disturbance to the greatest intensity; and just in proportion to the violence of these symptoms will be the chlorotic or anæmic condition of the patient. Constipation is an early and very damaging symptom, for it is not only a source of irritation, by its proximity to the uterus, but, by the straining necessary to evacuate the bowels, when loaded with hardened feces, the effort forces the os uteri against the distended rectum, thus greatly increasing the disease of the uterus.

Some ladies describe the pain of such action of the bowels to be about as bad as labor at full time. Under this condition of the bowels, the womb is forced down and its ligaments stretched out, each time the bowels are emptied, till they become relaxed to such an extent as to allow the os to rest against the rectum constantly.

The resulting irritation soon sets up or increases the inflammation, thus increasing its weight, and the weight increasing the prolapsus, and the prolapsus increasing the constipation, by mechanical obstruction.

Constipation is quite a constant symptom in chronic inflammation of the os and cervix uteri, and generally depends upon want of tone in the muscular structure of the bowels; but occasionally the inflammation extends to the mucous membrane of the bowels, to a sufficient extent to produce a mucous diarrhoea, from irritation, or, otherwise, to alternate constipation and diarrhoea, or to cause the formation of tube casts of the rectum, of muco-fibrinous character. All these conditions are accompanied with tumultuous movement of gas in the bowels and stomach, or with annoying distension or borborigmus, at times. In some cases, particular kinds of food appear to aggravate these symptoms, but in others they have no effect of that kind.

In regard to the nervous symptoms complained of by those suffering from this disease, their "name is legion;" and you must not accuse them of affecting them at will, if they experience a transition from the most extreme suffering and pain, and cramps, to a condition of calmness, or even of hilarity, in a moment. Both conditions are uncontrollable and unaccountable.

Cephalalgia is, like constipation, nearly a constant symptom of endocervicitis; and the occipital pain, of a burning character, is, perhaps, the most constant; but cephalalgia, confined to a particular place on the head, as the summit, or the temple, should direct your investigations to the uterus. Ladies suffering from endocervicitis will often call your attention to the spinal column, and claim they have spinal disease; but the pain at the lower end of the spine is caused by pressure from within, and that in the dorsal region, and through the sides and stomach, from the derangement of the digestive organs and portal circle. These nervous phenomena are often developed in violent hysterical paroxysms. One of these attacks being the occasion of your first call to see these cases, and if the real condition of the uterus is not recognized and treated, you will have repeated calls, on account of the same symptoms, with no lasting benefit resulting from your treatment. If you would relieve yourself of the opprobrium of the "no account doctor" and feel yourself satisfied, and have your patient satisfied likewise, that she was in the way of ultimate recovery, you must pay attention to, and treat, the uterus. Pain in the anterior crural nerve, and, also, in the sciatic nerve, are quite common, and are dependent upon pressure, instead of reflex action or neuralgia. If this mistake is made, and a corresponding treatment carried out, the result will be unfavorable.

Respiration is very curiously affected in this disease, sometimes. A case I have now under treatment has apparent spasm of the diaphragm, so that the respiration is entirely thoracic; and she thinks she will have to stop breathing entirely.

During these spells she has to be in the strongest current of cold air she can find; and then they last from fifteen minutes to an hour. These symptoms, with various irregular and spasmodic action of the respiratory muscles, together with that peculiar feeling of constriction of the throat, as if a ball was raising up in it, are some of the effects of this disease upon respiration.

A lady spoken of by Prof. W. H. Byford, of Chicago, by heaving up the lower part of her chest, made her friends think

she was suffering from violent palpitation; but when asked to hold her breath immediately became contemptuously calm.

At another time, she imitated throbbing of the temples, by sudden contractions of the temporal muscles; and when asked to open her mouth as wide as she could, again subsided. The circulation is often unequal, the extremities being cooler and the head hotter than in health.

In examining one of these patients, some months ago, the tumultuous action of the heart was such that I was afraid of organic disease of that organ; and, upon auscultation, at the same time, having my fingers upon the pulse, at the wrist, some beats of the heart could not be detected, at the wrist. This indicated insufficient valvular force; and for a week I reserved my prognosis, from fear of a fatal result, from lesion of the heart; but when visiting her one day, there were such marked hysterical phenomena that my fears all vanished, and the patient is still alive.

