Suppuration may develop slowly and lead to an abscess; this may open or break into the peritoneal cavity, causing general septic peritonitis, which will cause death in a few hours or days. The abscess may also suppurate and break into some of the adjacent organs or tunnel its way in different circuitous routes, being guided in its course by the pelvic and muscular fasciæ, so that it may perforate at the groin, show itself at the inside of the thighs, or in the lumbar region near the kidneys. It ruptures most frequently into the rectum, next in frequency into the vagina and into the bladder. I had a case, that came under my treatment, in which both rectum and vagina were perforated, and purulent matter discharged from both fistulæ; under appropriate treatment the patient recovered completely. If the inflammation is not of infectious origin, the exudation gradually becomes absorbed, and each day grows less, until finally nothing but a few fibrous bands can be felt, and these too may disappear in time. The symptoms of perimetritis depend in a great measure on the nature and severity of the attack. There are three distinct stages of this disease, and each has its characteristic symptoms. The first stage is that of inflammatory congestion, which is generally ushered in with a distinct chill or a chilly feeling, which is speedily followed by a high fever and a rapid pulse. The lower abdominal region becomes exceedingly sensitive and very painful on pressure; the abdomen becomes tympanitic or bloated, and it is a relief for the patient to draw her limbs up, so as to relax the abdominal walls. A vaginal examination in this stage gives only negative results; there is nothing but a painful sensitiveness, great heat, and the vaginal walls are puffed or swollen; there is as yet no inflammatory exudation that can be felt by the finger. After the affection has lasted one or more days, the second stage of the disease is recognized, this is the effusion or exudation. The characteristic physical signs of effusion are the only absolute proof of the existence of this disease. These signs are (1st) an immovable fixed state of the womb, which is quite the contrary to its natural healthy state, that permits of a mobility in all directions; (2d) a hard, non-bulging condition of the tissues that surround the womb, so that the impression which one receives gives the idea of all the pelvic organs being cast or set in wax, because everything is glued down and immovable; (3d) an indistinct fullness is felt by the patient, high up in the pelvis; this is the free exudation of the inflammatory material, which has now become solidified and has some characteristics of a tumor. This may push the organ forward or to either side or surround the womb on all sides.