Epilepsy & Behavior

St. Valentine—patron saint of epilepsy: Illustrating the semiology of seizuresover the course of six centuries

Gerhard Kluger *, Verena KudernatschClinic for Neuropaediatrics and Neurological Rehabilitation, Paediatric and Adolescent Epilepsy Centre, BHZ Vogtareuth, Krankenhausstrasse 20, D-83569 Vogtareuth, Germany

a r t i c l e i n f o

Article history:Received 19 August 2008Revised 12 September 2008Accepted 19 September 2008Available online 17 December 2008

Keywords:EpilepsyHistorySaint ValentineSeizure semiology

a b s t r a c t

From the 15th century to the present day, Christian art has portrayed people who suffer from epilepsy asattributes in illustrations of Saint Valentine (SV). The objective of our study was to interpret the works ofart from a modern epileptological perspective on the basis of a collection of portrayals of SV in Europethat was as comprehensive as possible. The people depicted as attributes were analyzed with respectto their age, gender, social status, and possible seizure semiology. Three hundred forty-one illustrationsof SV from Austria, Belgium, Croatia, Czech Republic, France, Germany, Hungary, Ireland, Italy, Luxem-bourg, Poland, Scotland, Slovakia, and Switzerland were systematically analyzed. Irrespective of theage of the work of art, among the 143 pictures of people with possible epilepsy characteristics, there weremore males than females from various levels of society. As far as could be interpreted, there were 17infants, 35 children, 7 adolescents, and 84 adults. With respect to possibe seizure semiology, infantilespasms (n = 10), atonic seizures (n = 13), tonic seizures (n = 53), absences (n = 2), psychogenic seizures(n = 4), and postictal or undefinable states (n = 61) were differentiated in a subjective assessment. Despitethe fact that from a modern perspective, the 15th to 20th centuries in Europe seemed to be dominated bya rather superstitious attitude toward epilepsy, there is striking accuracy in the detail of the semiology inmany of the historic portrayals, and a well-founded knowledge of epilepsy is apparent.

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1. Introduction

From around the 9th century, particularly in German-speakingregions, but also in English-speaking areas, Christians consideredSaint Valentine (SV) to be a significant patron saint of the ‘‘fallingsickness” (epilepsy) [1,2]. From the 15th century to the presentday, Christian art has often portrayed people with epilepsy as attri-butes in illustrations of SV. In a first assessment of illustrations ofSV, the authors were surprised at the accurate detail of the possibleseizure semiology in some artistic depictions of people who prob-ably had epilepsy. The objective of our study was therefore tointerpret these portrayals from a modern epileptological perspec-tive on the basis of a survey of depictions of SV in Europe thatwas as comprehensive as possible. In so doing, we drew culturalhistoric inferences as to how the Church, common faith, and sacredart have dealt with epilepsy in connection with SV.

2. Material and methods

Systematic research on churches and chapels under thepatronage of SV was carried out in all German, Czech, Slova-

kian, Polish, and Hungarian dioceses of the Roman CatholicChurch and less systematically also in Austria, Bulgaria, Italy,Romania, and Switzerland. Either illustrations of SV (paintings,sculptures, votive pictures, stained glass window images) werephotographed with the permission of the churches, or photo-graphs reproduced in church literature were used. Furtherdepictions of SV were obtained from the collections of bothauthors and other private collections (predominantly devotionalpictures and sculptures), from illustrations of Christian art andthe piety of people in the literature, and through Internetresearch.

All illustrations of SV were digitized in a database. Where theillustrations were not dated, the age was determined using histor-ical art criteria. The people depicted as artistic attributes were sub-jectively interpreted by both authors to establish gender, age,social status (in most cases based on their clothing), and possibleseizure semiology.

3. Results

Three hundred forty-one illustrations from the 13th to 21stcenturies, predominantly sculptures (n = 101) and paintings(n = 96) of SV from Austria (n = 7), Belgium (n = 1), Croatia(n = 1), the Czech Republic (n = 8), France (n = 1), Germany(n = 266), Hungary (n = 5), Ireland (n = 1), Italy (n = 11), Luxem-

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* Corresponding author. Fax: +49 8038 9013411.E-mail addresses: [email protected], [email protected] (G. Kluger).

