- Email: [email protected]
Goiter in the Art of Renaissance Europe
Accepted Manuscript Goiter In The Art Of Renaissance Europe Antonio V. Sterpetti, MD, Enrico Fiori, MD, Alessandro De Cesare, MD PII:
S0002-9343(16)30453-3
DOI:
10.1016/j.amjmed.2016.04.015
Reference:
AJM 13502
To appear in:
The American Journal of Medicine
Received Date: 18 March 2016 Revised Date:
3 April 2016
Accepted Date: 5 April 2016
Please cite this article as: Sterpetti AV, Fiori E, De Cesare A, Goiter In The Art Of Renaissance Europe, The American Journal of Medicine (2016), doi: 10.1016/j.amjmed.2016.04.015. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Goiter In The Art Of Renaissance Europe
Medical Humanities
There are no conflicts of interest No fund was received for this work
Short title: Goiter in Renaissance Art
M AN U
Antonio V Sterpetti takes responsibility for the content
SC
University of Rome Sapienza
RI PT
Antonio V Sterpetti, MD, Enrico Fiori, MD, Alessandro De Cesare, MD
AC C
EP
TE D
Text word count 1,180 Key words: Goiter, Renaissance Art
Address for Correspondence AV Sterpetti Viale del Policlinico 00167 Rome Italy Ph 39-6-49972188 Fax 39-6-49972245 e-mail [email protected]
The Renaissance (French for rebirth) was a cultural movement that characterised European life from the 14th to the 17th century. (1,2,3) 1
ACCEPTED MANUSCRIPT The artists of the Renaissance strove to portray the human form realistically (4). The aim of our study was to determine the prevalence of goiter in individuals depicted in the painting of the European Renaissance (5,6,7).
MATERIAL AND METHODS
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Two thousand paintings from artists of the European Renaissance, randomly selected, were taken into consideration.
The presence of a goiter was assessed by two independent reviewers. Only when both reviewers agreed that a goiter was present was the individual depicted in the painting considered positive for
SC
the study. In only 3 cases was there disagreement between the observers; these paintings were excluded from the study. The majority of the paintings were observed in reproductions. This fact makes the study bias prone, because the best method to make a clinical diagnosis of a goiter is
M AN U
palpation.
RESULTS
The prevalence of goiter was determined at 10%. Iodine deficiency was quite common in many regions of Europe.
TE D
The Representation of Beauty: In the early Renaissance, women were represented almost as “asexual”, adhering to the Medieval spirit of chastity. Raffaello Sanzio (b. Urbino 1483, d. Rome 1520), known as Rafael, and Leonardo (b. Vinci 1452, d. Amboice 1519) departed from this asexual representation of women, to impart physical form and rotundity to their depictions. Many of the
EP
women of their paintings have a round neck, almost a goiter. Portraits: Portraits were requested by rich and influential people. The artist had to make the subject as beautiful as possible. There was a tendency to represent young ladies with an enlarged neck,
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almost a small goiter.
Maria dei Medici was born in Florence, Italy, and later married the king of France. She became regent of France for his young son, the future Louis XIII, when the king died. Pieter Paul Rubens (b. Siegen 1577, d. Antwerp 1649) painted two portraits of her, in which Maria displays a goiter and exophthalmos. Albrecht Dürer (Nuremberg 1471-1528) represented Elsbeth Tuchers at her wedding with a goiter (1499) (Fig 1A, 1B). In religious portraits also, there was a tendency to represent the Virgin Mary and angels with fat necks, almost a goiter. The Virgin Mary had often a fat neck, almost a goiter, in representations by many artists, including The Virgin with Child by Cima da Conegliano (1499, North Carolina
2
ACCEPTED MANUSCRIPT Museum of Art, Raleigh NC) and other paintings by northern European artists (Virgin and Child, and Saint Catherine by Roger van Der Wieden (1399-1464)). (7) Francesco Furini (Florence 1603-1646) represented Saint Catherine of Alexandria, well known in her time for her beauty, with a goiter. Self portraits: Artemisia Gentileschi (b. Rome 1593, d. Naples 1656) painted herself with a goiter
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(Judith and her Maidservant). Differences between northern and southern European painters: In the southern part of Europe, there was a tendency to represent a small enlarged neck as a sign of beauty in slender women. In contrast, northern European artists showed a tendency to reflect more realistically the preferences of
SC
those days, often diverging from the classic standards of beauty.
