The disease is very often subacute or chronic from the beginning, and is not, as in the male, always preceded by a period of acute invasion, the symptoms of which necessarily attract the attention of the patient and the physician. For this reason gonorrhea in the woman is very often overlooked. We can as yet form no accurate estimate of its frequency. Certain lesions, such as pyosalpinx, which may be the remote result of gonorrhea, are often, especially by gynecologists, indiscriminately attributed to this disease without anything like sufficient evidence of such a causative relation. The fact that the husband may at some time of his life have had gonorrhea, or even that the woman may have had gonorrhea, is no evidence that a pyosalpinx that appears in later years has been caused by this disease. There are many other causes of pyosalpinx besides gonorrhea. The frequent causative relation of sepsis at labor, miscarriage, or criminal abortion, or during the intra-uterine manipulations of the physician, should always be remembered. I have no intention of underrating the danger to the woman of coitus with a man who is not entirely cured of a gonorrhea or a gleet. The lives of a great many women have been ruined by marriage with incompletely cured gonorrheal husbands, and but very few men in such a condition would contemplate marriage if they were aware of the danger to the woman that results from such an act. But, on the other hand, men who are at all careful of themselves are, without doubt, usually completely cured of gonorrhea; and there are thousands of men in the community who have had one or more attacks of gonorrhea before marriage, and who have now healthy and prolific wives. Every physician of experience will find such examples in the circle of his own practice or acquaintance. It is very unscientific to lay the responsibility upon such husbands for every pelvic inflammatory condition that may appear in their wives. The difficulty of proving the presence of gonorrhea in women is often very great. As has been said, the disease may begin and may exist for a long time without attracting the attention of the woman. She often pays no attention to a slight burning or tickling sensation in the urethra, which passes off in a few days. She may have had a leucorrheal discharge for a long time, and she may fail to notice any slight alteration in its character or quantity that may have been caused by gonorrhea. There is nothing in the gross appearance of the discharge from any part of the genital tract which is absolutely pathognomonic of gonorrhea. The condition may be suspected if there is a purulent discharge from the urethra, because urethritis in women is very generally of gonorrheal origin. But, on the other hand, there may be an innocent-looking mucous discharge from the cervix, such as occurs in health or in mild non-specific conditions, yet in which gonococci may be found.