The unforgettable faces, the fine art of medical diagnosis (2)

The unforgettable faces
the fine art of medical diagnosis
(2)

Making 'ward rounds', doctors have uncovered genetic disorder, syphilis, murder and all manner of ills...

This was not a satire but a depiction of an individual with a specific disease...
The sunken eyes, the deformed hands, the unusual distance between her upper lip and nose, distorted nostrils....
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.

MASSYS, Quentin
The Ugly Duchess
1525-30
Oil on wood, 64 x 46 cm
National Gallery, London

MASSYS, Quentin
The Ugly Duchess (detail)
1525-30

A great face because of the noble way its possessor carries a physical deformity...
Intimate and moving Florentine Renaissance masterpiece: a boy with an aged Florentine patrician disfigured
by rhinophyma.
Ghirlandaio turns the ideal of Renaissance beauty upside down to reveal the heroism of disfigurement.

GHIRLANDAIO, Domenico
An Old Man and His Grandson
c. 1490
Tempera on wood, 62 x 46 cm
Musée du Louvre, Paris

(detail)
c. 1490
Tempera on wood, 62 x 46 cm

The boy’s happy expression and the jerky movement of the puppet of which he holds a picture...
this is the painting from which Dr Harry Angelman derived the now defunct name of Happy Puppet Syndrome
for children with Angelman’s syndrome.

CAROTO, Giovanni Francesco
Boy with a Puppet (A child
with a drawing)
first half of 16th century
Museo di Castelvecchio,
Verona

Boy with a Puppet (A child
with a drawing) (detail)
first half of 16th century
Museo di Castelvecchio,
Verona

Old man with sunken cheeks, his ear is almost bent double by the weight of his hat...
Whether Francesco Giamberti had giant cell arteritis is unknown, but his left superficial temporal
artery was unusually prominent.

PIERO DI COSIMO
Portrait of Francesco
Giamberti da Sangallo
1482 - 1485
Wood panel, 47,5 x 33,5 cm
Rijksmuseum, Amsterdam

PIERO DI COSIMO
Portrait of Francesco
Giamberti da Sangallo (detail)
1482 - 1485
Wood panel, 47,5 x 33,5 cm
Rijksmuseum, Amsterdam

The work may seem erotic but it is really meant to be a warning about the dangers of sexual disease...
The nude child "Pleasure" showers Venus and Cupid with rose petals oblivious from the thorn that pierces
his right foot. Clearly feels no pain, this is the condition tabes dorsalis and it is caused by tertiary syphilis.
In the left of the canvas a toothless man clutches head; his reddened fingers and patchy hair are
symptoms of syphilis.

BRONZINO, Agnolo
Venus, Cupid and Time
(Allegory of Lust)
1540-45

BRONZINO, Agnolo
Venus, Cupid and Time
(Allegory of Lust) (detail)
1540-45

The least poetic diagnosis for one of history's most enchanting beauties: high cholesterol...
The woman whom Italians call "La Gioconda" suffered from xanthelasma, the accumulation of cholesterol
under the skin, just around Mona Lisa's left eye as well as evidence of a lipoma, a fatty-tissue tumor, on her
right hand.

LEONARDO da Vinci
Mona Lisa (Portrait of Lisa
Gherardini, wife of Francesco
del Giocondo)
c. 1503-5
Oil on panel, 77 x 53 cm

LEONARDO da Vinci
Mona Lisa (Portrait of Lisa
Gherardini, wife of Francesco
del Giocondo) (detail)
c. 1503-5
Oil on panel, 77 x 53 cm

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LEONARDO da Vinci
Mona Lisa (Portrait of Lisa Gherardini, wife of Francesco del Giocondo)
The beauty of Mona Lisa comes as much from what the subject is hiding as what she reveals. Who is she looking at? What triggered that famous smile?
Is she even smiling at all?
Art historians have deduced in that singularly mysterious visage everything from a cross-dressing self-portrait of Leonardo da Vinci to the knowing
glance of an unfaithful wife to the satisfied pride of a pregnant woman.
Vito Franco of the University of Palermo, professor of pathological anatomyhas concluded that the Mona Lisa suffered from xanthelasma, as lipoma, a
fatty-tissue tumor, on her right hand.
As for "La Gioconda" , that enigmatic face will keep prompting new theories from its admirers. American neurological researchers have suggested that
her seemingly disappearing smile is an effect caused by the way the brain processes certain elements of light.

