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Twin PregnanciesAuthor(s): Edwin BishopSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 16, No. 1 (Jan. 7, 1852), p. 23Published by: BMJStable URL: http://www.jstor.org/stable/25493242 .

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TWIN PREGNANCIES.?EXTRA-UTERINE FCETATION. 23

to Dr. Maunsell and Evanson's work on the " Diseases

of Children." At page 105 they beautifully describe

the means of diagnosis of disease in the three great cavities of the body?head, chest, and abdomen.

"Three principal indications of physiognomy present themselves," say the authors,

" connecting a particular

set of features with one of the three great cavities, as

we observed when speaking of the temperaments, and

related in a similar manner. The expression of the

tipper part of the face, the forehead, eyes, and brows,

indicating disease of the brain or nervous system; the

features of the middle of the face, in particular the

nose, being affected by morbid conditions of the organs of circulation or respiration ; while abdominal affections are in a peculiar manner pointed out by the expression of the mouth or state of the lips."

When the brows are knit, the eyes fixed and staring, i

or looking wild or vacant, our attention is at once

directed to the head; we observe whether the child

puts its hand to its head, as in health infants seldom

raise the hand above the mouth; next examine the

pupils, and whether the limbs are rigid; these and other symptoms are evidences of disease of the brain.

Disease of the chest is more apparent, and the

diagnosis easier; the ear will do much, assisted by the

eye, and other symptoms. In disease of the abdomen the lips are retracted or

drawn, so as to show the teeth or gums; the counte

nance pale, sallow, or sunk; the child lies on its back

with its knees bent or drawn up, and is pained by pressure on the abdomen ; diarrhoea constantly attends, the

stools being generally thin, green, or dark brown and

foetid ; there is much wasting ; great thirst, particularly

craving for cold water, and other symptoms. Teething commences in children about six months after birth,

when there is sympathetic irritation in various parts of

the body, which is more easily relieved by lancing the

gums, thus easing the pressure of the tooth, the cause

also being removed, than by giving medicines, which

only palliate for a time, the primary cause of the ail

ments still remaining.?Lancet, Nov. 29, 1851.

TWIN PREGNANCIES.

To the Editors of the Provincial Medical and Surgical Journal.

Gentlemen,? In the Lancet (Nov. 1), at page 415, is a report of the frequent occurrence of twin pregnancy,

under the care of Dr. Tyler Smith.

The report states, " We recently saw a patient in

St. Mary's Hospital, the subject of puerperal mania,

whose obst^ric history was very interesting and

remarkable. She was 34 years of age, was not the

subject of pelvic deformity, and had had, in all, seven

labours. In three of these she had given birth to

twins," &c.

During an engagement with L. Owen Fox, Esq., of

Broughton, Hampshire, which terminated this last

summer, I attended a Mrs. Phillips, living at a solitary

dwelling in the outskirts of the Stockbridge Union. This poor woman was the wife of a labourer, and on

three successive occasions gave birth to twins; these were her only pregnancies. Each time she suffered much from oedema of the abdomen and lower extremi

ties, which retarded the progress of labour. In the first and third confinements the presentations were

natural, in the second an arm presented ; turning, of

course, was necessary in the last-mentioned case.

I felt some anxiety to know the result of a fourth

pregnancy ; but unfortunately about the period of her last lying-in her husband received an injury from

the wheel of a waggon passing over his abdomen, which

caused his death.

I could not ascertain whether there was hereditary disposition in the family to plurality of births.

I have never seen recorded the fact of a woman

having given birth to twins three times in succession. If this poor woman had not been deprived of her husband

probably her fourth pregnancy might have proved of a

similar abnormal character.

I am, Gentlemen, Your obedient Servant,

November 3, 1851. EDWIN BISHOP.

EXTRA-UTERINE FCETATION, HEMORR HAGE AND DEATH.

To the Editor of the Provincial Medical and Surgical Journal.

Sir,?I observe in your last number, at page 593, a case headed

" Rupture of the Fallopian Tube," and

recorded by Dr. Whitton, of Llangollen, that so nearly

corresponds with one that fell under my own observa

tion, that I am induced to send it to you. I did not

see the patient during life, but was, by favour of my

colleague, Mr. Braithwaite, present at the autopsy, which took place April 30, 1840.

The subject of these memoranda was a young woman,

mother of four children, and understood to be at the

time five weeks advanced in pregnancy. She was in?

good health up to the 25th, on which day, while in the

act of preparing dinner, she first felt faint; this was

accompanied by a pain in the belly and a feeling of

alarm. Mr. Braithwaite was sent for, and found her

pallid and exhausted, with a frequent and feeble pulse ;

having been put to bed, she rallied considerably the

following day, but on the third, the faintness and pain,

with some sickness, increased, and she sank whilst in a

state of syncope.

| Post mortem appearances.?Body generally blanched

to the last degree. On laying open the cavity of the

abdomen, it was found distended with fluid and clotted

blood; there was no trace of inflammatory action.

After a minute search we discovered the source of the

haemorrhage to be a ruptured ovum that had been

arrested in its transit through one of the fallopian tubes, and had there acquired its proper bulk, and had so far

passed through its early stages without prejudice from

abnormal position ; the torn surface had a fibrinous

or placental appearance, and corresponded with the

ovum itself, which was found among the coagula. But

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