On January 6 he was taken down with a hard chill, fever following. The third examination was made at this time, with the phonendoscope, which revealed to me distinctly an enlarged liver, and a very large gall bladder. All symptoms abated after treatment was directed to liver and gall bladder.

CASE 4.-Mrs. L., a prostitute and beer drinker; has been treated for biliary calculi several years. I treated her about a year ago for the same trouble, at which time she passed several stones, which gave her longer relief than any previous treatment.

For practice-or an experiment, rather-I gave her a phonendoscopic examination in February last, at which time I could distinctly hear stone crepitation, upon manipulating the abdominal walls in the region of the gall bladder. They proved to be gall stones, by the passage of several small ones after a few days treatment.

CASE 5.-Mrs. W., white; six months pregnant; had been under treatment for two weeks for fever. When I was called in March, 1897, no foetal heart sounds could be heard, either with the ear alone or when aided by the phonendoscope, but a suppressed uterine souffle could be heard very indistinctly. Child was removed dead; placenta adherent and free to bleed.

CASE 6. Mrs. J., white, called me in April to tell her the cause of her large stomach, and stop her flow, which was considerable at the time, associated with uterine pains. She menstruated regularly every month, but the amount had been somewhat less since January, at which time she showed only a little pink water. After a very thorough examination I diagnosed pregnancy, but failed to detect any foetal or uterine sounds by the ear or with the aid of the stethescope.

At my next visit I verified my diagnosis by hearing indistinctly both the foetal heart sounds and the uterine souffle. After about two weeks' treatment, to prevent a then threatened abortion, I could hear neither foetal nor uterine sounds with the phonendoscope. All symptoms indicated death of the foetus, which was removed dead,--placenta being very badly diseased and disintegrated, having no attachments at all to the interior of the

uterus.

CASE 7.-Mrs. W., colored, called on me April 15 to remove a retained placenta, following a three and a half months' foetus. I found the placenta projecting through the cervix, and the

mother having no pains whatever about one hour after delivery of the fœtus. Failing to bring the placenta by expulsion, aided by traction on the projecting part with my right hand, I administered ergot, to be repeated in one hour if needed, and to again call me if patient was not relieved of placenta in two hours.

When again called, I found her condition practically the same as when I left her, excepting that she was having very hard pains, with no good results.

Upon the application of the phonendoscope, I could hear a very indistinct rumbling noise, between pains, which I suppose was the uterine souffle. During the pains I could hear a peculiar, crackling, grinding sound, which I suppose was the crepitation, caused by muscular contraction, both abdominal and uterine. I decided that the placenta was adherent, chloroformed the woman, introduced my hand into the uterus, and found the placenta firmly attached to the right fornix by a space the size of the bottom of a glass.

In none of the first six cases here reported could I have been positive of my diagnoses without the aid of the phonendoscope.

In the first case, I was not absolutely positive of my opinion expressed against several other diagnoses, and had the phonendoscope not cleared up the conditions, the patient would not have allowed me to dilate the cervix.

I am sure that I would not have been able to tell you in this paper of having listened to a distinct pulmonic murmur, had it not been for the aid of the phonendoscope in case 2.

In case 3, I failed to detect the enlarged gall bladder at two previous examinations, without the phonendoscope,-which I feel convinced was the original trouble,-- and that I could have detected it had I at that time possessed a phonendoscope.

In case 4, I had flattered myself with the idea that all gall stones had been passed after my last treatment, but the phonendoscope proved my flattery to be false.

In case 6, I am convinced that I could not have positively diagnosed pregnancy at the time without the aid of the phonendoscope, the case having such a contradictory history; and the death of the foetus could not have been proven so conclusively; consequently, a longer delay for the removal of the fœtus would have been allowed, thereby jeopardizing the life of the patient by subjecting her to such dangerous conditions.

In conclusion, I will say that although my present experience

with the phonendoscope will not enable me to corroborote and sustain all of Bianchi's claims, and, admitting, as he himself does, that many of its uses may be accomplished with the binaural stethoscope,-nevertheless, an honest comparison of the two instruments will certainly convince any one of unbiased opinion that the phonendoscope is, in a great many respects, a distinct and decided improvement on the stethoscope.

For the Texas Medical Journal.

DENTITION AND DIARRHEA.

BY F. PASCHAL, M. D., SAN ANTONIO, TEXAS.

[Read at meeting of West Texas District Medical Society, San Antonio, Texas.]

