Major Terata : Operations on Conjoined Twins

Anomalies and Curiosities of Medicine
by George M. Gould, M.D., Walter L. Pyle, M.D.

(Page 9 of 34)

Swingler speaks of two girls joined at the xiphoid cartilage and the umbilicus, the band of union being 1 1/2 inches thick, and running below the middle of it was the umbilical cord, common to both. They first ligated the cord, which fell off in nine days, and then separated the twins with the bistoury. They each made early recovery and lived.

In the Ephemerides of 1690 Konig gives a description of two Swiss sisters born in 1689 and united belly to belly, who were separated by means of a ligature and the operation afterward completed by an instrument. The constricting band was formed by a coalition of the xiphoid cartilages and the umbilical vessels, surrounded by areolar tissue and covered with skin. Le Beau says that under the Roman reign, A. D. 945, two male children were brought from Armenia to Constantinople for exhibition. They were well formed in every respect and united by their abdomens. After they had been for some time an object of great curiosity, they were removed by governmental order, being considered a presage of evil. They returned, however, at the commencement of the reign of Constantine VII, when one of them took sick and died. The surgeons undertook to preserve the other by separating him from the corpse of his brother, but he died on the third day after the operation.

In 1866 Boehm gives an account of Guzenhausen's case of twins who were united sternum to sternum. An operation for separation was performed without accident, but one of the children, already very feeble, died three days after; the other survived. The last attempt at an operation like this was in 1881, when Biaudet and Buginon attempted to separate conjoined sisters (Marie-Adele) born in Switzerland on June 26th. Unhappily, they were very feeble and life was despaired of when the operation was performed, on October 29th. Adele died six hours afterward, and Marie died of peritonitis on the next day.

CLASS III. Those monsters joined by a fusion of some of the cranial bones are sometimes called craniopagi. A very ancient observation of this kind is cited by Geoffroy-Saint-Hilaire. These two girls were born in 1495, and lived to be ten years old. They were normal in every respect, except that they were joined at the forehead, causing them to stand face to face and belly to belly. When one walked forward, the other was compelled to walk backward; their noses almost touched, and their eyes were directed laterally. At the death of one an attempt to separate the other from the cadaver was made, but it was unsuccessful, the second soon dying; the operation necessitated opening the cranium and parting the meninges. Bateman said that in 1501 there was living an instance of double female twins, joined at the forehead. This case was said to have been caused in the following manner: Two women, one of whom was pregnant with the twins at the time, were engaged in an earnest conversation, when a third, coming up behind them, knocked their heads together with a sharp blow. Bateman describes the death of one of the twins and its excision from the other, who died subsequently, evidently of septic infection. There is a possibility that this is merely a duplication of the account of the preceding case with a slight anachronism as to the time of death.

At a foundling hospital in St. Petersburg there were born two living girls, in good health, joined by the heads. They were so united that the nose of one, if prolonged, would strike the ear of the other; they had perfectly independent existences, but their vascular systems had evident connection.

Through extra mobility of their necks they could really lie in a straight line, one sleeping on the side and the other on the back. There is a report a of two girls joined at their vertices, who survived their birth. With the exception of this junction they were well formed and independent in existence. There was no communication of the cranial cavities, but simply fusion of the cranial bones covered by superficial fascia and skin. Daubenton has seen a case of union at the occiput, but further details are not quoted.

CLASS IV. The next class to be considered is that in which the individuals are separate and well formed, except that the point of fusion is a common part, eliminating their individual components in this location. The pygopagous twins belong in this section. According to Bateman, twins were born in 1493 at Rome joined back to back, and survived their birth. The same authority speaks of a female child who was born with "2 bellies, 4 arms, 4 legs, 2 heads, and 2 sets of privates, and was exhibited throughout Italy for gain's sake." The "Biddenden Maids" were born in Biddenden, Kent, in 1100. Their names were Mary and Eliza Chulkhurst, and their parents were fairly well-to-do people. They were supposed to have been united at the hips and the shoulders, and lived until 1134. At the death of one it was proposed to separate them, but the remaining sister refused, saying, "As we came together, we will also go together," and, after about six hours of this Mezentian existence, they died. They bequeathed to the church-wardens of the parish and their successors land to the extent of 20 acres, at the present time bringing a rental of about $155.00 annually, with the instructions that the money was to be spent in the distribution of cakes (bearing the impression of their images, to be given away on each Easter Sunday to all strangers in Biddenden) and also 270 quartern loaves, with cheese in proportion, to all the poor in said parish. Ballantyne has accompanied his description of these sisters by illustrations, one of which shows the cake. Heaton gives a very good description of these maids; and a writer in "Notes and Queries" of March 27, 1875, gives the following information relative to the bequest: -

"On Easter Monday, at Biddenden, near Staplehurst, Kent, there is a distribution, according to ancient custom, of 'Biddenden Maids' cakes,' with bread and cheese, the cost of which is defrayed from the proceeds of some 20 acres of land, now yielding L35 per annum. and known as the 'Bread and Cheese Lands.' About the year 1100 there lived Eliza and Mary Chulkhurst, who were joined together after the manner of the Siamese twins, and who lived for thirty-four years, one dying, and then being followed by her sister within six hours. They left by their will the lands above alluded to and their memory is perpetuated by imprinting on the cakes their effigies 'in their habit as they lived.' The cakes, which are simple flour and water, are four inches long by two inches wide, and are much sought after as curiosities. These, which are given away, are distributed at the discretion of the church-wardens, and are nearly 300 in number.