Charles Creighton and Peter Chalmers Mitchell

“ More usually the union in the pelvic region is complete, and produces the most fantastic shapes of two trunks (each with head and arms) joining below at various angles, and with three or four lower limbs extending from the region of fusion, sometimes in a lateral direction, sometimes downwards. A very curious kind of double monster is produced by two otherwise distinct foetuses joining at the crown of the head and keeping the axis of their bodies in a line. It is only in rare instances that double monsters survive their birth, and the preserved specimens of them are mostly of foetal size. ”

“ That economical adaptation of a portion of a vesicular organ, originally formed for purposes of communication between the embryo and the mother, appears to entail sometimes a defect in the wall of the abdomen just above the pubes, and a defect in the anterior wall of the bladder itself. This is the distressing congenital condition of fissure of the urinary bladder, in which its interior is exposed through an opening in the skin; the pubic bones are separated by an interval, and the reproductive organs are ill-formed ”

“ Acardiac and Acranial Monsters.—It sometimes happens in a twin pregnancy that one of the embryos fails to develop a heart and a complete vascular system of its own, depending for its nourishment upon blood derived from the placenta of its well-formed twin by means of its umbilical vessels. It grows into a more or less shapeless mass, in which all traces of the human form may be lost. Other viscera besides the heart will be wanting, and no head distinguishable; the most likely parts to keep the line of development are the lumbar region (with the kidneys) , the pelvis, and the lower limbs. ”

“ In zoology, monsters or monstrous births are the subject of Animal Teratology, a department of morphological science treating of deviations from the normal development of the embryo. The term “embryo” is conventionally limited, in human anatomy, to the ovum in the first three months of its intra-uterine existence, while it is still developing or acquiring the rudiments of its form, the term “foetus” being applied to it in the subsequent months during which the organism grows on the lines of development already laid down. ”

“ From the most intelligible form of double monstrosity, like the Siamese twins, there are all grades of fantastic fusion of two individuals into one down to the truly marvellous condition of a small body or fragment parasitic upon a well-grown infant—the condition known as foetus in foetu. These monstrosities are deviations, not from the usual kind of twin gestation, but from a certain rarer physiological type of dual development. In by far the majority of cases twins have separate uterine appendages, and have probably been developed from distinct ova ”

“ The nervous system at its beginning is a neural canal, not only as regards its bony covering, but in its interior; a wide space lined by ciliated epithelium and filled with fluid extends along the axis of the spinal cord, and expands into a series of chambers in the brain. ”

“ There are generally mere traces of the brain, although, in some rare and curious instances, the hemispheres are developed in an exposed position on the back of the neck. The cranial nerves are usually perfect, with the exception sometimes of the optic (and retina) . Vegetative existence is not impossible, and a brainless monster has been known to survive sixty-five days. The child is usually a very large one. ”

“ The normal proportions of the frame are adhered to more or less closely, except in the skull, which is relatively small; but accurate measurements, even in the best-proportioned cases, prove, when reduced to a scale, that other parts besides the skull—notably the thigh-bone and the foot—may be undersized though overgrown. In persons who are merely very tall the great stature depends often on the inordinate length of the lower limbs; but in persons over 7 ft. the lower limbs are not markedly disproportionate. ”

“ Symmetrical Double Monsters are subdivided according to the part or region of the body where the union or fusion exists—head, thorax, umbilicus or pelvis. One of the simplest cases is a Janus head upon a single body, or there may be two pairs of arms with the two faces. Again, there may be one head with two necks and two complete trunks and pairs of extremities. Two distinct heads (with more or less of neck) may surmount a single trunk, broad at the shoulders but with only one pair of arms. ”

“ Monstrosities in a Single Body.—The abnormality may extend to the body throughout, as in well-proportioned giants and dwarfs; or it may affect a certain region or member, as—to take the simplest case—when there is a finger or toe too many or too few. It is very common for one malformation to be correlated with several others, as in the extreme case of acardiac monsters, in which the non-development of the heart is associated with the non-development of the head, and with other radical defects.
Giants are conventionally limited to persons over 7 ft. ”

“ The Siamese twins are an instance of union at the umbilical region, with the viscera distinct in every respect except a slight vascular anastomosis and a common process of peritoneum; but it is more usual for union in that region to be more extensive, and to entail a single set of abdominal and thoracic viscera. The pelvis is one of the commonest regions for double monsters to be joined at, and, as in the head and abdomen, the junction may be slight or total. The Hungarian sisters Helena and Judith (1701–1723) were joined at the sacrum, but had the pelvic cavity and pelvic organs separate ”

“ The fusion, again, may be from the middle of the thorax downwards, giving two heads and two pairs of shoulders and arms, but only one trunk and one pair of legs. In another variety, the body may be double down to the waist, but the pelvis and lower limbs single. The degree of union in the region of the head, abdomen or pelvis may be so slight as to permit of two distinct organs or sets of organs in the respective cavities, or so great as to have the viscera in common ”