Epilepsy & Behavior 14 (2009) 219–225

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bourg (n = 1), Poland (n = 30), Scotland (n = 1), Slovakia (n = 4),and Switzerland (n = 4), were compiled and assessed (see Table1). The oldest illustrations with depictions of people with epi-lepsy were from the 15th century, the most frequent were fromthe 18th and 19th centuries, and there were also some from the20th century (see Table 2). A total of 143 people who possiblyhad epilepsy were depicted in 127 illustrations. As far as could

be interpreted, there were definitely more males (n = 122) thanfemales (n = 18) from various levels of society; 17 were infants,35 children, 7 adolescents, and 84 adults (see Table 3). In termsof possible seizure semiology, we interpreted infantile spasms(n = 10) (Figs. 1 and 2), atonic seizures (n = 13) (see Fig. 3), tonicseizures (n = 53) (Figs. 4 and 5), absences (n = 2) (see Fig. 6), andpsychogenic seizures (n = 2) (Fig. 7). For 61 people depicted asattributes, we interpreted their state as postictal (Fig. 8) or unde-finable, but we had the impression that they had epilepsy. Inaddition, many people in some of the illustrations of SV didnot exhibit any evidence of epilepsy, for example, relatives ofpeople who possibly had epilepsy.

4. Discussion

The origins of the veneration of the saints could already beseen in early advanced civilization; in Greek hero worship, for in-stance, Zeus and his son Apollo were invoked for assistance incases of illness or infirmity [3–5]. In the early and high MiddleAges, in the West, illness was viewed as a punishment for sinfulbehavior, considered to be witchcraft or bedevilment. Sacrifice,prayer, atonement, and exorcism of demons/the devil were ‘‘ther-

Table 1Origin and nature of 341 illustrations of Saint Valentine

Country Sculptures Paintings Devotional pictures Other All

Austria 4 3 0 0 7Belgium 0 0 0 1 1Croatia 0 1 0 0 1Czech Republic 3 5 0 0 8France 0 0 1 0 1Germany 85 43 91 47 266Hungary 3 2 0 0 5Ireland 0 1 0 0 1Italy 2 8 0 1 11Luxembourg 0 0 0 1 1Poland 3 27 0 0 3Scotland 0 1 0 0 1Slovakia 0 4 0 0 4Switzerland 1 1 0 2 4Total 101 96 92 52 341

Table 2Age of the depictions of Saint Valentine (n = 341) and number of people who possiblyhad epilepsy depicted as attributes

Century Number Illustrations of people with epilepsy

13th 1 014th 2 015th 20 1216th 23 1617th 43 2318th 55 3319th 69 3020th 20 2021st 1 0Age not definable 107 9Total 341 143

Table 3Interpretation with respect to gender, age, and possible social status of the people(n = 143) who may have epilepsy depicted as attributes

Gender

Male 122 (85.3%)Female 18 (12.6%)Gender not specified 3 (2.1%)

AgeInfant 17 (11.9%)Child 35 (24.5%)Adolescent 7 (4.9%)Adult 84 (58.7%)

Social statusLow 24 (16.8%)Middle 74 (51.7%)High 37 (25.9%)Not definable 8 (5.6%)

Fig. 1. Saint Valentine, ceiling fresco, Unterleiterbach, Germany, 1740: child with possible infantile spasm and demon.

220 G. Kluger, V. Kudernatsch / Epilepsy & Behavior 14 (2009) 219–225

apeutic” concepts [2,5,6]. In Christianity, saints were of great sig-nificance in the treatment of severe and chronic illnesses, as theirintercession with God was considered to have a great therapeuticeffect on human ailments [2,5]. In some illustrations of SV, the as-pect of exorcising demons in connection with epilepsy is depictedas a demon flying out of the mouth of a sick person (see Fig. 1)[7].

