=Operation.= To be effectual this must be thorough, and may take the form of deep cauterization with a Paquelin’s cautery, or excision. The latter operation consists in excising a wedge-shaped piece of the posterior wall of the urethra containing the caruncle. Free bleeding will usually take place, which must be controlled by means of hæmostatic forceps. The edges of the wound are brought together by fine silk or catgut sutures, which must be passed completely through the raw surfaces to prevent recurrent hæmorrhage. The _after-treatment_ consists in keeping the wound as clean and dry as possible. OPERATIONS FOR INCONTINENCE FOLLOWING LABOUR This is probably due to injury to the pelvic floor and the anterior fibres of the levator ani, producing a backward displacement of the urethra. =Operation.= The operation recommended by Dudley consists of first denuding the vaginal mucous membrane over a horseshoe-shaped space between the clitoris and the urethral orifice and then drawing the urethra forward with sutures passed through the anterior portion of the orifice and inserted near the clitoris. It will then be seen that the urethra is carried forward nearly an inch. The raw edges are brought together in the usual manner by catgut or silk sutures. The author’s experience of this operation has been unsatisfactory on the whole, and he has obtained better results by the wearing of a ring pessary. OPERATIONS FOR VESICO-VAGINAL FISTULA =For simple vesico-vaginal fistula.= This condition is fortunately very rare at the present time. Many operations have been devised for this condition, but the original one recommended by Sims, with subsequent modifications, appears to the author to be most efficient and applicable to the large majority of varieties of this condition. [Illustration: FIG. 37. AUVARD’S SELF-RETAINING SPECULUM.] [Illustration: FIG. 38. KNIVES FOR FRESHENING THE EDGES OF A VESICO-VAGINAL FISTULA.] [Illustration: FIG. 39. TOOTHED FORCEPS FOR USE IN VESICO-VAGINAL FISTULA.] =Preparatory treatment.= The chief object is to obtain a healthy condition of the fistulous edges, which are nearly always inflamed, thickened, and covered by urinary deposits, usually of a phosphatic character. These are best removed by means of a soft sponge or cotton-wool, and the raw edges treated with a weak solution of nitrate of silver (gr. ij to the ounce). Hot vaginal douches of lysol solution (ʒj to a quart) should be given night and morning, and the parts freely smeared with vaseline to protect them from the action of the irritating urine. Any cicatricial tissue which may be present around the fistula should be treated by submucous division. [Illustration: FIG. 40. EMMETT’S HOOK.]