The operation may be done on one or both sides depending on the amount of room required. The incision begins at a point just above the lower third of the vulvar outlet when distended by the head, and passes obliquely downward and outward. This severs unimportant tissues only, instead of allowing the valuable perineal body to suffer. It makes a clean wound that heals readily, instead of a ragged tear through bruised tissue. The cut is high enough to be free from the constant bath in infectious lochia, which troubles the healing of the usual perineal laceration. [Illustration: Fig. 92.—Episiotomy. (Hammerschlag.)] =Rectal Infusion (Drop Method).=—A douche bag containing normal saline solution is hung near the bed and kept warm with an electric pad, a hot flatiron, or by a hot water bag on either side. The tube ends in a catheter which is inserted into the rectum. The tube is clamped so that only a drop of solution can escape each second. =Wet packs= are both sedative and antipyretic and may be employed for a local or a general effect. For bronchitis the pack may be applied to the chest only as follows: The child (or adult) is stripped in a warm room (75° F.) and the chest swathed front and back with a thick towel wrung out of hot water (temperature 105° to 110° F.) Over this a woolen shirt may be drawn or a blanket wrapped, and the patient put to bed. After six or eight hours, the dressing is removed in a warm room, a hot bath administered, and the body well rubbed with alcohol, and dried. The treatment may be repeated if necessary. Do not burn the patient by applications too hot. The general pack is most serviceable in reducing temperature and producing a diaphoresis to relieve the kidney and cleanse the system, as in eclampsia. For this purpose the entire body, naked, is rolled in a sheet wrung out of hot water and then put between heavy blankets in bed. The pulse should be taken frequently and the temperature recorded at intervals. A cool application to the head is very soothing. The patient sweats profusely and hot drinks may be given to promote a more abundant diaphoresis. Usually the patient drops off to sleep as the fever subsides. Twenty to forty minutes is the average duration of such a treatment. When the pack is removed, the patient is wrapped at once, without drying, in warm blankets, and left for an hour or so. CHAPTER XIV COMPLICATIONS IN LABOR _Pelvic contraction_ is not infrequently the cause of difficult or prolonged labor. The deformity is most commonly due to rickets in childhood. There are many forms of pelvic contraction, but in this country only two are at all common; the generally contracted, and the flat pelvis. The generally contracted pelvis is, in the main, a well shaped pelvis, only its measurements are smaller than normal.