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siamese - Woman
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SIAMESE TWINS FACTS

Conjoined twins, born with their bodies physically linked, have intrigued people for centuries. Although the few pairs who have survived unseparated into adulthood can describe their experience, it's impossible to imagine what it is like to have such an intimately shared existence, joined to another human being 24 hours a day.

As surgical techniques improve, more of these rare children can be separated, although the operation always carries risks, and sometimes means the death of one or even both. Deciding to separate means making ethical and moral judgements that question many of society's basic assumptions about individuality, the need for privacy, and whether we have the right to rob one individual of life in order that another, stronger, person may live.

Whatever their situation, conjoined twins are extraordinary and memorable, and we can only marvel at the co-operation and compromise that underpins their daily lives. In Joined we see them, not as freaks, but as real, unforgettable people, caught up in a rare and remarkable physical phenomenon that the rest of us can barely imagine.

The history of conjoined twins

Conjoined twins have fascinated people throughout history, and their images are found in cave drawings and carvings dating back many centuries. In earliest times they were worshipped as gods, or feared as bad omens and exiled, abandoned or killed. Later they were viewed as curiosities, and of the few sets who survived into adulthood, many became circus or sideshow attractions, or went on to the stage. Only in the last 30 years, as separation techniques have become increasingly sophisticated, have conjoined twins begun to be seen as individuals rather than freaks.

HISTORICAL; The Biddenden Maids, 1100-1134

Eliza and Mary Chulkhurst lived in Kent, in the UK, and were joined at hip and shoulder. When one twin died, the remaining one is alleged to have refused separation, saying, 'As we came together, we will also go together'. She died shortly after her sister. The twins left 20 acres of land to the poor, and every Easter commemorative cakes, decorated with their image, are given to visitors to the village.

Lazarus and Joannes Baptista Colloredo, 1617-1640s or '50s

An example of parasitic twins, a rare type of conjoined twin where one of the pair does not form fully, and remains physically dependent on the other. The shrunken form of Joannes Baptista, whose body had begun to atrophy in the womb, appeared to grow out of Lazarus's torso. Born in Italy, they toured Europe and lived into their thirties.

Chang and Eng Bunker, 1811-1874

The original 'Siamese twins', they were born to a farming family in Siam (now Thailand). A 12cm ligament joined them near the breastbone. Nowadays separation would be straightforward, but although the twins asked surgeons to try, no-one was willing to attempt the operation. The King, Rama II, said they should be put to death in infancy, but their mother protected them until 1829, when they went to America. Their years spent touring the world as curiosities earned them enough to set up a farm in North Carolina, where they married the Yates sisters and between them fathered 21 children. When Chang died of pneumonia in 1874, aged 63, Eng refused separation and died a few hours later.

Millie and Christine McKoy, 1851-1912

Known as the Two-Headed Nightingale, the girls were black slaves born in North Carolina. They were separated from their family in infancy and sold for $30,000, but were reunited with their mother at the age of four. Joined back-to-back, they became vaudeville stars and toured the world, singing, dancing and playing the piano. Millie died of tuberculosis in 1912, aged 61, and Christine's death followed less than a day later.

Giovanni and Giacomo Tocci, 1877-1940s

A very rare type of twin, the Tocci brothers had two heads, and two pairs of arms, but shared a lower body from beneath their sixth rib. Their shared legs were very weak, with one deformed foot, so the boys found it hard to stand, and could not walk. Born in Italy, they lived into their sixties, but refused to be exhibited once they were out of their teens.

Simplico and Lucio Godina, 1908-1936

Male twins from the Philippines, they were joined at the back and made a living as entertainers, dancing and roller skating. They married twin sisters, and the four performed together on stage. When Lucio died of pneumonia, Simplico was successfully separated, only to die shortly afterwards from an infection.

historical separations ;
Surgeons have always been fascinated by the challenge of separating conjoined twins, and there have been many remarkable operations over the centuries. Until the mid-20th century, separation was attempted only if:

The join was simple, unlikely to involve shared liver or other organs, and situated away from the head, heart or pelvis.
The children had already survived beyond the first few months.
Earliest separation

The first successful separation was in Basle, in 1689, of twins joined by a ligament just 2.5cm long and 12cm wide. Both survived.

19th-century surgery

In 1860, girls joined at the torso were separated by their father, a physician. Only one survived.

