The Face, a dialogue between art and illness.ppsx

A medical look at the paintings ...

2. The Face
a dialogue between art and illness

4. A medical look at the paintings …

5. From The Birth of Venus by Botticelli to Mona Lisa by da Vinci
through
The Parable of the Blind by Bruegel the Elder and An Old Man and His Grandson by Ghirlandaio

6. Sandro Botticelli
The Birth of Venus
La Naissance de Vénus
El nacimiento de Venus
1482-1485
Uffizi Gallery, Florence

7. A subtle, deliberate asymmetry in Venus's eyes …
Botticelli depicted something really unexpected.
The naked Venus is covering herself for modesty, not because she is ashamed like Eve.
She is just born and stands in a giant scallop shell
Of course, she can be born fully grown because she is a goddess,
but …
her eyes are not perfectly aligned !
Medical Connection
... an ocular divergence considered a “charming default” :
this detail is often interpreted as a manifestation of her beauty and grace,
or as a way the artist evokes a beauty that is both earthly and celestial,
inspired by his muse, Simonetta Vespucci.
Historical context
Some studies have even suggested that Simonetta Vespucci herself may have had a medical condition (a pituitary adenoma)
that could have affected her features, potentially influencing Botticelli's portrayal.

10. Michelangelo Michel-Ange
The Delphic Sibyl
La Sibylle de Delphes
La Sibila Délfica
1509
Sistine Chapel, Vatican City

11. A solitary median maxillary central incisor in the Sistine Chapel’
Unwinding a scroll with her left hand, the Delphic Sibyl seems to be turning toward the viewer.
An accurate analysis of this fresco has shown the presence of
an anomaly on maxillary dental arch: a single incisor tooth is present precisely in the midline.
Medical Connection
In Michelangelo’s fresco, the central incisor appears completely erupted,
precisely located in midline and other visible teeth appear well aligned.
In conclusion,
available data suggest a case of solitary median maxillary central incisor rather than a mesiodens.
This anomaly, though a small detail, highlights Michelangelo's meticulous interest
in the human body and his commitment to depicting even the smallest anatomical elements
in his work.

14. Jan Joest of Kalkar Follower of
The Adoration of the Christ Child
Adoration du Christ Enfant
La adoración del Niño Jesús
1515
Metropolitan Museum of Art, Manhattan, New York City

15. An Angel With Down Syndrome in a Sixteenth Century Flemish Nativity Painting ...
The Holy Family, earthly admirers, and angels.
An angel next to and above Mary, seems to have features consistent with Down syndrome:
a flattened midface,
epicanthal folds,
up slanted palpebral fissures,
small and upturned nasal tip
The shepherd in the center behind the angels also has an unusual appearance
that is indicative of Down syndrome: up slant of the palpebral fissures
with some degree of ptosis
Medical Connection
These features could be suggestive for Down syndrome,
as well as for hypothyroidism which was frequent in this historical period.

18. Pieter Bruegel the Elder Pieter Brueghel l'Ancien
The Parable of the Blind
La Parabole des aveugles
La parábola de los ciegos
1568
Museo di Capodimonte, Naples

19. The title of the work refers to Christ's parable addressed to the Pharisees:
"Leave them; they are blind guides. If the blind lead the blind, both will fall into a pit.” Matthew 15:14
Six blind men, each appearing to suffer from a different cause of blindness.
Medical Connection
From a medical point of view, the precision of Brueghel's painting allows us to diagnose some of the blind men in the painting.
The first blind man has already fallen into the pit, and we cannot see his eyes.
The second has bilateral enucleation of the eyeballs.
The third blind man has corneal leukoma.
The fourth blind man shows signs of severe phthisis bulbi.
The fifth blind man wears a hat that hides his eyes.
The sixth blind man shows signs of suffering from cataracts.

