Medicine: The Siamese Twins

Every now & then, by a cruel quirk of nature, twins are born joined together. Medical science unfeelingly calls them double monsters. They come in almost infinite variety: complete and otherwise well-formed babies may be joined at the back of the head, down the side, or at the buttocks; grotesquely malformed twins may have one trunk and two pairs of legs, or two heads, two pairs of arms and one pair of legs. Nearly always they share the use of one or more organs.

Because delivery is difficult, there are few live births in such cases; most liveborn joined twins die in infancy. But medical history records perhaps twoscore cases which have reached maturity, usually joined at or near the rump, where fewest organs are affected. Most famed were the Chinese brothers Chang and Eng. Because they were born (1811) in Siam, P. T. Barnum billed them as “The Siamese Twins,” and the name has stuck to all their kind. Chang and Eng retired on their circus earnings to North Carolina, took the name of Bunker, married sisters (not twins), had many children, and died at 63.

Old Precedents. Medicine does not know for certain how joined twins are formed. Most authorities believe that the splitting of an ovum, which would form identical twins, is somehow arrested before the split is complete. Others, pointing out that Siamese twins show marked differences in height and weight, features and temperament, believe that two separate embryos from different ova may join up.

Only rarely has surgery sought to come between Siamese twins while both were living. Where several organs are shared, surgery is impossible. In simpler cases the twins are often in circuses, dependent on their deformity for a living, and refuse the operation. In 1925, Dr. Hillard Herman Holm of Glencoe, Minn, successfully separated twin girls. One died at twelve, of a heart ailment; one is still living and well. But each successful operation has been matched by one or more failures.

The hazards were well known to the team of Canadian doctors who, in Edmonton’s Royal Alexandra Hospital, performed this week what is believed to have been the most difficult operation of the kind in medical history.

Red-haired Brenda Carol and Beverley Lynn Townsend were born last November in the little hospital in the town of Tofield (pop. 800), Alberta, after a difficult, 2½-hour delivery. Dr. William Freebury had little hope for their survival when he saw that they were solidly joined (from the third rib to the navel), facing each other. A minister was called to baptize them when they were only ten minutes old. Their combined weight was 9¾ pounds.

Mirror Sisters. It was soon clear that they were generally healthy. In January, on their mother’s 20th birthday, they were taken home to the simple Townsend cottage in Tofield. Soon they went back to the Hospital for careful study, because their parents had agreed with Dr. Freebury that they should be separated. Said Elizabeth Townsend: “They would have no decent, proper lives the way they are. It is better to accept what risks there are in the operation.”

Brenda and Beverley grew into pretty babies, more than doubled their weight in 5½ months. Often one twin was wakeful while the other slept, or laughed while her sister cried. With four hands to reach for a bottle, feeding was sometimes a comedy of errors. With four legs to kick, diapering was doubly difficult. Sometimes Brenda put her fingers in Beverley’s mouth, or the other way around.

X rays showed them to be “mirror twins,” one having the heart inclining to the right, the other to the left. Other organs were similarly transposed. Their breastbones were fused. The twins shared some rib cartilage and other tissues. So far as the surgeons could tell in advance, their biggest problem was going to be separating the large liver which the twins shared.

But the X rays had not told all. The one liver had to be divided where it was thickest, three inches in diameter. Worse yet, the anxious doctors found that the twins’ chest cavities were connected and contained a single sac which held both their hearts. The hearts were abnormally long and crossed over, so that each beat partly in the other twin’s body. When the hearts were separated, there was no room for them in the tiny, undeveloped chest cavities.

Neither the doctors’ skill nor the prayers of interested Albertans could save the babies. For a while, each strained heart was kept going by massage, but in little more than three hours after the operation began, both stopped.