genesis were in the ascendant, I took her out of school, stopped her music, cut down her physical exertions, and soon had the gratification of finding her at the end of a few months a rosy, blooming girl, free from all neurasthenic manifestations, and gaining rapidly in weight.

I did not imagine from this, however, that she was well, but kept us this program until the beginning of the next school year. Such cases are common enough, and the plan of management is an every-day affair; but to make the management most effective a recognition of their true pathology is essential, and it is for the recognition of what I believe to be the most important factor in this pathology that I am now pleading. In this connection it must be borne in mind that the first menstruation is not the beginning of puberty, but is a phenomenon which occurs in the course of puberty. For at least a year before this sign, other evidences of the condition can be noted, and two or more years elapse after that before the active pubescent period is over. When pubescence has been established and the girl has become a woman, which is usually after the sixteenth year, it is possible she may now be able to withstand the trials and burdens of our medieval and pedantic educational curriculum and take her place in the last year of the high school or begin the college course. Woman must become a productive and independent member of society. She is not to be the ornament that the woman of the Turkish household is, nor the quiet drudge and housekeeper of the German family; and she ought not to be the game of gnyecologists which the women of the upper classes of society have latterly become. Less than one third of the women of the country are brought up in cities. The surroundings of the country girls are quite different from those of their city cousins, and yet they are much influenced by the same customs and habits of the great ag

gregations of people from whence civilization takes its name and inspirations; the training of the country girl differs very little from that of the city girl. They are taught to read and write, spell and figure, write compositions, read French and Latin, and to despise all sorts of domestic or manual labor. They dress as their sisters in the cities do, begirt themselves with corsets and other ills of the modern dress to which I called your attention in a paper on the subject of "Tight Lacing" at our last annual meeting. Why are the women of to-day more prone to disease of the genital tract, and to deficiency of lactation, both evidences of an inferior genetic power, than were their mothers and grandmothers, unless from some change in environment. I see in it evidence of defective pubescent nutrition and trace it, in part at least, to the high pressure of modern life which to-day throws upon growing children new social duties, intellectual labors, and even physical labors, with consequent diversion of energy into channels of immediate activity which should be potentialized. An objection which will at once be raised, is that the work of the gynecologist is concerned largely with disorders of an infectious origin, and that the organisms which infect the adult could hardly be much affected by attention to their hosts during puberty. Directly, certainly not, but the soil can be, and in the infectious disorders it is the soil of nutritive element which is much more in need of study than the invading organisms themselves. The ideal life of the child is one in which she comes in contact from necessity and pleasure with all things which go to make up the physical necessities and comforts of the common life.

CONCLUSIONS.

1st. At eighth year place the girl in school, public or private.

2d The curriculum should correspond to the need of the child's physical and mental capacities.

3d. At twelfth year and during the period of puberty, be careful not to overwork her mental faculties, allow plenty of outdoor amusements, travel, light literature, and keep her constantly under her mother's watchful care and attention, that she may be advised of the changes she is soon to experience.

4th. I would advocate that the quarterly anthropometric measurements, with quarterly medical supervision, should be used as a basis for the diagnosis for the next quarter's exercises and studies.

5th. After the fifteenth year let her finish the preparatory high school courses and enter college, when her constitution will be equal to the arduous duties she will have to perform, climbing stairs from recitations and prayers.

APHTHOUS TONSILLITIS, OR DIPHTHEROID

SORE THROAT.

BY MARK H. O'DANIEL, M.D., BULLARDS, GA.

This was a case of tonsillitis, the character and results of which, together with its similarity, and yet dissimilarity to diphtheria, rendered it of special interest to me, hence my reason for reporting same.

On August 17th I was called to see A. N., schoolgirl, nine years of age, blonde type, of rather small and slender figure. Previous general health good, with the exception of a tendency to sore throat, and occasionally attacks of indigestion, stomatitis, etc.

There was no hereditary disease or taint known to exist in her family history, the father and mother both being vigorous and healthy subjects. She had been attending school regularly until the morning previous to my visit; when she complained to her mother of headache, chilliness, and aching of her limbs, followed with sore throat and considerable fever, causing her to spend a restless night. Upon my arival the next morning, I found her sitting by the fireside, face flushed, eyes red and watering, resembling one with influenza or catarrhal fever. She had a temperature of 102, pulse 120, strong and full; throat quite red and the left tonsil swollen and ulcerated. were a number of small yellowish white spots, dense andpartially confluent, irregular in shape, appearing as a whitish mass or deposit upon the major portion of the inner

There

surface, which, upon being wiped with a probang, appeared raw and disposed to bleed.

There was some soreness about the angle of the jaw, but no enlargement of the glands. Her tongue was furred with a yellowish brown or bilious coating, as we term it; she complained a good deal in swallowing and talking. There was a decided weakness and nasal twang in her voice, the latter being characteristic of diphtheria, and rather suspicious (although the appearance of the throat did not warrant it). I inquired particularly as to whether or not there had been any sore throat in the community or amongst the school-children. Upon being informed to the contrary, I determined I had a case of aphthous tonsillitis or diphtheroid sore throat. My treatment consisted in small and broken doses of mit. chloridi hydrarg., phenacetin, Dover's powders, quin. and salol., a frequent spray, and the application of carbolic acid and glycerine to the ulcerated spots or patches; confinement indoors, and preferably rest in bed, the most nutritious and thoughtfully prepared liquid diet.

The mother stated she would endeavor to keep her indoors, but apprehended difficulty, as she had always been humored and allowed her own way.

On the morn of the 19th I was pleased to find my patient sitting up ciphering. The remedies had acted nicely, and she was quite comfortable, with the exception of her throat, which pained her as much as formerly in swallowing and talking.

She had told me of having become weary of the house, and going out in afternoon after my visit and riding a horse up and down the road; also of going to the schoolhouse, a mile distant, to return with the school-children. Her temperature was now 100. Bowels had acted well; tongue cleaned, the redness and ulceration somewhat im