being surmised to be in the right hemispheres,involving chiefly the centres for the wrist and hand ; andDr. Knapp decided that an attempt at removal afforded theonly chance for life, although with the advanced opticneuritis and secondary degeneration perfect recovery wasimpossible. The patient and his friends deciding to takethe risk of the operation, he was admitted under Dr. Brad-ford into the City Hospital, where several more observationswere taken, and on Dec. 28th Dr. Bradford trephinedover the upper part of the fissure of Rolando. Thetumour was found about half an inch beneath the surfaceof the cortex, and was removed from its bed without

hemorrhage. The pulse-rate at the beginning of the

operation was 58, but at the time of the removal of thetumour it had risen to 156; the breathing also became morerapid and shallow ; and the patient died three-quarters of

an hour after the operation. The tumour weighed 35grammes, and measured 7 by 4 and 3 centimetres. It wasof tubercular nature. No post-mortem examination couldbe obtained.

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SUFFOCATION OF INFANTS.

ALL who have had any dealings with coroners’ juries.know how prone they are to look leniently upon infantilecases in which there is, to say the least, a strong suspicionof contributory negligence. In cases of wasting where thereis little doubt that the infant has been insufficiently or im-properly fed, the task of proving that there has been anycriminal intent is extremely difficult. When, however, theinfant, previously in apparently good health, has been founddead in bed, the question of accident or manslaughter is stillmore difficult, and the parents ordinarily receive the benefit ofthe doubt. Although in such cases the verdict is usually"Accidentally overlain," frequently the Scotch verdict of"Not proven" would seem to be more appropriate. In ourlast issue we referred to a case in which the jury returned.a verdict of manslaughter against the parents, who hadgone to bed in a state of intoxication the night before the-child was found dead. The frequency of such cases in

Liverpool had called from Mr. Justice Charles the rulingthat gross neglect on the part of parents to children,resulting in death, would amount to manslaughter, andthis ruling was put before the jury by the coroner. Duringlast week on a single day no less than three cases

of deaths of infants from suffocation formed the subject of-inquests in Southwark, and the usual verdict was given in,each. In one, it appeared that the father, mother, andthree children occupied the same bed, but otherwise thepublished details of all three refer merely to the fact of th&death and the post-mortem appearances of suffocation.

Perhaps a few verdicts similar to that given at Liverpoolmay tend to diminish the frequency of these " Accidentaldeaths."

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LEGISLATION FOR THE PREVENTION OFMILK INFECTION.

THE proposal which Mr. Shirley Murphy made at theHastings Congress, that local sanitary authorities should beempowered to make regulations for the prevention of milkcontamination due to eruptive diseases of the cow, willcommend itself to those who only regard these affectionsas polluting the milk with pus and other morbid products,as well as to those who consider that they possess still

larger powers of inflicting injury on the health of milkdrinkers. We have no hesitation in saying that milk thus.contaminated ought not to be sold as food for man, and localauthorities might well be empowered to take steps to pre-vent the occurrence or extension of diseases of this nature.The enforcement of regulations for securing the quaran-tining of cows newly arrived on a farm, the isolation ofany cow thus affected, and the washing of the milker’shands between the milking of successive e cows, have

already been proved in different parts of the country to,

afford a material security against the occurrence of thesemaladies, and might with advantage be generally adopted.The fact that many cowkeepers enforce them in their owninterest is a sufficient answer to the objection that they wouldinterfere with business arrangements. So, again, the publichave a right to be protected against possible injury throughthe sale of any cow suffering from eruptive disease, andespecially if this animal be one of a herd whose milk isunder suspicion of having caused infectious disease amongits drinkers. At the present time there is no control exer-cised over these infectious maladies except that which is.dictated by the experience of careful and conscientious cow-keepers. To demand th at all should take the precautions