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When lhe pelvis is l. rce, or lhe head fm.l! , (in -.hieh
c~r(., (his misfortune feldom happens,) without doubt we
might fu cceed \Vith folauri&eau's broad 61lct or fling,
plO. ided il eould be propcrly applied,
\Vhen the head is fm. l!, or lhe pelvis largo, dilaling
(he foramen rnagnum with (he fcitfars, and introducing
lhe blunl hook, m.y be of ufe eilher 10 pulI the head a–
Jong. or keep it dow." until we can fi x lhe forceps, curve
crolcher, ar Ltverd's tire· tete.
o.r T~V INS,
T WINS are fuppofed ' o be ,be effeél of a do~ble con–
ceplion in oae coitioo, when t\Vo ar more ova are impreg–
.nated with as many animalcula i which defcending f.rom
the ovarium, tbrough lhe Fallopian lube, ioto (he fundus
uleri, as tbey ¡"creare, come in contaa with that pan,
and \Vith one another, and are (o prelfed as to form one
globular figu re, and fi rete:, lhe womb iAtO th.e [ame forro
which il a(fumes when diflended by one ovum only ; aod
thar during the whole term of uttrine geClation, ir is
impollible tO diflinguifh {\Vins, eitner by ,he figure
and magnitude of the uteru5, or by {he motion of tbe
dHferent fretulTes ; for one child, when it is large, and
furrounded \\ ¡tb a great quaritity af waters, will fome·
times produce as Jarge a prominence (ar eveo larger) in
the wamanJs beIly, tbao i9 cornmooly obferved when fhe
is big with , \Vins. One child will alfo, by moving its
legs, arms, and other paru of in body, agai ntl difFerent
'pans of tbe uterus, at the Carne io(1aO[, or by imervals,
)'ield lhe f.ome fenfalion 10 ,he motber, as may be obrerved
in two or more children; for pan of tbe modoo in twios
¡s c:mployed 00 each atber, as well as upan tbe uterus.
Thcrc is tberefore 00 celtain metbod af diClinguilhi ng
in ,hefe cafes, umil lhe 6rfl child is deli.ered, and the
accoucheur has examinen ¡flhe: placenta is comin~ along.
If this comes of !trelf, and afler ifs extraétion ,he mou,h
of [he \110mb be relt contraéted, and the operator is un·
wil!ing to give unnece pain by introducing hi. haod
iota lhe merus; let him lay his hand upon lhe woman's
abdomen, and if nOlhing is lef, in ,he womb, he will ge·
nerally feel i, jull aboye ,he os pubis, contr.éled into a
6rm rouod ball of lhe 6ze of , ch,lú's head, or lefs :
whereas J ir [bere i5 a"other child I¿ft, the (¡z.e will be'
fouod much Iarger. If lhe placenta does oOt come dowo
before ,he fecond child, whieh is frequenlly ,he eafe,
upon examining. he will commonJy feel the membranes
with lhe waters purhed down througu the os uteri; or. if
lhey are broke, the head or fome par! oi ,he hody wi11
b~ fele. 1f. thercfore, lhe 'llaman has í1:rong pdins, and
is in no danger from Boodiogs or weakoeC5, pfovided the
head prefenlS (:tir. alild feems ro come along, fue wiIJ be
drJivered of this alfo in the odlural way.
Ir the mcmbranes are nOI broke, if the rreóld does noc
immediately follow, or if the child prefeo.. wrong, he
ought co lUrD and bring it immeJiately by die feet; in
aTd~r tOrave the patient lhe fat igue or a fc:cond labou r,
that nuy prove tedious, and eveD daAgerous, by cnfl!ebling
her 100 mucho Beúdes, as the parlS are fu11y opcn<d by
the 6r!l delivery, he can iotroduce his haod with .afe; and
as ,he membraoes are, for ,h. 0l0!! part, whole, ,he wa-
F E R y,
' en may be lr.epl up, and the fa:tus eaúly turoed ; but,
if the pelvis i5 oarrow, the waman firong, llnd lhe he;ad
prefeou, he ougbt to I ~a "e jI to tbe effort! of oatuTe.
