128 FISTULA AND POLL-EVIL 



how tractable the patient may seem. Opera- 

 tions performed in the standing position under 

 some form of narcosis always turn out to be 

 very unsurgical exhibitions. The patient should 

 be cast with ropes or else placed upon an op- 

 erating table. The latter is much the best be- 

 cause of the elevated position of the head. On 

 the floor or ground the field is not so accessible 

 and must be elevated by blocking the neck and 

 head up in some way to bring it where the sur- 

 geon can work. Chloroformed, the patient can 

 be handled better than under narcosis. When 

 rope restraint is used chloroform should really 

 be administered because it is difficult to control 

 the sweeping movements of the head of a par- 

 tially anesthetized subject down on the ground. 

 Our plan in field work is to clean up the poll 

 well while the subject is standing, cast with 

 ropes, administer chloroform and then block 

 up the neck and poll with a tightly filled sac of 

 straw. This sac may be bound to the neck and 

 head with cords, one around the middle of the 

 cervical region and one around the head just 

 below the eyes. Thus tied the blocking will 

 stay in place when the neck and head move. 

 This form of blocking is particularly essential 

 when the operation is done on the ground un- 

 der narcosis. It is important that the sac be 

 well filled, otherwise it will flatten down and do 



