The existence of a shoulder presentation is not commonly suspected until the first examination is made during labor. Suspicion will arise from finding on examination that we are not able to reach the presenting part, and that the os uteri does not dilate as usual, and that when it becomes dilated the bag of membranes protrude of a conical form, but this is common to all malpresentations. When the shoulder has descended a little it is recognized as a round, smooth prominence, rounder than the elbow, and we may be able to reach the axilla, &c. The elbow may be recognized by the sharp prominence of the bone, and the hand can be distinguished from the foot by the fingers being wider apart and more readily separated from each other than the toes, and by the thumb which can be carried across the palm. The situation of the thumb and the aspect of the palm of the hand will mark whether it is the right hand or the left. As soon as the nurse ascertains or suspects from an external palpation or a vaginal examination, that it is a cross birth she should send for the doctor, who ought to be there as soon as the membranes are ruptured, and the nurse must not be very persistent in making examinations lest she rupture the membranes prematurely. She may perhaps give a small dose of morphine, but I would not advise that she give chloroform as it is not necessary. The right time to turn the child is when the os uteri is dilated, either before or immediately after the rupture of the membranes, and if a doctor cannot be soon obtained, it is better that a skilled nurse should turn the child, and if she is properly instructed, she should do it carefully and slowly, but without any fear and confidently. She can assure the patient that she will be able in a short time to relieve her sufferings. In England the ordinary position for turning is on the left side. I prefer that the patient be placed across the bed on her back with her legs drawn up and supported by assistants. I now describe my own mode of operating. I bare my right arm and hand (sometimes the left), lubricating it freely. If the waters have only recently escaped, and the os be dilated, the operation is performed with ease, especially after we have determined the position of the child.