File:Image from page 259 of "A theoretical and practical treatise on midwifery - including the diseases of pregnancy and parturition and the attentions required by the child from birth to the period of weaning" (1866) (14777462952).jpg

Identifier: theoreticalpract01caze Title: A theoretical and practical treatise on midwifery : including the diseases of pregnancy and parturition and the attentions required by the child from birth to the period of weaning Year: 1866 (1860s) Authors: Cazeaux, P. (Pierre), 1808-1862 Subjects: Obstetrics Pregnancy Complications Obstetrics Midwifery Publisher: Philadelphia : Lindsay and Blakiston

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Text Appearing Before Image: o tumors separated by a depres-sion ; the one at the right being much thehigher. The twins were born by the feet. The slight blows perceived by tbe. motherare sometimes felt at one and the same timein two distant parts of the abdomen; and theimportance of auscultation as an element inthis diagnosis has already been pointed out.(See p. 164.) The bellows murmur can, I think, rarelyfurnish useful information. Still, it is as-serted by Holl, that in sixteen twin preg-nancies, the murmur was. heard seven timeson both the right and left sides simultaneously,and nine times on one side only; and he af-firms, that when the latter was the case, tbere was a common placenta, whilst inthe other instances there were two. He is also of the opinion, that a doublesouffle is diagnostic of a double pregnancy, even though the sound of the heartbe heard at a single point only. We cannot admit the last conclusion, since wehave already denied the very relation which Holl would establish between the Fig. 64.

Text Appearing After Image: OF TWIN PREGNANCY. 249 seat of the murmur and the insertion of the placenta; besides which, we haveoften heard a souffle on both the right and left sides in single pregnancies. Again, as the two foetuses mutually interfere with each other, neither of thempresents itself to tbe vaginal touch, and of course the ballottement is then ex-ceedingly difficult, if not wholly impossible ; for, even if the finger should easilyreach the presenting part, the presence of another child would interfere with theascending movement of the first. Desormeaux, however, cites a case where theballottement was manifest in a twin gestation, but even here a large quantity ofwater was present at the same time. Whilst in charge of the Clinic of theFaculty, in 1845, I observed on two occasions the same fact noticed by Desor-meaux ; for the existence of dropsy of the amnion rendered the ballottement veryperceptible, although two children were present. The course of twin pregnancies is sometimes accompanied by pecu

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