t>80 
PARTURITION. 
thor of that communication Hates, that another cafe had 
come to his knowledge, in which fix weeks had elapfed 
between the births of the twins. Mrs. Dixon, of Mid¬ 
dleton Place, was delivered, on the 27th of Odtober, 1806, 
of a daughter, and on the 8th of December of a fon. 
March 4, 1814, the wife of Mr. James Pickworth, gra¬ 
zier, of Sempringhatn, Lincolnihire, was delivered of 
two boys ; after which (lie was lo much compofed, that die 
got up the next day, and remained in that Hate till the 
6th, when (he was delivered of two more boys. Gent. Mag. 
March 1814. From fuch cafes as thefe, lbme have con¬ 
cluded, rather haftily, that the birth of the fecond child 
may always be fafely trufted to nature, and that the in¬ 
terference of art is very feldom, if ever, neceffary. 
On the other hand, very dangerous, and not unfre- 
quently fatal, confequences, having occurred from allow¬ 
ing the fecond child to be long retained after the firft is 
born, many have argued, that it is always proper to ac¬ 
celerate by art the birth of the fecond child. 
Others, again, lteer a middle courfe, and teach us to 
wait a moderate or reafonabie time, before we interfere 
by art, to eftebt the fecond delivery; and it feems to be 
the opinion of fome authors of great reputation and 
judgment that about four hours is the proper time to 
wait. 
It will hardly be denied, that fome time ought to be 
allowed to recruit the woman’s ftrength, and to give an 
opportunity for the fecond labour to come on fponta- 
neoufly ; but there will often be a difficulty in determin¬ 
ing what fpace of time is to be conlidered as reafonabie. 
There are many cafes, in which it would be unadvifable 
to wait fo long as four hours, before the birth of the 
fecond child is artificially excited ; for, even when the 
firft labour has been favourable, and the fecond-child is 
in a proper pofition, it may be doubted whether any ad¬ 
vantage is likely to accrue from letting it remain four 
hours before an attempt is made to facilitate the delivery. 
In general, indeed, under thefe favourable circumftances, 
the fecondary pains come on fhortly after the firft birth, 
and expel the child ; but, fhould this not happen, it may 
be prudent to excite them, bj' rupturing the membranes, 
in a much fliorter fpace of time than four hours. “It 
lias feemed to me, (fays Dr. Merriman,) upon various 
occasions, when fo long a period as this has been per¬ 
mitted to elapfe, that the pains of the fecond labour have 
been more fevere than they would have been had the 
aftion of the uterus been earlier excited. I fhould be 
very unwilling (the dobtor adds) to appear the advocate 
of precipitation, in any part of the practice of midwifery; 
but, having known more than one inftance of mifchief 
arifing from the delay of bringing the fecond twin into 
the world, I think riiyfelf juffifiable in recommending an 
oppofife mode of conduct, though fomewhat different 
from that which other practical accoucheurs have taught. 
“ The following is an outline of the practice, which I 
have been in the habit of adopting. 1. When both the 
children prefent naturally, and the labour of the firft ter¬ 
minates without artificial aftiftance, and without much 
fatigue to the patient, I wait for the fponfaneous occur¬ 
rence cf the fecondary pains; but, fnould thefe not come 
on foon, I rupture the membranes ; and then commonly 
find, that the fecond child paifes with comparative eafe 
through the pelvis, the parts having already undergone 
fufficient dilatation. 2. If the firft labour has been na¬ 
tural, and the fecond child prefents in a wrong direction, 
I have deemed it generally expedient, witli very little de¬ 
lay, to extract it by the feet. 3. If the firft labour has 
been preternatural, or very difficult, or dangerous, this 
has always feemed to me an additional reafon for termi¬ 
nating the fecond as expeditioufly as circumftances will 
admit.” In every cafe, the extraction of the placenta is 
to be condufted with great care; for it is to be noted, 
that every foetus has its feparate placenta, though they 
are generally united at the edges. 
