Part 17

Another genus is the Craniopagus--twins joined only by the skull or scalp. There are three species, named from the place of union--Craniopagus Frontalis, C. Parietalis, and C. Occipitalis.

A third group of double autositic monsters are the Terata Anakatadidyma, which are divided above and below, but joined from the navel to the head. There are three genera. The first, the Prosopothoracopagus, is joined at the upper abdomen, the chest, and the faces; the spinal columns are separate. The faces are imperfect, the jaws are united; there is a broad neck with one oesophagus, and there is one stomach and one duodenum. This is a rare form, and it can not exist out of the uterus.

A second genus, the Thoracopagus, has a thorax in common, and the inner legs may be united. It is, as a rule, still-born.

The next genus is the Omphalopagus, in which the twins are joined from the navel to the bottom of the chest. This double monster has the slightest union of all, and it is very rare. The Siamese Twins were omphalopagi. They quarrelled; one became a drunkard and the other remained temperate. They married two women, and Chang had ten children, and Eng twelve. Chang died while Eng was asleep, and the latter died two hours after he had waked and learned of his brother's death.

There is a genus, the Rachipagus, the examples of which are joined behind like the class Terata Anakatadidyma that are joined in front.

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Four known attempts have been made to separate double monsters surgically, but all failed owing to crude surgery; modern methods might be successful in some cases.

The second order of double monsters comprises the parasitic class. There are three genera of these terata, with five species and seventeen varieties. The chief of these only will be mentioned. The Heterotypus is a parasitic child which hangs from the abdominal wall of the principal subject. Varieties of this species are the Heteropagus, which is a parasite with head and arms; the Heterodelphus, which has no head; the Heterodymus, which has a head, neck, and thorax. The Heteralitis is a second species, in which the parasite is inserted at a distance from the navel of the autosite. The Epicomus is the only example, and it consists of a parasitic supernumerary head. The Polypnathus is a parasite attached to the jaw of the autosite. When fastened to the upper jaw, it is an Epignathus; at the lower jaw it is an Hypognathns. Another group is made up of terata having parasitic legs which are attached to different parts of the autosite,--to the pelvis, the head, the abdomen, and so on. Finally, there is the Endocyma, which is a parasite enclosed within the body of an autosite.

Parasites are nourished through the blood supply of the autosite, and the parasites usually are incapable of motion. The autosite can feel when the parasite is touched, and in some cases the autosite can localise the touch. In India, in 1783, a child was born which had a supernumerary head attached to the autositic head, crown to crown; it lived four years. The parasite's eyes were always partly open, but they appeared to be incapable of intelligent vision. They contracted under strong light, and when the autosite was suddenly awakened both sets of eyes moved.

Gould and Pyle (Anomalies and Curiosities of Medicine) give an account of an Italian boy, aged eight years, who had a small parasitic head protruding from near the left third rib. Sensibility was common. Each of the heads received baptism (one was called John and the other Matthew), and there was question as to whether extreme unction should be administered to the parasitic head. A similar case occurred in {86} England in 1880 (British Med. Journal), and the parasitic head could be pinched without attracting the attention of the autosite.

Teratologists now exclude Dermoid Cysts from the lists of terata. The hair, teeth, and particles of bone found in these cysts are looked upon as the development of abnormal ectodermic and endodermic cells, rather than as evidence of a separate personality.

There is only one well-authenticated case of a triple monster, and this happened in Italy in 1831. The monster had a single broad body with three distinct heads and two necks. It was killed in delivery.

In Katadidyma (terata divided from above downward), when we have dicephali, ischiopagi, or pygopagi, there are evidently two individuals present. Is the Diprosopus, however, the two-faced monster, possessed of one or two souls? The cases vary, as we said, from examples with two distinct faces and four ears to cases that have merely two noses. What portion of a human body is required to contain a new soul? That is an interesting question for the psychologist and a very practical one for the moralist, and no moralist has yet attempted to solve it. The presence of a brain is not essential, because acephalous monsters develop without brain, and they are born alive; they have a vital principle which is identical with the soul.

Among the Terata Anadidyma (divided from below upward) the Syncephalus and the Craniopagus are unquestionably two persons. Is the Dipygus (single down to the navel, double below) one or two persons? Mrs. B., the example already given, was as double below the navel as any Dicephalus is above that point. She had features so well ordered in unity that she was a pretty woman, but that unity ceased at her waist. Was her husband unknowingly a bigamist? I think he was. After a consideration of the fission of terata, and the non-essential quality of the brain, why should fission that started at the feet differ from fission that started at the head?

