The rectum and the genitourinary organs are so closely grouped together in the pelvic cavity; the nerves, blood vessels, and lymphatics so intimately associated that it seems only reasonable to expect disease in one would be very likely to disturb the other, functionally or sympathetically. Indeed, this anatomical relation is even more strongly brought to our attention when we consider their common origin from the mes-blast The reproductive organs of the female are particularly prone to reflex disturbances due to rectal pain.

In old men a pro static atrophy or hypertrophy is very commonly associated with a rectal disease over the prostate an-analogous in its pathology. The anatomical and physiological association of the bladder and rectum is most complex in both sexes as a disturbed physiological activity is easily ascribed to either organ. This is again confusing on account of diseases in either being of frequent occurrence.

So, too, the symptoms of diseases located in the reproductive organs of the female, when occurring on the left side, cannot be made out clearly enough in some cases by our modern means of diagnosis. Without great care in examination one is very apt to overlook the disease in the intestine and ascribe the tender point over the ovary to an inflammation of that organ, when in reality the real source of trouble is due to an impacted sigmoid. An strangulation of the sigmoid may be caused by adhesion to the stump of an extirpated ovary, which may. long after the operation, cause the patient to complain of pain and suffering, almost identical in character and in the same location as the original trouble.

There also seems to be a nervous impression, if one may use the term, of one with the other, as a traumatize to one or an inflammation of the other is very likely to have its effect upon both. This may be due to the close anatomical relation in the spinal cord of the nerve centers governing these organs which allow seemingly a short circuit of efferent and afferent impulses.

These phenomena are often illustrated by the retention of urine after hemorrhoid operation, and from the other side of the tract, congestion due to gonorrheal and prolapsed ovaries; or with the presence of a parametric inflammation the subject also suffers from proctorial, spasmodic anal sphincters and cystitis.

Irritation of the rectum may have a reflex action upon the female pelvic organs owing to the close relationship or proximity of their nerve centers. An ulceration of the rectum may cause irregularities of the menstrual flow; or gonorrheal, in cases of periodic bleeding from the rectum.

An encroachment from growths of the female pelvic organs upon the rectum, as a rule, does not occur unless the cavity is snugly filled up, or the growth is wedged in the pelvic cavity so as to be unable to rise above the pelvic brim. Large tumors rise above the brim in the same manner as the pregnant uterus and seldom cause constipation. Ovarian cysts, pelvic hematologic, hematology and large inflammatory exudate into the broad ligaments, often cause some degree of constipation. Stricture due to malignant growths in the uterus or its appendages, involving the surrounding tissue, or secondary deposits in the pouch of Douglas, almost invariably cause constipation and inflammation of the sigmoid or rectum.

The per-rectal tissue is often involved in female pelvic inflammations or abscesses and it has been my experience to see a case in which three strictures of the rectum resulted from such an inflammation which extended to the rectal walls. Perpendicular abscesses sometimes rupture into the sigmoid flexible, particularly those formed post-operative. Abscesses which rupture into the rectum usually have very small opens and tend to repeated retention and discharge of pus, which is always a menace to the life of the patient from reinfection. An enema has been known to enter an abscess which opened into the rectum and caused infection of the peritoneum by bursting through the abscess wall.

Abscesses in the lower abdomen are limited by the juxtaposition and adhesion formed by the small gut, momentum, sigmoid flexible or the rectum. A pelvis-rectal or retro-rectal abscess commonly originates from the female pelvic organs. Statistics reveal the history of the rupture of a tubal gestation through the bowel with the discharge of blood and feces, and in another instance, records the rupture and discharge of an ovarian cyst into the gut. Generally a retro-uterine abscess is associated with painful defecation which is referred high up in the rectum. These patients continue to suffer for a long while after the subsidence and absorption of the abscess cavity as a result of the scar. Scars which follow inflammation of the cervix, the parametric, or tears in the cervix, are said to be common causes of constipation.

Viewing the subject of reflex neuralgic pains, due to ovarian or cervical disease, from the standpoint of the gynecologist, we have many truthful instances of relief from suffering in distant parts of the body by removal of the diseased ovary or repair of the cervix. Sometimes the secondary disturbance to disease of the Benito-urinary organs produces even a greater reflex agitation than the primary trouble, as a dyslexia, gonorrheal or vaginally due to a rectal ulcer, fissure, proctorial, or constipation with auto-intoxication. Almost invariably an ulcer of the rectum, stricture, fissure or inflammation of the crypts of Morgan, when of long duration, will inflict sufficient irritation to the nervous system to cause either a local neuralgia or other symptoms of nerve impairment. These cases sometimes give a well-marked symptomatic of ovarian or uterine pain and after douches and tampon in the treatment given by the gynecologist, are relieved of these symptoms by the cure of some rectal disease. These mistakes arise from the description of the pain as given by the patient being accepted as sufficient for a correct diagnosis. An ulcer of the rectum, fissure in anew, anal stricture or a cryptic will often not only cause widespread reflexes but cause local reflex spasm of the elevator an and sphincter vaginae muscles, which, while in a state of spasm, constricts the parts.