Siamese Twins

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Conjoined twins are always newsworthy, and these days with the advances in surgical techniques, they have a greater chance of independent survival. Conjoined twins are also known as Siamese twins but did they really come from Siam (the old name for Thailand)? In a way, yes, though the condition is not restricted to Siam.

The incidence in the world is about one in 400,000 births, though it is difficult to get exact figures. Stillborn Siamese twins have been disposed of and the mothers have remained ignorant of their anatomical problems. It is rumored that in Russia there was the case of conjoined twins that were kept in a pediatric institution and the mother told they had died at birth. There is still a lot of superstition surrounding Siamese twins, even in the present day.

I have personal experience of one pair of Siamese twins in Pattaya. These two girls had been separated, having been joined at the lower part of their bodies. Unfortunately, the parents did not have any money and although the operation had apparently been done for free, they were unable, or even perhaps unwilling, to continue follow up surgical care. I managed to find a farang sponsor and the two girls did get some further treatment, but then disappeared as quickly as they had come into view. They would be around 20 years of age today, if they have survived.

The major deciding factor in survival of Siamese twins is where the joining is, and how many common organs are shared. The most common varieties encountered are joined at chest and abdomen (28 percent), joined at chest (18.5 percent), joined at abdomen (10 percent), parasitic twins (10 percent) and joined at the head (6 percent). Of these, about 40 percent were stillborn, and 60 percent live born, although only about 25 percent of those who survived at birth lived long enough to be candidates for surgery.

Conjoined twins can occur in any country, but the most publicized conjoined twins did come from Siam, and gave the condition its original name. They were called Chang and Eng Bunker, born in the Mekong Valley to a Chinese father and a Thai-Chinese mother in 1811. Their surname came later after they had lived in America for some time, as in 1811 Siamese people did not have any family name. A law requiring Thai people to have a surname was not enacted until 1913 by King Vajaravudh, Rama VI.

In 1829, Chang and Eng were discovered in old Siam by a British merchant, Robert Hunter, and exhibited as a curiosity around the world. This was the fate of anyone who had some major deformity in those days, and live adult Siamese twins would have been very rare, with most never making it through childhood.

Chang and Eng were joined at the breast-bone (sternum) by a small piece of cartilaginous tissue. Their livers were fused but independently complete. Unfortunately, 19th century medicine did not have the diagnostic imaging equipment necessary or the surgical know-how to separate them. Modern advances in diagnostic and surgical techniques would have allowed them to be easily separated.

Upon termination of their contract with their discoverer, they successfully went into business for themselves, which is really quite amazing, considering their origin in rural Siam. In 1839, while visiting Wilkesboro, North Carolina, the twins were attracted to the town and settled there, eventually becoming naturalized United States citizens.

They had become wealthy, thanks to Robert Hunter and his world tours, so they settled on a plantation, bought slaves, and adopted the name “Bunker”. They were accepted as respected members of the community. On April 13, 1843, they married two sisters: Chang to Adelaide Yates and Eng to Sarah Anne Yates. Chang and his wife had ten children; Eng and his wife had twelve. The mechanical difficulties in procreation would have been even more of a problem than the mental acceptance of a strange four some in those more straight-laced days.

Unfortunately, the sisters squabbled and eventually two separate households were set up just west of Mount Airy, North Carolina — Chang and Eng would alternate, spending three days at each home. Domestic bliss? Or two women in the kitchen?

Joined in life, they died together in 1874.