In the Rituale Romanum Pauli V. (tit. ii. cap. i. nn. 18, 19, 20, 21), the following directions for the baptising of terata are given:

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18. In monstris vero baptizandis, si casus eveniat, magna cautio adhibenda est, de quo si opus fuerit, Ordinarius loci; vel alii periti consulantur, nisi mortis periculum immineat.

19. Monstrum, quod humanam speciem non praeseferat, baptizari non debet; de quo si dubium fuerit, baptizetur sub hac conditione: Si tu es homo, ego te baptizo, etc.

20. lllud vero, de quo dubium est, una ne, aut plures sint personae, non baptizetur, donec id discernatur: discerni autem potest, si habeat unum vel plura capita, unum vel plura pectora; tunc enim totidem erunt corda et animae, hominesque distincti, et eo casu singuli seorsum sunt baptizandi, unicuique dicendo: Ego te baptizo, etc Si vero periculum mortis immineat, tempusque non suppetat, ut singuli separatim baptizentur, potent minister singulorum capitibus aquam infundens omnes simul baptizari, dicendo: Ego vos baptizo, in nomine Patris, et Filii, et Spiritus sancti. Quam tamen formam in iis solum, et in aliis similibus mortis periculis, ad plures simul baptizandos, et ubi tempus non patitur, ut singuli separatim baptizentur, alias numquam, licet adhibere.

21. Quando vero non est certum in monstro esse duas personas, ut quia duo capita et duo pectora non habet distincta; tunc debet primum unus absolute baptizari, et postea alter sub conditione, hoc modo: Si non es baptizatus, ego te baptizo in nomine Patris, et Filii, et Spiritus sancti.

AUSTIN OMALLEY.

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VII

SOCIAL MEDICINE

The influence of the clergyman or the charitable visitor in matters of health and sanitation can scarcely be overestimated. The removal of prejudices with regard to sanitary regulations for the prevention of disease and modern advances in the treatment of disease is an important social duty. There is no doubt that if this influence be properly directed, sanitary measures of various kinds will be much more readily enforced and the precautions necessary to prevent the spread of serious infectious ailments more faithfully observed. As this amelioration of sanitary conditions will affect mainly the poor, lessening their suffering and adding to their possibilities of happiness, its accomplishment becomes a great Christian duty, obligatory on all those who are interested in the uplifting of the poorer classes.

Professor Virchow, the distinguished German pathologist, used to say that popular medicine was in all ages at least fifty years behind scientific medicine. He had himself discovered the principles of cellular pathology nearly half a century before his death, yet he declared that the popular mind still believed in the old doctrines of humoral pathology,--that is, that the conditions of health and disease depended on the constitution of the fluids of the body (the blood, the bile, the mucus, and so forth), and had not generally accepted modern advances in medical knowledge of the underlying basis of disease in the solid tissues. There is no doubt that many old-fashioned notions long since discredited by physicians are still very generally accepted by the popular mind, and even the intelligent classes sometimes harbour convictions with regard to the good or evil effects of habits {89} of life, diet, and the operation of drugs of various kinds that are entirely contrary to present-day medical knowledge.

It is extremely important, then, that the clergyman or charitable visitor, in giving views on medical matters, which are sure to have much more weight than he perhaps attributes to them himself, should be careful not to make statements for which he has not good authority in modern medical science. It is very easy, in a matter of this kind, to state principles that are not the result of education, properly so called, but are gleaned from early false impressions obtained one knows not how or where, entirely without definite consciousness as to their real origin. The physician himself finds that he is compelled to be careful of this same tendency to put too much stress on traditions with regard to health which he imbibed before he began to study medicine. It is perhaps not so surprising, then, to hear physicians complain often that clergymen instead of being a help are sometimes a hindrance to the enforcement of modern hygienic rules, because they still cling to old-fogy notions of hygiene and sanitation retained from a defective early training. Owing to the influence that the clergyman is sure to exert, this becomes an extremely important matter. Great harm may be done and the physician discredited, almost without a realisation, on the part of the clergyman, that he is interfering in another's department. Sympathetic coordination of clerical and medical efforts would accomplish much good that is now unfortunately left undone.

There is no doubt that for the important crusade against tuberculosis, for instance, the aid of the clergyman will accomplish much for the reduction of the death rate from this disease. What is needed at the present moment is a universal conviction that tuberculosis is not an hereditary but a communicable disease. This does not mean that it is virulently contagious and that as a result sufferers from tuberculosis must at once be segregated from other members of the family and from the community generally; but it does mean that careful precautions must be taken with regard to the disposal of sputum, with the enforcement of the most exacting cleanliness on the part of consumptives themselves. {90} It also means that the person suffering from the disease should not sleep with those as yet unaffected, nor be allowed to live in very close contact, especially with children or susceptible individuals.