[Illustration: Fig. 85.—The Naegele perforator. (Hammerschlag.)] The time of election is when the woman is at term but not in labor. This, of course, can be determined by the history, but more certainly by careful measurements of the child. When it becomes necessary to operate on a woman who has been in labor a long time and especially if she has been examined frequently, the mortality is disproportionately high. It is a hospital operation, but may be done in the house. If not an emergency, the bowels are emptied by a laxative and enema the day before. Regular preparations for laparotomy are made, plus the equipment necessary for tieing the cord and resuscitating the child. A table must be found large enough to hold the patient in the horizontal position at full length. Solutions of lysol 1 per cent and sterile water are placed on each side of the table. The instrument table carries towels and suture material as well. On a stand behind the operator is placed the hot bath and tracheal catheter. This center is presided over by someone skilled in the treatment of respiratory difficulties in the new born. Altogether, five assistants are required for the operation: an anæsthetizer, a clean nurse, and a nonsterile nurse to manage supplies, an operating assistant and one to take charge of the child. Rubber gloves must be worn by the clean assistants. _Instruments.—_ 2 scalpels. 2 scissors. 8 eight-inch forceps. 10 six-inch artery forceps. 4 sponge carriers. 4 tenaculum forceps. 2 rat-toothed tissue forceps. 4 full curved round needles for uterine wall. 4 smaller needles for the fascia. 2 Hagedorn needles for the skin. 2 needle holders. 1 dressing forceps. Plenty of suture material, both catgut (No. 3 and 4) and silkworm gut for the abdominal wall. _Supplies.—_ 1 doz. laparotomy sponges with metal rings sewed in or a long tape attached. 6 large laparotomy pads. 1 large pillow slip full of sterile cotton. Sponges. 1 laparotomy sheet. 1 dozen towels. 1 pair of leggins. Gowns and head dressings (gauze will do) for the operator and assistants; rubber gloves, basins and accessories. All are sterilized. If the woman has been examined, the vagina should be sponged out with tincture of iodine. The abdomen is shaved, scrubbed with green soap, nail brush, and hot water for five minutes. It is then rinsed with ether and painted with iodine. The presentation of the child, the presence and location of the heart tones must be determined before operation. The patient is anæsthetized with ether, chloroform or gas. The incisions are made; the child delivered to the proper assistant; the placenta and membranes removed; the sponges counted; and the uterus and abdominal wall sutured.