In the famous painting The Birth of Venus by Sandro Botticelli, Venus has a slender neck; the similarity to the statue of the Venus Pudica dei Medici (a 200 AD copy of the Venus Pudica of
M AN U
Athens) is evident. In the paintings of Venus at the Mirror (1615- Vaduz Fürstlich Liechtensteinische Gemaldegalerie) and the The Three Graces (1630, Prado Museum, Madrid) by Pieter Paul Rubens, all four personages, representing beauty, are obese with a fat neck, almost a goiter. This difference testifies to the evolution towards the Baroque, where sensuality was emphasised.
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Portraits of “beloved” women. Artists often used their beloved women as models. Rafael used his lover as model in 3 paintings. The young woman in Figure 2 seems to have a small goiter. Michelangelo Merisi, called Caravaggio (b. Milan 1571, d. Porto D’Ercole 1610) used his lover, a young woman called Lena, as the model of two paintings of the Madonna (La Madonna dei
EP
Palaniefri, 1606, Galleria Borghese, Rome, and La Madonna dei Pellegrini, 1605, Basilica Sant Agostino in Campo Marzio, Rome). In both paintings, the Madonna displays a goiter. Both works, were rejected by the monks who commissioned the paintings, for many reasons, including that the
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Madonna appeared too sensual. Cima da Conegliano (Conegliano, Italy 1450-1517) used the same model for several paintings. Most llikey there was some kind of relationship with the young woman. She has a goiter. Pieter Paul Rubens painted a portrait of his sister in law with an evident goiter (Portrait of Suzanne Fourment, 1622, National Art Gallery, London). Thyroid Swellings as a sign of “aggressiveness”: Psychiatric symptoms which accompany hyperthyroidism include emotional mood swings, excitability, tremors, and agitation. A patient in those days could be defined as “possessed by Satan”. In the Transfiguration of Christ by Rafael, the painting is dominated by the splendour of Christ. In the lower left part, there is a boy “possessed by Satan” with his parents, waiting for a miracle from Jesus that He will soon perform. The boy has 3
ACCEPTED MANUSCRIPT an enlarged neck, exophthalmos, weight loss, agitation: signs and symptoms that lead to the suspicion of a toxic goiter (Fig 3). Hypothyroidism: Hypothyroidism, if present in childhood, can lead to cretinism with mental retardation, poor growth and dwarfism. In adulthood, hypothyroidism results in physical and mental fatigue and weight gain. Velasquez (b. Seville 1599, d. Madrid 1660), one of the greatest of Spanish
RI PT
and indeed European painters, painted in his Christ After Flagellation (1628, National Art Gallery, London) a young boy with a large goiter praying to Jesus for sufferance. DISCUSSION
In the period 1350-1400, Europe was devastated by a severe pandemic of Plague (Black Death) ,
SC
which killed about 50% of the European population, generating terror and general depression. (1,2,3) Patients with plague suffered a significant weight loss. Thus, in the Renaissance times, following the plague pandemics, to be thin and slender was not a positive physical aspect. In those
M AN U
days, when food was not easily available, a fat neck signified a high social status. In addition, a goiter was quite common among the population due to diffuse iodine deficiency. Clark and Clark, in their outstanding textbook “The Remarkable: Endocrine Abnormalities in Art”(8) analysed this phenomenon in depth.
Despite the fact that the function of the thyroid was not yet understood, and that a goiter or a
TE D
swelling of the neck was never known to derive from the thyroid, the presence of a goiter was related nevertheless to aggressiveness or reduced mental capability. Artistic interpretation of reality often precedes scientific validation. Observational skills remain very important in everyday clinical practice. Precision and attention to
EP
details are essential in literature and the figurative arts. It is possible that educational schemas for physicians, which may include the analysis and study of paintings, sculptures and literary works, can provide the possibility of improving observational skills. Improvement in medical knowledge
AC C
derives often from “alternative” ideas, and these ideas come from an “alternative” observational interpretation of the same reality. (9,10)
4
ACCEPTED MANUSCRIPT
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LEGENDS TO FIGURES
Fig 1A: Elspeth Tucher at her Wedding, by Albrecht Dürer (1499, Staatliche Kunstsammlungen, Kassel) . The lady has a goiter.
