There is, however, one exception of which I desire to remind the reader, and that is a hemorrhagic or granular variety of inflammation. In this form of the disease the mucous glands, and the blood vessels that are distributed between these glandular tubules, increase or multiply enormously, so that I have seen the mucous membrane in some places a quarter of an inch in thickness. This is the most obstinate variety to yield to ordinary remedies, and as it occasions excessive and at times dangerous hemorrhage from the womb, it should not be treated as conservatively as the other varieties of which I have spoken. There is only one sure method of cure that proved in my hands a success, and that consists in the entire removal of the diseased mucous surface. Dr. Düvelius of Berlin made the discovery and demonstrated the fact that the mucous glands of the uterus project into the muscular tissue of the organ, and that if the diseased mucous membrane is removed or scraped off, down to the muscular layer, a healthy membrane is regenerated from the terminal glandular ends that remain imbedded in the muscular tissue. This seems to have been proved by experience, for I have performed this operation in several obstinate cases of uterine catarrh, and in several instances the woman became subsequently pregnant, which proves at least that the regenerated mucous membrane is capable of performing its physiological function, as though it never had been interfered with. With proper antiseptic precautions and in skillful hands, there is absolutely no danger in this operation, but the technique should be thoroughly understood by the operator. The etiology or causation of uterine catarrh resolves itself into predisposing and exciting causes. Predispositions are defined as that constitution or condition of the body which disposes it to the action of disease under the application of an exciting cause. Persons who possess a thoroughly healthy constitution may be exposed to exciting causes without the slightest danger of contracting diseases, to which others who are predisposed fall victims. The predisposing causes of endometritis are a naturally enfeebled constitution; the existence of a scrofulous or tuberculous habit; impoverishment of the blood from chlorosis; prolonged mental depression; improper and insufficient food; prolonged lactation; frequent parturition under unfavorable surroundings; any indiscretion after delivery which interferes with the regeneration of the womb; styles of dress that depress the uterus; want of fresh air and wholesome exercise. Professor T. G. Thomas, in his work on Diseases of Women, asks the question why most of these influences should produce this affection more than others. His answer is that “they do not do so.” “Sometimes they cause chronic pneumonia; at other times granular lids, and again at other times chronic endometritis.”