23 March 2013

Detecting disease in 17th century portraits

Several years ago I heard a conference paper on the signs of disease and illness in famous C17th portraits. Art historians in the audience knew that the painters generally attempted to show their sitters in the best light possible, presumably because the artists hoped to have more royal or noble commissions in the future. But the medicos in the audience were certain that in some cases, the signs of disease were so pronounced that leaving out the changes in facial features, bone structure and skin colour was not possible.

Luca Giordano, King Charles II of Spain, c1685

Nowhere in art can the casual viewer see medical crises better than in the portrait of King Charles II of Spain c1685, painted by the court artist from 1692-1702, Luca Giordano. The Spanish Habsburg dynasty in fact ended with this sickly product of generations of intermarriage between cousins; he was physically unable to produce a son. But the young king also suffered from a range of other physical, mental and emotional disabilities. Mandibular prognathism/Habsburg jaw was so pronoun­ced in King Charles II that he was actually  incapable of chewing. It does not take a medical clinician to note the very unusual relationship of the soft tissue portion of the King' chin to his nose.


Painted in c1654, Rembrandt's housekeeper/de facto wife Hendrickje Stoffels was the model for the biblical character, Bathsheba at her Bath. Rembrandt may have painted his lover with such a sad face for any number of reasons, including:  his troubles with the Church, his impending bankruptcy and her pregnancy outside of marriage.

But Peter Allen Braithwaite suggested something else. Asymmetrical depiction and clear skin discolouration in the left breast was not an artefact of the port­rait’s light and shadow. If Rembrandt painted the features that he actually saw, then perhaps there were already clinical signs of breast cancer. In fact Hen­drickje lived for 8+ years after the paint­ing of Bathsheba but she deteriorated throughout this period, part­icularly towards the end when her general ill health became apparent in other paintings. Historians re­corded that she was probably consumptive, dying of tub­er­cul­osis in 1663. Is it more reasonable to suggest, from the art, that she died of disseminated breast cancer?

Rembrandt, Bathsheba at Her Bath, 1654, 142 x 142 cm, Louvre

Recently a very interesting analysis of Nicolas de Largilliere’s Portrait of an Officer appeared in the MJA. Examine the swollen knuck­les in both hands, inflamed and reddish. Largilliere was consid­ered  to have had a genius for depicting hands, so the all-important accuracy in his art was always found in his paintings. The authors Weisz and Albury concluded that a possible diagnosis in the context of swollen but undeformed fingers could have been rheumatic fever or juvenile rheumatoid arthritis. 

Does disease, intentionally or unintentionally displayed in 17th century paintings, matter? Yes it does. Firstly art historians decode everything in paintings, including clothes, furniture, books, flowers and architecture. So we should be careful about the body as well. Secondly the portraits' models had the full range of illnesses that everyone in the community had in the 17th century, albeit less readily diagnosable than now and not treatable at all. Recognising that the artist wanted to flatter the sitter and would have toned down the sitter’s worst features, we can assume for example that King Charles II’s jaw was probably far bigger and uglier than Luca Giordano dared show. Nonetheless the portraits are a gold mine of medical information, if the viewer analyses the images carefully. Especially if the biography of the sitter is well known.

Nicolas de Largilliere, Portrait of an Officer c1714, Art Gallery NSW


Even in the 19th century, the biography of a person may have been very well known but his/her medical records were hidden or inadequate. Carson and Wakely described as best they could the health problems suffered by arguably the most famous woman in the world, Florence Nightingale - spinal pain, brucellosis, post-traumatic stress disorder, chronic fatigue syndrome and particularly manic depression. If my hypothesis is correct, art historians should now go back and re-examine the portraits of this very famous woman.


Leon and Sue Sims said...

Enjoying my art, I found your article thought provoking and something I had not preciously considered. I'll be looking more closely in future.

Student of history said...

I think we should include mental disease as well. Edvard Munch's anxiety, hallucinations and descent into psychosis were visible in his paintings. Vincent van Gogh suffered from intense manic depression, suicidal thinking, epilepsy and Meniere's disease - as his paintings suggest.

Hels said...


Me either. I have examined portraits and other paintings in detail since 1990 and had never thought of looking for disease. Despite my husband being a doctor who spends 40 hours a week diagnosing common and rare conditions!!

