The patient does not cooperate. Couldn’t even wanting, because it is painting on a canvas, and he lived hundreds of years ago: portrayed by a master of painting who unwittingly outlined and immortalized not only his features, but also the signs of an illness. There are many clinical mysteries in the famous paintings of art history and one of the diagnostic puzzles that seemed impossible to solve is what the Bathsheba with the letter of David, a masterpiece painted by Rembrandt in 1654 that can be admired at the Louvre Museum in Paris: looking at it, in fact, a bluish and bruised shadow leaps to the eyes on the left breast, a sort of slightly detected stain, certainly anomalous. The solution came thanks to Paolo Zamboni, director of the Center for Vascular Diseases of the University of Ferrara, who recently published the solution of the riddle on the pages of the Journal of Thrombosis and Haemostasis: Zamboni, passionate about diagnosis on canvas, he sifted through everything that was published on the painting in question and then, thanks to a small “stroke of luck” in his clinic, he solved the case. For a long time it was considered the photograph of a patient with advanced breast cancer: for a long time the skin anomaly was in fact considered the evidence of an orange peel skin typical of breast tumors that infiltrate the skin.
Suspicious shadow
“In support of the hypothesis, the sad expression of Bathsheba’s face, repeatedly painted and erased by Rembrandt, and the short life of Hendrickje Stoffels, the lover of the painter who had posed as a model for the picture and who died nine was underlined years later », says Zamboni. «However, the orange peel skin typical of carcinomas is not a simple stain as on Bathsheba’s breast, the skin is retracted inwards; in addition it seems difficult that a young woman with a cancer in such an advanced stage at that time, in the absence of treatment, he could live for another nine years ». Some had therefore assumed that it could be mastitis: Hendrickje had not had children, but he may have had mastitis for an unfinished pregnancy since then this type of inflammation was much more frequent than today. The discussion continued until, in 2014, a study of Dutch biophysicists and opticians showed that the bluish coloration painted by Rembrandt cannot be perceived on the skin unless it is caused by something that is two, at most three millimeters below the surface: it could therefore not be a tumor or mastitis to provoke that stain that the painter had noticed and reported on canvas. “After reading these conclusions, I hypothesized that the cause could be Mondor syndrome, a rare thrombophlebitis of a vein in the chest that I had seen in a couple of patients, the last one at least twenty years earlier,” says Zamboni. «Unfortunately I was not able to find those medical records, lost in the 2012 earthquake. I thought I could not solve the mystery when, a few days after my research in the archive, a nurse came to the clinic and, worried, showed me the right breast: it seemed painted by Rembrandt, it was identical to that of the painting. I hypothesized Mondor’s syndrome and the ultrasound confirmed, there was a vein occluded by a thrombus a few millimeters below the skin “.
Cold-case medicine
Mystery solved, and not the first for the art-lover from Ferrara, who often and willingly tells his students about these “cold houses” of medicine: “I think it is useful not only as a” gym “to learn how to do remote diagnosis, but above all because the clinical sense develops with the spirit of observation “, explains the expert. «Today many doctors rely only on instrumental tests forgetting to observe the patient, instead his story and the careful analysis of the available clues are the main way to arrive at the right diagnoses. The tools must serve to corroborate the suspicions, not the other way around ». When you can only count on a few clues, it’s up to Dr. House, the internist of the TV series of the same name, who didn’t miss the slightest detail: Zamboni had to use it to solve an “artistic” case similar to the riddle of Bathsheba, that of Fornarina by Raffaello. In the painting of 1518, preserved in the Galleria Borghese in Rome, the painter’s lover is portrayed, the daughter of a baker from Trastevere Margherita Liuti: the girl touches her left breast with the index finger, the only finger not covered by the veil, and seems to point something. This, combined with the brownish color that seems to indicate a depression right where the finger is, has led Carlos Espinel, a passionate doctor of art like Zamboni, to diagnose Fornarina with a malignant breast lump. His case, on the pages ofThe Lancet, has been compared precisely to Rembrandt Bathsheba where the “spot” on the breast was even more visible but Zamboni observes: “The brownish color at the time of Raphael was the standard for creating shading and in fact we also find it under the right breast , although less evident; as we have seen with Bathsheba, then, these colors can indicate a pathology of the breast visible only if it is located two or three millimeters under the skin, and the volume of the breast of the Fornarina seems to exclude it. Also, if a woman pushes a finger under the nipple it can cause a slight dimple without having to have a lump. Finally, the almost graceful plastic pose is not unusual in art and is found in other paintings, from Long-necked Madonna with Child of Parmigianino alla Expulsion of Adam and Eve del Masaccio: it is highly probable that Margherita Liuti, the model, was completely healthy. It is more likely that art historians are right that the girl, with that pose, wanted to indicate the heart, in love with the artist who portrayed her ».