22. Jan van Eyck
The Arnolfini Portrait
Les Époux Arnolfini
El matrimonio Arnolfini
1434
National Gallery, London

23. This must be one of the most famous and intriguing paintings in the world ...
A richly dressed man and woman stand in a private room.
They are probably Giovanni di Nicolao di Arnolfini,
an Italian merchant working in Bruges, and his wife.
Medical Connection
The abnormal facial morphology of Arnolfini,
Hertoghe's sign (loss of outer eyebrow),
bilateral ptosis (drooping eyelids),
forehead melasma (skin discoloration),
and
the reason why he is wearing lavish and heavy clothes
(particularly as the painting is likely in the summer as the trees outside are bearing summer fruits)
have led to the hypothesis that the subject may have been suffering from hypothyroidism.

26. Juan Carreño de Miranda
Eugenia Martínez Vallejo, desnuda
Eugenia Martínez Vallejo, nude
Eugenia Martínez Vallejo, nue
1680
Museo del Prado, Madrid

27. A six-year-old girl …
Brought to court to be presented to the king because of her unusual appearance,
the king was enchanted by her presence.
At palace parties, the ladies wanted to have their portraits taken alongside her
to compare the slenderness of their figures with those of the girl.
To soften the appearance of the “Naked Monster,” the girl is depicted as the god Bacchus,
with various attributes alluding to wine.
Medical Connection
Studies associate her obese appearance with Prader-Willi syndrome, a genetic disorder.
Its symptoms include hypotonia, hypogonadism, developmental delays, and obesity.

29. Jusepe de Ribera
Le Pied-bot
El pie varo, El patizambo
The Clubfoot, The Club-Footed Boy
1642
Musée du Louvre, Paris

30. Smiling and engaging the viewer ...
a Neapolitan beggar boy with a typical equinus clubfoot;
a contorted right hand and wrist.
Proudly holds a paper permitting him to beg
and carries a crutch over his left shoulder, striking a proud,
confident pose similar to a conquering hero.
Medical Connection
Gummy smile.
The specific cause of the boy's clubfoot has been a subject of debate.
Hemiplegia Hypothesis suggests the clubfoot is a result of cerebral palsy,
causing hemiplegia and speech difficulties, supported by the contorted hand and wrist.
Arthrogryposis Hypothesis proposes that the condition is due to arthrogryposis,
a non-progressive contracture of multiple joints.

33. Quinten Matsys, Quentin Metsys
The Ugly Duchess as A Grotesque Old Woman
La Duchesse laide ou Vieille femme grotesque
La duquesa fea
1513
National Gallery, London

34. She brazenly challenges every traditional canon of beauty and rule of propriety ...
the sunken eyes,
the unusual distance between her upper lip and nose,
distorted nostrils
enlarged jaw
the deformed hands
The face that has something of the wild animal about it-the lion; typical face has been called by clinicians facies leontina,
as seen infrequently in patients with Paget's disease.
Medical Connection
A advanced form of Paget’s disease or historically osteitis deformans.

36. José de Ribera
The Bearded Lady or Magdalena Ventura with Her Husband and Son
La Femme à barbe ou Magdalena Ventura avec son mari et son fils
La mujer barbuda, Magdalena Ventura con su marido)
1631
Museo del Prado, Madrid

37. Standing upright, it stares intently into our eyes,
questioning us about the causes of this strange phenomenon.
The viewer, lacking answers, is overwhelmed by an unexpected situation,
which provokes a mixture of curiosity, surprise, and horror.
Baroque in all its splendor.
The painting is disturbing:
from a dark background emerges the figure of the bearded woman, standing, holding a child at her breast.
Above her right shoulder, the figure of her husband appears, like a shadow.
Medical Connection
According to all the symptoms, it is a case of hirsutism, probably caused by the presence of an adrenal tumor.

39. Rembrandt
Portrait of Gerard de Lairesse
Portrait de Gérard de Lairesse
Retrato de Gérard de Lairesse
1665-1667
Metropolitan Museum of Art, Manhattan, New York City

40. Steadfast dignity of a 25-year-old man with facial deformities …
saddle nose, a collapsed bridge of the nose,
frontal bossing, a pronounced, large forehead,
short maxilla, a shortened upper jaw, causing a relatively protruding jaw
Medical Connection
in the absence of serological backup, but so true were the eye and hand of Rembrandt
that the portrait could well serve as an illustration for Sir William Osler’s
description of the stigmata of late congenital syphilis.
De Lairesse, who was born with the disease, also eventually went blind,
which further supports the medical diagnosis that the stigmata visible in the 1665 portrait
are due to Congenital syphilis.

