many operations of a major kind are not followed by insanity at all. The fact that many women go through the menopause without mental symptoms can not be urged as an argument either way, because, though the ovaries cease to ovíllate after the menopause, they might still secrete some substance beneficial to the nervous system. Insanity may follow any operation. Picqué and Briaud2 state that all the surgeons taking part in the discussion of the Société de Chirurgie in 1898 were unanimous in the

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... nclusion that operations on the female genital organs did not predispose to psychoses any more than other operations did. Previous to this, in 1891, the surgeons who took part in the discussion of the Congrès de Chirurgie reached the same conclusion. In this Picqué and Briaud agree. I am not prepared to accept this view of the subject. I believe that insanity does follow more frequently from operations on the pelvic organs than from any other operation. There are reasons for this to which I will refer later. The forms of insanity which follow operations on the pelvic organs are, first, the toxic insanities. These psychoses have no place in this article because they are caused by toxemia and, therefore, have no direct relationship to the removal of the pelvic organs. The organic insanities are paranoia, melancholia, presenile delusional insanity, periodic erotic mania and paresis. Paranoia, of course, is not caused by any operation. The individual is born a paranoiac, the operation simply hastening the development of a disease ready to exhibit itself under suitable conditions. Nor can paresis be regarded properly as a postoperative psychosis. The syphilitic basis must be present in this disease. The operation with its exhaustive consequences simply develops a disease already present. The causes for insanity, following operations on the pelvic organs, are, first of all, heredity and congenitally defective brains. I do not believe it is possible for any psychosis to develop after any operation on the pelvic organs in a healthy brain. The psychologic causes are not by any means unimportant-the fear of death from the operation, disappointment at not being able to bear children, and the consequent curbing of the maternal instinct, the fear of the loss of the husband's love, the fear of becoming cold and indifferent to the husband, and the fear of acquired masculinity-all exert a powerfully depressing effect on the mind, and contribute, in a brain predisposed to insanity, a great influence in developing psychoses. Such physical causes as anemia, neurasthenia and the breaking down of the general health from long-continued disease, also influence a tendency to the development of a psychosis. In almost all cases the patient has suffered for months and even for years from an exhaustive disease before operative procedures are advised, and this exhaustion and malnutrition is certainly influential as a causative factor in insanity. Surgical shock is by no means an unimportant cause. My position on this subject is that the ovaries and uterus have nothing to do with the preservation of the integrity of the brain, and that their removal alone never causes insanity; that the insanities which follow operations on these organs depend on a hereditary tendency to insanity, the psychologic causes and the physical causes, and the surgical shock already referred to, but that the principal cause of all is the congenitally defective brain. 2. Picqu\l=e'\ and Briaud: "Etudes de psychoses postoperatories,"