An apocryphal case of craniopagus parasiticus: the legend of Edward Mordake

Conjoined twins fused at the head, or craniopagus twins,occur with an approximate incidence of one in every 2.5million live births, and such twins represent only 2 to 6 % ofconjoinedtwins[10].Incraniopagusparasiticus,whichisalsoknown as epicome [3]orepicomus [8], a parasitic twin headwith an undeveloped or underdeveloped body is conjoined tothe head of the developed twin [7, 8], as in the case of the“two-headedboyofBengal”(Fig.1andCoverFigure)bornin1783[3].TheauthorsbrieflydiscusstheapocryphaltaleofanEnglishman afflicted with this condition, Edward Mordake(Fig. 2), who has been the subject of various works of art,includingMordake,anoperabythecomposerErlingWold[5],and “Chained Together for Life,” asongbythesinger-songwriter Tom Waits, which is featured on his album Alice[6].Mordake’slegendmayfindagreateraudienceamongfansof the cinematic genre of horror through the fourth season ofthe American television series American Horror Story,subtitled Freak Show. This season of the series is set in 1952in Jupiter, FL, and revolves around a troupe of carnival per-formers with various congenitalanomalies [9].The actorWesBentleyplaysthetwo-facedcharacterof“EdwardMordrake,”whom one of the show’s creators, Ryan Murphy, describes asa subject of superstition among carnival performers [9].Mordake’s predicament is detailed in the following passagefrom Anomalies and Curiosities of Medicine by Gould andPyle, which was first published in 1896 [4]:“One of the weirdestas well as most melancholy stories ofhuman deformity is that of Edward Mordake, said to havebeenheir to one of the noblest peerages in England. He neverclaimed the title, however, and committed suicide in histwenty-third year. He lived in complete seclusion, refusingthe visits even of the members of his own family. He was ayoung man of fine attainments, a profound scholar, and amusician of rare ability. His figure was remarkable for itsgrace, and his face – that is to say, his natural face – was thatof Antinous. But upon the back of his head was another face,thatofa beautiful girl, ‘lovelyasa dream,hideousasa devil.’The female face was a mere mask, ‘occupying only a smallportion of the posterior part of the skull, yet exhibiting everysignofintelligence,ofamalignantsort,however.’ItwouldbeseentosmileandsneerwhileMordakewasweeping.Theeyeswould follow the movements of the spectator, and the lipswould ‘gibber without ceasing.’ No voice was audible, butMordake avers that he was kept from his rest at night by thehateful whispers of his ‘devil twin,’ as he called it, ‘whichnever sleeps, but talks to me forever of such things as theyonly speak of in hell. No imagination can conceivethe dread-ful temptations it sets before me. For some unforgiven wick-edness of my forefathers I am knitto this fiend – for a fiend itsurely is. I beg and beseech you to crush it out of humansemblance, even if I die for it.’ Such were the words of thehaplessMordaketoManversandTreadwell,hisphysicians.Inspite of careful watching he managed to procure poison,whereof he died, leaving a letter requesting that the ‘demonface’mightbedestroyedbeforehisburial,‘lestitcontinuesitsdreadfulwhisperingsinmygrave.’Athisownrequesthewasinterred in a waste place, without stone or legend to mark hisgrave.”Gould and Pyle note that Mordake’scasewas“taken fromlaysources”butwas“ofsufficientnotorietyandinterest”tobe