TREATMENT 129 
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 
eanal. Ifa 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 
