WEIBEL, W. Das Verhalten der Ureteren nach der erweiterten abdominalen Operation des Uteruskarzinoms. _Zeitsch. f. Geb. u. Gyn._, 1908, lxii. 184. SECTION I OPERATIONS UPON THE FEMALE GENITAL ORGANS PART II VAGINAL GYNÆCOLOGICAL OPERATIONS BY JOHN PHILLIPS, M.A., M.D. (Cantab.), F.R.C.P. Professor of Obstetric Medicine, King’s College, London Obstetric Physician and Gynæcologist to King’s College Hospital CHAPTER XII PREPARATION OF THE PATIENT FOR PERINEAL AND VAGINAL OPERATIONS: OPERATIONS FOR INJURIES TO THE PERINEUM AND PELVIC FLOOR PREPARATION OF THE PATIENT In operations upon the perineum and vagina, the same scrupulous precautions against sepsis should be taken as in abdominal section. Before proceeding to practical details, it will be useful to consider a few points regarding the distribution of bacteria in these parts. Not only the ordinary bacteria of the skin, but also those from the rectum, and, under certain conditions, from the urine and the vaginal secretion abound on the perineal and vulval surfaces. The healthy virgin vagina may be considered free from pathogenic organisms, harbouring only the harmless vaginal bacillus of Döderlein. After sexual congress the vagina contains pathogenic organisms, and in conditions such as carcinoma of the cervix and body of the uterus, and in all forms of vaginitis, many varieties of bacteria are present in great numbers. The normal uterus is germ-free; in fact the external os uteri may be said to divide the bacteria-free from the bacteria-containing area of the genital canal. But in carcinoma and in the various forms of septic endometritis, the uterus not only contains many pathogenic bacteria, but acts also as a continual source of infection to the vagina and external genital organs. It follows, therefore, that this area may be exceedingly difficult to render sterile, and in certain conditions this is indeed impossible. None the less, every effort should be made to attain this object; for even if the organisms cannot be entirely removed, yet their numbers can be considerably reduced, and it must be remembered that the action of septic organisms is, to a great extent, directly proportionate to their numbers.