pipes, traps and all the plumbing should be uninclosed by wooden casings, and be in full view, so as to afford no hidden depositories for filth of any sort. (2) The plumbing should be as simple and uncomplicated as possible. The old pan watercloset fixtures should be utterly discarded as a sanitary abomination and only the simpler "hopper closets" or other improved closets be allowed. (4) Ventilation should be provided by hav ing the main soil pipe carried up in a line as nearly perpendicular as possible through the roof to a point higher than the windows of any part of the building, or of any adjoining building. An air inlet pipe should admit fresh air into the drain pipe at some point on the house side of the trap, which should be introduced between the house and the sewer. In order to secure perfect ventilation, a gas jet or lamp may be so placed in connection with the ventilating flue as to cause a current of heated air to ascend and carry up with it the foul gases. Water closets should always be so placed as to have light and air from out doors.

Where it is deemed not best to have water-closets, but privy vaults instead, if an adequate sewerage system is provided, the sewers skould be utilized for the constant removal of all the ex creta; and if privy vaults are used, they should be so arranged as to be constantly flushed out by the waste water from the building. No less than four closets should be supplied for each hundred scholars.

In cases where there is no adequate sewerage system. it is necessary that the privies should be attended to more carefully and intelligently than is often the case.

In a "Sanitary Survey of School-Houses in Indiana", presented to the A. P. H. A., at the St. Louis meeting, by Dr. E. S. Elder, Sec'y. Ind. S. B. of H., it is stated that in that state "20 per cent of the school-houses have no water-closets, and that where they have them 40 per cent are in bad repair; that 70 per cent of these closets have no vaults, and that 85 per cent of the vaults were never cleaned or disinfected. Many of the closets were filthy and unfit for use. In several of the vaults there were dead animals, a sheep in one, several dogs, cats, etc., in others."' He we I says: "It is a standing reproach upon our civilization that school children should be compelled to attend to the calls of nature under the most painful embarrassment of having no more

provision made for privacy than is given the brutes of the field; or that a pure, neat, clean, innocent girl should have to go into a revolting, filthy, nauseous water-closet, or sacrifice her modesty, or neglect these duties to the peril of her health. We cannot too strongly condemn such a condition of affairs as alike detrimental to health, morals and delicacy. A few pounds of sulphate of iron and a few minutes work semi-weekly, would keep the water-closets of school-houses from becoming a revolting nuisance or a source of ill-health.

Entirely separate accommodations in unconnected buildings should be provided for the two sexes; and certainly for the girls and little children there should be a dry sheltered approach to the building, not only for the sake of appearance and modesty but as a protection in cold and wet weather.

One point in regard to the structure of the privy, which has not been mentioned by others, is that the lower part of the building should be set close to the ground so as to protect the girls from unnecessary exposure in cold and stormy weather. I have known cases of severest dysmenorrhea which seemed to be due solely to the exposure of young women to the stinging blasts of a cold winter's day, when attending to the calls of nature in an improperly constructed school-house privy. Ample provision for ventilation can be made without leaving the whole building open to the wind.

Provision should be made for the frequent cleaning and disinfection of school privies. A few pounds of sulphate of iron dissolved and thrown into the vault once or twice a week, will efficiently deodorize its contents which should,

ever, be thoroughly cleaned out once or twice each year. In large schools, both in the interest of decency and morality, one of the teachers or a monitor from among the older scholars should be on duty near the closets to see that propriety is not violated. In towns where there is an abundant water supply, there is decided advantage in having water-closets on the second floor for the pupils on that floor, and when properly constructed and properly kept, they are entirely free from nuisance, and are desirable, especially on the girl's side of the building, thus avoiding the unnecessary burden of going down stairs and returning, and exposure to the weather as well. It would be still better to have such accommodations provided in a detached tower, connected by a covered way with the main building. [TO BE CONTINUED.]

CASES FROM PRACTICE.

EXSECTION OF HEAD OF FEMUR IN HIP-JOINT

DISEASE.

By G. W. HOLCOMB, M. D., CLINTON, Mo.

It is not my purpose in this report, to say anything as to the pathology or treatment of hip-disease, but to add what little weight. of testimony these cases may carry, in favor of excision in the third stage of that disease. I fail to see any anatomical or statistical reason why the same surgical principles which guide us in the treatment of caries and necrosis in other bones, should not obtain in all cases of hip-joint disease in the third stage. I take it that when these cases come to us with sinuses about the joint, and a history of suppuration, and the occasional discharge of small fragments of bone, and other signs of serious bone trouble, surgical science offers us nothing equal to excision of all diseased bone, let it be much or little.

