DISEASES OF THE GENERATTV^E ORGANS. 195 



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 screw-like 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 screw-like twist is increased and the resistance 

 of the bones and joints of the neck prevents 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 may be brought 

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

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



But sometimes 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 repeller 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 upper border of the neck is to increase the spiral twist, 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 employ 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 not even the ears nor orbit can be reached, a cord should be 

 passed around the neck of the calf as near to 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 round the neck a cord earner (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 

 ring on the handle, close to this joint. (PI. XX, fig. 4.) A cord is 

 passed through both rings and a knot tied on its end, just back of the 

 terminal ring. The instrument, straightened out, is inserted until it 

 reaches just beyond the upper border of the neck, when, by dragging 

 on the cord the movable segment is bent down on the farther side of 



