is worn at the neck, as I have myself seen in the Nautch girls brought to this country for the purpose of exhibition; and the Woloff negress wears a bright-colored folded cloth upon the cheek.

In the same manner the necessary rest is accorded woman for the susceptibility from three to four and even five more days each month throughout functional life.

We either find that a hut is erected at some distance from the village, as among the Bedas, in Cambodia and on the Isle of Yap, one of the West Caroline islands, or that a certain house is assigned for the purpose as a place of seclusion within the village; so in New Caledonia, upon the coast of Guinea, among the Caffres, the Hottentots and the American Indians; the Hindoos, the Nayers of Malabar and others, assign to the woman in families favorably situated, a separate room in the house.

In Japan, likewise, she is confined in a separate room, not permitted to eat with the family, and forbidden even the visiting of the temple, admitting no possible excuse for leaving the house.

Work of every kind and the bath is strictly forbidden, the dangers of cold water at this time being thoroughly appreciated by all these people, whilst it is a necessary part of their religious teachings that before returning to the village and their families, after the wave has passed, a bath is taken. The laws of Moses and Zoroaster are almost identical, pointing to these great functional waves as a working of the gods.

The laws of Zoroaster necessitated a seclusion of four nights for women, and, what is remarkable, she was then forced to determine her condition by examination, and if the flow had not ceased, indicating an abnormity, additional precautions were observed. She must remain five more nights to which nine days were added, after which time she might cleanse herself and return to life.

The life of woman does not run smoothly like that of man. It is characterized by marked periodicity, by ebbs and floods, by great life waves, which are dominant in the sphere of her especial functions; waves of vascular tension and nerve excitement,

marked by a higher activity and susceptibility of her entire being, distinctly indicating that woman's periodical activity is not a local process, as we have been taught, but one involving the entire female organization, as it was held to be by the ancients, and exerting a permanent influence upon that organism of whose condition and development it is indicative. This function of woman involves the entire vascular and nervous system, and may be said to be the central exchange of that great network of wires, the vaso-motor nerves, the great sympathetic, linking it most intimately with the brain and spinal cord, so with every part of the system.

The most persistent period of nerve and vascular excitement is that of developing womanhood, and for months the system is in a period of unusual activity, and consequently the highest susceptibility, which does not cease as speedily as we see its outward tokens disappear. Then follow the cyclical changes of mature activity, varied by the highest waves of active reproduction.

The functional wave slowly rises until it reaches flood height, with an increase of nerve activity and vascular tension, accompanied by a rise of temperature, as Mary Putman Jacobi tells us, of from 0.01 to 0.8° F., and it is during the decline of this wave that the depletion takes place, when the distended vessels rupture and nature relieves herself, the temperature steadily sinking, but not reaching the normal until after the cessation of all external symptoms.

Are we to believe that a function which so deeply implicates the entire system can be so completely disregarded? That it does not demand special care-greater care than functions less general, less susceptible, less intimately connected with the or ganism?

Are we to believe that this function can be ignored? Are we to be guided by the dangerous arguments of those who claim that precautions are unnecessary at this period?

In considering the initial causes of disease in their effect upon woman, we must analyze not alone this one function, but we must consider the entire being of woman, that we may apply the proper

standard, and that we may not measure her capacity for labor, mental or physical, or her powers of endurance with those of

men.

Women, the women of our civilization, can not be properly compared with men; she is differently organized; differences of many kinds exist, the most obvious, of course, external and anatomical. Form and shape differ; her organism is a different one; individual organs are said to be more vascular and more nervy; she is emotional, more readily exhausted, less able to bear continuous and prolonged application; more blood is produced, the circulation is more active, so also the respiration. The period of puberty is shorter and more marked, and the last stages of development are reached at an earlier period in life.

Consider her lighter frame, her nervous organization, her emotional nature; consider the constant activity of the reproductive functions, the influence of this sphere which dominates her entire being; the intimate connection of every organ, above all the spinal cord, with this reproductive center, and then, need we wonder that injury befalls this sensitive organization when exposed to the intense and continual muscle strain of our present system of education and labor, upon a basis of male vigor?

