Howard Fischer
Uppsala, Sweden

“They were so close to each other that they preferred death to separation.”
– Gabriel García Márquez, One Hundred Years of Solitude

Eugène Louis Doyen, M.D. (1859–1916), was an internationally known Parisian surgeon. He was a “skilled and innovative physician,”¹ famous for his dexterity and the speed of his operations.² He wrote a three-volume surgical textbook, an anatomic atlas, as well as fifty other publications.³ He invented a dozen surgical instruments and pioneered the use of electrocoagulation in surgery. His interest in cinematography led to his arranging the filming of surgical procedures for the education of physicians.⁴

In 1902, he operated on conjoined twins Radhika and Dudhika, to save the life of the healthy twin (Radhika) by separating her from her severely ill sister.⁵ He is considered by some to have performed the first successful separation of conjoined twins.^6-8

The conjoined twin pair, Radhika (1888–1903) and Dudhika (1888–1902) Nayak were born in Orissa (now Odisha), India. They were considered a bad omen by their parents, who put them into the care of some sadhus (Hindu holy men). They were taken to England and then to the U.S. by a “Captain” Coleman, an entertainment promoter. They learned several European languages, were exhibited in circuses as the “Orissa twins,”⁹ and were considered doubly exotic because they were joined (at the thorax), as well as coming from South Asia.¹⁰

During a visit to Paris in 1902, Dudhika appeared seriously ill. She weighed 12 kg (her sister weighed 19 kg), had a fever of 39o C, and on examination Dr. Doyen palpated several abdominal nodules, which he suspected were tuberculous nodules.¹¹ A twenty-minute operation separated the girls. They were united by a skin-covered “bridge” containing liver tissue. The procedure was filmed.¹² Two days after the surgery, the twins were drinking liquids, but five days after that, Dudhika had a convulsion and died. An autopsy showed an embolism in the pulmonary artery and a pus-filled abdomen caused by a perforated tuberculosis-infected appendix.¹³ Radhika recovered and lived for twenty-one months after the surgery, and then died of tuberculosis.¹⁴

Conjoined twinning occurs in 1/50,000 to 1/200,000 pregnancies. About 50% of these pairs are stillborn, and another 30% die within twenty-four hours. It is thought that a fertilized egg splits only partially, producing two babies attached to each other. They may be joined at the skull, the abdomen, chest, or back, in varying combinations.¹⁵ Maternal age has no influence on the incidence of conjoined twins. No contributing genetic or environmental factors have been found. The twins are twice as likely to be girls than boys. There is an uneven geographic distribution of conjoined twin births—0.08/100,000 births in Northeast Italy, 3.22/100,000 births in Finland. Based on a study of 400 sets of conjoined twins in twenty-six million births, the overall worldwide incidence of conjoined twinning is 1.47/100,000 births.¹⁶ At various times and in different locations, “clusters” of births of conjoined twins have been reported—again, without discernible environmental causes.¹⁷

In the nineteenth century, conjoined twins were known as “Siamese twins” because a famous twin pair, Chang and Eng (1811–1874), were born in Siam (now Thailand). Their parents were of Chinese origin, so that in Siam, they were called “the Chinese twins.” After touring as an “exhibit” for ten years, they married American sisters, settled in North Carolina, and eventually had twenty-one children between them.¹⁸

Was Dr. Doyen the first to successfully separate conjoined twins? In 945 A.D. in the Byzantine Empire, an attempt was made to separate a living twin from his dead brother. After the separation, the living brother survived three days. In 1689, surgeon Johannes Fatio successfully separated conjoined twins. The report was written and published by physician Emanuel König in Germany.¹⁹

Physicians in France criticized the film Doyen made of the operation separating the conjoined twins, saying that the integrity of the medical profession had been “compromised.”²⁰ Worse, the photographer who filmed the procedure was exhibiting films of Doyen’s operations at fairs and sideshows. Doyen sued him,²¹ but the outcome of this suit is unknown. An American newspaper claimed that the films showing the separation surgery “on the Hindoo twins, Radica and Doodica…awakened a storm of disgust in Vienna.” The film, it said, shows “all the horrors of the dissecting [sic] room, and the dreadful contortions of the limbs under the knife.”²² It should be remembered that the operation was performed under chloroform anesthesia.

This article has covered some historic and medical aspects of conjoined twinning. Importantly, the emotional and social burdens that conjoined twinning produces for the twins and their parents should not be forgotten.

References

1. Eugène-Louis Doyen. Wikipedia.
2. Eugène Doyen. Wikipedia. fr.wikipedia.org.
3. NA. “Liste de Résultats. Doyen, Eugène Louis,” Bibliothèque numérique Médica, ND. archive.org.
4. Eugène-Louis Doyen. Wikipedia.
5. Marcus Lindsköld. “Att separera ett tvillingpar,” Lälartidningen, 119, 2022.
6. Ian Aird.”Conjoined twins – further observations,” BMJ, 1(5133), 1959.
7. Omar Sultan and Ahmed Tawfeek. “Conjoined twins- thoraco-omphalopagus (type A), BJR, 2(11), 2015.
8. Sidney Cywes and Cecil Bloch. “Conjoined twins: A review with a report of a case,” S Afr Med J, 38, 1964.
9. Radhika and Dudhika Nayak. Wikipedia.
10. Kristina Gaddy. “Dr. Doyen and the Hindu twins, Radica and Doodica,” 2016.kristinagaddy.com.
11. Lindsköld, “Att separera.”
12. Radhika and Dudhika Nayak. Wikipedia.
13. Lindsköld, “Att separera.”
14. Radhika and Dudhika Nayak. Wikipedia.
15. Conjoined twins. Wikipedia.
16. Osvaldo Mutchinick and Leonora Luna-Muñoz, et al. “Conjoined twins: A worldwide collaborative epidemiological study of the International Clearing House for Birth Defects surveillance and Research,” Am J Med Genet C Semin Med Genet, 4, 2011.
17. E Zake. “Case reports on sixteen sets of conjoined twins from a Uganda hospital,” Acta Genet Med Gemellol, 33, 1984.
18. Chang and Eng Bunker. Wikipedia.
19. Erwin Kompanje. “The first successful separation of conjoined twins in 1689: Some additions and corrections,” Twin Research, 7(6), 2004.
20. Eugène-Louis Doyen. Wikipedia.
21. NA. “Surgical photography,” Wyoming Democrat (Tunkhannock, PA), 1904.
22. NA. “Horrors of the cinematograph,” Watertown News (Watertown, WI), 1903.