For centuries, medicine has not only been dealing with the study and treatment of diseases, but also engaged in almost every aspect of human existence--seeking to comprehend the mystery of life and death, understand the causes of physical and mental health issues along with their impact on our behavior and activity. Medicine has developed in conjunction with art, religion, intellectual thinking and other fields of science, oftentimes overlapping in many ways.

I believe everyone would agree that painting plays a special role in the perception of the world around us, since it simultaneously presents the viewer with facts, emotions, and experience. The artist seems to “intercept” the reality, “absorb” and “metabolize” it, before producing their vision. Thus, works of art are not solely a factual reflection of a moment in life, but also an expression of the psychological drama of the artist themself, representing relevant thinking during their era. For centuries, artists skillfully and meticulously documented on their canvases the portraits of people with various interesting and rare health disorders. Such findings are extremely fascinating and useful for all, not only an inquisitive physician. In this regard, painting can become another imaginative and accessible “artistic” method of mastering the complex world that is medicine.

Let us delve together into an “artistic diagnostics” using an interesting example and going through the feasible steps of a medical.

“Magdalena Ventura with Her Husband and Son or The Bearded Lady” Jusepe de Ribera, 1631, National Museum Prado.

Our first “patient” is a woman named Magdalena Ventura. A canvas with her portrait was commissioned by the Viceroy Don Fernando Afán de Ribera y Enríquez, III Duque de Alcalá (1570-1637), who was very intrigued by her unusual appearance after meeting Magdalena on a walk. The painting took three years to accomplish. The Viceroy was a passionate collector of such “scientific” portraits, and there were other portraits of people with various disabilities and physical abnormalities in his collection.

Upon general examination, we can clearly see marked facial hair growth and signs of alopecia. The artist accentuated not only every wrinkle on her face, but also the frozen tears in the sad eyes of the “patient”. Even beside her husband Felice de Amici, she looks emphatically masculine--the woman stands confidently and firmly in the foreground, as if protecting the man standing behind her. Her breast is bare, adding to the boldness of the piece. The canvas makes the viewer reflect on how truly unexpected and uncontrollable nature can be with its terrible tricks and turns.

In this case, we are very lucky, as besides the general examination of the “patient,” we also have access to pieces of her anamnesis vitae and morbi, which are indispensable in the diagnostic process. The Latin inscription in the right corner of the picture reads (translation): “Natural miracle Magdalena Ventura, 52 years old, from the city of Accumol, colloquially - the city of Abruzzi, Kingdom of Naples. It is noteworthy that at the age of 37 she started growing facial hair, and her beard was so thick and long that you would expect to see something like this on a man, and prior to this she had given birth to three children with her husband Felice de Amici, whom you see next to her.”

From a medical perspective, there are inconsistencies between the dates of the painting’s creating, the estimated age of the depicted infant and the onset of hirsutism in Magdalena. However, it is absolutely certain that the “patient” had a healthy reproductive system and managed to give birth to three children, indicating her disease is not hereditary, but acquired. Let us analyze the data that we have.

“EN MAGNV[M] NATVRAE / MIRACVLVM / MAGDALENA VENTVRA EX- / OPPIDO ACVMVLI APVD / SAM NITES VVLGO, EL A-/ BRVZZO REGNI, NEAPOLI-/ TANI ANNVRVM 52 ET / QVOD INSOLENS EST CV[M] / ANNVM 37 AGERET COE- / PIT PUBESCERE EOQVE / BARBA DEMISSA AC PRO- / LIXA EST VI POTIVS”

Hirsutism is an excess, male-pattern growth of terminal hair on the face, chest and back in a woman. It mostly develops in the third to fourth decade of life. Causes may include polycystic ovary syndrome, adrenal hyperplasia, Cushing’s disease, and adrenal or ovarian tumors resulting in the high testosterone production and consequently hair growth. Although the most common cause of hirsutism these days is polycystic ovary syndrome, our “patient” likely had a rather rare disorder--virilizing androgen-producing androblastoma, ovarian Sertoli-Leydig cell tumor. It is detected in approximately 0.2% of patients with signs of hyperandrogenemia.

Another similar portrait has survived, painted by Juan Sánchez Cotán some 40 years prior to Magdalena’s; however, you can see that it lacks the necessary anamnestic data and the dramatic plot created by Ribera.

Nowadays, perhaps less attention is paid to such disorders--as they say, “medicine has discovered so many new diseases that it is forced to ignore the old ones.”

Such “artistic diagnostics,” in my opinion, allow one to develop observation skills while gaining information about the history of medicine, the methods of examining and treating patients, medical instruments used and much more. This is extremely important in the modern era of dazzling technologies, when the work of a physician is increasingly becoming more dependent on the laboratory tests and radiologic examination. What do you think?

“Brígida del Río, the Bearded Lady of Peñaranda”, Juan Sanchez Cotan, 1590, National Museum Prado.

References:

1. Jonathan Jons blog. The Bearded Woman of Abruzzi: a 17th-century heroof gender fluidity. The Guardian, Dec 2016

2. Piruzyan A, Shahsuvaryan G. Palette of medical finds, 2021, ISBN 978-9939-76-773-4

3. Alexis LeVee, Nissi Suppogu,Christine Walsh, Wendy Sacks,James Simon and Chrisandra Shufelt. The Masquerading, Masculinizing Tumor: A Case Report and Review of Literature. J Womens Health (Larchmt). 2021; 30: 1047–1051.