Doctor's Review: Medicine on the Move

March 26, 2017
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The men with two faces

They say two heads are better than one, though not everyone would agree

What defines us as human beings? Some say our DNA, others say it really just comes down to our awesome opposable thumbs. Less literally, various thinkers have made the case that our deeds, our consciousness, our beliefs or even our very souls are what lie at the crux of who we are. But whether it be righteousness, reason, sentience or a sequence of nucleic acids that set us apart from the beasts, most scientists, theologians and philosophers would agree that our individuality is a crucial piece of the human puzzle.

The notion plays out physically as well as psychologically and spiritually. No two people among the many billions who have walked the face of the earth have ever looked exactly alike. Even twins – long believed to be identical in every way – are actually slightly different, recent research proves, from the tips of their fingers to their very DNA. It is perfectly natural, therefore, that the faces we see in the mirror and present to the world are intricately connected to our identities, our sense of self.

The way others perceive us, the judgments they attach and the impressions they form – though not necessarily accurate or even critical to our essential selves – often begin with our faces. Indeed, the eye-contact necessitated by face-to-face interaction is quite arguably the basis of human communication. Perhaps this is why the notion of a man with two faces is so troubling, and yet so simultaneously alluring.

The duplicated human face – and the duality of human nature – is a powerful image, something represented by Janus, the Roman god of beginnings, endings, transitions and time. The month of January was named for him – a time to anticipate the new year while simultaneously looking back to the old. Feline fanciers might also recognize his name in Janus cats; two-faced genetic marvels prized for their rarity and striking facial duplication. Technically, the condition in animals and humans is known as diprosopus.

The first mention of cranio-facial duplication in the literature is attributed to the great French surgeon, Ambroise Paré (1510-1590). He wrote of the condition in Of Monsters and Prodigies published in 1634. Diprosopus is basically an unusual form of symmetrical conjoined twinning with a degree of severity ranging from partial to virtually complete facial and cranial duplication.

Fortunately, it is exceedingly rare, especially in regards to complete diprosopus. The prevalence is considered be as low as one in 15 million, with a total of only 35 known cases. The vast majority of fully afflicted infants die either in utero or shortly after birth due to a range of other associated cardiac, CNS and respiratory anomalies. Those born with partial diprosopus fare much better – modern plastic surgery is always an option for those with an extra facial feature or two.

The two-faced duke

By far the most famous case of diprosopus is that of the probably apocryphal aristocrat Sir Edward Mordrake. The oldest reference to this dismal duke appears in 1896, in Anomalies and Curiosities of Medicine by George Gould and Walter Pyle. The story of the hapless fellow reads more as fairy tale than case study.

Edward was born the rightful heir of a highly distinguished (but unnamed) aristocratic family in the mid-19th century England. He was lovely in all regards – beautiful features, eloquent speech, talented musician – except for one: he was sported a complete and distinct human face on the back of his skull. The extra face (reported as either hideous or beautiful by various sources) was perfect in nearly every way, with moving eyes and life-like expressions, though it could not eat or speak clearly, apart from some maniacal laughing and wailing.

Edward’s doctors, Treadwell and Manvers, described the face as “occupying only a small portion of the posterior part of the skull, yet exhibiting every sign of intelligence, of a malignant sort, however.... It would be seen to smile and sneer while Mordrake was weeping.”

Understandably, this was a source of great distress for its host, and so Edward rejected his title, and locked himself away from all family and friends. Driven mad by the taunting visage he could never see, Edward claimed to his doctors that it: “never sleeps, but talks to me forever of such things as they only speak of in Hell. No imagination can conceive the dreadful temptations it sets before me. For some unforgiven wickedness of my forefathers I am knit to this fiend — for a fiend it surely is. I beg and beseech you to crush it out of human semblance, even if I die for it.”

Eventually, Edward poisoned himself at the age of 23. In his suicide note, he requested that his demonic twin be surgically removed post-mortem so that it would accompany him into the sweet hereafter. His request to be buried in a sewer was thoughtfully honoured by his family.

Despite the fondness of English aristocracy to record and research their peerage, no official birth or death record exists for poor Edward Mordrake. That’s not to say he was a figment of the public’s imagination, for really, who would claim him as their own? One lone photograph exists (from which several life-like wax renderings have been made) but despite the fact that it is said to be reliably dated to the end of the 19th century, the photo cannot be conclusively proved as either authentic or fake.

Sir Edward Mordrake lives on through legend, theatrical interpretations, wax and song, immortalized by singer Tom Waits so that future generations could revel in his misery forever. Interested parties will also have the chance to check out the latest version of the sad tale this coming fall, when Hollywood takes a stab at the story in a full-length feature film.

Other sufferers

While Edward Mordrake is probably the most famous case, other two-faced fellows have piqued the public curiosity over the years. One man, Chang Tzu Ping, rose to infamy in the 1980s after travelling from an obscure Chinese village to receive surgery in the US to remove his “Devil Face” – an extra mouth, snaggly teeth and a few other unidentifiable but superfluous features. Ping’s experience was beneficently relayed to the public via a spot on the television series, That’s Incredible.

Equally incredible was the case of circus performer Pasqual Pinon (1889–1929), a.k.a. Two-Headed Mexican, a man whose bulbous forehead protuberance (likely courtesy of neurofibromatoma or a benign cyst of some sort) was thoughtfully altered by side-show hustlers to make it appear more face-like, complete with eyes, mouth, nose and hair. But a true case of cranio-facial duplication it was not.

Similarly, the American-born Bill Dirks (1913-75) also had his disfigurement “enhanced.” Born with partial facial diprosopus, circus promoters painted on a third eye to drum up business. At the very least, he caught the eye of one lucky lady, Milly The Alligator-Skinned Woman, and eventually made an honest woman out of her.

In recent times, the most famous and legitimate case of a human with diprosopus is that of Lali Singh, an infant girl born near Delhi, India, in March of 2008. Not only was Lali extremely rare in that she survived her birth to breathe on her own, but she also had complete cranio-facial duplication – two sets of eyes, two noses and two mouths. Instead of being reviled and shunned, Lali was elevated to an even higher status, and believed to be the reincarnation of several Hindu deities. She died at two-months old following hospitalization due to dehydration related to feeding issues stemming from her cleft palate, and ultimately cardiac failure.

The human with two faces, it seems, calls into question not only what makes us unique, but also what darkness and mystery lurks within us all. The idiomatic duplicity of the two-faced man, the classic Jekyll and Hyde dichotomy, as well as countless other examples throughout our mythology, medicine and literature remind us that every one of us, while different from each other, are also different from ourselves. The face we present to the world is one; the other, the secret self, remains mostly hidden, knowable only to ourselves. Indeed, it seems we all have two faces of one kind or another.

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Comments

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  1. On July 9, 2014, robert mossberg said:
    Write more, thats all I have to say. Literally, it seems as though you relied on the video to maoe your point. You clearly know what youre talking about, why waste your intelligence on just posting videos to your site when you could be giving us something enlightening to read?

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