The unforgettable faces, the fine art of medical diagnosis (1)

The unforgettable faces
the fine art of medical diagnosis
(1)

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

Las Meninas, art and genetic disorder...
Infant Margaret of Austria, Albright Syndrome: a typical Café-au-lait skin pigmentation on the face, eyes are
prominent and telarquia as part of precocious puberty.
Maria Barbola, achondroplasia: a typical large head, bulging forehead and short limbs.
Nicolaus Pertusato, pituitary nanisms: short stature (dwarfism), prominent forehead, depressed nasal bridge,
underdevelopment of mandible.

VELÁZQUEZ, Diego Rodriguez
de Silva y
Las Meninas
1656-57
Oil on canvas
Museo del Prado, Madrid

VELÁZQUEZ, Diego Rodriguez
de Silva y
Las Meninas (detail)
1656-57
Oil on canvas
Museo del Prado, Madrid

The diagnosis of art: Caravaggio's jaundiced Bacchus...
This is no simple hangover.
Bacchus was, of course, ‘affable and hospitable at every hour’; in other words, a chronic alcoholic.
And presumably Caravaggio had seen chronic alcoholics, jaundiced and dying of liver failure due to cirrhosis.

CARAVAGGIO
Young Sick Bacchus
c. 1593
Oil on canvas, 67 x 53 cm
Galleria Borghese, Rome

CARAVAGGIO
Young Sick Bacchus (detail)
c. 1593
Oil on canvas, 67 x 53 cm
Galleria Borghese, Rome

Bruegel's interest in human physiognomy and caricature is clear...
A man on the right wears spectacles, implying inability to see the truth.
Melchior, tightly holding a golden pot of frankincense, shows bilateral facial drooping, partial ptosis and
premature frontal balding, all features of myotonic dystrophy.

BRUEGEL, Pieter the Elder
The Adoration of the Kings
1564
Oil on wood, 111 x 84 cm
National Gallery, London

(detail)
1564
Oil on wood, 111 x 84 cm

This is not the outcome of a romantic tragedy...
This is the result of a brutal murder.
What we are looking at is a picture of a woman who has had her throat cut after desperately trying to defend
herself from a knife-wielding killer.

PIERO DI COSIMO
The Death of Procris
c. 1500
Oil on panel, 65 x 183 cm

PIERO DI COSIMO
The Death of Procris (detail)
c. 1500
Oil on panel, 65 x 183 cm

An Angel With Down Syndrome in a Sixteenth Century Flemish Nativity Painting...
The artist regarded people with Down’s as angelic.
As, indeed, they are.

UNKNOWN MASTER, Follower
of Jan Joest of Kalkar
Adoration of the Christ Child
ca. 1515
Oil on wood, 104.1 x 70.2 cm
Metropolitan Museum of Art,
New York

UNKNOWN MASTER, Follower
of Jan Joest of Kalkar
(detail)
ca. 1515
Oil on wood, 104.1 x 70.2 cm
Metropolitan Museum of Art,
New York

The unforgettable faces_the fine art of medical
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VELÁZQUEZ, Diego Rodriguez de Silva y
Las Meninas
The brilliant artist has painted, with admirable perfection, several pathologies of some inhabitants of the Palace.
Infanta Margarita de Austria,
murió a temprana edad, ya casada con el rey de Austria.
En el cuadro la menina que se encuentra reclinada le ofrece un remedio a base de barro en un recipiente tan sencillo para la familia, lo que hace pensar que la infanta padecía de pubertad
precoz. La frente y ojos prominentes, la mancha hiperpigmentada de contornos mal definidos en la piel, telarquia, baja talla simétrica y proporcional inducen al diagnóstico del Síndrome
de Mc Cune Albright ó displasia fibrosa poliostótica, que en su sinonimia cuenta también Síndrome Albright.
Maribárbola, María Bárbara Asquín,
una de las damas de compañía de la infanta, era procedente de Alemania y tenía alrededor de 20 años en esta pintura.
El pintor con su mayor crudeza retrató en un primer plano esta enana acondroplásica de estatura pequeña, de cabeza agrandada con frente prominente y puente nasal ensanchado, con
extremidades desproporcionadamente cortas.
Se dice que por estos signos objetivos ella rechazaba mirarse en el espejo, no obstante, aparece en el cuadro con una actitud de desafiante orgullo.
Nicolás de Pertusato, Nicolasito,
tenía 14 años en este retrato. Era de origen italiano y fue traído a España a los seis o siete años por el caballero Del Castillo para divertir al Rey.
Por los hallazgos fenotípicos se plantea que tenía un naismo hipofisiario por déficit en la producción o utilización de la hormona de crecimiento.
Su baja talla es simétrica y proporcional. Hay algunos aspectos en su perfil que llaman la atención como la frente algo abombada, el puente nasal y las mejillas plenas, por lo cual de los
nanismos hipofisiarios, que son varios, podría haber padecido específicamente un síndrome Laron.

