October 5, 1957 – Surgeons Successfully Separate Conjoined Twins

Dr. C. Everett Koop teaching in a hospital in Japan, 1961. Photo: National Library of Medicine, The C. Everett Koop Papers

Dr. C. Everett Koop teaching in a hospital in Japan, 1961. Photo: National Library of Medicine, The C. Everett Koop Papers

On October 5, 1957, a team of surgeons and assisting medical staff successfully separated 9-day-old conjoined twins girls Pamela and Patricia Schatz.  The dramatic operation – only the fourth such procedure in the United States after which both twins survived – was accomplished at Philadelphia’s Children’s Hospital and lasted two hours and thirty-five minutes.  The fourteen-member team of medical experts included a urologist, a plastic surgeon, a neurosurgeon, two anesthetists, two doctors who gave blood transfusions to the twins, four nurses, two medical photographers (filming the surgery as a teaching and training resource), and lead surgeon (and future United States Surgeon General) Dr. C. Everett Koop, surgeon-in-chief at Children’s Hospital.

Pamela and Patricia were born joined together near the base of their spines.  Their surgery held a greater chance of success because they did not share any vital organs.   During the operation, the heart of the smaller twin, Pamela, stopped suddenly and Dr. Koop quickly made an incision in her chest and manually massaged her heart, while she received a transfusion of blood.  About six minutes later, Pamela’s heart started again and it became clear to attending physicians that she had been born with a congenital heart lesion.  She did not appear to suffer ill effects from her heart stoppage.  Dr. Koop explained to reporters that both Pamela and Patricia might need additional plastic surgery at their separation site.  When asked for the twins’ prognosis, Koop replied, “Fine, for the larger baby.  That of the smaller one depends completely on its heart, whose lesions would seem amenable to surgery later.”

The operation was reported by Philadelphia’s daily newspaper, the Inquirer, in an article which included background information about the history of other such conjoined twin surgeries in America.  The unnamed writer of the article explained, “Attempts surgically to separate Siamese [conjoined] twins have been confined largely to the last decade, when better anesthetics, more potent drugs, and new techniques combined to make such operations feasible.  Few of the attempts, however, have met with complete success.  Most of the twins involved – and there have been dozens of cases here and abroad in recent years – have died under surgery or lived only a few days afterward.  That was largely due to the fact that the twins shared one or more vital organs that could not be surgically divided.”

The professional expertise of Dr. Koop and his team at Philadelphia Children’s Hospital made it possible for Pamela and Patricia to survive and grow as separate individuals.  The followup surgery Koop mentioned for Pamela’s heart lesion became necessary when she was seven years old.  Sadly, tragically, she died five days after undergoing the open-heart procedure.  Her autopsy could give no explanation for her death.

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