42. Pieter Bruegel the Elder Pieter Bruegel l'Ancien
The Adoration of the Kings
L'Adoration des mages
Adoración de los magos
1564
National Gallery, London

43. The Virgin Mary sits with the Christ Child on her knee,
peasants, soldiers, spectators
and ...
the three Magi presenting their gifts: Balthazar stands, Caspar kneeling
and
Melchior with his bilateral facial drooping, partial ptosis and premature frontal balding,
all features of myotonic dystrophy
Medical Connection
Myotonic dystrophy type 1, the most common form of muscular dystrophy in adults,
is an inherited, autosomal dominant disease characterized mainly
by myotonia (sustained muscle contraction),
progressive muscle weakness (especially of distal limbs, the neck, and the face),
muscle wasting ...

45. Giovanni Lanfranco
St Luke Healing the Dropsical Child
Saint Luc guérissant
 un enfant hydropique
San Lucas cura al niño hidrópico
1620
Galleria Nazionale di Arte Antica, Palazzo Barberini, Roma

46. A dropsical Child at Palazzo Barberini …
Saint Luke turns his eyes to heaven, as if imploring divine help
to cure the case presented to him:
child 2-3 years of age
with intensely cyanotic lips and eyelids,
a very prominent, clearly swollen belly-ascites.
Medical Connection
It could have been heart failure of congenital origin, given the child's young age.
Some authors have proposed the diagnosis of kala-azar, a visceral leishmaniasis
that presents with hepatosplenomegaly (with severe abdominal distension),
fever, anemia.

48. Rogier van der Weyden
The Descent from the Cross
La Descente de Croix
El descendimiento de la cruz
1436
Museo del Prado, Madrid

49. A powerful, empathetic, and raw depiction of death and mourning ...
The figures exhibit extreme sorrow through both their faces and their slumped, bent postures.
Mary has fainted.
Joseph of Arimathea wraps Jesus Christ in a sheet.
Nicodemus holds the body.
Mary Magdalene and Saint John, Mary Salome, sister of the Virgin, and Mary of Cleophas,
as recounted in the Gospels, are also present when Christ is taken down from the cross.
Medical Connection
María has a feature that catches our attention. A large, rounded mass occupies a large part of her neck. A goiter, no doubt.
Less obvious is María Salomé's goiter.
The presence of this pathology in two of the figures in Van der Weyden's work
is evidence of the high incidence of thyroid disorders in his time, especially among women.
Perhaps a diet lacking in iodine was one of the causes.

52. Titian Titien
Portrait of Charles V seated
Portrait de Charles V
Retrato de Carlos V sentado
1548
Alte Pinakothek, Munich

53. The Habsburg jaw of Charles that has been skillfully concealed …
Charles V, Holy Roman Emperor seated on a chair facing the viewer,
zygomatic bone deficit (cheekbone)
sunk upper lip
prominent lower lip
very open gonial angle
Medical Connection
Mandibular prognathism.
Charles V was unable to speak clearly or even close his mouth.
Legend has it that when he toured Spain in 1530 a peasant shouted:
"Your Majesty, shut your mouth, the flies of this country are very insolent."

55. Juan Carreño de Miranda
Carlos II
King Charles II of Spain
Charles II d'Espagne
1680
Museo del Prado, Madrid

56. Melancholic expression, fragile and childlike appearance …
Charles II
with his Golden Fleece on his chest
and
with the classic feature of the “Habsburg jaw,” making it difficult for him to chew and speak
and
with his physical and mental condition deteriorated by the inbred marriages of the Habsburg family,
Medical Connection
A pronounced prognathism, a deformity of the jaw, prominent and protruding
from its normal position.
An everted lower lip, also known as a ‘Habsburg lip’.
It is suggested a combination of rare genetic disorders:
infertility, testicular dysfunction, hypogenitalism, eunuchoid appearance.