CASE I.—E. S., a girl 13 or 14 years old, came under my care some years since, with this history. Six or seven years previous, while romping at school, as she expressed it, she strained her hip. An acute inflammation and fever of two or three weeks duration followed the hurt. Some three months afterward, fistulous openings appeared, and have continued ever since in various places about the hip. A great many fragments of bone passed at intervals; at times general health good, at other times bad. Present condition fairly good, leg three or four inches short, toes slightly turned in, trochanter major indistinctly felt, one sinus on outer side of thigh about four inches below joint, another in gluteal region, no diseased bone could be felt with probe, back and forward motion good.

I made a cut about six inches long, as nearly over trochanter major as possible, in a line with femur going straight to the bone. I found the head and most of the neck of femur gone, upper part

of the femur including trochanter major was a mere shell, cancellous tissue all destroyed by caries. I separated muscles and other tissues from the femur as low as trochanter minor, keeping knife close to the bone. I then sawed off the femur at the level of the trochanter minor. As an after treatment, I packed some lint in the wound, made extension by means of a smoothing-iron attached to the foot by adhesive straps. I kept the leg straight by salt bags laid on either side, no fever of any moment followed the operation. The wound was dressed once or twice daily. In about three weeks the cut had healed. This patient had a good leg, and could walk well with the aid of a cane and high shoe. She was in good health when last heard from something more than one year after the operation.

CASE II was a mulatto girl about seven years old. She had had no known injury, could not get a satisfactory history of the case. Abscesses at hip-joint had been running five or six months. This was about all the girl's mother knew of the case. I operated in this case in substantially the same way as in No. I; found carious spots about head and neck of femur; cancellous tissue of neck was soft and easily penetrated by the probe. I passed a strong cord around the neck of the femur as closely as possible to the acetabulum, and made extension on the foot, when the head of the femur was easily lifted from the acetabulum by the cord. The head of the femur was then turned out through the wound and sawed off below the trochanter major. Same dressings as in the other case. I visited patient next morning and found her sitting up in bed with weight drawn up in the bed, the wound gaping open, and the end of femur close to acetabulum. I made extension again, reapplied weight, sand bags, etc. At next visit, I found same state of affairs as before, and could not get the girl's mother to understand or do anything right, so I let her sit up or lie down, or do as she pleased. I told the parents they must abide the results. Nevertheless this child got well, with a stiff hip-joint however, with thigh projecting in front almost at a right angle with the pelvis. I am sure if it had been possible to keep up extension for two or three weeks until cicatricial tissue had formed between the acetabulum and end of femur, this child would have had a good leg.

CASE III.-A scrofulous boy about thirteen or fourteen years old was operated upon by me on the first day of Dec. last. His trouble began about one year previous to operation. Sinuses had existed

six months, one on outer side of thigh and one in the gluteal fold of right hip. Also fistulous opening at upper part of right humerus, which led to carious bone, upper part of left ulna was enlarged and carious, operation and after treatment same as other cases. In this case bone waste had gone on very rapidly, neck of femur was entirely gone, the circular part of head was lying loose in acetabulum entirely denuded of cartilage; trochanter minor had separated from shaft, trochanter major was turned out and drawn upon the the dorsum of ilium and firmly tied by adhesions. I cut through the trochanter major with chisel to facilitate removal, pushed end of bone through the wound and sawed it off an inch or so below the trochanter minor. This boy's wound healed readily, in fact too fast, he had some trouble with secondary abscesses, caused by fragments of bone, which I failed to remove in operation. Still his hip was permanently cured, he has a useful leg and can walk well with one crutch. I think he will in time, walk by the aid of a cane. In April last, I also resected this boy's elbow joint, removing five inches of the ulna and two inches of the radius, from which he made a good recovery with a useful arm.

CYST OF THE THORACIC DUCT.

BY N. B. CARSON, M. D., ST. LOUIS.

Case reported to St. Louis Medico-Chirurgical Society, Sept 7, 1886.

The specimen which I present for your consideration tonight, is one of more than ordinary interest, on account of its rarity. It was taken last Sunday a week from a patient that came to my office to consult me concerning a tumor of the abdomen, which he said gave him no trouble or pain, except by its weight. He was a man

of medium height, slight build, and apparently in perfect health. He gave his age as 38 years, his occupation, a manufacturer. Family history good. Had always enjoyed excellent health except in the hot weather, when he lost in flesh somewhat. About five months before he came to me, he stated that he began to feel a fulness in the abdomen, accompanied by a heavy dragging sensation. About the same time he noticed the tumor which was then nearly as large as an orange, and situated just below the umbilicus.