TWIN-TO-TWIN TRANSFUSION—AN HISTORIC NOTE

¹ Long Island Jewish-Hillside Medical Center and Health Sciences Center of the State University of New York at Stony Brook, New Hyde Park, New York

Polycythmia as a result of twin-to-twin transfusion in monozygotic twins has only been recognized as a clinical entity in the last few decades. The first recorded case of polycythemia in the newborn due to twin-to-twin transfusion, however, was reported in the Bible: "And when her (Rebekah) days to be delivered were fulfilled, behold, there were twins in her womb. And the first came forth ruddy, all over like a hairy mantle; and they called his name Esau . . .". Genesis XXV, 24-26. A ruddy newborn twin is a clear description of polycythemia in the newborn presumably due to twin-to-twin transfusion. According to Hirsch,¹ despite the contrastrating differences between Esau and Jacob, they were identical twins with complete exterior similarity. Twin-to-twin transfusion occurs in 15% of identical twins. One may further speculate that because of the marked intellectual and emotional differences between Esau and his brother Jacob, that Esau's intellectual restrictions might very well have been evidence of brain damage due to cerebral sludging as a result of polycythemia or kernicterus due to uncorrected hyperbilirubinemia pursuant to polycythemia. ". . . nothing is new under the sun . . . . It has already been in the ages before us."²