The disease begins with signs of an active congestion in the pelvic organs; such as drawing pains in the small of the back and in the groins, and a feeling of fullness and weight at the bottom of the pelvic floor. The urine is voided with pain and there is a sensation of heat in some parts of the urethra. Pressure on the lower abdominal region is painful, and the sensitiveness diminishes from the middle towards one or the other side. In mild cases these symptoms are not accompanied with fever, headache or a disturbance of the nervous system; there may be diarrhœa due to reflex irritation of the rectum, and the stools are accompanied with bearing-down pain. After three or four days there is usually a discharge of a viscid liquid, which in eight or ten days becomes creamy, purulent and often tinged with blood. The fluids that are discharged from the vagina sometimes become so acrid and irritating that, when they come in contact with the skin of the vulva, abdomen or thighs, it becomes irritated and inflamed, which leads to excoriations and an itching, that may spread over the entire body. The reaction of this discharge is either acid or alkaline, depending upon whether the discharge of the uterus or that of the vagina predominates; as the discharge from the uterus is always alkaline and that from the vagina always acid, there is nothing of a practical diagnostic value in ascertaining the chemical reaction of the secretion. The vagina will generally be found to be hot and more or less swollen as in ordinary vaginitis. The womb itself, however, will be enlarged and sensitive, while the cervix is gaping or open. Through the speculum, it is seen to be red and congested, and from the gaping mouth there issues a clear, albuminous-looking fluid or a muco-pus. In the subacute or chronic form the symptoms are by no means always so prominent as to indicate the existence of the affection, or they are so marked, by some of the numerous complications, which are in the nature of cause or effect, that its recognition will become extremely difficult. The effect which the disease has on the general organism varies greatly in different individuals. Some women of robust appearance have an aggravated form of uterine catarrh without any immediate ill effects on their nutrition or general health. Other women lose flesh early and become weak and worn; they become pale, and the face assumes a yellowish ashen hue with dark rings under the eyes. Through reflex irritation from the nerves of the uterus other nerve centers become involved, so that a general neurasthenia becomes developed with its characteristic concomitants of neuralgia, muscular spasms, uterine colic and hysteria.