anomalies and curiosities of medicine-第41部分

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s　with　a　single　body　and　double　lower　extremities。　　CLASS　10。Diphallic　terata。　CLASS　11。Fetus　in　fetu；　and　dermoid　cysts。　　CLASS　12。Hermaphrodites。

CLASS　I。Triple　Monsters。Haller　and　Meckel　were　of　the　opinion　that　no　cases　of　triple　monsters　worthy　of　credence　are　on　record；　and　since　their　time　this　has　been　the　popular　opinion。　Surely　none　have　ever　lived。　Licetus　describes　a　human　monster　with　two　feet　and　seven　heads　and　as　many　arms。　Bartholinus　speaks　of　a　three…headed　monster　who　after　birth　gave　vent　to　horrible　cries　and　expired。　Borellus　speaks　of　a　three…headed　dog；　a　veritable　Cerberus。　Blasius　published　an　essay　on　triple　monsters　in　1677。　Bordenave　is　quoted　as　mentioning　a　human　monster　formed　of　three　fetuses；　but　his　description　proves　clearly　that　it　was　only　the　union　of　two。　Probably　the　best　example　of　this　anomaly　that　we　have　was　described　by　Galvagni　at　Cattania　in　1834。　This　monster　had　two　necks；　on　one　of　which　was　a　single　head　normal　in　dimensions。　On　the　other　neck　were　two　heads；　as　seen　in　the　accompanying　illustration。　Geoffroy…Saint…Hilaire　mentions　several　cases；　and　Martin　de　Pedro　publishes　a　description　of　a　case　in　Madrid　in　1879。　There　are　also　on　record　some　cases　of　triple　monster　by　inclusion　which　will　be　spoken　of　later。　Instances　in　the　lower　animals　have　been　seen；　the　three…headed　sheep　of　Pare；　already　spoken　of；　being　one。

CLASS　II。Double　Monsters。A　curious　mode　of　junction；　probably　the　most　interesting；　as　it　admits　of　longer　life　in　these　monstrosities；　is　that　of　a　simple　cartilaginous　band　extending　between　two　absolutely　distinct　and　different　individuals。　The　band　is　generally　in　the　sternal　region。　In　1752　there　was　described　a　remarkable　monstrosity　which　consisted　of　conjoined　twins；　a　perfect　and　an　imperfect　child；　connected　at　their　ensiform　cartilages　by　a　band　4　inches　in　circumference。　The　Hindoo　sisters；　described　by　Dr。　Andrew　Berry；　lived　to　be　seven　years　old；　they　stood　face　to　face；　with　their　chests　6　1/2　inches　and　their　pubes　8　1/2　inches　apart。　Mitchell　describes　the　full…grown　female　twins；　born　at　Newport；　Ky。；　called　the　Newport　twins。　The　woman　who　gave　birth　to　them　became　impregnated；　it　is　said；　immediately　after　seeing　the　famous　Siamese　twins；　and　the　products　of　this　pregnancy　took　the　conformation　of　those　celebrated　exhibitionists。

