This solved part of my patient’s problem.  There remained the adjustment to domestic life.  This was hard, and though in part successful, it was delayed by the sterility of the marriage.  The husband and wife agreed that pending a child she might well become active again in the larger world.  Though the best place would have been her old work, pride and convention stood in the way, and so she entered upon more or less amateurish social work.  Finally, perhaps as an unconsciously humorous compensation for her own troubles, she became an ardent and thoroughly efficient secretary to a league of housewives that aimed at better conditions.  This work took up her time except for the supervising of a servant, and this nondomestic arrangement worked well since she had no children.

Case VIII.  The childless, neglected woman.

It happened that two of the severest cases I have seen occurred, one in a Jewish woman and the other in a young Irish woman, with such an identity of symptoms and social domestic background that either case might have been interchanged for the other without any appreciable difference.  The factors in the cases might simply be summarized as childlessness, anxiety, neglect, and loneliness, and in each case the main symptoms were anxiety, attacks of cardiac symptoms, fatigue, and sleeplessness.

The young Jewish woman, thirty years of age, had been married since the age of twenty.  Before marriage she worked in the needle trades, was well and strong and had no knowledge of any particular nervous or mental disease in her family.  She married a man of twenty-four, who had also been in the tailoring business and had branched out in a small way in business.  This business required him to go to work at about seven-thirty in the morning and he finished at nine-thirty in the evening.  In the earlier years of their marriage he came home rather promptly at the end of his long day and the pair were quite happy.

At about the third year after marriage the woman became quite alarmed at her continued sterility.  She commenced to consult physicians and in the course of the next three years underwent three operations with no result.  She began to brood over this, especially since about this time her husband began to show a decided lack of interest in the home.  He would come home at twelve and later, and she found that he was playing cards,—­in fact had become a confirmed gambler.  When she first discovered this, she became greatly worried; made a trip to New York where his people lived and induced them to bring pressure to bear on him for reform.  This they did, with the result that for about six months he remained away from cards and gave more attention to his wife.