These are some of the prominent symptoms of disease of the uterus, and I have dwelt so long on these general symptoms and sympathetic uterine diseases, that Dr. Hodges' remark, in his work "Diseases of Women," is brought forcibly to mind: “That if this all be true, it is a pity a woman has a womb;" yet, as remarked of old, "the half is not told," is as true in reference to the subject under consideration, as it was of Solo

Of all these symptoms there is no one that may not occur in a person who has a healthy uterus; but when we find an aggregation of these symptoms, they call your attention to the womb as the cause, and if you do not follow up the investigation to an ocular demonstration, as to whether the womb is healthy or not, you will not have done your whole duty. In so doing, you will be able to so direct your efforts to cure, as to be quite certain of results; and this is of importance, as patients do not like to take medicine without some benefit, and it is not pleasant to me to treat a case a long time, and then find a mistaken diagnosis. This brings us to the consideration of the local symptoms, and in doing so, let me say, the local and general symptoms may bear no relation to one-another, in many

cases; for when the general symptoms are violent, the local disease may be slight, and "vice versa," according to peculiarity of constitution or temperament.

Leucorrhoea is a strong symptom of uterine, os, and cervical inflammation, and also of ulceration. We do not expect sufficient secretion of mucus, even from a mucous membrane, to inundate the parts and appear externally, and when it does so appear we suspect disease. A male urethra showing a gleety discharge, we say, is an inflamed urethra; and the same may be said of other mucous membranes, the rectum, or the conjunctival mucous membrane. If the leucorrhoeal discharge is purulent, or greenish, or yellowish, with foetor, we conclude ulceration accompanies the inflammation, and is, in a degree, a worse disease. This discharge is known among the ladies as "whites," and appropriately enough too, when it arises simply from inflammation; for as the discharge passes from the womb into the vagina, it is of an albuminous character, and meeting with the acid of the vagina, it is coagulated, and when it appears externally it is of an opaque whiteness, on account of these minute coagula.

When all the acid of the vagina is used up and the discharge continues, it is seen to be a tenacious, glairy mucus; but this should not be mistaken for the vaginal mucus, arising from glandular excitement, that will not discolor the linen, and is a healthy discharge. Quantity of discharge does not correctly indicate extent of disease, for ulcerated surfaces differ in amount, and some secrete none at all, and the rapidity of absorption is different in different cases.

The pains in the illia, loins, groins, and sarcal region are more due to that vague and indescribable condition known as sympathetic than they are to pressure or traction on the uterine ligaments, and easily disappear upon the cure of the inflammation. Hemorrhoids is often caused by the pressure of the uterus, accompanied with constipation upon the hemorrhoidal vessels; and if it has continued a long time will have caused deposition of fibrin or tumors, or other change of structure. The results will not be cured when the uterine inflammation is,

but will require special attention afterwards. Ordinarily the sensation of bearing down is on account of the increased weight of the uterus, from inflammation, and loss of tone of the ligaments of the womb, and is no more complained of when the uterine inflammation is cured. Sometimes it is only apparent, and is accounted for by irritability and exalted sensibility, from inflammation; in others there is real displacement, that may require treatment, after the primary disease is cured.

Menstruation is generally affected by uterine inflammation, but not invariably. It is not regular as to time, it being sometimes delayed, and again more frequent than natural. A case under my care last year had not menstruated for five years, but after four months' treatment they (the menses) were reëstablished. Another case had profuse menstruation at the regular time; and, between the periods, bleeding would occur from the slightest disturbance. The function of reproduction is often suspended in ladies suffering from this disease. One of my patients had been married nine years, and had never been pregnant, but after three months' treatment became so, and has now a living child.

Abortions frequently occur in consequence of it, and inflammation is often caused by forced abortions. It is possible, however, for a woman to get pregnant and bear living children, even if she is suffering from inflammation of the womb; but, commonly, it occasions sterility. Endocervicitis is, indeed, a more common cause of sterility than any other.

It is not supposed that this disease affects labor one way or the other, but the effects upon the post partem condition are slow involution, a tedious getting up, a longer continuance of the lochial discharge, and more danger of metritis, phlebitis, and pyæmia.

Some physicians have been in the habit of recommending ladies to marry who were suffering from this disease, and encouraging them in the belief, that if they became pregnant, they would be cured by it. It may be possible pregnancy has cured this disease, but I do not believe it, and would recommend the cure of the disease previous to pregnancy; for sexual