Pelvic inflammatory disease includes in the uterus and its adnexa alone metritis, salpingitis, oöphoritis, pelvic peritonitis, cellulitis, lymphangitis, and perimetritis. Pus may rupture into the pelvic cavity and set up local or general peritonitis or septicemia. It may burrow through from behind the uterus into the vagina, rectum, or other parts of the intestines, or into the bladder, and leave fistulas. Pus has been known to get through the abdominal wall itself. When the disease advances beyond the tubes there is, as a rule, invalidism until after the menopause, although the woman may be cured by surgery. Even skilled surgery does not always cure, because it is practically impossible to get rid of the gonococcus once it has been fixed in the tissues. In cases where the gonorrheic or other bacterial infection has been chronic in the uterine adnexa, palliative treatment will in a certain percentage of cases make surgical intervention unnecessary, and when such treatment does not avail we must decide between the total removal of organs and the partial removal. Partial removal is called conservative surgery, and the term conservative is used as a synonym of preservative. Prochownick[176] reported 420 cases where pus in the tubes or ovaries was let out extraperitoneally, and no organs were removed. Of these cases, one hundred and sixty, or 38 per cent., were permanently cured. Fourteen of the one hundred and sixty who had received only one treatment subsequently gave birth to children, and three aborted. After a second treatment twenty-seven remained well and three became pregnant, of whom one aborted. Olshausen,[177] a great authority in gynecology, used the palliative treatment, and he commonly waited for nine months after the infection and until the temperature was normal. Goth[178] reported excellent results in seven hundred cases of pelvic disease treated by the palliative method. The chief objections to this method are the time required to get the result, and the difficulty of controlling the patients and their chronically diseased husbands, who reinfect them despite the medical prohibition of marital intercourse. [176] _Monatschrift f. Geburt. u. Gynä._, 1909, n. 20. [177] _Zeitschr. f. Geb. u. Gyn._, 1907, vol. lix, n. 1. [178] _Archiv. f. Gyn._, vol. xcii, n. 2. In cases of chronic pelvic peritonitis the question comes up frequently whether the womb and both tubes and ovaries should be removed wholly or in part. The text-books decide the question without any heed whatever to the notion of the morality of mutilation as such. They take into account the age of the patient, whether she has children or is desirous of maternity, whether or not she supports herself by manual labor, her temperament and character, and the results attained by men who have tried various methods of operating.