CANADA

MEDICAL & SURGICAL JOURNAL

OCTOBER, 1878.

Original Communications.

A DESCRIPTION OF THE CONJOINED TWINS, MARIE-ROSA DROUIN.

By D. C. MACCALLUM, M.D., M.R.C.S, Eng.

Professor of Midwifery and Diseases of Women and Children, McGill University.

This remarkable specimen of the fusion in part of the bodies. of two female children was brought to Montreal for exhibition during the month of April, 1878. It was exceedingly difficult to make a thorough examination of the children, as the mother was strongly opposed to having them handled or touched. By frequent visits, and by obtaining the consent of the mother to see the children whilst she was washing and dressing them, I succeeded in making out, not only the most important points relating to their union, but also in obtaining an excellent drawing, by Hawksett, of the appearances which they present anteriorly and potseriorly. The specimen belongs to St. Hilaire's class of Monstres Doubles; Famille-Sysomien; Genres-P80dyme; to Playfair's division of Dicephalous Monsters.

The children lie in their mother's arms much as they are represented in the plate, the two upper separated portions being about in a line with each other, and each forming nearly a right angle with the single trunk. The one to the left of the observer, named Marie, resembles the mother, has a fairer complexion, is

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more strongly developed and healthier looking than her sister Rosa, who is smaller, darker, more delicate-looking and resembles the father. They are both bright, lively and intelligentlooking children. The two bodies, from the heads as far as the abdomen, are well formed, perfectly developed, and in a state of good nutrition. The union between them commences at the lower part of the thorax of each, and from that part downwards they present the. appearance of one female child; that is, there is but one abdomen with one navel, a genital fissure with the external organs of generation of the female, and two inferior extremities. The floating ribs are distinct in each, as is also the ensiform cartilage. The lateral halves of the abdomen and the inferior extremities correspond in size and development respectively to the body of the same side; and the same remark applies to the labia majora. The spinal columns are distinct and appear to meet at a pelvis common to both, although the fusion of the children commences at some distance above their junction. From near the extremity of each spine, a fissure extends downwards and inwards, meeting its fellow of the opposite side at the cleft between the buttocks near the anus, including a somewhat elevated soft fleshy mass, thicker below than above. At a central point between these fissures, at the distance of two and a half inches from the point where the vertebral columns meet, and three and a half inches from the anus there projects a rudimentary limb with a very movable attachment. This limb, which measures five inches in length, and is provided with a joint, tapers to a fine point, which is furnished with a distinct nail. It is very sensitive and contracts strongly when slightly irritated.

The respiratory movements are not synchronous, nor do the pulsations of the hearts correspond-Marie's heart beating at the time of examination 128 per minute; Rosa's, 133. The sensation of hunger is not always felt at the same time, as very frequently one child sleeps while the other is nursing. When one child cries and the other is tranquil, the abdomen on the side of the crying child contracts and expands, and the limb of that side is agitated, while the corresponding

parts of the opposite side are at rest. There is slight movement of the lateral half of the abdomen on the side of the quiet child, but this is evidently communicated. Precisely the same phenomena are observed when either child forces during a motion.

From these observations it would appear that the spinal, respiratory, circulatory and digestive systems of these children are quite distinct. They have each a separate diaphragm, and the abdominal muscles on each side of the mesial line, and the limb of that side are supplied with blood by the vessels and are under the control of the nervous system of the corresponding child. They have each a distinct stomach and an alimentary canal, which probably opens at a point close to the common anus. It would follow also that the accessory organs of the digestive system are distinct for each child.

The two fissures behind are evidently the original clefts between the buttocks of each child; one buttock remaining in its integrity, whilst the other in a rudimentary condition is fused with that of the opposite child, forming the soft fleshy mass from the upper part of which the rudimentary limb projects.

These children are the products of a second gestation. They were born at St. Benoit, county of Two Mountains, on the 28th February, 1878. The mother, a fine healthy lookeng woman, aged 26 years, states that she experienced unusual sensations in the womb during the period of gestation, and that towards its close the abdomen became so prominent she was ashamed to be seen by her friends. The weight also greatly fatigued her, and the movements of the children were very distressing. During her labour she was attended by a midwife. It lasted seven hours, commencing at 1 a.m. and terminating at 8 a.m. One head and body were first born; this was shortly followed by the lower extremities, and immediately after the second body and head were expelled.

REMOVAL OF THE END OF THE RECTUM WITH THE SPHINCTER ANI FOR EPITHELIOMA.

BY GEORGE E. FENWICK, M.D,

PROFESSOR OF SURGERY, MCGILL UNIVERSITY.

(Read before the Medico-Chirurgical Society of Montreal.)

The operation which I desire to describe to the Society this evening is rather novel in procedure, simply from the fact that very few cases are met with in which it may be considered suitable; extirpation or amputation of the rectum or rather a portion of that bowel has been practiced for over half a century. Lisfranc performed it as early as 1826, and claims to have relieved six out of nine cases. Other continental surgeons have, in isolated cases, removed several inches of the end of the bowel with variable success. It is an operation which has received unqualified condemnation from British surgeons, but I am under the impression that their opinions are too sweeping, as in my own limited experience there are occasionally met with undoubted cases of malignant disease of the end of the bowel which are capable of safe removal. In the 4th vol. of Holmes' Surgery, Mr. Henry Smith, in writing on this subject, remarks: "Some surgeons were, a few years since, in the habit of performing excision of the lower part of the rectum when affected with cancer; but this proceeding must be looked upon both as barbarous and unscientific, and is now happily exploded from the catalogue of surgical operations." This was the opinion of Mr. Smith in 1870, but from the more recent light that has been thrown on this subject, he may have greatly modified his views. Mr. Erichsen, in the last edition of his work just published, remarks (vol. 2, page 680): "When it (cancer) occurs as a primary disease it is usually in the form of epithelioma and may then form around the anus, just as it does at other muco-cutaneous appertures. If limited and detected in the early stage it may advantageously be excised, but at a more advanced period of the disease such a practice can scarcely be adopted with any prospect of success, in consequence of the impossibility of removing the whole of