MONSTERS. 417 



948. The turning and delivery by the feet resorted to by Pen, 

 Walter, Walgen, M. Evrat, M. Brez, Regnoli, &c., and recom- 

 mended by Asdrubali, MM. Desormeaux, Duges and others, whe- 

 ther the child be exactly double or merely bi-cephalous, living or 

 dead, and at any stage of gestation, will suffice in nine cases out of 

 ten, at least, where there are no other causes of dystocia present. 

 It ought therefore to be tried in all cases. However, if one of the 

 head should be already so far engaged, that it could not possibly be 

 returned, we might, after the manner of Plenck, try the application 

 of the forceps. Should the forceps prove insufficient, there would 

 be a last recourse, the removal of the parts that had descended into 

 the excavation, that is to say, of the head alone, or the head and 

 arms; after which the feet could be brought down so as to deliver 

 by turning, as was done by M. Retel, in 1818, in such a case. 

 There would be less to fear in such a case, as the foetus generally 

 dies long before we are reduced to tliis extremity. The difficulty of 

 separating two children, united to a certain extent, outside of the 

 womb, and the danger to which by such operations they are exposed 

 clearly show how imprudent it would be to follow the advice of 

 Sraellie, and attempt to do so, in the interior even of the uterus. 



949. When, in twin pregnancy, two fostuses present simulta- 

 neously at the straits, the intervention of art almost always becomes 

 necessary, and sometimes indispensable. If it be found that both 

 the heads tend to engage at the same time, which is excessively rare, 

 it is proper to push up the rriost moveable one with the fingers, so as 

 to let the other advance first; the same procedure may be adopted 

 for the feet, the knees or breech; if the children present across, or 

 in any other way except by the head or the pelvis, recourse must be 

 had to turning; but it may happen that one of them comes by the 

 head, whilst the other descends by the feet, and that upon reaching 

 the superior strait the chin of the latter hooks in with the chin of 

 the former, so that the two heads at length become immovably fixed, 

 each opposing an insurmountable resistance to the other, and con- 

 stituting one of the most embarrassing cases in the practice of mid- 

 wifery; neither turning nor the application of the forceps can be 

 thought of; even the cesarean operation itself, which has been re- 

 commended by some authors, would not always enable us to disen- 

 gage the fcetus; so that the detruncation of the one that is without, 

 constitutes almost the only resource left to us for the safety of the 

 mother and one of the children. 



