tion and a treatment for the chronic endometritis, as she improved, I lengthened the period of time between the massage treatment, until a treatment given only in one or two weeks kept her comfortable. After several months I found it necessary to replace the womb and use massage every two or three months until symptoms entirely disappeared. She is now in comparatively good health. The uterus does not remain in its absolute normal condition, but the symptoms that kept her a half invalid have disappeared, and she is able to do not only housekeeping, including cooking, but to render as much service as is customary for a farmer's wife. She has been advised several times to submit to an operation to fix and retain the uterus forward.

I have in mind and notes for the report of at least a dozen cases discharged within the past few months. But they are similar and the results are much as the one given, and I decline to take your time.

The question is, should these cases have been given the ventral suspension or Alexander operation? I think not. While the womb is placed in its normal position at each seance, it does not remain so except when held so by substantial support, only in exceptional cases. But the extreme retroversion and retroflection are overcome. The surrounding slight chronic inflammation disappears. The symptoms disappear and the patient is practically cured. I instruct patients to assume the knee-chest position two or three times a day. The malposition of the uterus in such cases would cause but slight trouble were it not for complications. "The importance of retroversion and retroflection in producing disability and disease is not considered so great as in former years." Dr. Schroeder gives important statistics of 411 cases examined. Of these 117, or 28.71 per cent., had retroversion or retroflection. As Dr. Davis says, the interesting question is, in how many of these cases did the condition of retroversion and retroflection cause suffering? Of the 411, 303 had no symptoms referred to the pelvic regions, and among these there were 79 cases of retroversion and retroflection of the uterus, or 26.7 per cent. The remaining 108 patients complained of pelvic disorders, and among these 39, or 36.11 per cent., had

retroversion or retroflection of the uterus. I quote from Dr. Davis's article in commenting on the statistics of Dr. Schroeder, which is in accordance with my own limited experience:

"That retroversion and retroflection of the uterus, uncomplicated by disease of the tubes and ovaries, does not materially influence the health of the patient and does not in itself demand treatment; but that there must be no interference with the mobility of the abdominal and pelvic viscera if the patient is to remain in a condition of comfort, and hence the ordinary corset must be discarded and the clothing especially adapted to each case."

THE RELATION THE UTERUS BEARS TO THE MIND.

J. C. CARLTON, M. D.,
BONHAM, TEXAS.

In dealing with this subject every general practitioner is directly interested. Every specialist, no matter what specialty he is practicing, is also interested, in that not a single one escapes the appalling appeals of such patients. Every woman suffers more or less, and some almost constantly, from some functional derangement of the organic structures of the body. We are frequently consulted by those who, although suffering from no gross pathological lesion, nevertheless, require our aid, for the great discomfort, both physical and mental, which these various functional disturbances entail, and we should make every effort to afford them relief. Many of these simple deviations from the normal are really precursers of conditions of the most serious nature. There is every reason to investigate these minor ailments because of their great frequency and important bearing upon our success as practitioners. No scientific physician is pleased when he finds he has lost some of his patients because they have become discontented and annoyed at his lack of interest and sympathy for their minor functional disturbances and that an arrant imposter has them in charge, because by his tact and knowledge of human nature he has readily relieved their imaginary or their apparently trifling ailments. Old ladies and lay persons generally are often loud in their praise of these irregular practitioners simply because they have given attention to these minor difficulties.

Among the more important of such lesser derangements are the reflex neuroses, which will be considered from the standpoint of the general practitioner or gynecologist. There are many who seem to consider them insignificant, and some even appear to doubt their actual existence. The reflex neuroses are, of course, symptoms, and yet are more than simple symptoms, as they are frequently pro

ductive of more distress than the organic disease from which they take their origin. Neuroses is a generic term for a condition of the hyperasthesia or disturbance of the nervous system which simulates disease in a healthy organ, or an apparently healthy organ, or without evident lesions of any of its parts. Take the uterus, which gets its nerve supply from two main sources, namely, first, the third and fourth branches of the sacral nerve, which is of the greater importance; and, second, from the inferior hypogastric and ovarian plexuses. If the reflex is from the ovarian plexus alone you find that the mind is never disturbed, or if from the inferior hypogastric alone you find a disturbance of the stomach and not of the mind; however, you do find all the reflexes often manifest at the same time. These are only confusing and calculated to mislead the physician. Reflexes that disturb the mind are the most difficult to diagnosticate, for only irritations of the body of the uterus are productive of reflexes to the brain. You will find that where there is some irritation of the third and fourth sacral nerves, whether it be congenital or not, your reflex is invariably a partial or complete loss of consciousness or hystero-epileptic in character. If you have an inflammation of the third and fourth sacral nerves in a young girl you will perhaps have no reflex trouble, only at her menstrual epoch, and not then unless there is some constriction retarding the flow so that pressure is made by the walls of the uterus becoming distended, making pressure on the peripheral irritated nerve; then, in that event, you have a reflex to the brain that will render the patient unconscious, deaf to reason, and nothing more than a lunatic until the pressure is relieved. Again, you find the irritation of such a character that the body of the uterus is very much enlarged, making such pressure on the third and fourth sacral nerves that your patient is illucid for days, and even months, or until she falls into the hands of some one that will give her local treatment and such rest as will reduce the size of the womb so that the pressure on the irritated nerves is relieved, and then, and not until then, it is that your patient is relieved.

There are other conditions that will enlarge the size of the womb that do not give off any reflex, but when such is the case you will

find the nerves in a healthy condition. You will also find the uterus without any hypertrophy whatever, and yet have the nervous reflex; but when such is the case you will find that the growth is of the nerves and will produce the same reflex as if it were in the fibres of the uterus and making pressure on the nerves, and these are the ones which apparently have nothing the matter. Yet you find them going from one doctor to another, resisting any and all treatment offered or suggested, for this one reason. On examination you find. a healthy uterus, apparently, find nothing that would indicate disease, neither by appearance or size, yet your patient will insist she has some disturbance and, as you often hear them complain, that they feel as if they were going crazy. These are patients that worry the doctor the most, and usually go from one to another until finally they are convicted of lunacy.

Neuroses of the womb should be studied carefully, both from an anatomical and physiological standpoint. Plainly stated, there is yet much to be learned. The nervous system should be studied by the general practitioner, as well as the specialist; otherwise he is shut out from a true knowledge of disease. That there are many nervous troubles that are reflex no doubt, and one cannot in justice to himself and patient study the nervous reflex too carefully. Do not understand me to say that every woman who is crazy dates her dementia back to a diseased condition of the womb alone, and can be cured by some local treatment; but I do say that if on examination you find some diseased condition of the womb which makes pressure on the third and fourth branches of the sacral nerves you will always find some reflex trouble of the mind, which should have the attention of the physician until relieved.