BRONZINO, Agnolo
Venus, Cupid and Time (Allegory of Lust
In the centre of the painting the viewer is drawn to the unmistakable figure of Venus. Entwined with her is the virile adolescent male figure with wings and quiver, Cupid – her son. The
undeniable sexuality of their embrace (cupid fondling his mother's breast and kissing her parted lips) has long been the subject of scandal and debate.
The puzzle of the remaining characters inhabiting the edges of the scene is far more difficult to decipher. However, an additional hypothesis is that they accurately portray the clinical
presentations of untreated syphilitic infection.
The figure in the top left of the picture represents "Oblivion" (depicted with a hollow head that cannot remember anything), is trying to draw a veil over the events below. With her
missing eyes and brain Bronzino may also be portraying the neurological consequences of untreated syphilis; characterized by optic nerve involvement and dementia associated with
general paresis of the insane.
Below Oblivion is the tortured figure of a man often interpreted to represent Jealousy. The character in fact displayed the clinical signs of secondary syphilis.
The figure is held in painful flexion, the periarticular nodal swelling of his fingers evident, pulling at his hair with signs of patchy syphilitic alopecia. In addition, a fingernail is missing,
consistent with syphilitic anchonia.
His ocular sclera are reddened, and his toothless gums show signs of a sero-sanguinous discharge and perhaps a gumma present on his lower palate.
Interestingly, his loss of teeth may be the result of the mercury poisoning, the established therapy for syphilis infection in Renaissance times.
In contrast to this tortured soul is the playful child to the right of the painting. His smiling face shows no sign of the trauma ensuing as a large rose thorn pierces through his right foot –
is this lack of sensation also the result of syphilitic myelopathy and nerve damage – Tabes dorsalis?

MASSYS, Quentin
The Ugly Duchess
She is one of the most popular paintings in the National Gallery, whose rather unfortunate looks inspired illustrations for Lewis Carroll's Alice's
Adventures in Wonderland.
The medical research shows that The Ugly Duchess was suffering from an advanced form of Paget's disease - osteitis deformans - which enlarged her
jaw bones, extended her upper lip and pushed up her nose. It also affected her hands, eye sockets, forehead, chin and collarbones.
Michael Baum, emeritus professor of surgery at University College London who, with his student Christopher Cook, investigated the portrait, is
convinced that the sitter would have been "a very powerful woman and may even have been a real duchess".
He said: "I reckon the artist was paid a princely sum to do it because who is going to buy a painting like that? Artists had to make a living."

A great face because of the noble way its possessor carries a physical deformity.
The old man is shown with uncompromising realism, the light coming from the right enabling the painter to detail the gray hair, the wart on the
forehead, the wrinkles around the eyes, and, especially, the nose deformed by rhinophyma.
Rhinophyma is a slowly progressive condition due to hypertrophy of the sebaceous glands of the tip of the nose often seen in cases of long-
standing acne rosacea; it is not a neoplasm.
It presents as a pink, lobulated mass over the nose with superficial vascular dilation; it mostly affects men past middle age.

Boy with a Puppet (A child with a drawing)
This is the painting from which Dr Harry Angelman derived the now defunct name of Happy Puppet Syndrome for children with Angelman’s
syndrome.
In the painting, the boy’s happy expression and the jerky movement of the puppet of which he holds a picture, reminded Angelman of the
behaviours exhibited by three young patients with the eponymous syndrome in his paediatric ward in Warrington, England.
Angleman’s syndrome, caused by a deletion of parts of chromosome 15, is a rare genetic disorder characterised by intellectual and
developmental delay, sleep disturbance, seizures, jerky movements (especially hand-flapping), and frequent laughter or smiling. It affects
approximately one in 20,000 children.

PIERO DI COSIMO
Portrait of Francesco Giamberti da Sangallo
Francesco Giamberti is painted in profile which gives a clear outline of the face offset against the background.
His face has signs of light gray stubble and we can see his left superficial temporal artery was unusually prominent.
Temporal arteritis, also known as Horton’s disease or giant-cellular ar-teritis, is a systemic immune-mediated vasculitis affectingmedium-sized to large-
sized arteries with a preference for cra-nial vessels—eminently the temporal branch of the carotidartery.
Its main signs and symptoms include headache, tonguenumbness, myalgia, fever, and anorexia/weight loss. Amongstits most terrible complications
are visual loss leading to blind-ness.

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