When, however, the adhesions are more extensive, treatment for their relief may be demanded, even though all inflammatory action has disappeared from the body of the uterus and the tubes. Treatment in such cases is demanded, not to cure the salpingitis or on account of any danger that threatens the woman’s life, but to relieve the pain caused by the results of the inflammation. It may be necessary to perform celiotomy in order to free or break up adhesions that bind down the ovary in an abnormal position, or to liberate an adherent intestine, or to replace a uterus that has been displaced by the traction of adhesions. The degree of suffering experienced by the woman is the guide in advising such operative interference. Pelvic massage has been used for the relief of pelvic adhesions of this kind, the uterus, tubes, and ovaries being manipulated between the fingers in the vagina and a hand upon the abdomen. The results of this treatment have not been encouraging. In discussing the treatment of chronic salpingitis the cases may be divided into two classes: those in which palliative treatment may be followed, and those in which operation is demanded. There are a great number of cases of chronic salpingitis in which there is no gross disease of the tubes, and in which operation upon the tubes is not immediately indicated. It is proper in such cases to try milder palliative treatment first. Salpingitis is always preceded, and usually accompanied, by inflammation of the endometrium, and in every chronic case attention should first be directed to the cure of the endometritis. If there is no tubal and ovarian displacement--that is, if the ovary is not prolapsed; if the uterus has not been retroverted; if there are no extensive tubal adhesions; and if there is no gross disease of the tube, such as pyosalpinx, hydrosalpinx, hematosalpinx, a thorough curetting of the uterus, or, if necessary, a trachelorrhaphy or an amputation of the cervix, will often relieve the woman of her suffering, and it may not be necessary to operate for the damaged tubes. In all such cases, however, the operator must be very careful to exclude active or purulent tubal disease. If he overlooks a pyosalpinx, the curettage or the trachelorrhaphy may be followed by an active peritoneal inflammation that will destroy the woman. If there is ovarian or uterine displacement, we cannot expect relief until these conditions have been treated, and such treatment usually requires celiotomy.