REMARKS.
With reference to the cause of death of the Siamese twins it may be briefly said that, in consequence of the restrictions by which we were bound, no examination of the brains was made. It cannot, therefore, be proved that the cause of Chang’s death was a cerebral clot, although such an opinion, from the suddenness of death, preceded as it was by hemiplegia and an immediate engorgement of the left lung, is tenable. Eng died, in all probability, in a state of syncope induced by fright—a view which the over-distended bladder and the retraction of the right testicle would appear to corroborate.
The existence of lateral curvature was not unsuspected. It was known to those who had examined the twins before death. Indeed, it must have been a necessity of the acquired position.
The presence of a pad of subperitoneal fat at the usual position of the umbilicus was certainly curious.It would appear to be an example of a localized nutritive change about the peritoneum, at the centre of the umbilical region, anticipating the exit of the vessels of the cord at that point. Familiar examples of this anticipation between structures developing from different layers of the embryo are seen in malformations of the genital organs, eye, ear, etc. In the above example it is remarkable only from the rarity of the conditions yielding it.
The circulation in each individual of the twins was practically complete, since the demonstration of continuity between the portal systems, although satisfactory, invites the conclusion that the amount of blood which passed from one to the other side of the band must have been, in the condition of the parts at the time of the demonstration, very inconsiderable, and was not competent in all probability to modify the performance of any act of the economy.
In the fœtal and early period of extra-uterine life the vessels must have been more capacious, and associated with a large tract of liver tissue. It follows, all things being equal, that an attempt at division of the band in early life would have been accompanied with more venous hemorrhage than at any subsequent period.
In proof that the twins were the product of a single conception, the strict correspondence between the markings of the two spleens, as well as the number of the ribs, may be observed. The absence of available data bearing upon the question of symmetry between visceral organs of twins, prevents us from drawing here too positive an inference. It is probable, however, that the twins were individuals of a single organism,remarkable for its complete expression of duplexbilaterality.[5]
Fig. 19.Foreshortened view of the trunks, showing in the acquired position the band from above and the contours of its lateral surfaces.