[103] In looking over the literature of reflex neuroses and more direct injurious results, I find that George Macilwain, in a work on "Surgical Observations on the More Important Diseases of the Mucous Canals of the Body," published in London in 1830, calls special attention to the case of a man aged thirty-eight, admitted to the Finsbury Dispensary, and who was in the care of Mr. Hancock. The patient was suffering from excruciating pain in different joints, the pain being so great that he was confined to his bed and unable to stand on his feet. He was unable to rest at nights, and neither rheumatic nor any other apparently suitable treatment was of any service. Rigors were soon added to his other troubles, and during their continuance the pain in his joints was greatly aggravated. He was referred to Mr. Macilwain for treatment, who promptly relieved him by the removal of a urethral stricture, which had quietly been the cause of all the disturbance. It is particularly interesting that even at that early day the reflex neuroses and complications that may arise from the irritability of the genito-urinary organs were so well understood. How well Dr. Macilwain appreciated the nicety of these relations can be seen from his remarks in connection with the above case, in which he says: "It may be observed that the severity of the symptoms is not always commensurate either with the duration of the disease or the degree of stricture, and that, although the progressive development of them varies considerably in rapidity, in different individuals, it is, nevertheless, in the latter stages, always more rapid." Macilwain also graphically describes the insidious approach of these genito-urinary troubles. In speaking of stricture he says: "Although minute inquiry generally informs us that the stricture has been of some standing, and in some instances has existed for years, yet it may happen that it is only a few months or a year since the patient's attention has been directed to the disease. This is very intelligible; for, in conformity with what we observe in other parts of the body, the bladder has a power of accommodating itself to a change of circumstances. Its strength, for a long time, may increase so correctly in proportion to the increase of the obstacle which opposes the ejection of its contents that a very considerable period elapses before the difficulty in making water becomes cognizable to the patient, or it occasions an annoyance so trifling as scarcely to excite his attention. This increase of