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Related post: slightly suspicious. With the history of
the water as known, few men would have
been bold enough to condemn the water
as dangerous before the outbreak oc-
curred.
The inference drawn from the outbreak
is that we can not exert too much care or
exact too high a standard with our public
water supplies. The quality of the Pedlar
water had been passed upon by several
specialists of undoubted competency and
had been pronounced safe, and in this
opinion the speaker concurred. The sole
lapse from the conditions imposed for
safety was that at intervals lasting only
a few hours, occurring proTsably three or
four times a month, chlorine was cut off
and yet during these brief intervals the
bacilli which in the untreated water but
rarely reached the intake, seems to have
gotten by and caused infection.
Vol. X No. 10
SHALLENBERGER: NERVOUS MANIFESTATIONS
797
SURGERY, GYNECOLOGY, OBSTETRICS AND
GENITO-URINARY DISEASES
GYNECOLOGIC ORIGIN OF NERVOUS
MANIFESTATIONS*
By W. F. SHALLENBERGER. A.M., M.D.,
Associate Iv Avelox Professor of Gynecology, Emory
University (Atlanta Medical College),
Atlanta, Ga.
Nervous manifestations as an accom-
paniment of gynecologic conditions are ex-
tremely common. The problems presented
by these cases are often manifold and dif-
ficult. The question arises, are we deal-
ing with a pure functional neurosis, an
organic nervous disorder, or is the nerv-
ousness more or less the outgrowth of the
gynecologic condition? The proper man-
agement of the case Avelox 40 Mg depends upon this de-
termination. Pelvic symptoms are fre-
quent in women with functional neuroses
and the women becoming consciously
aware of functions that are normally only
sensed by Avelox 400 Mg Tablet the subconsciousness, may im-
agine that they are the victims of all sorts
of "female troubles." Such patients are
not gynecologic and their attention should
be led away from the pelvis. Local treat-
ments, operations, etc., will, as a rule, work
nothing but harm to them.
On the other hand, it is frequently very
difficult to determine, with absolute assur-
ance, that the pelvis is perfectly clear.
Pelvic adhesions, which are a common
source of pain and discomfort, are often
not to be made out. A careful history and
a thorough study of the patient will be
helpful. The assistance of a neurologist
may be necessary. The possibility of an
organic nervous lesion must always be
kept in mind.
Women are more prone to nervous dis-
orders or neuroses than men. The clien-
tele of the average neurologist is composed
largely of women. These neuroses mani-
fest themselves most frequently during
the period of sexual activity, between
puberty and the menopause. They are not
commonly met with at the extremes of
life. During her sexual life a Avelox Moxifloxacin 400 Mg woman is
constantly passing through a monthly
cycle in which her entire organism par-
ticipates, — an ebb and flow of her vitality.
Menstruation is not a local phenomenon
but a systemic phenomenon with local
manifestations. There is a close and im-
portant relationship between the endo-
crine system and menstruation ; and de-
i-angement of many of the glands of this
system is accompanied by nervous symp-
toms more or less marked. Therefore, it
is Purchase Avelox Online small wonder that the nervous equilib-
rium of many women is upset at the time
of the menstrual period. Havelock Ellis
calls attention to the fact that a number
of investigators have found that among
women criminals and suicides the acts
were in the great majority of cases com-
mitted during the menstrual period. He
also states that among insane women the
insane impulse becomes more marked dur-
ing menstruation, and he says that:
"These facts of morbid psychology are
very significant; they emphasize the fact
that even in the healthiest woman a worm,
however harmless and unperceived, gnaws
periodically at the roots of her life."
That derangement of the endocrine sys-
tem may be the important factor in the
production of nervous symptoms in con-
nection with various other gynecologic
conditions may be true, but, in many cases,
the pelvic condition, per se, is primarily
responsible. That gynecologic conditions
are a frequent source of nervous mani-
festations can not be denied. The intens-
ity of the nervous symptoms depends not
so much upon the extent of the lesion as
upon the nervous organization and sta-
bility of the patient. A most extensive
condition with uterine displacement and
adherent adnexa, such as we often see in
colored women, may exist with few if any
symptoms in this race, whereas a minor
and insignificant pelvic affection may com-
pletely undermine the nervous reserve
force of a more highly organized white
woman. It is somewhat of a mooted ques-
tion just how the nervous symptoms are
produced. The neurologists have gotten
away from the idea that it is a simple re-
flex phenomenon. The effect of pelvic dis-
ease may be and probably is largely psychic

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