Tlatilco double-faced figurines: the world’s oldest medical illustrations?

Were the world’s earliest medical illustrations made in ancient Mesoamerica?

A few days ago, while perusing the online catalogue of Norwich’s Sainsbury Centre for the Visual Arts, I stumbled upon a curious figurine fragment–a terracotta head with two faces and three eyes, the central eye being shared between the two faces (left). According to the catalogue, this figurine probably originated in Tlatilco, a large farming village that flourished in the Basin of Mexico between about 1200 and 200 BC. A little online snooping further revealed that double-faced figurines are a relatively common find at Tlatilco, and are thought to date to between 1200 and 700 BC–although it’s unclear how many of these figurines were excavated by looters and how many were unearthed by professional archaeologists, so I couldn’t get a sense of where in Tlatilco these figurines would have been found. It seems that ancient Tlatilcans (?) used to bury one-faced figurines under fields, perhaps believing they would make their crops grow faster–but there’s no word on where Tlatilcans placed two-faced figurines. So we don’t really know what these double-faced figurines mean, or how they were used.

Double faced head. Central America, Mexico, Tlatilco. Middle Pre-Classic period (1200-900 BC). Earthenware, traces of red pigment. h. 4.5 cm. Acquired 1973. Robert and Lisa Sainsbury Collection. UEA 136.

Fig. 1: Double faced head. Central America, Mexico, Tlatilco. Middle Pre-Classic period (1200-900 BC). Earthenware, traces of red pigment. h. 4.5 cm. Acquired 1973. Robert and Lisa Sainsbury Collection. UEA 136. Photo from the SCVA website.

BUT. I did come across this interesting theory, by one Gordon Bendersky (2000), that the Tlatilco double-faced figurines were the world’s earliest medical illustrations–and, more specifically, the world’s earliest medical illustrations of a rare congenital disorder known as diprosopus.

Science-wise, diprosopus is caused by the mutation of the “Sonic Hedgehog Homolog” protein (SHH), which controls facial expansion during foetal development. The way it works is that, if the SHH protein is longer than it should be, this leads to face duplication. However, there are many different possible lengths to which SHH can stretch, which means that, for example, particularly long SHH can lead to two fairly distinct faces, while slightly shorter SHH can lead to two faces that share a large central eye. There’s a whole spectrum of possibilities (Fig. 2).


Schematic representations of documented diprosopus cases (Bendersky 2000: 482).

Now, the interesting thing is that Tlatilco double-faced figurines seem to reflect this same spectrum of possible different types of facial duplication. In other words, double-faced figurines are not all the same (some have two very distinct faces, some have two faces that share a central eye, etc.), in exactly the same way that cases of diprosopus are not all the same (Fig. 3). It’s because of this that Bendersky believes they were medical illustrations of an actual anatomical phenomenon, rather than fanciful depictions of imaginary supernatural creatures.


Selection of Tlatilco double-faced figurines, ordered according to how distinct the two faces are (Bendersky 2000: 480).

You could say that the term “medical illustrations” is imprecise and anachronistic. The very idea that you can understand how the physical world works by poking and prodding it with science (and, as regards the human body, medicine) is a relatively recent one, and probably did not quite exist in ancient Tlatilco.

However, if these figurines are indeed depictions of diprosopus, they do suggest genuine curiosity and towards a natural anatomical phenomenon, and a compulsion to make sense of it through classification. This is the basis of a lot of scientific research–and it does make them a sort of flickering, short-lived example of “proto-science”, for lack of a better word.

NB A question some of you might have is, if diprosopus is a rare condition, how come it appears so frequently in Tlatilco art, and with sufficiently great variation that it’s probably many different cases being represented rather than the same two or three over and over again? It’s a good question, and Bendersky isn’t sure himself, although apparently “clusters” or “epidemics” of conjoined twins in modern times have been documented in a number of locations worldwide, from Wales to California, from China to Israel, so maybe a similar thing happened with diprosopus in Tlatilco. Also, it’s possible that, for cultural reasons, inbreeding was common in Tlatilco, making an otherwise rare condition like diprosopus more common than it normally is. However, it’s worth saying that no two-faced skeletons have been found at Tlatilco, in case you were wondering, although that may well be because the archaeological record was disturbed by looters–and/or because the remains of diprosopus individuals may have been treated in a special way that prevented them from being preserved properly, or made them very difficult to find (I should probably say now that diprosopus is normally incompatible with life, although I did hear of a pig born with two faces who survived to a relatively old age).


Suggestions for further reading/watching:

1. The Brain Scoop’s Emily Graslie and Anna Goldman have tackled diprosopus recently: check out their two-parter on the dissection of a two-faced calf here and here.

2. Gordon Bendersky was an interesting guy–he was a paediatric cardiologist and amateur historian/archaeologist of medicine, whose academic papers cover a motley array of subjects, from depictions of foetuses in Olmec art to depictions of epilepsy in Raphael’s paintings, from the use of saffron as medicine in the ancient Aegean to sports injuries in ancient Greece. You can read his New York Times obituary here.



Berensky, G. 2000. Tlatilco sculptures, diprosopus, and the emergence of medical illustrations. Perspectives in Biology and Medicine 43 (4): 477-501.

  1. Sylvia Notini said:

    Enri! Ciao! Unearthing is back, che bello!! Will read Now…

    Inviato da iPhone


  2. This is fascinating! Your comment about diprosopus usually leading to shorter lifespans makes me wonder about the sculptures, and if they are of adult faces vs children’s faces? Could the maturity of the subject of the sculpture provide insight into whether or not it was of a real person?

    • Thank you! The elaborate/long hairstyles may be meant to suggest that these are adults, or at least not newborns–but the fact that the figurines are so stylised makes ageing them difficult. Maybe Tlatilcans just didn’t have artistic conventions that allowed them to portray newborns realistically, or maybe they just didn’t think age was an important thing to convey. Or “fusing” their “study” of diprosopus with the same proportions and hairstyles we see in the propitiatory figurines they used to bury under fields made some sort of sense to them.

      Or, perhaps, the fact that these figurines don’t clearly depict babies should be taken to mean that these are NOT portrayals of diprosopus.

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