Unnatural or abnormal labor may be caused by some peculiarity on the part of the child, in the position or presentation. These cases demand the services of the skilled accoucheur, and I do not intend to hint that the nurse should ever attempt to do what an educated physician should be called to do in these cases. FACE PRESENTATIONS sometimes retard the labor so much in the second stage as to give rise to unfavorable symptoms. In cases where the action of the uterus is so energetic as to finally expel the child, the sufferings of the mother are severe and prolonged. I have in my practice met with four cases, three of which were delivered by the natural powers, the children living; in one case craniotomy was performed. The mothers all lived. The diagnoses of face presentations is not easy at an early stage of labor. The finger first touches the forehead, which may be mistaken for the vertex. When the membranes are ruptured we may be able to make out the presentation. We may distinguish the edges of the orbits, the prominence of the nose, the mouth, &c. The bridge of the nose is the best guide, it being prominent, firm, and unlike any part of the breech or vertex. The face becomes tumefied during the labor, and the cheeks pressed together to resemble the nates, and it may be mistaken for a breech presentation. But in either presentation the proper course for the nurse is to leave the case alone in the expectation that the natural efforts will be sufficient to complete delivery. The child when born has a frightful appearance from the swelling and discoloration of one cheek, &c., but the injuries pass away in a day or two. THE FOREHEAD TOWARDS THE ARCH OF THE PELVIS at the time of delivery is not favorable, but unless the pelvis is proportionately small no interference is necessary. The BREECH may present at the brim in different positions, and the breech is distinguished by its roundness and softness, by the cleft between the buttocks, by the arms and by the organs of generation. In some cases the labor is concluded as quickly as if the head descended, in others it is more tedious. The results as regards the mother are as favorable as in head presentations. The danger to the child is in direct proportion to the length of time between the birth of the body and that of the head.