Of the more than 40 named ‘‘epilepsy saints” (among oth-ers, Aegidius, Anastasia, Antonius, Cosmas, Cyriacus, Damian,John the Baptist, Ladislas of Hungary, Veit, Zeno), SV was themost well known and he was the saint who was invoked mostoften [1,8–11]. Today, we can no longer verify whether hispatronage was based on the phonetic use of his name withthe word fall, as Luther had suspected, or on an incident inhis legend (SV is said to have healed a person with epilepsy)[1,8,12].

Two saints with the name Valentine were and are worshipped inthe Roman Catholic Church: Valentine of Terni, patron saint dayFebruary 14, and Valentine of Rhaetia, patron saint day January7. Valentine of Rhaetia is one of the patron saints of the Passau/

Fig. 2. Saint Valentine, painting, Svitavy, Czech Republic, 1794: child with possibleinfantile spasm.

Fig. 3. (a) Saint Valentine, altar sculpture, Unterföhring, Germany, 1932: child withpossible atonic seizure.

Fig. 4. (a and b [detail]) Saint Valentine, altar sculpture, Kösslarn / Germany, 1733:child with possible tonic seizure.

G. Kluger, V. Kudernatsch / Epilepsy & Behavior 14 (2009) 219–225 221

Bavaria and Chur/Switzerland dioceses. People with epilepsy areportrayed in illustrations of both Valentine of Terni and Valentineof Rhaetia.

It is likely that two saints with the name Valentine had theirpatron saint day on February 14. Although the two SVs aresometimes entered separately in martyrologies and biographies,most scholars believe they are the same person [3,9,11]. Thepatronage is complex, as SV’s help is invoked not only againstdiseases of cattle and pigs, but also against a host of human ail-ments, such as diseases of the uterus, gout, and, most notably,fainting, madness, and epilepsy. The use of pigs as attributes inillustrations of SV leads us to assume that there is also a refer-ence to the description of the ‘‘healing of the demoniac of Gad-ara” (Mark 5:1–19; Lucas 8:26–40; Matthew 8:28–34) [13]. Thispassage in the Bible is interpreted as the curing of a personwho possibly had epilepsy [8]. Interestingly, this passage in theBible is depicted as a demon riding a pig, in a 16th-century ceil-ing fresco in Ioannina, Greece (see Fig. 12). Corresponding patronsaints in the Russian and Greek Orthodox Churches are St. Trifonand St. Pantelmeion [14].

Other passages in the Old and New Testament are interpretedas possible descriptions of epilepsy [8,15]. In particular, the pas-sage ‘‘Jesus heals a somnambulistic boy” (Matthew 17:14–18;Mark 9:14–27; Luke 9:37–42) has been depicted many times inChristian art, often including demons, similar to illustrations ofSV [3,13].

In medieval German language, the ‘‘falling sickness” wassometimes referred to as ‘‘St. Valentine’s illness, St. Veltin’sinfirmity” [8]. In popular belief and superstition, numerous

‘‘alternative cures” for epilepsy have been connected to SV.Fig. 11, for example, features an ‘‘epilepsy bonnet” (Fraisenhäub-chen, Fraisen is an expression for epilepsy in Middle High Ger-man) in a depiction of SV; these Fraisenhäubchen were placedas hoods on the heads of infants who had a fever, to protectthem from seizures.

For the first time we have systematically assessed a compre-hensive collection of illustrations of SV from mainly central andmiddle Eastern Europe for historic aspects of epilepsy. However,this interpretation of artistic portrayals is subjective. Neverthe-

Fig. 5. (a and b [detail]) Saint Valentine, sculpture, Eppertshausen, Germany, 18thcentury: adult with possible tonic seizure.

Fig. 6. (a and b [detail]) Saint Valentine, altar sculpture, Erlach, Germany, 1676:adult with possible absence.


less, it delineates interesting aspects of the knowledge ofepilepsy and the attitudes toward this disease over six centuries.