Obvious pathology
Suffering is so evident that even the title of the painting does not hide it: the Sick bacchusby Caravaggio, at the Galleria Borghese in Rome, is the portrait of a person who is certainly not healthy. But what is the pathology that afflicts the model, painted by the genius of lights and shadows in 1593? Another mystery of art that can be solved this time with the mere observation of the clues on the canvas, if anything helping with the comparison with other works of the Roman years by Caravaggio to understand how the painter used to portray his models at that time. “The unhealthy complexion is a first evident sign: Bacchino is pale, with dark reflections in some areas of the skin”, explains Paolo Zamboni, director of the Center for Vascular Diseases of the University of Ferrara, which is collecting clinical cases in a volume -artistic examined by him over the years. «Quite different from the pink and well-sprayed skin of the Bacchus painted in those same years which is located in the Uffizi Gallery in Florence. The Bacchino was therefore probably anemic and perhaps had abdominal pain, as the forward curved position suggests; compared to Bacchus or even to Boy with fruit basket (Caravaggio’s canvas from 1595, preserved in the Borghese Gallery) the fruit does not seem only ornamental, it seems that Bacchino is feeding on it even if grapes and other fruits appear to be second choice, as if the boy needed sugar for a possible hypoglycemia. If other details are observed, these sensations are confirmed: the inner corner of the eye, poorly sprayed, poses for anemia. And just look at the hands of the Bacchus to have other decisive clues: the thumb is not pink but dark, blackish and opaque is also the nail, which has the appearance of what in medicine is called “acantosi nigricans” (a condition in which nails and skin, especially where there are skin folds such as neck, armpits and so on, are thickened and darker than the areas around, ed). Nothing to do with the rosy nails of the other two subjects painted in similar poses in the same period ».
An undiscovered disease
In short, the model chosen for the Bacchino definitely had something wrong; which, however, would return with what is said of the painting, or that the subject had been met by Caravaggio while the teacher was hospitalized after being hit by a horse kick. Even only taking into account the clues collected (anemia, brown skin, acanthosis nigricans) and only presumed ones (abdominal pain, hypoglycaemia), according to Zamboni there are already all the ingredients for a diagnosis: “Addison’s disease”, reveals the clinician. «The disease at the time of Caravaggio did not even have the name, because it was described by Addison in the 19th century. The symptoms match perfectly: in case of Addison’s disease, patients are tired and suffering from chronic asthenia because the adrenal gland does not produce adequate amounts of cortisol (stress hormone, but also important for giving us the “sprint” for example when we wake up, ed) and the pituitary gland reacts by producing a lot of Acth, a hormone that stimulates the adrenal glands to “work”. The excess of Acth leads to an increase in the melanin deposit under the skin, hence the brownish color of the nails and skin of the Bacchino. Addison’s disease, which also affected John F. Kennedy, is unfortunately still largely ignored: most patients do not have the diagnosis and the signs of weakening of these “sunless tanned” people remain unknown for years. Just like those hidden in Caravaggio’s painting », concludes Zamboni.
–