Perhaps　the　best　known　of　all　double　monsters　were　the　Siamese　twins。　They　were　exhibited　all　over　the　globe　and　had　the　additional　benefit　and　advertisement　of　a　much　mooted　discussion　as　to　the　advisability　of　their　severance；　in　which　opinions　of　the　leading　medical　men　of　all　nations　were　advanced。　The　literature　on　these　famous　brothers　is　simply　stupendous。　The　amount　of　material　in　the　Surgeon　General's　library　at　Washington　would　surprise　an　investigator。　A　curious　volume　in　this　library　is　a　book　containing　clippings；　advertisements；　and　divers　portraits　of　the　twins。　It　will　be　impossible　to　speak　at　all　fully　on　this　subject；　but　a　short　history　and　running　review　of　their　lives　will　be　given：　Eng　and　Chang　were　born　in　Siam　about　May；　1811。　Their　father　was　of　Chinese　extraction　and　had　gone　to　Siam　and　there　married　a　woman　whose　father　was　also　a　Chinaman。　Hence；　for　the　most　part；　they　were　of　Chinese　blood；　which　probably　accounted　for　their　dark　color　and　Chinese　features。　Their　mother　was　about　thirty…five　years　old　at　the　time　of　their　birth　and　had　borne　4　female　children　prior　to　Chang　and　Eng。　She　afterward　had　twins　several　times；　having　eventually　14　children　in　all。　She　gave　no　history　of　special　significance　of　the　pregnancy；　although　she　averred　that　the　head　of　one　and　the　feet　of　the　other　were　born　at　the　same　time。　The　twins　were　both　feeble　at　birth；　and　Eng　continued　delicate；　while　Chang　thrived。　It　was　only　with　difficulty　that　their　lives　were　saved；　as　Chowpahyi；　the　reigning　king；　had　a　superstition　that　such　freaks　of　nature　always　presaged　evil　to　the　country。　They　were　really　discovered　by　Robert　Hunter；　a　British　merchant　at　Bangkok；　who　in　1824　saw　them　boating　and　stripped　to　the　waist。　He　prevailed　on　the　parents　and　King　Chowpahyi　to　allow　them　to　go　away　for　exhibition。　They　were　first　taken　out　of　the　country　by　a　certain　Captain　Coffin。　The　first　scientific　description　of　them　was　given　by　Professor　J。　C。　Warren；　who　examined　them　in　Boston；　at　the　Harvard　University；　in　1829。　At　that　time　Eng　was　5　feet　2　inches　and　Chang　5　feet　1　1/2　inches　in　height。　They　presented　all　the　characteristics　of　Chinamen　and　wore　long　black　queues　coiled　thrice　around　their　heads；　as　shown　by　the　accompanying　illustration。　After　an　eight…weeks'　tour　over　the　Eastern　States　they　went　to　London；　arriving　at　that　port　November　20；　1829。　Their　tour　in　France　was　forbidden　on　the　same　grounds　as　the　objection　to　the　exhibition　of　Ritta…Christina；　namely；　the　possibility　of　causing　the　production　of　monsters　by　maternal　impressions　in　pregnant　women。　After　their　European　tour　they　returned　to　the　United　States　and　settled　down　as　farmers　in　North　Carolina；　adopting　the　name　of　Bunker。　When　forty…four　years　of　age　they　married　two　sisters；　English　women；　twenty…six　and　twenty…eight　years　of　age；　respectively。　Domestic　infelicity　soon　compelled　them　to　keep　the　wives　at　different　houses；　and　they　alternated　weeks　in　visiting　each　wife。　Chang　had　six　children　and　Eng　five；　all　healthy　and　strong。　In　1869　they　made　another　trip　to　Europe；　ostensibly　to　consult　the　most　celebrated　surgeons　of　Great　Britain　and　France　on　the　advisability　of　being　separated。　It　was　stated　that　a　feeling　of　antagonistic　hatred　after　a　quarrel　prompted　them　to　seek　〃surgical　separation；〃　but　the　real　cause　was　most　likely　to　replenish　their　depleted　exchequer　by　renewed　exhibition　and　advertisement。

A　most　pathetic　characteristic　of　these　illustrious　brothers　was　the　affection　and　forbearance　they　showed　for　each　other　until　shortly　before　their　death。　They　bore　each　other's　trials　and　petty　maladies　with　the　greatest　sympathy；　and　in　this　manner　rendered　their　lives　far　more　agreeable　than　a　casual　observer　would　suppose　possible。　They　both　became　Christians　and　members　or　attendants　of　the　Baptist　Church。

Figure　31　is　a　representation　of　the　Siamese　twins　in　old　age。　On　each　side　of　them　is　a　son。　The　original　photograph　is　in　the　Mutter　Museum；　College　of　Physicians；　Philadelphia。

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　34　inches　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