MONSTROUS FCETUS. 415 



in the case that fell under M. Nivert's notice, the foetus had a very- 

 solid and projecting gibbosity which lodged above the pubis; the for- 

 ceps was applied, but without effect, for it became necessary to empty 

 the head; still, it was only by means of the crotchet and by employ- 

 ing the utmost strength, that he succeeded in extracting the trunk 

 of the foetus. Who could have suspected the existence of such an 

 obstacle? and even had it been understood, what could have been 

 done? Ought turning to have been attempted? Would any advan- 

 tage have been derived from pressure suitably applied to the lower 

 part of the hypogastrium? It belongs to future experience to solve 

 these questions. 



945. The simultaneous presence of several foetuses in the womb 

 is far from always being a cause of dystocia, especially when they 

 are independent of each other, and are each enclosed within a 

 separate amnios. But this is not the case where they are contained 

 within the same set of membranes, or have contracted any adhesions 

 that compel them to present simultaneously at the straits of the 

 pelvis. 



In the latter case, the union of the children may be in very vari- 

 ous degrees. Sometimes they are connected together by a very 

 circumscribed point upon the inferior, middle, or superior part of the 

 back, sometimes by almost the whole back, side, or front; at others 

 they are conjoined at the head, or placed end to end at the breech. 

 The fusion is in some cases much more complete: or, there may be 

 only one single trunk to two heads and two or four arms; or, on the 

 contrary, there may be only one head to two trunks, with limbs more 

 or less completely isolated. 



946. The signs of these monstrosities are so vague, that they 

 really do not deserve to be repeated in this place; there can be no 

 certainty, nor even probability, of their existence, except in so far 

 as certain portions of the foetus are already emerged; and even then, 

 it is for the most part very difficult to characterise the nature of the 

 monster we are about to receive. 



We have enough of cases of monsters from excess of parts, born 

 living and under the mere resources of nature, to warrant us in not 

 acting too hastily in such circumstances. If a double foetus with 

 a single head presents by the vertex, or even by the feet, provided 

 the conformation of the pelvis be good, the delivery will not require 

 any particular interference; the same would be the case with two 

 foetuses attached to each other by their extremities, either the head 

 or breech, as is proved by the cases mentioned by Meckel, Palfyn, 

 Duverney, Home, &c. Further, M. Duges saw one born without 

 assistance, though it was completely double, at full term, and of large 



