nd the shoulder blade and arm bone with their masses of investing
muscles are carried backward and applied on the side of the chest, greatly
increasing the bulk of this already bulky part. As the elbow is carried
back on the side of the chest, the forearm from elbow to knee further
increases the superadded masses of the shoulder and renders it difficult or
impossible to drag the mass through the passages. When the fore limbs are
fully extended, on the contrary, the shoulder blade is extended forward on
the smallest and narrowest part of the chest, the arm bone with its muscles
is in great part applied against the side of the back part of the neck, and
the forearm is continued forward by the side of the head so that the nose
lies between the knees. In this natural presentation the presenting body of
the calf forms a long wedge or cone, the increase of which is slow and
gradual until it reaches the middle of the chest.

The difficulty of extending the fore limbs will be in proportion to the
advance of the head through the pelvic cavity. In the early stage all that
is necessary may be to introduce the oiled hand, the left one for the right
leg or the right one for the left, and passing the hand from the knee on to
the foot to seize the foot in the palm, bend it forcibly on the fetlock,
and lift it up over the brim of the pelvis, the knee being, of course,
pressed upward against the spine. As soon as the foot has been raised above
the brim of the pelvis (into the passage) the limb can be straightened out
with the greatest ease.

When, however, the shoulders are already engaging in the pelvis the feet
can not thus be lifted up, and to gain room a repeller (Pl. XX, fig. 7)
must be used to push back the body of the calf. This is an instrument with
a long, straight stem, divided at the end into two short branches (2 to 3
inches long) united to the stem by hinges so that they can be brought into
a line with the stem for introduction into the womb and then spread to be
implanted in the breast. In the absence of a repeller a smooth, round, fork
handle may be used, the prongs having been removed from the other end. A
third device is to have an assistant strip his arm to the shoulder and,
standing back to back with the operator, to introduce his right arm into
the passages along with the operator's left (or vice versa) and push back
the body of the calf while the operator seeks to bring up a limb. The
repeller or staff having been pl