Fig 1B: The artist Albrecht Dürer (Nuremberg 1471-1520) probably suffered from hyperthyroidism,
SC
as testified by the exophthalmos evident in the self portrait. (1500, Alte Pinakothek, Munich Germany)
Fig 2: Woman with a Veil (Raffaello Sanzio, 1516, Palazzo Pitti, Florence). The lady, Margherita
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Luti, called La Fornarina (small baker) because she was the daughter of a baker, was the lover of Rafael; she has a round, fat neck, almost a goiter. Rafael died four years later at the age of 37. At that time, a woman with veil represented a married woman; most likely Rafael, already unwell, wished to indicate that he considered her his wife. Margherita shows simultaneous happiness (to be considered so by Rafael) and sadness (knowing that Rafael is not well). Rafael suffered from
TE D
syphilis, which in those days was cured with periodical and excessive bloodlettings.
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Fig 3: The Transfiguration of Christ by Raffaello Sanzio (Vatican Museum, Rome).
5
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REFERENCES.
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1- Burckhardt J. “The civilization of Renaissance in Italy” Trans S.G.C. 1878, Middlemore 2- Cantimori D. “Studi di Storia, Umanesimo, Rinascimento, Riforma” 1976 Einaudi Ed Turin 3-Burke P. “The Italian Renaissance: Culture and Society in Italy” Princeton University Press, 1999, Princeton
SC
4-Vescia FG, Basso L. “Goiters in the Renaissance” Vesalius 1997; 3: 23-32
5-Sena LM. “Arte e Tiroide; gozzuti nelle scene di natività e nei presepi” ” 2013; Aracne Ed., Rome
Meeting Las Vegas- October 2011
M AN U
6-Sena LM. “Thyroid in Art” Proceedings of the American Society for Clinical Pathology. Annual
7-Sterpetti AV, De Toma G, De Cesare A. “Thyroid swellings in the art of Italian Renaissance” Am J Surg 2015;
8-Clark E, Clark O. “The remarkable: endocrine abnormalities in art” University of South California Press 2012
90: 1624-1630
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9-Welbery C, Mc Ateer RA: “The art of observation: A pedagogical framework” Acad Med 2015;
10-Welbery C: “Art-Science collaboration: Avenues toward medical innovation” N Engl J Med
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2015;24: 2495-2497
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S0002-9343(16)30453-3
DOI:
10.1016/j.amjmed.2016.04.015
Reference:
AJM 13502
To appear in:
The American Journal of Medicine
Received Date: 18 March 2016 Revised Date:
3 April 2016
Accepted Date: 5 April 2016
Please cite this article as: Sterpetti AV, Fiori E, De Cesare A, Goiter In The Art Of Renaissance Europe, The American Journal of Medicine (2016), doi: 10.1016/j.amjmed.2016.04.015. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Goiter In The Art Of Renaissance Europe
Medical Humanities
There are no conflicts of interest No fund was received for this work
Short title: Goiter in Renaissance Art
M AN U
Antonio V Sterpetti takes responsibility for the content
SC
University of Rome Sapienza
RI PT
Antonio V Sterpetti, MD, Enrico Fiori, MD, Alessandro De Cesare, MD
AC C
EP
TE D
Text word count 1,180 Key words: Goiter, Renaissance Art
Address for Correspondence AV Sterpetti Viale del Policlinico 00167 Rome Italy Ph 39-6-49972188 Fax 39-6-49972245 e-mail [email protected]
The Renaissance (French for rebirth) was a cultural movement that characterised European life from the 14th to the 17th century. (1,2,3) 1
ACCEPTED MANUSCRIPT The artists of the Renaissance strove to portray the human form realistically (4). The aim of our study was to determine the prevalence of goiter in individuals depicted in the painting of the European Renaissance (5,6,7).
MATERIAL AND METHODS
RI PT
Two thousand paintings from artists of the European Renaissance, randomly selected, were taken into consideration.
The presence of a goiter was assessed by two independent reviewers. Only when both reviewers agreed that a goiter was present was the individual depicted in the painting considered positive for
SC
the study. In only 3 cases was there disagreement between the observers; these paintings were excluded from the study. The majority of the paintings were observed in reproductions. This fact makes the study bias prone, because the best method to make a clinical diagnosis of a goiter is
M AN U
palpation.
RESULTS
The prevalence of goiter was determined at 10%. Iodine deficiency was quite common in many regions of Europe.
