The same general principles apply to the preparation of patients for operations on the perineum and vagina as for operations on other parts of the body. Very particular attention, however, must be paid to the bowels; nothing is more prejudicial to the success of an operation, or more annoying to the operator, than to have the area of operation soiled by an escape of fæcal matter from an imperfectly emptied lower bowel. The aperient should be given at least 24 hours before the time of operation. A copious soap-and-water enema should follow after the usual interval, and, an hour or two beforehand, the lower bowel should be thoroughly washed out with a gentle stream of warm water. [Illustration: FIG. 29. PATIENT PREPARED FOR OPERATION. In lithotomy position with crutch applied, Auvard’s speculum inserted, and volsella attached to the anterior lip of the cervix uteri. Kelly’s pad is omitted for sake of clearness. (_From a photograph._)] The external genitals should be shaved, and washed with ethereal soap solution and hot water the day before the operation, then douched with a 1-2,000 solution of perchloride of mercury, and a compress, soaked in the same solution, laid over the vulva. After the enema has acted, and after the final wash-out, the washing and douching should be repeated and a fresh compress applied. If there is any vaginal discharge, the vagina should be douched out three times a day for two or three days previous to the operation, with an antiseptic such as 1-4,000 perchloride of mercury, or 1% formalin. The healing of a perineal wound is considerably impaired if it be continually bathed in an unhealthy vaginal discharge. When the patient is on the table and under the anæsthetic, the external parts should again receive a thorough final disinfection, and, in addition, the vagina should be thoroughly swabbed out with ethereal soap solution, by means of swabs on holders. A final douching with 1-2,000 perchloride of mercury completes the process. In all cases of vaginal hysterectomy for carcinoma, particular attention must be paid to the preliminary disinfection of the vagina by means of douching for two or three days before the operation. The vagina is swarming with various kinds of bacteria, and by careful attention to these principles the risk of sepsis will be materially diminished. After the above preparations have been carried out, the patient is anæsthetized and placed on the table in the lithotomy position, the legs being kept well apart and fixed by means of a crutch. The buttocks are brought well to the edge of the table, and a Kelly’s pad may be placed beneath them. The legs should be encased in sterilized towels or linen stockings, and towels placed on the hypogastrium (Fig. 29). OPERATIONS FOR THE REPAIR OF COMPLETE LACERATION OF THE PERINEUM