THER

HERE is a prevalent belief among the laity, and especially the women part of it, and which is shared by some of the members of our profession, that many of the gastro-intestinal disorders occurring during dentition are physiological, and therefore to be expected. That gastro-intestinal disorders do occur so frequently at the time of teething as to make this belief accepted by many, we well know, but that gastro-intestinal disorders are caused by dentition I do not believe can be substantiated. It has been my experience that properly fed infants are, as a rule, constipated instead of having diarrhoea during the first two years of their lives. It is true that the gastrointestinal tract is undergoing rapid changes at the time of dentition, and is more easily deranged than it is after dentition, but the underlying cause for these derangements is not the physiological processes, but others, chief among which is improper feeding. It may seem to many of you that this is an unimportant subject to bring before you this hot night, but the advent of the hot weather is a reminder of the fact that the greatest mortality among infants is during just such weather. The mortality of infancy is variously estimated at from 15 to 30 per cent. during the first year of life. Within a few years returns from Berlin, French and Italian cities, and even Boston placed the mortality of infants of one year or less at from 20 to 30 per cent. Nor are these statistics exaggerated by the inclusion of still births. Of course there are many diseases of infancy responsible for this large mortality, but nevertheless careful compilations estimate that 42 per cent. of deaths

occurring amongst infants are due to digestial disorders. It is a notable fact that in Norway where almost every child is nursed, it is only 10 per cent. In Wurtemburg the mortality of breast-fed children is 13.5 per cent., and of artificially fed children it is 42.7. In saying that breast milk is the proper food for infants during the first year of their life is stating a too well known fact, but unfortunately there are more mothers who do not have enough nourishment for their infants thun those who do have enough. Of 525 cases analyzed at the Freisburg maternity only one-half were able to nurse their babies during the first two weeks. In 99 no milk was secreted; in 46 imperfect nipples; in 46 fissures; in 44 insufficient secretion. Only 33 suckled freely without complications.

With this large percentage of mothers unable to nurse their children, it is certainly desirable to find some substitute for infants deprived of the breast; and if I were to bore you with the number of proposed substitutes, I am sure you would never invite me to read another paper. The most available one is cow's milk, but this is subject to so many conditions as to make it an element of importance to every health department, and unless proper measures are adopted it is a danger to every community. Many homicides are probably committed, traceable to infected milk, and which are preventable. There is no better media for germ life than cow's milk, and barring the fact that an infant's stomach is often made a truck farm of where anything from fruits and vegetables to bacon is forced into it, accepting the belief that various contagious germs, as typhoid fever, scarlet fever, diphtheria and tuberculosis, have been found in milk, and no doubt have been the cause of death. Yet these are insignificant factors of danger as compared to the bacteria with which milk is found to be swarming after an exposure of two hours in such weather as we are now having, and it is here that the chief cause of digestial disorders is to be found during dentition; and here, also, is an explanation of such a large mortality during the first year of infant life, whether from that rapid toxæmia causing the so-called "cholera infantum," and which we know is nothing more or less than a ptomaine poisoning, or whether from a less rapid intestinal septicæmia, or from deeper involvement, causing gastro-intestinal inflammation and ulceration. However the case may end, in the very great majority of cases it is from infected food, of which milk forms the principal part. We eat cooked foods and

are less liable to being poisoned; the infant depends upon what it gets-mostly uncooked milk.

As we must rely upon condensed milk as a food for infants we should, after prescribing it in such proportions as the age and conditions of the infants require, order that it be boiled and put in sterilized bottles tightly corked, and kept on ice in a cool place. Of course, where one has an intelligent family to deal with, more elaborate means, or possibly better means can be adopted, but as a rule some easy means must be suggested for sterilizing or nothing will be done. I think it best to order it put in bottles well stopped, for if kept in an ice chest uncovered or exposed to the air, it only becomes infected less slowly, but infected all the same. A glance into an ice chest will convince one that these valuable repositories for meats, vegetables, cooked and raw fruits, butter, eggs-smeared over with one broken a few days before-and snugly placed among the promiscuous mass is baby's milk, getting the full benefit of a mixed infection of animal and vegetable germs; and poor baby, if taken ill with diarrhoea during teething, why, of course, it is its teeth. The old ladies think so, and of course, many doctors think with the old ladies-that it is the child's teeth, and if baby dies, why, it died of teething.

Now one word about artificial food and I am through. For my part I have no faith in them, and I think that what cannot be accomplished with condensed milk, modified to meet requirements, will not be accomplished by the many nostrums in the food line, prepared to fill the coffers of the manufacturers. I do not think it is beneath us to educate people to the facts which recent science and perfect experimentation, aided by that most of all valued instruments, the microscope, have taught us; for every human life saved, however insignificant it may be, even the life of an infant, certainly reflects the highest gift of our profession, for after all we are merely tools for the purpose of benefitting our race.

Society Notes.

TERRELL, TEXAS, June 15, 1897. DEAR DOCTOR:-The fifth meeting of the Texas Association of Railway Surgeons will be held in the city of Galveston on the second Tuesday in August. As that is a very desirable time to visit the "Island City," and being solicitous of having the