Never Alone At Last

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Shortly after the death of the twins, Dr. William Pancoast, of a family of famous Philadelphia physicians, requested the mayor of Philadelphia to telegraph the mayor of Greensboro, North Carolina, seeking permission for an autopsy. The mayor of Greensboro replied that he had no knowledge or power in the matter. A week after the death, Dr. Hollingsworth met in Philadelphia with Dr. Pancoast and Professor Samuel D. Gross, of Jefferson Medical College, and a letter was dispatched to the widows of Chang and Eng proposing that Dr. Pancoast come to embalm and examine the bodies. A commission consisting of Dr. Pancoast and Dr. Harrison Alien, famous anatomist of the University of Pennsylvania, with a Dr. Andrews as companion and aide, arrived in Mt. Airy on January 31, two weeks after the twins’ death.

At a conference with the widows, it was agreed that, as a consideration for embalming the bodies, permission would be granted to exhume and to examine the structure between them, provided that no incision be made that would impair the external surface of the band. Later a written agreement allowed the bodies to be taken to Philadelphia, if kept safe in a fireproof building.

Great and curious crowds of Carolinians gathered to help the commission exhume the bodies, which were carried to a large chamber for photographs and autopsy. The room was then cleared of all except the commission. The bodies were found well preserved, and embalming was begun. It was found that the aortas of both twins were marked by fatty degeneration—Chang’s so much so that the chloride of zinc used as an embalming agent had to be injected in the lower part of the abdomen rather than downward through the aorta. It was soon decided that a better autopsy could be done in Philadelphia. Back the bodies went into the coffin and into Gus Reich’s tin masterpiece and into an express car, and thence to the College of Physicians and Surgeons in Philadelphia. There they were placed under the care of the commission in the Mutter Museum and were closely locked and guarded.

At well-attended meeting of the College on February 18, the commission exhibited the bodies and demonstrated the findings. These indicated that the band of union connected the twins at the abdominal segment of the breastbone. It contained peritoneal pouches and an extension of liver substance from each abdomen. Vascular connections were sparse but colored plaster material injected into the portal circulation of Chang was found to flow into Eng’s portal vessels as far down as the lower abdominal cavity. The limitations imposed by the widows on the extent of the autopsy left certain anatomical features unclear. It was found that the lower pointed ends of the hearts “present toward each other.” The bladder of Chang, who died first, was found contracted and empty, while Eng’s was markedly distended with urine.

In discussions of his findings before the College, Dr. Pancoast made no statement as to the cause of Chang’s death but speculated about Eng’s: “Probably the valves of his heart were in a disorganized condition, and probably also the shock [of Chang’s death] upon that weakened organ caused death.”

Dr. Harrison Alien said, In my opinion, Chang died of a cerebral clot. From inquiry at his home, I was led to believe that the lung symptoms were not due to pneumonia; indeed, were not severe enough to have been so caused. The suddenness of the death, the general atheroma [fatty inner degeneration] of the arteries, and the fact that there has been previously an attack of cerebral paralysis, all indicated that the death was of cerebral origin. Eng probably died of fright as the distended bladder seemed to point to a profound emotional disturbance of the nervous system, the mind remaining clear until stupor came on,—a stupor which was probably syncopal [ i.e. , due to cerebral anemia]!

A modern medical man, Dr. Worth B. Daniels of Washington, D.C., has also speculated upon the cause of death. In a paper delivered before the American Clinical and Climatological Association, of which he is president, Dr. Daniels began by reviewing the known facts. Chang had severe atherosclerosis and had suffered a cerebral thrombosis. Five days before his death he developed a cough productive of frothy sputum and some chest pain. Chang’s death was so quiet it did not awaken Eng. This would indicate, Dr. Daniels thought, that Chang’s death was not due purely to the pulmonary edema.

“It was,” he said, using a succession of medical terms, “probably sudden as might occur with an abnormal rhythm. It appears to me that the diagnoses in Chang’s case were: (i) Xiphopagic twin. (2) Generalized atherosclerosis. (3) Coronary atherosclerosis. (4) Myocardial infarction. (5) Congestive heart failure with pulmonary edema. (6) Arrhythmia, probably ventricular fibrillation.”

Then he added: “In Eng’s case, I fully agree with Dr. Harrison Allen. Eng died of fright. If you doubt this try being joined to a dead, xiphopagic twinl”

Could the twins have been separated safely? Considering the medical conditions of the time, probably not. Efforts at separation prior to the introduction of anaesthesia and aseptic surgical techniques were fraught with great danger. Most such attempts resulted in the deaths of both twins. Frequently, even now, the connecting structures are so vital to the survival of both individuals that separation is still hazardous. This is particularly true when the union involves the heads and brain or brain coatings and the spine or the covering of the spinal cords.