nd behind it as far as these can
be reached. Steady traction is now made upon the foot, the remaining
muscles attaching the shoulder blade to the trunk are torn through with a
cracking noise, and the whole limb, including the shoulder blade and its
investing muscles, comes away. If the shoulder blade is left the bulk of
the chest is not diminished, and nothing has been gained. Before going
further it is well to see whether the great additional space thus secured
in the passages will allow of the missing limb or head to be brought into
position. If not, the other presenting part, limb or head, is to be
amputated and extracted. For the limb the procedure is a repetition of that
just described.

_Amputation of the head._--The head is first seized and drawn well forward,
or even outside the vulva, by a rope with a running noose placed around the
lower jaw just behind the incisor teeth, by a sharp hook inserted in the
arch of the lower jaw behind the union of its two branches and back of the
incisor teeth, or by hooks inserted in the orbits, or, finally, in case the
whole head protrudes, by a halter. (Pl. XXI, figs 4_a_ and 4_b._) In case
the whole head protrudes, a circular incision through the skin is made just
back of the ear, and the cut edge being held firmly by the left hand, the
neck is skinned as far as it can be reached. Then the great ligamentous
cord above the spine is cut across at the farthest available point,
together with the muscles above and below the spine. Strong traction on the
head will then detach it at this point and bring it away, but should there
still be too much resistance the knife is inserted between the bodies of
two vertebrae just behind one of the prominent points felt in the median
line below, and their connecting fibrous cartilage is cut through, after
which comparatively moderate pulling will bring it away. The detached neck
and body at once slip back into the womb, and if the fore limbs are now
brought up and pulled they are advanced so far upon the chest that the
transverse diameter of that is greatly diminished and delivery
correspondingly facilitated.

If the head is still inclosed in the vagina two methods are available: (1)
The removal of the lower jaw and subsequent separation of the head from the
neck; (2) the skinning of the whole head and its separation from the neck.

To remove the lower jaw the skin is dissected away from it until the throat
is reached. Then the muscles of the