Illness on Canvas: Diseases Depicted in Renaissance Art

Parul Sarwal, MD

It was 2014. I was on a pediatric nephrology rotation at Mass General as a visiting medical student. One day, while making my way to the noon conference, I came across a poster that instantly caught my attention. “What is Italian Renaissance art doing in a pediatric unit?” I thought, somewhat distracted by another pressing question: whether there would be lunch at the conference. Following my subsequent hour-long struggle with renal tubular acidosis, I stayed back to check out the poster on Ellison 17. Titled Pediatric Disease in Artwork, it was authored by one of the residents, Dr. Thomas Heyne. After the first couple of paintings and reading about the physical signs they depicted, I was quite pleased with myself for having “diagnosed” most of the other pictures. After all, spot diagnosis is every medical student’s leisurely pursuit in any given setting. This incident spurred a nascent interest I had long harbored. I spent that evening looking up paintings related to nephrology. I stumbled upon the manuscript, Michelangelo: Art, Anatomy, and the Kidney (1) by Dr. Garabed Eknoyan, a nephrologist at Baylor. He writes about Michelangelo’s interest in anatomy which the latter refined by performing dissections on cadavers. This interest later translated into textbook illustrations by the artist in his collaboration with the Italian anatomist and surgeon Realdo Colombo. Michelangelo, who was known to have recurrent nephrolithiasis, was treated by Colombo for his stones. I personally find some irony in knowing that the sculptor’s medium was also his malady. Dr. Eknoyan postulates that the Renaissance man’s tryst with obstructive nephropathy may have inspired his panel showing God separating the Earth from the Waters on the ceiling of the Sistine Chapel (figure 1). The nephrologist interprets the shape of the painting resembling a bisected right kidney in the panel and thus Michelangelo’s allusion to the concept of filtration of gravel (or stones) from fluids.

I eventually wrote to Dr. Heyne to thank him for the inspiration and shared the above paper. Fast-forward two years—I had now moved to Boston for my research fellowship. It was HubWeek 2016. One of the events was Michelangelo to Van Gogh, organized by the Arts and Humanities Initiative (AHI) at Harvard Medical School (HMS). The audience was called on to participate in a collective visual thinking exercise to diagnose disease in the works of famous artists. I was quite pleased to see Michelangelo and the kidney feature in this symposium. In addition to Dr. Heyne, the panelists included Dr. Joel Katz, Vice Chair for Education at Brigham & Women’s Hospital, who has spearheaded the use of visual arts in clinical training. He is the co-director of the HMS course Training the Eye: Improving the Art of Physical Diagnosis at the Museum of Fine Arts (MFA) in Boston. Having participated in the AHI during my two years in Boston, I had the chance to attend one of his sessions at the MFA and observe an adaptation of this program myself.

For over a decade now, Worcester has had an analogous curriculum locally, led by Drs. Hugh Silk and Sara Shields at the UMass Family Medicine Residency. This multifaceted program (2) includes an introduction to the concepts of humanities in medicine and narrative writing at the beginning of residency. Every year, the residents are taken on a guided tour of the Worcester Art Museum to examine the art, utilizing it as a tool to hone the skills of observation, team building, and communication. So, what comes of exploring disease depicted in art? It is an exercise in observation, which is the essence of diagnostic medicine. This lends itself to the art of interpretation with limited information or clinical context at one’s disposal. Looking for disease in paintings cultivates an appreciation of the physical exam, a fading skill in today’s defensive and imaging-focused clinical culture. It creates the opportunity to become comfortable with ambiguity, with detecting patterns, and with presenting differential diagnoses. Finally, it nurtures a meditative inner dialogue, while simultaneously encouraging communal conversation on the deviations from a healthy form.

An interesting sample is hidden in plain sight in Raphael’s Sistine Madonna (figure 2). Upon closer inspection, you would notice that Pope Sixtus is illustrated to have six fingers on his right hand. Whether this was simply wordplay on Raphael’s part, or subtle

Figure 1: Separation of the Earth from the Waters, Michelangelo, 1511, and a schematic1 to draw a comparison to the kidney with the renal pelvis (inset); Figure 2: The Sistine Madonna, Raphael, 1513-14.; Figure 3: St. Luke healing the Dropsical Child, Giovanni Lanfranco, 1625. symbolism of the Pope’s fabled sixth sense, continues to be debated (3). Either way, it is an interesting depiction of a case of hexadactyly in a painting.

Another example – and one of the paintings Dr. Heyne has referenced in his works (4) – is Giovanni Lanfranco’s St. Luke Healing the Dropsical Child (figure 3). It shows Luke the Evangelist palpating the radial pulse of a toddler with a distended abdomen. This is speculated to be one of the earliest portrayals of congenital heart disease, specifically a ventricular septal defect. The cyanotic appearance of the child displaces liver or kidney dysfunction on the differential. So, the next time you look at a certain Italian noblewoman in one of da Vinci’s iconic masterpieces, you will not miss the golden glimmer of her xanthelasma. +

Dr. Sarwal is an internal medicine hospitalist at Saint Vincent Hospital. After graduating from Kasturba Medical College in India in 2015, she completed a research fellowship at Mass General Hospital before moving to Worcester for residency. Taken by the industrial charm of the city, she decided to stay on. In her free time, she enjoys birding and is an ardent member of Mass Audubon.

References:

1. Eknoyan, G. “Michelangelo: Art, Anatomy, and the Kidney.” Kidney International, vol. 57, no. 3, Mar. 2000, pp. 1190–201. PubMed, https://doi. org/10.1046/j.1523-1755.2000.00947.x.

2. Silk, Hugh, and Sara Shields. “Teaching Humanities in Medicine: The University of Massachusetts Family Medicine Residency Program Experience.” Journal for Learning through the Arts, vol. 8, no. 1, 2012. escholarship.org, https://doi.org/10.21977/ D9812657.

3. Beccia, Carlyn. “Can You Spot the Medical Conditions in These Famous Paintings?” The Grim Historian, 9 Sept. 2022, https:// medium.com/grimhistorian/can-you-spot-themedical-conditions-in-these-famous-paintingsa2a0d3c35776. Accessed 29 Mar. 2023.

4. Heyne TF. Lanfranco’s Dropsical Child: The First Depiction of Congenital Heart Disease? Pediatrics, vol 138, no. 2, Aug. 2016;138(2):e20154594. https://doi. org/10.1542/peds.2015-4594