The feasibility of the operation of separating them was discussed by many of the leading men of America, and Thompson, Fergusson, Syme, Sir J. Y. Simpson, Nelaton, and many others in Europe, with various reports and opinions after examination. These opinions can be seen in full in nearly any large medical library. At this time they had diseased and atheromatous arteries, and Chang, who was quite intemperate, had marked spinal curvature, and shortly afterward became hemiplegic. They were both partially blind in their two anterior eyes, possibly from looking outward and obliquely. The point of junction was about the sterno-siphoid angle, a cartilaginous band extending from sternum to sternum. In 1869 Simpson measured this band and made the distance on the superior aspect from sternum to sternum 4 1/2 inches, though it is most likely that during the early period of exhibition it was not over 3 inches. The illustration shows very well the position of the joining band.
The twins died on January 17, 1874, and a committee of surgeons from the College of Physicians of Philadelphia, consisting of Doctors Andrews, Allen, and Pancoast, went to North Carolina to perform an autopsy on the body, and, if possible, to secure it.
They made a long and most interesting report on the results of their trip to the College. The arteries, as was anticipated, were found to have undergone calcareous degeneration. There was an hepatic connection through the band, and also some interlacing diaphragmatic fibers therein. There was slight vascular intercommunication of the livers and independence of the two peritoneal cavities and the intestines. The band itself was chiefly a coalescence of the xyphoid cartilages, surrounded by areolar tissue and skin.
The "Orissa sisters," or Radica-Doddica, shown in Europe in 1893, were similar to the Siamese twins in conformation. They were born in Orissa, India, September, 1889, and were the result of the sixth pregnancy, the other five being normal. They were healthy girls, four years of age, and apparently perfect in every respect, except that, from the ensiform cartilage to the umbilicus, they were united by a band 4 inches long and 2 inches wide. The children when facing each other could draw their chests three or four inches apart, and the band was so flexible that they could sit on either side of the body. Up to the date mentioned it was not known whether the connecting band contained viscera. A portrait of these twins was shown at the World's Fair in Chicago.
In the village of Arasoor, district of Bhavany, there was reported a monstrosity in the form of two female children, one 34inches and the other 33 3/4 inches high, connected by the sternum. They were said to have had small-pox and to have recovered. They seemed to have had individual nervous systems, as when one was pinched the other did not feel it, and while one slept the other was awake. There must have been some vascular connection, as medicine given to one affected both.
Fig. 36 shows a mode of cartilaginous junction by which each component of a double monster may be virtually independent.
Operations on Conjoined Twins.--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.
