TREATMENT 12^ 



no good. For this purpose we also use when 

 available two or three buggy or automobile seat 

 cushions. 



The head should be maintained at about its 

 normal angle with the neck. Extreme ex- 

 tension or flexion is undesirable. 



The patient should lie on its right side. Al- 

 though this is not mandatory, the surgeon finds 

 that it is easier to cut backward with the right 

 hand when the patient is thus positioned. 



Incision. First Step. — The scalpel is pushed 

 carefully downward, with its cutting surface 

 backward, just behind the occipital crest in 

 the very middle of the neck, until it either en- 

 ters the bursa or is blocked by the occipital 

 bone. Its blade should be buried about four 

 inches in the average case. It is then drawn 

 backward, maintaining this depth, about eight 

 inches. If a longer incision is decided upon it 

 is best to make it more shallow posteriorly be- 

 cause of the danger of invading the neural 

 canal. If a short bladed scalpel is used several 

 strokes will be required. Blood will flow cop- 

 iously from many sources, but no attempt is 

 made to control it either by ligation or forceps. 

 It is our experience that more blood is lost 

 when the operation is stopped to make these 

 attempts at hemostasia. We, however, grasp 