It is an eftablifhed rule, not to acquaint the mother that 
there are twins, till both are born ; for it is known that 
fudden emotions of the mind have been productive of ill 
confequences during labour, and fome mifchief or incon¬ 
venience might enfue from the apprehenfion with which 
the patient might contemplate the fecond labour. But, 
though it is proper to conceal this circumftance from the 
mother, if poffible, yet it is right to acquaint the huf- 
band, or fome friend of the patient, of the real nature 
of the cafe, as foon as it is certainly known to the prac¬ 
titioner. 
The rules which are applicable to twin-cafes, will 
equally apply to cafes where there are three or more chil¬ 
dren. It very commonly happens, that twin-labours 
occur before the full term of nine months. 
There feems to be a very extraordinary variety in the 
averages of twin and triplet births, in different countries, 
and under different circumftances. Thus the average of 
twin births has been Itated, 
By Dr. Clarke, at the Dublin Lying-in Hofpital as 1 in 56^ 
By Dr. Bland, at the Weftminfter Difpenfary-80 
By Prof. Boer, in the Vienna Lying-in Hofpital-80 
By Dr. Denman, at the Britifti Hofpital-91 
By Dr. Denman, at the Middlefex Hofpital-■ 93 
By Mr. Burns, in his own practice -95 
By Mad. Boivin, at theHofpice de la Maternite-132 
By M. Tenon, furgeon to the Salpetriere at Paris--96 
RefpefHng triplets, the averages are ftill more va¬ 
rious : many accouchers, of very extenfive practice, have 
palled through a long life, without once witnefling three 
children at a birth. Dr. Bland kept a very exabt regifter 
of 1897 women delivered at the expenfe of the Weftmin¬ 
fter General Difpenfary, among which there was one 
cafe of triplets; while Dr. Merriman held the office of 
phyfician-accoucher to that charity, about 3500 women 
were delivered ; among whom he was twice called to 
triplet-labours. In the firft 18,300 women delivered at 
the Britifti Lying-in Hofpital, not a fingle inftance of 
triplets had occurred : but there were three fuch cafes 
among 20,357 women delivered at the Holpice de la Ma¬ 
ternite, at Paris, and 19 among 59,354 women at the 
Dublin Lying-in Hofpital ; or 1 in 3124. 
The averages of four children at a birth can fcarcely 
be afcertained, yet feveral fuch inftances are known to 
have happened in this ifland.—In the year 1674, there 
was publifhed in London a 4to. pamphlet, in titled, “ The 
Fruitful Wonder; ora ftrange Relation, from Kingfton- 
upon-Thames, of a Woman who, on Thurfday and Fri¬ 
day, the 5th and 6th days of this inftant March, 1673-4, 
was delivered of 4 children at one birth, viz. 3 Tons and 1 
daughter, all born alive, lufty children, and perfect in 
every part, which lived twenty-four hours, and then 
died, all much about the fame time; with feveral other 
Examples of numerous Births, from credible Hifto.rians, 
with the Phyfical and Aftrological Reafons for the fame: 
By J. P. Student in Phyfic.”—Dr. Plott, in his Hiftory 
of Staffordfhire, mentions Eleanor, the wife of Henry 
Diven, of Watlington, who was delivered of 4 children 
at a birth in the year 1675.—Sir Robert Sibbald, in his 
Scotia Illuftrata, after mentioning a cafe of three born 
at once, adds, “ Imo in variis regni locis repertae funt 
mulieres quas quator fcetus uno partu ediderunt;” but 
makes no mention of more.—In the Gentleman’s Maga¬ 
zine, which is reckoned a pretty authentic record of 
the times, we have the following accounts.—Ann 
Boynton, of Henlbridge, in Somerfetlhire, was this day, 
June 1, 1736, delivered of three daughters and one fon; 
one of the daughters died, the reft are likely to live. 
The mother has been married but four years, and has 
had twice twins before, which completes the number of 
eight children at three births.—Oftober 3, 1743, at Rate, 
in Berkffiire, Joan Galloway was delivered of two boys 
and two girls, three of whom were alive.—In January 
1746, the wife of Plumer, a labouring man, at Mill- 
Wimley, near Hitchin, Hertfordfliire, was delivered of 
three 
