Respecting other instruments, such as the _Crotchet_, the _Vectis_, and the _Cephalotribe_, or _crushing forceps_, it is not necessary to say anything here, as their use, when imperatively needed, must necessarily be confined to the surgeon; and fortunately may now be dispensed with altogether. The recently introduced practice of bringing on _premature labor_, in all cases of deformity or smallness of the pelvis, entirely obviates the necessity for any of these dreadful resorts, if the difficulty be known in time, which it is sure to be when a sufficient degree of knowledge is disseminated. The _Cesarian operation_, or cutting open the womb externally; and _Cephalotomy_, or the opening of the child's head, may also be dismissed with the same observations. _They can always be avoided_, if the real condition of the patient is known in time; and if from neglect nothing else can be done, they must always be performed by a skillful surgeon. CHAPTER XXV. OPERATIONS WITH THE HAND. TURNING. This is one of the most useful operations that the accoucheur can perform, in many cases, and has the advantage of being altogether accomplished _by the hand_. Its object is to change the presentation, when unfavorable, and to facilitate delivery. Most usually the hand is introduced into the uterus, and the _feet_ are brought down. This is called _pelvic version_; but sometimes the head is brought to the mouth of the womb, particularly in shoulder presentations, and this is called _cephalic version_. _Cephalic Version._--This can seldom be performed, and not often attempted with safety. In some cases however, when it is ascertained that the shoulder presents, and before the membranes are broken, an effort may be made to remove it and bring the head in its place. To do this the position of the head must be ascertained externally, and one hand placed upon it; then with the two forefingers of the other raise up the shoulder from within, as in ballotment, and endeavor to push the head into its place. If the child be very moveable this may sometimes be done, and will be highly advantageous; but most frequently the substitution cannot be accomplished, and the attempt ruptures the membranes, after which it is still more difficult, and even becomes dangerous. Even if the head be brought down there is always danger of its becoming displaced, and the shoulder again presented, owing to the tendency which any presentation has to be reproduced. To prevent this the hand should be firmly pressed on the fœtus, externally, as soon as the head is brought down, to fix it; and the membranes should be ruptured so that it may begin to descend, after which there is no danger of a change.