Chapter III · (continued 2)

Human terata are now commonly classified in four groups: (1) Hemiteratic; (2) Heterotaxic; (3) Hermaphroditic; and (4) Monstrous. Hemiterata are giants, dwarfs, persons showing anomalies in shape, color, closure of embryonal clefts, in absence or excess of digits, or like defects. The Heterotaxic group are persons whose left or right organs are reversed in position. A true Hermaphrodite would have the complete reproductive organs of both sexes, but such an individual has not been observed. There is never any question of double personality in hermaphrodites.

Terata more properly so called may be single, double, or triple; and single monsters may be autositic or independent of another fetus, or they may be omphalositic, dependent upon another which is commonly well developed and which supplies blood for both through the umbilical vessels. There are four genera of autositic single monsters, with eight species and thirty-four varieties. Of the monstra per defectum the commonest are caused by a failure of closure in the embryonal medullary canal, which leaves part of the brain and spinal cord or their bony covering lacking. Some terata, as the Acephalia, have no brain or spinal cord, but they die in the fetal stage. The Anencephalia may have a spinal cord, a medulla oblongata, and parts of the basal ganglia, but the cerebral hemispheres are wanting. Such monsters are sometimes born at term and live for several days: they cry, suckle, show some reflexes and a sense of pain, and move the arms and legs.

I described the various kinds of terata in Essays in Pastoral medicine,[58b] and of these the most important in the matter under discussion here are the double and triple monsters. Many of the double monsters evidently were two persons. There is only one well authenticated case of a triple human monster, and this happened in Italy in 1831. It had a single broad body with three distinct heads and two necks, and was killed in delivery. There is no proof as to whether it was one or more persons. The standard of judgment in such cases as regards the presence of one or two souls in the monster is the evidence of one or more distinct consciousnesses. A monster double from the navel or breast downward (terata anadidyma) is, I think, one person. There was an example of a monster in this group which was divided from the foreheads downward; or better, the distinct twins were united by their foreheads only; but such a form is very exceptional. In my article on "Human Terata and the Sacraments," in Essays in Pastoral Medicine, in 1906, I expressed the opinion that a monster which is single to the navel and double below is composed of two persons, but I now am of the opinion that such a monster is only one person, because there is apparently only one consciousness. There are about eight cases of two-headed monsters known which were evidently two persons in each case, and several terata kata-anadidyma, divided above and below but joined at the sternum, abdomen or sacrum. Several ischiopagic twins, joined at the pelvis with the heads at the opposite ends of the double body, are grouped with either the katadidyma or kata-anadidyma. It is commonly not difficult to recognize individuality or duality of personality in monsters, but it is not easy to explain the origin of life, to point out the moment the second soul enters these fused or undivided twins.

We can artificially obtain double embryos of frogs by inverting the blastomeres in the two-cell stage.[58c] We thus get united twins with heads turned in opposite directions, twins united back to back like the Blazek Sisters, twins united by their ventral sides, and double-headed tadpoles, but we have no knowledge of how similar doubling in human monsters takes place; we must guess vaguely from analogy. There was one soul, at least, present from the one-cell stage of the human monster; when the second soul is created and infused we do not know, but the moment of the creation of this second soul has no practical significance in this discussion.

The presence of certain kinds of monsters in the uterus can be diagnosed before labor, but double monsters are mistaken for ordinary twins. A woman who has given birth to a monster is likely to have subsequent monstrous fetuses. Where the intrauterine existence of a single monster is suspected the X-ray will at times clear up the diagnosis. Women gravid with monsters commonly abort early in pregnancy, but even united twins may go on to term. Those monsters that offer an obstacle to delivery by the abnormal bulk of one or the other end are mostly twins joined above or below the navel; those joined at the middle are easier of delivery. Monsters that are joined at the pelves are commonly in a straight line, and may not be difficult to deliver. Most double monsters cannot be delivered alive except by cesarean section, and the fact that the content of the uterus is monstrous is, as a rule, not diagnosed until it is impossible to attempt cesarean section without killing the mother through infection. In such a condition the double monster would, in the ordinary medical practice, be delivered by craniotomy, exenteration, cleidotomy, or the like operation.

The Rituale Romanum Pauli V[59] gives the following directions for the baptizing of human terata:

"18. In monstris vero baptizandis, si casus eveniat, magna cautio, adhibenda est, de quo si opus fuerit, ordinarius loci, vel alii periti consulantur, nisi mortis periculum immineat.

"19. Monstrum, quod humanam speciem non praeseferat baptizari non debet; de quo si dubium fuerit, baptizatur sub hac conditione; Si tu es homo ego te baptizo, etc.

"20. Illud vero, de quo dubium est, una ne, aut plures sint personae non baptizetur, donee id discernatur: discerni autem potest si habeat unum vel plura capita, unum vel plura pectora; tune enim totidem erunt corda et animae, hominesque distincti, et eo casu singuli seorsim sunt baptizandi, unicuique dicendo: Ego te baptizo, etc. Si vero periculum mortis immineat, tempusque non suppetat, ut singuli separatim baptizentur, poterit minister singulorum capitibus aquam infundens omnes simul baptizari, dicendo: Ego vos baptizo in nomine Patris, et Filii, et Spiritus Sancti. Quam tamen formam in iis solum, et in aliis similibus mortis periculis, ad plures simul baptizandos, et ubi tempus non patitur, ut singuli separatim baptizentur, aliis nunquam, licet adhibere.

"21. Quando vero non est certum in monstro duas esse personas, ut quia duo capita et duo pectora non habet distincta; tune debet primus unus absolute baptizari, et postea alter sub conditione, hoc modo: Si non es baptizatus, ego te baptizo in nomine Patris, et Filii, et Spiritus Sancti."

Any kind of monster coming from the human womb, if it is only a head and lacks a body (Acardiacus Acormus), or is a body and lacks a head and heart (Acardiacus Acephalus), or is a Foetus Anideus, which is a shapeless mass of flesh covered with skin, should be baptized, provided it shows signs of life. Number 19 in the Ritual would be liable to an interpretation which is too narrow if it were not that very monstrous fetuses, which appear to a lay observer to be not human, are as a rule delivered dead. Here it may be worth while to mention that a hybrid between a human being and a lower animal is impossible. As to number 20, the rule for differentiating unity or duality of personality is not the number of heads, but the number of evident consciousnesses, and this differentiation commonly cannot be made at birth. There have been examples of two-headed monsters delivered alive, which were single as to soul because the consciousness evidently was one.