DISEASES OF THE GENERATIVE OEGANS. 193 



the womb in qiiantitv. Ropes with running nooses are phiced on the 

 presenting feet and the oiled hand introduced to find the head. If, 

 now, the fingers can be passed inside the lower jawbone, and drag the 

 head upward and toward the passage, it unwinds the spiral turn given 

 to the neck in bending back, and greatly improves the chances of 

 bringing forward the nose. If, at first, or if now, the lower jaw can 

 be reached, a noose should be placed around it behind the incisor 

 teeth and traction made upon this, so that the head may continue to 

 be turned, forehead up, toward the spine and jaws down, thereby 

 continuing to undo the screwlike curve of the neck. If, on the con- 

 trary, the nose is dragged upon by a cord passing over the upper 

 border of the neck, the screwlike twist is increased and the resistance 

 of the bones and joints of the neck pre Agents any straightening of the 

 head. As soon as the lower jaw has been seized by the hand or 

 noose, a repeller (PL XX, fig. 7), planted on the inside of the elbow 

 or shoulder most distant from the head, should be used to push back 

 the body and turn it in the womb, so that the head ma}' be brought 

 nearer to the outlet. In this way the head can usually be brought 

 into position and the further course of delivery will be natural. 



Sometimes, however, the lower jaw can not be reached with the 

 hand, and then the orbit or, less desirably, the ear, may be availed of. 

 The ear may be pulled by the hand, and by the aid of the repeller on 

 the other shoulder the calf may be so turned that the lower jaw may 

 be reached and availed of. Better still, a clamp (PI. XVIII, figs. 3 

 and 4) is firmly fixed on the ear and pulled by a rope, while the re- 

 peller is used on the opposite shoulder, and the hand of the operator 

 pulls on the lower border of the neck and lifts it toward the other 

 side. To pull on the upjjer border of the neck is to increase the spiral 

 iwist, while to raise the lower border is to undo it. If the outer 

 orbit can be reached, the fingers may be inserted into it so as to em- 

 ploy traction, or a blunt finger hook (PI. XXI, fig, 8) may be used, 

 or a hook with a rope attached, or, finally, a hook on the end of a 

 long staff. Then, with the assistance of the repeller, the body may 

 be so turned and the head advanced that the lower jaw may be 

 reached and availed of. 



In case neither the ears nor the orbit can be reached, a cord should 

 be passed around the neck of the calf as near the head as possible, 

 and traction made upon that while the opposite shoulder is pushed 

 toward the opposite side by the repeller, assisted by the hand drag- 

 ging on the lower border of the neck. To aid the hand in passing a 

 rope around the neck a cord carrier (PI. XXI, fig, 5) is in use. It 

 fails, however, to help us in the most difficult part of the operation — 

 the passing of the cord down on the deep or farthest side of the 

 neck — and to remedy this I have devised a cord carrier, furnished 

 with a ring at the end, a joint 6 or 8 inches from the end, and another 

 54793°— 2.S 1,3 



