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.

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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

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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.