DETRUNCATED HEAD IN PELVIS. 481 



would be insufficient, or too dangerous; 2. When the same part has 

 not cleared the superior strait. But then, it must be engaged in it, 

 or at least the face must be chiefly in the excavation, and it must be 

 possible to reach the os uteri with some of the fingers. It is well 

 understood, moreover, that in both cases, the chin must have been 

 previously forced to descend, the head must have executed its rota- 

 tion movement, and the shoulders must have been disengaged. 



§. VI. The Child is completely or partially 

 Double. 



1082. In cases where two children are united to each other at 

 their anterior or posterior surface, and where two large heads are 

 supported by a single trunk, it is possible that the efforts both of the 

 woman and the accoucheur, although properly combined, may be in- 

 sufficient to effect the delivery without the aid of the forceps. 



If the trunk or the two trunks have escaped, it will be necessary, 

 in order to admit of the application of the instrument, that one of the 

 heads shall be in the excavation; nor, provided the monstrous foetus 

 should present by the vertex, ought this instrument to be reject- 

 ed, although neither of the two heads should have cleared the supe- 

 rior strait. In the former case, that is to say, where the trunk is de- 

 livered, the head nearest the posterior plane of the pelvis ought to 

 come down first, and in the latter, on the contrary, that one which is 

 naturally turned towards the pubes. 



Finally, the operation, if conducted agreeably to the general rules 

 indicated higher up, would require no other precaution than that of 

 raising the handle of the forceps forcibly upwards at an early 

 period, and to pull, almost from the commencement, in the line of 

 the axis of the vulva. This would be the only way to avoid forcing 

 the second head, still contained in the womb, to reverse itself, or to 

 remain hitched, as it were, above the pubis or the sacro-vertebral 

 angle. 



§. VII. The Head, separated from the Body, 

 remains alone in the Pelvis. 



1083. Formerly so litde care was taken in regard to the extractive 

 force exerted upon the fostus, when it was deemed necessary to de- 

 liver it footling, that it was not very uncommon to see the neck sepa- 

 rate from the head and the trunk, being torn off during the violence of 

 the exertions. At the present day this accident could happen only 

 to the most ignorant or thoughtless practitioner; for it is never 

 allowable to employ a force with the hand alone, sufficient to pro- 

 duce the occurrence. It is only where one of the passages, of size 



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