But we KNOW that the average life expectancy back then was very short, so health and ill health was critically important to people on an every-day basis.

Hels said...


Oh yes..mental ill health was as significant as breast cancer and TB. And once again I would hope that the mental health status of the sitter was well documented in medical reports.

Artists created some very distorted portraits and self portraits, but the distortions could easily have been caused by any number of factors eg drug abuse, alcoholism, psychoses or even cancer on the brain.

Anonymous said...

Fascinating and thought-provoking. Thank you for sharing.

Hels said...


pleasure. Do you have know of any portraits that might be decoded with an eye to disease?

Parnassus said...

Hello Hels, One remarkable instance of odd appearance now interpreted as a medical syndrome is ancient Egypt's Amenhotep IV (Akhenaten) and his family, with their many portraits showing very elongated heads.

Perhaps most diseases do not leave identifiable marks, and some that do are on the order of genetic syndromes, such as dwarfs and midgets, which are often depicted in photographs and paintings.
--Road to Parnassus

Hels said...


bless your heart. I was not at all familiar elongated heads in ancient Egyptian portraits but that is exactly what medical art historians should be examining.

Velazquez's Spanish paintings, on the other hand, are very dear to me. Courtiers with short limbs and prominent foreheads and noses "explained" achondroplasia to mid 17th century audiences.

SassyCountess said...

This is certainly interesting. I have seen many paintings that are so perfect that it is so obvious that the person could not have looked like that. I think that I may like these better. They make the subject human.

Hels said...


Noone was perfect, especially in centuries when washing was rare and healthcare was limited. Yet you are sooo right; sitters could not have looked so good so often.

Two statements should focus our mind:

1. Queen Elizabeth I said she was the most over-washed woman in Europe. Her advisors _forced_ her to bathe every month, whether she needed it or not. And

2. Oliver Cromwell insisted that portrait artists paint his famous face "warts and all". That suggests that blemishes and disfigurements would normally be air-brushed out.

Ana said...

I've been planning on doing a post on the portraiture of the Habsburg jaw for quite some time now.

And yes, the though of 'if this is the way they were pictured by royal portratists, how pronounced it must have been in real life!' is a constant.

* * *

How it pains me to see that last one - my mother has had a bad case of RA ever since she was young.

Donna Seger said...

Very thought-provoking post. I show a succession of Spanish Habsburg portraits to my students in class, and their jaws drop!

Hels said...


you are right. "How pronounced a problem must have been in real life" is something that occurs to us increasingly, as we read more historical records.

The famous and important Samuel Johnson had Tourette's syndrome, scrofula and scars across his face and body. Yet all his portraits were cleaned up by the artists.

Hels said...


*nod* In the case you cite, the implications of the disease/genetic condition were political as well as aesthetic. The entire Habsburg dynasty fell over in Spain, followed by terrible wars of successi

Lord Cowell said...

A medically and artistically fascinating post. I am reminded of the many paintings of Queen Anne which demonstrate her swollen and oedematous flesh due to dropsy.

Hels said...

Lord Cowell

nice example. Poor Queen Anne had 3 medical problems: she had 18 pregnancies that went to term; she overate to an alarming extent; and as you say she retained an abnormal accumulation of fluid.

I suspect her portraits, bloated though they were, were gross underestimations of her real shape. We know, for example, that she couldn't walk up and down stairs at all. She had to be hoisted up to her rooms via a wooden platform on ropes.

iancochrane said...

Fascinating Hels.
I can't say I've ever thought past the fashion aspect of portraits. (Yes, very shallow of me I know!)

I shall certainly pay more attention in future.
Cheers, ic

Hels said...


*nod* and I always focused on the architectural details and the decorative arts in portraits.

That is my point. We "know" portraits, but may have missed important elements in the past. Thank you for raising this question in blogcatalog.

Mott said...

Have a look at Inside History Magazine Sept-Oct 2011. Diseases picked up during the ordinary working day included TB, phossy jaw, mercury poisoning, skin cancer, rheumatism, grinders' lung disease, potters' asthma, scurvy, Weil's disease and other terrible events. These would have shown up in paintings and later in photographs.

Hels said...


Thank you. I wonder if every worker in the universe suffered from one or more of these conditions, to a greater or lesser extent. But that people who worked in the church, professions and on the land did not. Since most portraits were of gentlemen and not of workers, perhaps we won't know.