TE D
The Representation of Beauty: In the early Renaissance, women were represented almost as “asexual”, adhering to the Medieval spirit of chastity. Raffaello Sanzio (b. Urbino 1483, d. Rome 1520), known as Rafael, and Leonardo (b. Vinci 1452, d. Amboice 1519) departed from this asexual representation of women, to impart physical form and rotundity to their depictions. Many of the
EP
women of their paintings have a round neck, almost a goiter. Portraits: Portraits were requested by rich and influential people. The artist had to make the subject as beautiful as possible. There was a tendency to represent young ladies with an enlarged neck,
AC C
almost a small goiter.
Maria dei Medici was born in Florence, Italy, and later married the king of France. She became regent of France for his young son, the future Louis XIII, when the king died. Pieter Paul Rubens (b. Siegen 1577, d. Antwerp 1649) painted two portraits of her, in which Maria displays a goiter and exophthalmos. Albrecht Dürer (Nuremberg 1471-1528) represented Elsbeth Tuchers at her wedding with a goiter (1499) (Fig 1A, 1B). In religious portraits also, there was a tendency to represent the Virgin Mary and angels with fat necks, almost a goiter. The Virgin Mary had often a fat neck, almost a goiter, in representations by many artists, including The Virgin with Child by Cima da Conegliano (1499, North Carolina
2
ACCEPTED MANUSCRIPT Museum of Art, Raleigh NC) and other paintings by northern European artists (Virgin and Child, and Saint Catherine by Roger van Der Wieden (1399-1464)). (7) Francesco Furini (Florence 1603-1646) represented Saint Catherine of Alexandria, well known in her time for her beauty, with a goiter. Self portraits: Artemisia Gentileschi (b. Rome 1593, d. Naples 1656) painted herself with a goiter
RI PT
(Judith and her Maidservant). Differences between northern and southern European painters: In the southern part of Europe, there was a tendency to represent a small enlarged neck as a sign of beauty in slender women. In contrast, northern European artists showed a tendency to reflect more realistically the preferences of
SC
those days, often diverging from the classic standards of beauty.
In the famous painting The Birth of Venus by Sandro Botticelli, Venus has a slender neck; the similarity to the statue of the Venus Pudica dei Medici (a 200 AD copy of the Venus Pudica of
M AN U
Athens) is evident. In the paintings of Venus at the Mirror (1615- Vaduz Fürstlich Liechtensteinische Gemaldegalerie) and the The Three Graces (1630, Prado Museum, Madrid) by Pieter Paul Rubens, all four personages, representing beauty, are obese with a fat neck, almost a goiter. This difference testifies to the evolution towards the Baroque, where sensuality was emphasised.
TE D
Portraits of “beloved” women. Artists often used their beloved women as models. Rafael used his lover as model in 3 paintings. The young woman in Figure 2 seems to have a small goiter. Michelangelo Merisi, called Caravaggio (b. Milan 1571, d. Porto D’Ercole 1610) used his lover, a young woman called Lena, as the model of two paintings of the Madonna (La Madonna dei
EP
Palaniefri, 1606, Galleria Borghese, Rome, and La Madonna dei Pellegrini, 1605, Basilica Sant Agostino in Campo Marzio, Rome). In both paintings, the Madonna displays a goiter. Both works, were rejected by the monks who commissioned the paintings, for many reasons, including that the
AC C
Madonna appeared too sensual. Cima da Conegliano (Conegliano, Italy 1450-1517) used the same model for several paintings. Most llikey there was some kind of relationship with the young woman. She has a goiter. Pieter Paul Rubens painted a portrait of his sister in law with an evident goiter (Portrait of Suzanne Fourment, 1622, National Art Gallery, London). Thyroid Swellings as a sign of “aggressiveness”: Psychiatric symptoms which accompany hyperthyroidism include emotional mood swings, excitability, tremors, and agitation. A patient in those days could be defined as “possessed by Satan”. In the Transfiguration of Christ by Rafael, the painting is dominated by the splendour of Christ. In the lower left part, there is a boy “possessed by Satan” with his parents, waiting for a miracle from Jesus that He will soon perform. The boy has 3
ACCEPTED MANUSCRIPT an enlarged neck, exophthalmos, weight loss, agitation: signs and symptoms that lead to the suspicion of a toxic goiter (Fig 3). Hypothyroidism: Hypothyroidism, if present in childhood, can lead to cretinism with mental retardation, poor growth and dwarfism. In adulthood, hypothyroidism results in physical and mental fatigue and weight gain. Velasquez (b. Seville 1599, d. Madrid 1660), one of the greatest of Spanish
RI PT
and indeed European painters, painted in his Christ After Flagellation (1628, National Art Gallery, London) a young boy with a large goiter praying to Jesus for sufferance. DISCUSSION
In the period 1350-1400, Europe was devastated by a severe pandemic of Plague (Black Death) ,
SC
which killed about 50% of the European population, generating terror and general depression. (1,2,3) Patients with plague suffered a significant weight loss. Thus, in the Renaissance times, following the plague pandemics, to be thin and slender was not a positive physical aspect. In those
M AN U
days, when food was not easily available, a fat neck signified a high social status. In addition, a goiter was quite common among the population due to diffuse iodine deficiency. Clark and Clark, in their outstanding textbook “The Remarkable: Endocrine Abnormalities in Art”(8) analysed this phenomenon in depth.
