lengthening out his illness by several weeks, into a
long-protracted convalescence. The man is not yet circumcised,
and, from the knowledge that I have of his tendency to uraemia,
I feel that, although in his prime, a fever or an accident may
take him off at any moment.

[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