If we now inquire into the causes which induce this disease, we shall find that there is not a single inflammatory disease of any of the pelvic organs that may not lead to its inauguration. Metritis after an abortion or a confinement is a fruitful source, so are all the other causes that operate in exciting metritis indirectly concerned in this affection. Since etiology or the causation of diseases has been made a special study in connection with this subject, some startling discoveries have been made in regard to the origin of pelvic peritonitis. Dr. Noeggerath, of New York, has found in the majority of cases that came under his observation, that pelvic peritonitis, either acute or chronic, is due to gonorrhœal infection. He claims that gonorrhœa in the male is in the majority of instances incurable; although it may be apparently cured, it continues as a latent affection which regularly infects his female companion. This shows itself at first as a slight vaginal catarrh, which gradually and stealthily spreads to the cavity of the womb, thence to the Fallopian tubes and ovaries and afterwards involving the pelvic peritoneum, for it must be remembered that the Fallopian tubes open directly into the peritoneal cavity. Dr. Noeggerath has collected statistics that agree with those of the celebrated French physician, Ricord, which show that on an average 80 per cent of the male population have had gonorrhœa, and, believing themselves cured, when not, enter into married relations, and unwittingly infect their wives. He says that “it has come to pass that young ladies dread to marry, because all their friends become invalids soon after the nuptial rites.” The late Professor Schroeder, of the Berlin Gynecological clinic, says that “the assertions of Noeggerath are extravagant, but that he must particularly emphasize that chronic inflammatory conditions of the internal female genitals, like catarrh of the vagina and uterus, metritis and perimetritis, are extraordinarily frequent results of gonorrhœal infection.” I am inclined to think, from my own experience, that the more conservative view of Professor Schroeder is perfectly safe and true, but if Dr. Noeggerath made due allowance for the number of invalids among newly-married people whose uterine diseases, especially pelvic peritonitis, were traceable to criminal abortions and monthly probing of their uterine cavities to induce the menstrual flow, his views would about coincide with those of the distinguished Berlin authority. These catarrhal affections cause sterility, and if conception supervenes, then there is a likelihood of a miscarriage or a premature birth, or a perimetritis during pregnancy or confinement. Menstrual disorders in which the flow is either obstructed or suppressed may also give rise to perimetritis.