Deep-seated inflammatory changes may also take place as a result of cervical catarrh, so that at first a slight hypertrophy from inflammatory exudate results, and later the formation of connective tissue produces a sclerotic condition of the cervix. As has been said, chronic cervical catarrh, unless of gonorrheal origin, is nearly always secondary to some local or general condition. The most usual cause of the disease is laceration of the cervix, which causes inflammation of the mucous membrane by direct injury and exposure. The various flexions and displacements of the uterus are often accompanied by cervical catarrh, which probably is caused by the chronic congestion brought about by interference with the circulation of the body and cervix. The use of frequent douches of cold water to prevent conception is said to result in chronic inflammation of the cervical mucous membrane. Imperfect involution after labor, miscarriage, or menstruation may cause cervical catarrh from the chronic congestion that results. Gonorrhea seems in many cases to be communicated directly and primarily to the cervical mucous membrane, and results in a most obstinate form of chronic inflammation. The scrofulous and tubercular diatheses seem undoubtedly to predispose a woman to chronic inflammation of the mucous membrane of the cervix, as of other mucous membranes of the body. Cervical catarrh often appears in such women without any local lesion to account for it. The severity of the local trouble depends upon the general condition, diminishing when the general health improves. In all cases of cervical catarrh, even though dependent upon a distinct local lesion like a laceration of the cervix or a flexion of the uterus, the severity of the catarrh, as measured by the quantity of the discharge, is very much dependent upon the general health. The woman is often troubled by leucorrhea only at those times at which her general health is impaired by overwork, anxiety, or from some other cause; and even though the disease may be apparently cured by appropriate treatment, the symptom, leucorrhea, is very apt to reappear whenever the woman is subjected to such depressing influences. The most conspicuous =symptom= of cervical catarrh is the leucorrhea--the discharge from the cervical glands. As has already been said, in its physical properties it is characteristic. It is a thick, opaque, tenacious mucus. The quantity is often so great that the clothes of the woman are soiled and she is obliged to wear a napkin. There may be present slight backache and a feeling of vague discomfort or pain in the pelvis as a result of the inflammation of the cervix. It is difficult, however, to separate symptoms referable distinctly to the cervical inflammation from those due to the primary trouble, to which the cervical inflammation is also to be attributed. The only one distinct symptom of cervical inflammation is the leucorrhea.