Engelmann, after stating that his experience in America was similar to Tilt's in England, continues ("The Health of the American Girl," _Transactions of the Southern Surgical and Gynæcological Society_, 1890): "To innumerable women has fright, nervous and emotional excitement, exposure to cold, brought injury at puberty. What more natural than that the anxious girl, surprised by the sudden and unexpected loss of the precious life-fluid, should seek to check the bleeding wound--as she supposes? For this purpose the use of cold washes and applications is common, some even seek to stop the flow by a cold bath, as was done by a now careful mother, who long lay at the point of death from the result of such indiscretion, and but slowly, by years of care, regained her health. The terrible warning has not been lost, and mindful of her own experience she has taught her children a lesson which but few are fortunate enough to learn--the individual care during periods of functional activity which is needful for the preservation of woman's health." In a study of one hundred and twenty-five American high school girls Dr. Helen Kennedy refers to the "modesty" which makes it impossible even for mothers and daughters to speak to each other concerning the menstrual functions. "Thirty-six girls in this high school passed into womanhood with no knowledge whatever, from a proper source, of all that makes them women. Thirty-nine were probably not much wiser, for they stated that they had received some instruction, but had not talked freely on the matter. From the fact that the curious girl did not talk freely on what naturally interested her, it is possible she was put off with a few words as to personal care, and a reprimand for her curiosity. Less than half of the girls felt free to talk with their mothers of this most important matter!" (Helen Kennedy, "Effects of High School Work upon Girls During Adolescence," _Pedagogical Seminary_, June, 1896.) The same state of things probably also prevails in other countries. Thus, as regards France, Edmond de Goncourt in _Chérie_ (pp. 137-139) described the terror of his young heroine at the appearance of the first menstrual period for which she had never been prepared. He adds: "It is very seldom, indeed, that women speak of this eventuality. Mothers fear to warn their daughters, elder sisters dislike confidences with their younger sisters, governesses are generally mute with girls who have no mothers or sisters."