PIERO DI COSIMO
The Death of Procris
A Satyr Mourning over a Nymph, there is a young woman who is supposed to be Procris, killed accidentally during a deer hunt by a spear.
Yet in the painting, we see no evidence of a spear wound. Instead, we see her arms covered in long cuts as if she was defending herself from a knife-
wielding assailant.
Her left hand is also contorted in a position with wrist flexed and fingers curling inwards, known as “the waiter’s tip”, which indicates an injury to the
spinal cord at the level of C3 and C4.
To paint Procris, di Cosimo probably used the corpse of a girl as a model, and because as an artist, he had no understanding of medicine and injury, he
portrayed the model in his painting exactly as he saw it.
Without intending to, di Cosimo was able to capture this girl’s true injuries. In this way, someone with medical knowledge can extract a likely theory of
cause of death.

CARAVAGGIO
Young Sick Bacchus
Michelangelo Merisi in 1592, fell ill and spent six months in the hospital of Santa Maria della Consolazione. Over the next two years he
painted the Self-portrait as Sick Bacchus, also known as Bacchino malato.
The external sign of Bacchus's (i.e. Caravaggio's) problem is jaundice, as can be seen from the flesh tints, which match those of the
peaches on the table in front of him, the slight tinge of yellow in the sclerae, and a comparison of this Bacchus with one that Caravaggio
painted in 1596, an altogether healthier specimen.
Caravaggio's Bacchus is a portrait of himself while suffering from an acute illness, from which he eventually recovered. In late 16th century
Rome, jaundice of unknown origin was most likely to have been due to acute infective hepatitis, perhaps caused by a zoonosis, such as
brucellosis or Q fever.

Melchior shows bilateral facial drooping, partial ptosis and premature frontal balding, all features of myotonic dystrophy.
This condition, relatively common and with a characteristic facial appearance, would have appealed to an observant artist such as Bruegel who
specialized in portraying expressive heads.
Bruegel would probably have encountered such cases when seeking unusual faces to paint amongst the peasantry.
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, and variable multisystemic features.

UNKNOWN MASTER, Follower of Jan Joest of Kalkar
Created in the 16th century by a Flemish artist.
What stands out in this sublime presentation of the Nativity is the detail of the characters standing around the crib.
Two of them, an angel and a shepherd, appear to have Down’s Syndrome.
The angel next to Mary, whose single visible wing is behind the head, seems to have features consistent with Down syndrome: a fl attened midface,
epicanthal folds, upslanted palpebral fi ssures, small and upturned nasal tip, and downward curving of the mouth corners. (The curly hair of this angel is
not characteristic of Down syndrome but is conventional for paintings of angels.)
Further symptomatic are the short fi ngers, especially on the left hand. This contrasts with the hands of Mary and the other foreground angels who have
long and tapering fi ngers.
The shepherd with a ram's horn in this painting (in the center behind the angels) also has an unusual appearance that is indicative of Down syndrome.
The shepherd's hair is straight and he has increased length and an up slant of the palpebral fi ssures with some degree of ptosis. In addition, the eyes
are widely spaced but this apparent hypertelorism may be an artistic interpretation of fl attened nasal bridge.
Whether this fi gure was intended to resemble the unusual angel is uncertain, but these features could be suggestive for Down syndrome, as well as for
hypothyroidism which was frequent in this historical period.
The painting is a message from 500 years ago from the artist, of what they see as heaven here on earth: where individuals with Down syndrome are
included and respected, like everyone else.

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