DEPARTMENT OF SURGERY. 
619 
foetal membrane, the delivery of the first foetus usually inter¬ 
feres with the distribution of nutrition to, and the removal of 
excretions from the remaining - foetus, which will soon cause its 
death.. In studying this form of pregnancy we recognize the 
following varieties of multiparity, viz. : 
(A) Isolated. 
(B) Associated. 
(C) Inclusive. 
(A) Isolated Multiparity .—This variety of multiparity is 
that in which each foetus has its own foetal membranes. When 
the condition is such, one or more may be retained indefinitely 
after the delivery of the first foetus. We do not mean, however, 
that they can be retained for weeks or months as in superfceta- 
tion, but for a reasonable length of time (hours or even a day or 
two) after the birth of the first. In multiple cases of this va¬ 
riety, it frequently happens that the foetuses are unequally de¬ 
veloped, and this unequal development often leads to the death 
of one of them, either caused by compression resulting from the 
excessive development of the other or the unequal distribution 
of the blood supply. If they are equally developed each foetus 
is generally smaller than ordinary, and parturition is usually 
easy if not accompanied with other complications ; but, numer¬ 
ous complications may be associated with this condition that 
may require surgical attention, and the course adopted should 
be governed by the indication, but surgical interference should 
not be delayed until the vitality of the mother has been so im¬ 
paired that it could not withstand the shock. 
(B) Associated Multiparity includes that variety of multi¬ 
parity in which all foetuses are found in one foetal membrane 
common to all of them, occurring in the uterus at one time. In 
such instances the delivery of one foetus requires the immediate ' 
removal of the remainder. When the placenta is common to 
all, they are generally equally developed, and if the presenta¬ 
tion is not complicated beyond correction, delivery is usually 
comparatively easy ; but, if unequally developed and attended 
with malpresentations that cannot be rectified, the condition is 
more serious; however, these cases should not be subjected to 
Caesarian section without exhausting all possible means to 
rectify the condition. 
(C) Inclusive Multiparity rs not a common condition, at 
least those examples which are completely enclosed in another 
foetus. Occasionally an undeveloped foetus may be found en¬ 
veloped in a larger one, and sometimes one is found only partly 