Whilst the evil is great I am happy to say that an improvement in the physique of the American girl of the better classes has become distinctly evident of late years, due to the progress of the science of hygiene, and its better understanding by the educated public, and perhaps to the introduction of sound physiological and hygienic doctrine in some of the more advanced schools, but above all to the new fad, the increased popularity of outdoor sports.

In the higher classes we mark this change, and we may thank a benign Providence for the change of fashion which has produced this result. The girl must have a good color, a healthy figure, a brisk walk to be in the swim; riding and walking, lawn-tennis and rowing, even fencing, have become fashionable, and are wonders upon the health of the American girl who can afford these luxuries, the same girl who twenty years ago drank vinegar to acquire a fashionable pallor and—an early grave.

Compare the swinging gait of the girl of to-day with the mincing walk and the Grecian bend of some years ago.

A beginning has been made, but the greatest difficulties are still to be overcome. The American girl has a just claim to the most perfect and harmonious development, mental, moral and physical, by virtue of the invigorating influence of an intermingling of race and blood, the favorable hygienic poisibilities of her life, and the freedom she is given. But the average girl is not what she might be, and I repeat that this is due to our habits of life and our methods of education.

[ TO BE CONTINUED IN FEBRUARY NUMBER ]

EXSECTION OF THE HIP.

BY W. B. YOUNG, M.D., OF BON AIR COAL MINES, TENN.

Sometime ending July 1889 I was called to see Mary M., aged 13 years, who was suffering from coxalgia in the second stage. Her mother supposed that she was suffering from dislocation of the hip, as she had been told this by some former physician.

The family came from England to Pennsylvania several years ago and from Pennsylvania to this State during the summer of 1889.

The history of the case, as gathered from the mother, is about this:

When only 7 years of age while attending a public school in Pennsylvania, she was accidentally thrown from her seat upon the floor, falling on her now diseased hip, resulting in a severe bruise. A physician was called in and pronounced it a simple bruise and it would soon be over. But she continued to suffer, and during the interval, from the day on which she received the injury until I was called in, some five or six physicians had been consulted in regard to the case. Some advised exsection, others advised and gave "blood purifiers," but she continued to grow worse. When I was called in the symptoms pointed to a bladder trouble, the hip giving her very little pain.

I thought perhaps she was suffering from a stone in the bladder. She was so tormented by this trouble. frequent micturition, painful urination, etc., that I at once determined to investigate the bladder.

Assisted by Dr. W. W. Hill I placed her under ether, and made a thorough examination of the bladder and the other pelvic organs, and being unable to detect any calculus, or organic lesions of the bladder, I took advantage of the anesthetic and examined the hip, but found no dislocation, and from the investigation on this cccasion and the history of the case, we concluded that it must be a case of coxalgia.

We first attempted to relieve the bladder trouble. This we found very difficult, not being able to give permanent relief, simply mitigating her suffering. While taking certain diuretics I used various injections into the bladder, tried a permanent catheter, and, in fact, I resorted to all the best and most recent treatment recommended by the journals and "standard authorities." Failing in all these I concluded that the bladder trouble was caused by the coxalgia.

During the course of the bladder symptoms I was also giving the hip the best treatment possible under the circumstances. I gave tonics, hypophosphites, "blood purifiers," etc., using extension, but to no purpose. She continued to grow worse.

When I discovered the symptoms characteristic of the third stage of coxalgia, showing the extensive and frightful mischief that had been going on in the joint, I advised an incision, then perhaps an exsection. The family gave their consent and seemed rather anxious for surgical interference, as all other means had proved fruitless. Consequently on Dec. 21, 1889, assisted by Dr. D. R. Gist, of Sparta, we cut down upon the bone (Sayres' operation), and found that the neck and head of femur were almost "rotten," vulgarly speaking.

We at once proceeded to remove all diseased bone possible, therefore we removed the head, neck, trochanter and about one inch of the shaft of femur and scraped the acetabulum, which was also involved.

We closed the wound with a few silk sutures, put in a drainage