“ Although monstrosities, both in the human species and in other animals, tend to repeat certain definite types of erroneous development, they do not fall readily into classes. The most usual grouping (originally suggested by G. L. L. Buffon, 1800) is into monstra per excessum, monstra per defectum, and monstra per fabricam alienam. It seems useful, however, to place the more simple cases of excess and of defect side by side, and it is necessary, above all, to separate the double monsters from the single, the theory of the former being a distinct chapter in teratology. ”

“ As development proceeds the walls thicken at the expense of the internal spaces, the original tubular or chambered plan of the central nervous system is departed from, and those organs assume the practically solid form in which we familiarly know them. ”

“ The lower jaw is sometimes wanting in cyclopeans; the cheek-bones are apt to be small, and the mouth a small round hole, or altogether absent; the rest of the body may be well developed. The key to the cyclopean condition is found in the state of the brain. ”

“ If, however, the spaces persist in their embryonic proportions notwithstanding the thickening of the nervous substance forming their walls, there results an enormous brain which is more than half occupied inside with fluid, contained in spaces that correspond on the whole to the ventricles of the brain as normally bounded. ”

“ Injuries to the mother during pregnancy have been unquestionably the cause of certain malformations, especially of congenital hydrocephalus. The embryo itself and its membranes may become the subject of inflammations, atrophies, hypertrophies, and the like ”

“ The pelvis and pelvic viscera share in the abnormality. A much more common and harmless case of unseparated symmetrical parts is where the hand or foot has two, three, or more digits fused together. This syndactylous anomaly runs in families.
Limbs Absent or Stunted.—Allied to these fused or unseparated states of the extremities, or of parts of them, are the class of deformities in which whole limbs are absent, or represented only by stumps. The trunk (and head) may be well formed, and the individual healthy ”

“ Monstrosities in man and animals have attracted attention since the earliest times, and amongst primitive and uncivilized peoples have been regarded as of supernatural origin. Aristotle himself appears to have been the first to examine them as a naturalist, and to explain that although they were outside the usual course of nature they were in the strictest sense of natural origin. ”

“ Evidence accumulates, however, that at least in all the higher vertebrates, including man, the sex is predetermined in the fertilized ovum, and it is more than doubtful if true hermaphroditism occurs. ”

“ Those who believed that the normal process of development was an unrolling and expansion of a pre-formed miniature of the adult had to apply a similar theory to monsters, and Sylvain Regis, a contemporary of Malbranche, obtained acceptance of his view that monstrous germs as well as normal germs had been created at the beginning of the world. ”

“ The myths of siren, satyr, Janus, cyclops and the like, with the corresponding figures in Northern mythology, find a remote anatomical basis in monstrosities which have, for the most part, no life except in the foetal state. The mythology of giants and dwarfs is, of course ”

“ In the middle ages they were treated in the fullest spirit of superstition, and many relics from such a point of view still survive. The human monstrosities were regarded as having been engendered in women by the devil who had commerce with them either in his own form or in the guise of some animal. ”

“ Amongst human beings the greater number of so-called hermaphrodites are really females, in which there is an abnormal development of the clitoris, but it also happens that true males may be born with a small clitoris-like penis, with hypospadia—that is to say, with imperfect urethra, open on the ventral side, and with undescended testes. ”

“ These last pass by a most interesting transition into common forms of congenital. sacral tumours (which may be of enormous size) , consisting mainly of one kind of tissue having its physiological type in the curious gland-like body (coccygeal gland) in which the middle sacral artery comes to an end. The congenital sacral tumours have a tendency to become cystic, and they are probably related to the more perfect congenital cysts of the neck region, where there is another minute gland-like body of the same nature as the coccygeal at the point of bifurcation of the common carotid artery. ”

“ The belief still to be found amongst uneducated persons that unnatural union between women and male animals, or between men and female animals, may be fertile and produce monsters, is an attenuated form of the satanic legend. ”

“ Where the supernumerary digits are more than one on each extremity, the whole set are apt to be rudimentary or stunted; they look as if two or more of the embryonic buds had been subject to cleavage down the middle and to arrest of longitudinal growth. ”

“ But it is by defect in the middle line that the mischief manifests itself, and it is in that anatomical category that the malformations are included. The osseous deficiency at the crown of the head is usually accompanied by want of the scalp, as well as of the brain and membranes. The bones of the face may be well developed and the features regular, except that the eyeballs bulge forward under the closed lids ”

“ That initial defect would carry with it naturally the undivided state of the cerebrum, and with the latter there would be the absence of olfactory lobes and of a nose, and a single eyeball placed where the nose should have been. A cyclops has been known to live for several days. The monstrosity is not uncommon among the domestic animals, and is especially frequent in the pig. ”

“ Their size is sometimes excessive at birth, but more often the indications of great stature do not appear till later, it may be as late as the ninth year; they attain their full height before the twenty-first year. They have been more frequently male than female. ”