58. Piero della Francesca
Portraits of the Duke and Duchess of Urbino or The Duke and Duchess of Urbino
Double Portrait des ducs d'Urbino ou Le duc et la duchesse d'Urbino
Díptico de los Duques de Urbino
1472
Uffizi Gallery, Florence

59. Federico da Montefeltro: the most famous nose in Italy and the first rhinoplasty …
Both of them are portrayed in profile, in a position that remember the one of the medals, where the figures are very solemn.
This painting is world-renowned because it highlights Federico’s profile,
and above his very singular nose:
we can see that a part of it is missing! What happened to Montefeltro?
Around 1450 he took part to a tourney: here he was injured with a lance and he lost his right eye.
According to the legend, he said: «Patience, I’ll see better with one eye than with a hundred!».
So, he decided to cut the upper part of his nose away, in order to see better with his left eye.
Probably this nose is one of the most famous in history,
because of the empty space that we see in the profile painted by Piero.
Medical Connection
Nasal deformity, and maybe the first nose job that we know about.

61. Jan van Eyck
Virgin and Child with Canon van der Paele
La Vierge au chanoine Van der Paele
La Virgen del canónigo Van der Paele
1434-1436
Groeningemuseum, Bruges

62. Temporal arteritis of Canon Van der Paele …
Virgin and Child flanked by Saints Donatian and George,
with Saint George presenting the Virgin to Canon Joris Van der Paele
It is surprising how realistically Van Eyck portrays the donor, whose face shows signs of certain pathologies:
giant cell arteritis in the temporal region,
an intradermal nevus in the crease of the cheek,
and an epidermoid cyst on the lobe of the left ear.
The awkwardness with which the canon holds his breviary suggests weakness in his left arm,
possibly due to pain in his arm and shoulder.
Medical Connection
Giant cell arteritis, or temporal arteritis, is an inflammation of the blood vessels,
particularly the temporal artery.
It is probably caused by a faulty immune response and is often associated with polymyalgia rheumatica.
It causes pain in the jaw area and arm.

65. Domenico Ghirlandaio
An Old Man and His Grandson
Le Portrait d'un vieillard et d'un jeune garçon
Un anciano con su nieto
1490
Musée du Louvre, Paris

66. Alopecia, wrinkles, sparse eyebrows, an intradermal nevus, deformed nose …
None of this detracts from the dignity and wisdom of the elderly, or the affection of the child.
A large, prominent nose is clearly a clinical case of rhinophyma.
Of all the depictions of skin diseases in works of art, this is perhaps the most paradigmatic and the one most commonly cited.
Medical Connection
Rhinophyma is considered a severe form of rosacea, in which the skin of the nose thickens,
appears reddened, with telangiectasias and occlusion and hypertrophy of the sebaceous glands,
which form nodules and cysts.

It usually affects men between the ages of 50 and 70 and is chronic in nature.
In addition to rhinophyma, the old man also has an intradermal nevus in the frontotemporal area.

69. Léonard de Vinci
La Joconde
1503-1506
Musée du Louvre,Paris

70. One of the most famous gazes in art history.
No matter where we look at her from, she always returns her enigmatic gaze.
Perhaps this Florentine lady, who observes us directly, regardless of our angle,
is happy to receive our visit.
Lisa Gherardini, wife of Il Giocondo.
On her head she wears a veil, a sign of chastity and a frequent attribute in portraits of wives.
Medical Connection
The Mona Lisa's medical history has accumulated diagnoses from almost every medical specialty.
This is what happens when your portrait is publicly exposed to the opinions of doctors …

71. they may say
that you are pregnant or that you suffer from ovarian failure;
that you have the after-effects of facial paralysis;
that you are missing teeth or that they have been damaged by anti-syphilis treatments
and that is why you don't dare to smile openly;
because of this, or because the bruxism you suffer from stress prevents you from doing so;
stress that may have caused alopecia;
that your cholesterol is sky-high;
you are diagnosed with progressive muscular atrophy;
you suffer from severe respiratory failure;
or even that you've been drinking too much.
Impressive!
Such a cluster of pathologies seems quite unlikely in the apparently young woman who posed for Leonardo.

74. The Face: a dialogue between art and illness
Le visage: un dialogue entre l'art et la maladie
El rostro: un diálogo entre el arte y la enfermedad
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