Plurality of Children. The disposition to multiply is general throughout the whole creation ; even in vegetables it is not unusual to see two kernels in one nut; and the sheep, instead of having one lamb, will sometimes bring two. All uniparous animals may have two young ones, though in some species it is more frequent than in others ; it is not so com mon for a mare to have two foals, as for the ewe to have two lambs. In the hu man subject twins occur once in about forty-eight labours; this calculation is ta ken from the lying-in hospitalsof London, Edinburgh, and Dublin. There are some times more than two; as three, four, and five ; but such instances are extremely rare. Dr. Osborn mentions a case, where in an early miscarriage he saw six distinct ova, each complete ; and there is a monu ment in Holland to a woman, who, the inscription declares, had 365 children. But it signifies not,, whether there is one or 365 in the uterus, for each has still its distinct bag of membranes, each its own placenta ; though sometimes the placentr are joined so closely, that they would almost seem one cake.
There is no mark by which we can dis tinguish twins till after the birth of one child. It has been said that labour is then more slow than at other times , but this would imply that single labours were ne ver slow, which happens to be very far from true. Another opinion is, that the woman is bigger than in other labours i and this would seem to be very natural I but it certainly is not very true, but very much the contrary ; and many practition ers have declared, that they have never once been right in their opinion upon this subject. So that the difficulty of the labour will at first depend on itself with out any reference to the child. But after one child is born, we can easily lay our hand upon the abdomen, and determine the point ; not forgetting that, where there are more than one child, the placenta must never be brought down till the last child be delivered ; for if we use any force, so as to detach a part of the placen ta from the uterus, we produce a flood ing. If the abdomen be examined before delivery, we shall feel the tumour reach ing high up to the scrobiculus cordis ; if after delivery, we shall perceive a round ed tumour lying on one side above the pelvis like a foot-ball If we examine the abdomen in a twin case, after one child is delivered, we shall not be able to say, from the diminished size of the tumour, that one child has come away.
When we have ascertained that a se cond child remains in the uterus, we should wait quietly, and without com municating the feet to the patient her self, lest we alarm her, till by a recur rence of the pains we find the part that presents ; and if it be an arm or shoulder, we should tuck up the sleeve of our shirt, and pass up the hand greased into the uterus, without any preparation on the part of the woman ; it is here better avoided, and the child may be turned at once. The one child has already passed,
therefore the contractions of the uterus and vagina will be a smaller impediment here, than in any other case. Before we thus act, however, it will be better to leave the patient to recruit herself a while. Should there be a remission of labour pains, and no urgent symptom requiring the interference of art, if the practitioner be a young man, it is best to wait about four hours, before he does any thing to. wards the delivering the second child; an experienced person probably need not wait so long. If we wait four hours, no harm can happen from hastening the de live ; we have waited so long as to in the eyes of all the livery .
A twin cue is not quite so safe as a single birth ; for the woman will some times die without our being able to give the least reason for it. As there have been some fatal instances, we should be upon our guard not to say there is no danger in such a cue ; we may say they are commonly not cases of danger, but should not, when asked, affirm that they are perfectly safe.
Convulsions. Cues of puerperal con vulsion bear a strong analogy to epileptic fits ; so much so, that it is nearly impossi ble to distinguish them at first sight, ex cepting from the different degree of vio lence attending each ; the fit of puer peral convulsion being much more vio lent than any fit of epilewy. The par oxysm is so violent, indee that a woman, who, when in health, was by no means strong, has shaken the whole room with her exertion& Puerperal convulsions may occasionally arise at anytime between the sixth month and the completion of labour t they sel dom or never happen before the sixth month. They may arise as the first symp tom of labour, in the course of labour, or after the labour is in other respects finish. ed. Puerperal convulsions have these characters belonging to them ; they al. ways occur in paroxysms, and those par oxysms occur periodically, like labour pains ; so that there is a considerable space, perhaps two hours, between the two first attacks; after this they become more frequent. They not only occur with the labour pains, but in the inter vals; and whether there have been labour pains or not, before they come on we shall always find the os uteri dilated, and it is sure to become dilated from the con tinuance of these convulsions; and at length, if the woman be not relieved, and the convulsions continue without killing her, the child is actually expelled, with out any labour pain at all : On opening such cues after death, where the con vulsions have been violent, the child has been found partly expelled, from the contraction of the uterus; which power is capable of expelling it even after death. In one case in which it happened, the whole child was expelled except the bead.