Most of the people who presumably had epilepsy and aredepicted as attributes are males from various levels of society. Bothupper class and ‘‘common” people, possibly even ‘‘beggars,” aredepicted. The ‘‘witch hunt” in the Middle Ages concerned mainlywomen. With the background of associating epilepsy with ‘‘possessionby demons” and the additional fact that SV had the ability to exor-cise the ‘‘demon epilepsy,” the predominant use of males from alllevels of society in illustrations of SV may have been an expressionthat people were perfectly aware that epilepsy could occur irre-spective of gender and background.

Another large group depicted as attributes are infants and chil-dren. The fact that epilepsy occurs particularly during childhoodhad already been ascertained in Hippocrates’ time. In the CorpusHippocratum, the work ‘‘regarding the sacred illness” (dated be-tween 430 and 410 BC), seizures involving falling are specificallydescribed as childhood manifestations of epilepsy [4,6]. Our inter-pretation of the artistic depictions draws us toward the conclusionthat the occurrence of epileptic seizures in people of all ages, andparticularly in infancy and early childhood, was well known at thattime. In the art we examined, people are often depicted falling overor following a fall, sometimes with bandages on their heads; thisprobably expresses an awareness of the danger of head injuriesin drop attacks (see Figs. 9 and 10).

The authors were especially impressed by the accuracy of thedetail of the ictal phenomena in the illustrations. In addition to sei-zures involving falling, infants are often depicted with what ap-pears to be tonic elevation of the arms, as in infantile spasms(see Figs. 1 and 2). Therefore, these were already well known asepileptic phenomena in infants at that time. Some illustrations(see Fig. 6) could be interpreted as absences with retropulsions.However, tonic seizures are prominent; with few exceptions, peo-ple are portrayed with open eyes and therefore in the process ofhaving a seizure. However, in some illustrations we assume to beictal portrayals, people are shown with closed eyes. In connectionwith the overall context of the picture, we can speculate that non-epileptic/psychogenic states are also being depicted by the artist(see Fig. 7). Psychogenic seizures had been described by Tissot in1770 [7].

In summary, on the basis of our systematic interpretation ofillustrations of SV, we believe that the artists themselves witnessedpeople who had epileptic seizures and wanted to depict the sei-zures, sometimes with detail, in their works of art. The frequently

Fig. 7. Saint Valentine, copper engraving, Germany, 18th century: adult withpossible nonepileptic/psychogenic seizure.

Fig. 8. (a and b [detail]) Saint Valentine, sculpture, Oppenheim, Germany, 18thcentury: adult in possible postictal state.


astounding accuracy in detail suggests that the artists were im-pressed by the seizures they observed. Despite the fact that fromtoday0s perspective, the 15th to 19th centuries in Europe seemedto be dominated by a rather superstitious attitude toward epilepsy,there is a striking accuracy in detail in the semiology of many ofthe historic portrayals, and a well-founded knowledge of epilepsyis apparent.

Fig. 10. Saint Valentine, sculpture, Austria, 18th century: person who possibly hasepilepsy being held by the saint while falling during a drop attack.

Fig. 11. Epilepsy bonnet (Fraisenhäubchen: Fraisen = Middle High German expres-sion for epilepsy) with a depiction of Saint Valentine, Germany, 18th century.

Fig. 9. Saint Valentine, sculpture, Bergham, Germany, 1525: person who possibly has epilepsy with probable head injury.


Acknowledgments

We thank Dr. D. Pollak, Prague/Brno, for collecting all of thedata on St. Valentine from the Czech Republic, Slovakia, Poland,

and Hungary, and the St. Valentine’s Group of Paediatric Epileptol-ogists (T. Bast, U. Bettendorf, P. Borusiak, E. Haberlandt, H. Freitag,H. Philippi, G. Wiegand, K. Schrader, K. Strobel, G. Wohlrab) fordiscussions.

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Fig. 12. Detail of ceiling fresco with demon and pig, Monastery Filanthropinon,Ioannina, Greece, 1540: ‘‘Healing of the demoniac of Gadara” (Mark 5:1–19; Luke8:26–40; Matthew 8:28–34).


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