Acute metritis comes on suddenly, and this occurs quite often during the menstrual period. Women as a rule are altogether too careless during menstruation; they seem to forget that at this time the womb is congested and swollen, and that if the natural flow of the blood is interfered with, this congestion will turn into an inflammation. Exposure to cold, or getting the feet damp, or inordinate exercise that overheats the system, will bring this about. Sometimes there may be a tumor or swelling in the womb which occludes the cervical canal, so that the menstrual fluid cannot escape; this will also cause inflammation. A stricture of the cervical canal, occasioned by the womb being flexed, will interfere with the egress of the menstrual flow, and this also may give rise to inflammation. Vaginal injections either too hot or too cold, and particularly immediately after copulation, when the pelvic organs are still in a high state of congestion, is quite liable to excite metritis. Gonorrhœal infection is another source of inflammation, but this is invariably preceded by an _endometritis_, which I will consider separately. Large, ill-fitting pessaries worn in the vagina for a supposed retroflected or prolapsed uterus, or a stem pessary, are fruitful causes of metritis. Other causes are criminal abortion, complicated with blood poisoning from the unclean probes or instruments, that the abortionist has employed on previous operations without thoroughly cleansing and disinfecting them; the application of strong caustics to the cervix of the womb, as well as injections into the cavity of the uterus. Meddlesome doctoring by means of the unskillful and unnecessary use of instruments, like the probing of the womb without proper antiseptic precautions, or the scraping, stretching or operating on the womb without the essential antiseptic precautions which a scientific comprehension of the subject demands, has frequently caused this affection. It occurs very often as a part of the general inflammation produced by the absorption of putrid or septic matter during the childbed period. This indicates a lack of cleanliness on the part of the attendants during confinement; inflammations of this nature constitute one of the types of _puerperal_ or childbed fever. The most prominent symptom is pain. This is greatly aggravated on the slightest pressure, or on moving or turning in bed. Upon a digital examination, the womb is found enlarged or swollen, and when the organ is tilted up on the examiner’s finger, there is a sharp lancinating pain radiating from it in all directions.