as well as the council, and provide clinics at the hospitals and colleges as an important feature of the program. These are mere suggestions and while I do not wish to press these changes at this time, I hope to live to see them put into effective operation. We will now take up the real work of the society. This subject has not, as far as I know, ever been brought to the attention of the medical profession. I have been impressed with the frequency of its occurrence in connection with nervous cases, and there can be no doubt that it is the cause of many of the cases of hysterical paryoxisms, headaches, and general nervous attacks, which we see. It is, therefore, a matter of importance to recognize the existence of this condition, as otherwise many cases must remain uncured owing to the lack of knowledge on the part of the physician and the patient also. It frequently happens that women know this to be associated with, or the cause of, their nervousness, and yet from modesty will not tell their physician about it. I have seen altogether quite a number of these cases, and they are usually due, as in men, to unsatisfied sexual desire. For example, one patient was a young woman, age twenty-eight, unmarried, but a semi-prostitute, very erotic, and had frequent intercourses. She had an operation performed for appendicitis, and as this necessitated a long sexual rest, she began to have dreams at night like sexual intercourse which terminated by a climax and the passage of a small plug of mucus, which seemed to come from her cervix. On the day following this spending, she would be extremely nervous, have crying spells, her appearance cyanotic, her features looked pinched, a bluish appearance under the eyes, and the vessels of the eyes injected. Frequently she had severe headaches after the spending, and on one of these occasions she took Antikamnia and came near dying from its effects. After she recovered from her operation sufficiently to resume her usual practices, she recovered entirely from her nervous symptoms. twenty She has She has In another case, a married woman, aged three, complained of headaches for four weeks. one child living and well. Married six years. had two operations, one for appendicitis, and in another one ovary was removed and a part of the other, and curettage. She had heat prostration six months before consulting me, and this lasted a week. Also, she had headache lasting a week, three months ago. Four weeks ago, headache began again and has continued ever since with perhaps two hours relief at a time. Started on the day of menses and is now menstruating again, Menses regular, twenty-eight days, last two to three days, no pain, or less than before operation. Every other month it is scanty. Headache begins with mental depression and she feels like she had committed a crime. Begins in top of head and passes down to neck and the muscles of the neck get stiff and sore, accompanied by throbbing which is continuous and severe, and she was confined to the bed for the first three days. Has had dreams and thinks some one is beating her on the head. Before this headache, for a week, had spending dreams, like intercourse, two or three times a night and wakes up just at the end of it. Has had these spendings on and off for two years. Never in day time. Husband is living with her, but has been incapacitated for three years. Aged forty-four. Backache in sacroiliac region for six months on an off. Better at times, worse at others. When she goes to bed at night, she has to get up two or three times to urinate every fifteen minutes before she can get to sleep and again about midnight and the first thing in the morning. No dribbling, but voids often during the day, about six or seven times. No fever, appetite natural, taste good after eating. Pain in region of heart at night. often, due to indigestion she thinks. Belching after eating. No nausea or vomiting, except some nausea when headache is severe. Bowels regular. Weight about 125 pounds, gained some lately. Dyspnoea on exertion and weakness for a month. Says she has laceration of cervix. Has had, three severe headaches altogether spending only preceded the last headache. She says she had spendings ever since she married, not before and is always nervous after it. In another case, a married woman, age twenty had been married for six months, but has been much troubled with spendings for nine or ten months. This occurs in spells and may not occur for a week or two, and then has two or three spells in one or two weeks, or may have two in one night, followed by intense nervousness, crying, headaches, trembling and "all to pieces." Never has spending when her husband is away, even if he is gone a month. It often occurs on night of intercourse. and always then, if it does not occur during intercourse, and may occur two or three times in one night. Intercourse occurs very frequently and is always very painful to her. Rarely has any sexual gratification, although her husband has no premature discharge. She says the spending consists of sexual feelings and she thinks there is a slight discharge; says she seldom has any continued feeling or climax during the act. Says it is usually done without any petting or arousing and desire on her part. The spendings before marriage were brought on by husband being too affectionate, but had no nervous spells until after marriage. Since then they were brought on by excessive intercourse without gratification. Otherwise she seems fairly healthy, weight 130 pounds. Appetite poor for two or three months; tastes food often after eating, much belching, no nausea or vomiting, bowels regular, menses twenty-eight days, regular, last four days usually, slight pain just before it. Sleeps well except when nervous, then has night mares. In another case, a girl, aged eighteen, had been operated on ten months before consulting me for cystic ovaries, which were lanced and cauterized, but the ovaries were not removed. Her sexual desire was aroused at age fifteen by riding horseback astride, and since then has had sexual feelings both in day time and at night. She had frequent dreams at night, as of seeing a naked man, etc., and with it strong sexual feelings, followed by a climax, and was extremely nervous afterwards. At times being very hysterical with crying and screaming attacks, muscular rigidity. Opisthotonus, convulsions, nausea and vomiting, abdominal and general pains and severe headaches. When she would go for a few weeks without spending she would be almost entirely free from nervousness, but it would invariably occur on the day following the spendings and cease when the spendings and sexual felings were finally relieved. In another case, a yound lady, age twenty years, suffered from attacks of nervousness and trembling which always followed spending dreams and gradually subsided until another nocturnal orgasm occurred. I have seen quite a number of other cases on this order and with such frequency that I am inclined to consider it a very important factor, in many cases of hysteria, general nervousness and nervous headaches. As a rule, patients will not tell their physician about this, and it is only on careful inquiry, as to the cause of their getting suddenly worse while under treatment that the information is obtained. Nevertheless it is essential to know of it, otherwise many cases must remain uncured, which with this knowledge are readily curable. By his request, Dr. Westmoreland's paper is not published. Discussion on Papers of Dr. Block and Dr. Westmoreland Dr. J. G. Earnest, Atlanta: I wish to call attention to one important point in Dr. Westmoreland's paper in which he states that there is no longer any place for the |