Despite the fact that the function of the thyroid was not yet understood, and that a goiter or a
TE D
swelling of the neck was never known to derive from the thyroid, the presence of a goiter was related nevertheless to aggressiveness or reduced mental capability. Artistic interpretation of reality often precedes scientific validation. Observational skills remain very important in everyday clinical practice. Precision and attention to
EP
details are essential in literature and the figurative arts. It is possible that educational schemas for physicians, which may include the analysis and study of paintings, sculptures and literary works, can provide the possibility of improving observational skills. Improvement in medical knowledge
AC C
derives often from “alternative” ideas, and these ideas come from an “alternative” observational interpretation of the same reality. (9,10)
4
ACCEPTED MANUSCRIPT
RI PT
LEGENDS TO FIGURES
Fig 1A: Elspeth Tucher at her Wedding, by Albrecht Dürer (1499, Staatliche Kunstsammlungen, Kassel) . The lady has a goiter.
Fig 1B: The artist Albrecht Dürer (Nuremberg 1471-1520) probably suffered from hyperthyroidism,
SC
as testified by the exophthalmos evident in the self portrait. (1500, Alte Pinakothek, Munich Germany)
Fig 2: Woman with a Veil (Raffaello Sanzio, 1516, Palazzo Pitti, Florence). The lady, Margherita
M AN U
Luti, called La Fornarina (small baker) because she was the daughter of a baker, was the lover of Rafael; she has a round, fat neck, almost a goiter. Rafael died four years later at the age of 37. At that time, a woman with veil represented a married woman; most likely Rafael, already unwell, wished to indicate that he considered her his wife. Margherita shows simultaneous happiness (to be considered so by Rafael) and sadness (knowing that Rafael is not well). Rafael suffered from
TE D
syphilis, which in those days was cured with periodical and excessive bloodlettings.
AC C
EP
Fig 3: The Transfiguration of Christ by Raffaello Sanzio (Vatican Museum, Rome).
5
ACCEPTED MANUSCRIPT
REFERENCES.
RI PT
1- Burckhardt J. “The civilization of Renaissance in Italy” Trans S.G.C. 1878, Middlemore 2- Cantimori D. “Studi di Storia, Umanesimo, Rinascimento, Riforma” 1976 Einaudi Ed Turin 3-Burke P. “The Italian Renaissance: Culture and Society in Italy” Princeton University Press, 1999, Princeton
SC
4-Vescia FG, Basso L. “Goiters in the Renaissance” Vesalius 1997; 3: 23-32
5-Sena LM. “Arte e Tiroide; gozzuti nelle scene di natività e nei presepi” ” 2013; Aracne Ed., Rome
Meeting Las Vegas- October 2011
M AN U
6-Sena LM. “Thyroid in Art” Proceedings of the American Society for Clinical Pathology. Annual
7-Sterpetti AV, De Toma G, De Cesare A. “Thyroid swellings in the art of Italian Renaissance” Am J Surg 2015;
8-Clark E, Clark O. “The remarkable: endocrine abnormalities in art” University of South California Press 2012
90: 1624-1630
TE D
9-Welbery C, Mc Ateer RA: “The art of observation: A pedagogical framework” Acad Med 2015;
10-Welbery C: “Art-Science collaboration: Avenues toward medical innovation” N Engl J Med
AC C
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2015;24: 2495-2497
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