Sympathetic Xsuroses.—The connection between genital disease and neurosis can most frequently be observed in organs richly supplied by sympathetic nerves; among these are to be mentioned in the first place the stomach and intestines.
The connection between the uterus and the stomach, as evidenced by "morning sickness" during pregnancy, has also been experimentally dem onstrated. C. F. Kretschy observed, in a patient with fistula of the stomach, that during menstruation acid formation in the stomach went on uninterruptedly, while during the inter-menstrual period, the acid was only formed at regular intervals, with periods of alkalinity. It is not known whether or not she suffered from genital disease. Specialists in diseases of the digestive organs, as for instance latterly Oser, emphasize the frequent occurrence of neuroses of the stomach and intestines simul taneously with diseases of the genitals, and admit that the two are often connected. Any motor, sensory or secretory neurosis may occur, but the most frequently observed are, eructations, nausea, vomiting, globus, car dialgia, enteralgia, dyspepsia and anorexia. To explain the frequent coexistence of diseases in the digestive organs and genitals, we must not always refer to irritation of the peripheral nerves in the pelvis, for atonic conditions in the digestive tract frequently are present in weak and anm mic women, and after delivery the uterus of such women is frequently subinvoluted or retroflexed, and the impaired function of the stomach and intestines coexists with diseased genitals. During menstruation such women usually lose a large quantity of blood, the condition of the stomach grows worse, excitation of the nerves by the retroflexed or enlarged uterus may be assumed as the cause, and yet anaemia be at the bottom of the whole trouble.
Cerebral and Spinal Seuroses.—Next in frequency are neuroses in organs richly supplied by the Tagus. Partly dependent upon genital dis ease are the so-called respiratory and cardiac neuroses. Further, although it is difficult to prove their connection, since they often exist without sexual disease, are the following: cephalalgia, clavus, hemicrania and tri geminal neuralgia.
Very common, and sometimes dependent upon genital disease, is spinal irritation, a general or localized tenderness of the spinal column, with more or less hyperesthesia; it seems to lead rather to neuralgia of the cer vical and intercostal, the lumbar and sacral nerves, and is especially fre quently observed as mastodynia and coccyodynia.
In the majority of women suffering from sexual diseases, who have been under our treatment for years, the reflex neuroses in the stomach and intestinal canal are the only ones which remain probably dependent on psychical alterations of varying form and severity.
Functional disturbances in the organs of special sense are also fre quently observed in women, and are said to depend upon sexual irritation. Forster has described a morbid condition, which begins with pain in the eye-ball and its neighborhood, and is accompanied by photophobia, which he terms "kopiopia hysterica." A. Mooren has also laid stress on the connection between visual disturbances and uterine disease, and Weber Liel the influence of the latter upon affections of hearing. We have ob served such phenomena too infrequently to be able to express decided views, but it is likely that disease of the genitals may have a reflex influ ence on the organs of special sense.
Vasomotor Disturbances. —We frequently observe, especially in ner vous women, sudden flushes of the face and neck, continuing for a long time or limited to one side of the face. Blood extravasations into the skin and mucous membranes are frequent in women, and probably many a hemoptosis, hematemesis, etc., and many menorrhagias, are only of vasomotor origin. To this class belong also the obscure hemicrania, migraine, etc., the cause of which was believed by Du Bois Raymond, 1860, to be narrowing of the arteries of the corresponding side of the head, while 31011endorf, eight years later, stated that it was due to paraly sis of the muscular layer of the blood-vessels, and dilatation of the arter ies of the brain. Under this heading belongs also swelling of the thyroid gland during pregnancy, and the fact that this gland becomes more fre quently swollen in women than in men. We must also mention in this connection the various phenomena of the skin which are more frequently observed in women than in men: chloasma uterinum, the yellow or yel lowish brown pigmentation of the skin, which is observed in nearly one third of pregnant women; and which is more rarely seen and is less in tense in non-pregnant women; acne rosacea also occurs more frequently in women. With all these skin affections, however, we very often cannot discover any disease of the genitals, but they are frequently accompanied by menstrual irregularities, such as occasional amenorrhoea, scanty men struation. prolonged menstruation, which may however be caused only by nervous influences.