If [he child prefents wrong, and, in turniog lbat, he
feels. another, he muíl beware oE breaking me membrant.
of one, while he is al work upon the other : but, {hould
they chaoee 10 be broke, aod the legs of bo,h eotaogled
,oge,her, (lho.uCh Ihis is feldom lhe eafe, becaufe ,hey
are commooly di,ided by IWO fe.. of membrape.,) let ,he
operalor, when he ha. go, bold 00 'wo legs, ruo up his
fingen 'o lhe breech., aod feel if lbey beloog ,n ,he flme
body; aod ooe cbild being delivered, Je, ,he o,her be
turoed and brought out in lhe fame manDer. If there are:
more than two, lhe fame metbod mufi take place, in ex·
traét:iog one after another.
In cafe of lwin., ,be placeot. ·of ,be firfl feldom cornea
. long, uOlil ,be feeood chiJd is delívered; but, as ,his
does 0 0' always happen, he ought, as formerly direét.d,
' o certify himfelf lbal lhere is nOlhiog lefl iD Ihe uterus,
wheo ,he cake comes of ilfelf. Bo,h childreo deiog de–
lavered, lec him extrjlét: botb placentas, if they come not
of lhemfelfes; and if ,hey form difl'ioél cake., fepara,e
firll one, tben the other ; but if they are joined iogether,
forming but ooe lIIafs, ,hey may be delivered al ooce.
When ,here ar.o ,hree or four childreo, (a eafe lha,
rarely happeos,! ,he placen,a. are fome,imes diflioél, aod
fome.imes all together form but one round cake; but,
when tbis ir macerated in water for fome day', cbey, wich
lheir feveral merobraoes, may be eaGly feparaled from ooe
aoolher; for (hey only adhere in confequeoce of ,heir loog
prdfure in lhe u[crus, and feJdom have any cornmunicatioQ.
of ve(fels.
Twins for lhe moll par! li~ diagooally iD ,he uteru.,
one below Ihe other ; fo thal ,hey feldo., obflruét ooe·
aoolhec .t lhe os iOleroum. See P Ja,e eXI, fig . 5,
ONS ·rERS,
Two chjldren joined ,ogether by ,heir bellies, (which
is the mofl commoo cafe of mooflrous bir!hs;) or hy lhe
lides, or when ,he belly of ,he one adheres ,~ lhe back
of the other, having commonly but ene [ucis, are compre.
heod<d io ,his chfs, aod fuppof<d tO be ,he effeél of tWO
aninulcula iOlpregnating [he. faroe ovum, in whicb tbe y
grow togelher. aod arc oourifhed by ooe navel.ftring, o–
riginally belonging to the fecundincs; bec¡uCe, the veC·
feJs penaining tO lhe coats of [he vein and aneries, do Dot
an. (lomofe with ,he. ve(fels beloncing ' o the fa:tus_
lo fueh a cafe, vJhe'Te the childreo were fmall, ,he ad–
heGon ha,h been known 10 flr<ICh in pulliog a' ,be fee,
of one, fo as tO be delivered ; aDd lhe other h:ltb beea
arterwards brought along. in lhe fame manDer-, without
,he oeceffity of" reparativn.
'vVhen ,he accouch"ur is called l B a cafe of lhis kiod,
if rhe chddren an~ larg::, and the woman cOlDe [O her full
time, lec him lira attempc to ¿c1iver cbem by thar me..
lhoc!: but if, after the Jegs and par! of ,he bodyof ,he
firfl are brought down, the reil wil! no' follow, Jel him
Ilide up his hand, alid witb his fingers exaroioe ,he adhe–
(jon; theo i:ltro4u.:ing che fcilfars betwecAhis hand and
,he budy of lhe fa:tus, endeavour 10 Ceparate them by
foipping