In the very rare cases which are incurable by operation _kolpokleisis_, or closure of the vagina, has been practised by some. The operation was performed by removing a circular strip around the circumference of the vagina, immediately above the ostium vaginæ, and approximating the raw surfaces by a transverse row of sutures. This operation makes of the bladder and the vagina one urinary pouch into which menstrual blood and uterine discharges flow. It should never be practised. I quote from Emmet in this connection: “From my own observation I have learned that it is but a question of a few months, a year, or possibly two years, before serious consequences must arise after leaving a receptacle, like a portion of the vagina, in which the urine may stagnate. To give a retentive power for so short a time is not a sufficient compensation for the suffering and consequences that supervene. As the result of my experience, I would urge that the operation never be resorted to under any circumstances. The maximum has now been reduced to 2 or 3 per cent. of cases where the resources of the surgeon cannot overcome all the difficulties that may be presented in closing a vesico-vaginal fistula.” The forms of operation in which the cervix uteri is utilized to assist in the closure of a vesical fistula, as a result of which the menstrual blood and the uterine secretions are discharged into the bladder, are contraindicated for similar reasons. =Urethro-vaginal fistula= is much less common than vesical fistula. Unless the neck of the bladder be involved, there may be perfect control of urine; though, of course, when the urine is voided it will escape from the ostium vaginæ, and not from the external meatus. The _treatment_ of urethro-vaginal fistula is essentially the same as that already described for vesico-vaginal fistula. The edges should be denuded, and the opening into the urethra closed over a large-sized catheter. The line of union should be in the long axis of the urethra. =Vesico-uterine Fistula.=--In this form of fistula the opening usually extends from the bladder into the cervical canal. It is caused by labor in which the anterior lip of the cervix is lacerated. The lower portion of the cervical laceration may unite, leaving the fistulous opening above. The _diagnosis_ of the condition is made from observing urine escape from the cervical canal, or by injecting the bladder with milk or other colored fluid. A sound introduced in the cervix may be brought in contact with a probe passed through the urethra and bladder into the fistula. If these methods of examination are not satisfactory, endoscopic examination of the interior of the bladder will reveal the abnormal opening. The _treatment_ consists in dividing the anterior lip of the cervix and the vaginal wall down to the fistulous tract; thorough denudation of the walls of the fistula; and closure of the whole incision by interrupted sutures.