Paediatric advances in the last century

As paediatrics developed, so surgeons grew more daring. In 1955, Dr Rowena Spencer separated the newborn Duckworth twins 18 hours after birth, in order to save the life of the stronger twin. The girls had two upper bodies, but only one lower body, inside which were two kidneys, two bladders, two uteruses, and two or three vaginas. The survivor, Linda Duckworth, is still alive, and lives in Mississippi.

The liver was considered a risky prospect for separation, because of the danger of haemorrhage. In 1970, Mr Keith Roberts, a Birmingham surgeon, successfully separated Anna and Barbara Rozycki, joined at breastbone and liver. Both are still alive, Anna living with her parents, Barbara married with children.

21st-century practice

Separation nowadays is attempted far more frequently, but this in itself raises many medical, ethical, cultural and religious questions, as parents struggle to make the right choice for the long-term wellbeing of their children.

Conjoined Twins
Facts About Conjoined Twins

Births of conjoined twins, whose skin and internal organs are fused together, are rare. Conjoined twins occur once every 200,000 live births, and their survival is anything but assured.

Approximately 40 to 60 percent of conjoined twins arrive stillborn, and about 35 percent survive only one day. The overall survival rate of conjoined twins is somewhere between 5 percent and 25 percent.

For some reason, female siblings seem to have a better shot at survival than their male counterparts. Although more male twins conjoin in the womb than female twins, females are three times as likely as males to be born alive. Approximately 70 percent of all conjoined twins are girls.

How They Are Formed
Conjoined twins are genetically identical, and are, therefore, always the same sex. They develop from the same fertilized egg, and they share the same amniotic cavity and placenta.

Twinning occurs one of two ways: either a woman releases two eggs instead of the usual one or she produces only one egg that divides after fertilization. If she releases two eggs, which are fertilized by separate sperm, she has fraternal twins. When a single, fertilized egg divides and separates, she has identical or paternal twins.

In the case of conjoined twins, a woman only produces a single egg, which does not fully separate after fertilization. The developing embryo starts to split into identical twins during the first few weeks after conception, but stops before the process is complete. The partially separated egg develops into a conjoined fetus.

A History of Conjoined Twins
One of the earliest documented cases of conjoined twins were Mary and Eliza Chulkhurst. They were born in Biddenden, County of Kent, England in the year 1100, and were joined at the hip.

The wealthy sisters, who were known as the Biddenden Maids, lived for 34 years. When they died, they left a small fortune to the Church of England. In honor of their generosity, it was customary for English citizens to bake little biscuits and cakes in the sisters' images and give them to the poor.

Another set of famous conjoined twins was Eng and Chang Bunker, who were born in Thailand (then called Siam) in 1811. The term Siamese twins was coined as a reference to Eng and Chang, who achieved international fame shortly after leaving Siam as teenagers.

They were joined at the lower chest by a narrow band of flesh, which connected their livers. They were exhibited in circus shows around the world before settling in the United States, where they married two sisters and had nearly two dozen children. They were successful businessman and ranchers in Wilkes County, North Carolina, where they lived until 1874. They were 63 years old when they died.

The term Siamese twins is no longer considered appropriate. Conjoined twins aren't limited to any racial or ethnic group and indeed have been born all over the world.

Various Types of Conjoined Twins
There are nearly a dozen different types of conjoined twins. One of the most common classifications is thoracopagus twins. These twins are connected at the upper portion of the torso.

Thoracopagus twins share a heart, which, depending on how closely they are joined, makes it nearly impossible to separate them and save them both. Thoracopagus twins make up about 40 percent of all conjoined cases.

Another common type of conjunction is called omphalagus, where twins are connected from the breastbone to the waist. About 33 percent of all conjoined cases are categorized as omphalagus. These twins may share a liver, gastrointestinal or genitourinary functions, but rarely share a heart.

One of the rarest types of conjoined twins is craniophagus twins, which are joined at the cranium or head. In fact, only 2 percent of all conjoined twins are joined in this way.

Separating Twins: No Easy Matter
The surgical separation of conjoined twins is a delicate and risky procedure, requiring extreme precision and care. Therefore, the decision to separate twins is a serious one.

Mortality rates for twins who undergo separation vary, depending on their type of connection, and the organs they share. For example, twins joined at the sacrum at the base of the spine have a 68 percent chance of successful separation, whereas, in cases of twins with conjoined hearts at the ventricular (pumping chamber) level, there are ...


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