In some instances the puppy presents itself at the mouth of the womb with the top of the head foremost, the nose being pressed down against the chest; if it is at all large, birth is very difficult in this position. In such cases, one should try and elevate the nose with the point of the finger; when the bitch is not a large one this is often possible, but when she is, it is necessary to employ a crotchet or crook—as mentioned before, a button-hook with a long handle does very well—and, if possible, it should be fixed in the mouth and the nose drawn up; this is rendered more easy, if one can, by means of the finger of the other hand, press the neck backwards towards the body of the bitch. It is, however, often impossible to raise the head, and the only thing to be done is to seize the neck firmly with a pair of forceps, and by traction at each time of straining, extract the puppy. Care must be taken not to injure the bitch, or inflammation, which may prove fatal, will occur. In other cases the head may be bent in a backward direction, the front of the neck presenting. These cases, though somewhat more difficult, require similar treatment to the previous kind. When all other means have failed, the neck may be divided and the head removed by forceps; the body will then generally come away by itself. The fœtus assumes numerous other positions besides those mentioned—as, for instance, lying transversely, the puppy’s side presenting to the mouth of the womb, and when the labour pains are strong, no amount of manipulation will put the body in a normal position. Rather than let the bitch waste her strength uselessly, the puppy should be divided or broken up by means of a sharp-cutting hook, and removed by means of forceps. When a fore and a hind leg are presented into the vagina, the former should be pushed back into the womb, and the hind leg seized with forceps and made fast with a piece of tape. (It is easy to distinguish one leg from the other by feeling for the hock-joint in the hind limb.) When this is done, the other back leg should now be felt for, and when its position is ascertained, it should, if possible, by means of a small pair of forceps (ordinary dressing forceps answer very well for this purpose) or crotchet, be drawn into the vagina, or made fast with tape like its fellow, and then by gentle traction on both limbs the puppy is delivered. It occasionally happens, in cases of head presentation, that the hind legs are bent forward on the body, which renders the delivery difficult, and unless the passage is large, and the pains are very strong, the bitch cannot bring forth the pup without assistance. This is best rendered by grasping the puppy across the hips with a small pair of thin-bladed parturition forceps, and gently pulling the puppy during each throe.