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SPECIAL ARTICLE

PROBABLE DEPICTION OF JUVENILE ARTHRITIS BY SANDRO BOTTICELLI

DONATO ALARCON-SEGOVIA, ARMAND0 LAFFON, and JORGE ALCOCER-VARELA

There is a question whether rheumatoid arthritis is a disease of recent or ancient onset since it was only first described in 1800. In support of its earlier appear- ance are depictions of rheumatoid hands in Flemish paintings of the fifteenth through eighteenth centuries. The first description of juvenile arthritis is attributed to Cornil in 1864, making the question of its antiquity also pertinent. We show here that the “Portrait of a Youth,” painted in 1483 by the Florentine artist Sandro Botticel- li, has features of rheumatoid arthritis in the hand of the subject, who would be young enough to be considered as having juvenile arthritis. A review of all of Botticelli’s paintings revealed that these changes could not be attributed to stylistic traits. Neither could they be attributed to lack of technique, for he has been consid- ered a superb artist. If the “Portrait of a Youth” does indeed represent juvenile arthritis, it would mean that this disease is older than its initial description would indicate.

The earliest generally accepted medical de- scription of rheumatoid arthritis (RA) was made by Landre-Beauvais in his receptional thesis of 1800 (reported in ref. 1). This, plus its absence in ancient

From the Department of Immunology and Rheumatology, Instituto Nacional de la Nutricion “Salvador Zubirin.” Mexico City, Mexico.

Dr. LaEon is the recipient of a grant from the Instituto de Cooperacibn Iberoamericana, Madrid, Spain.

Donato Alarcon-Segovia. MD: Professor and Chairman: Armando Laffon, MD: Research Fellow; Jorge Alcocer-Varela, MD: Career Investigator.

Address reprint requests to Dr. Donato Alarc6n-Segovia. Instituto Nacional de la Nutrici6n “Salvador Zubiran,” Vasco de Quiroga No. 15, Delegaci6n Tlalpan, Mexico, D.F., 14000, Mexico.

Submitted for publication April 4, 1983; accepted in revised form May 24. 1983.

bones, absence of mention in the Bible, by Homer, or Shakespeare, and absence of depiction in paintings, led Boyle and Buchanan to postulate that rheumatoid arthritis is a disease only recently acquired by humans (2). However, Caughey reports an illness, very likely RA, suffered by the Byzantine emperor Constantine IX Monomachus (c. 980-1055) and described by Mi- chael Psellus in his Chronographia (1063) (3). De- queker gathered paintings by Jan Rombauts (c. 1500), Justus van Gent (143&1475?), Jan van Eyck (?-1441), Jan Gossaert (1478-1532), and particularly one by Jacob Jordaens (1593-1678) that depict hand changes suggestive of RA (4). More recently, a peculiar tenden- cy of Peter Paul Rubens to paint apparent swelling of the wrists and deformities of hands has been discov- ered (9, and the suggestion has been made that either he or his second wife, Helena Fourment, or both may have had rheumatoid arthritis.

The initial description of juvenile arthritis is ascribed to Cornil at a date (1864) that is even later than the description of the adult onset form (6). The question of the antiquity of juvenile arthritis may thus be pertinent, similarly to that of the adult form.

We describe here swelling at the wrist, metacar- pophalangeal, and proximal interphalangeal joints on the one hand that is portrayed in “Portrait of a Youth” by Sandro Botticelli (Figure 1). The young age of the beardless subject suggests that this swelling may rep- resent juvenile arthritis.

Alessandro Filipepi, called Sandro Botticelli, was born in Florence, Italy in 1445 and learned paint- ing under Fra. Filippo Lippi. Later, Botticelli became the teacher of Lippi’s son, Filipino (7). When he painted the “Portrait of a Youth” (c. 1483), Botticelli had already become famous, was in full command of

Arthritis and Rheumatism, Vol. 26, No. 10 (October 1983)

DEPICTION OF JA BY BOTTICELLI 1267

Figure 1. “Portrait of a Youth” by Sandro Botticelli. c. 1483. 45.2 x 31.8 cm, tempera on wood (reproduced with permission of The National Gallery of Art, Washington, DC).

his technique, and was patronized by the Medicis, rulers of the city of Florence and well known for their capacity to discriminate among the many artists of the day. This painting had been previously attributed to Massachio but was reattributed to Botticelli in 1922 by Berenson (8). The attribution to Botticelli was later confirmed by Fry and by Mesnil (8). This belated recognition is not strange since Botticelli was scarcely known until he was rediscovered in the nineteenth century by Ruskin, Rossetti, and the English pre- Raphaelites, and particularly by Walter Pater (9).

In this portrait the apparent swelling of the joints cannot be ascribed to faulty technique since, as Berenson noted, Botticelli’s art reached “the pinnacle of what is draughtsmanship” (9) and he was “the greatest artist of linear design Europe has ever had” (10). Neither can it be attributed to a stylistic trait present uniformly in Botticelli’s paintings. A review of all his 184 catalogued paintings (7) shows that when painting an extended hand he, like many other painters of the Renaissance, placed both middle fingers togeth- er and the second and fifth apart, as if to relieve the

monotony the fingers would have if all were spread. A bent fifth finger is often encountered (as in “Christ Presenting the Crown of Thorns,” Birmingham Muse- um of Art; the “Madonna Havemayer,” New York Metropolitan Museum; or “Fortitude,” Uffizi Gallery, Florence), but the swelling of the other joints and that of the wrist are not apparent in his other paintings, including the 8 other portraits in which hands are shown. Only in the fresco representing “Saint Augus- tine in his Studio,” which Botticelli painted at the Church of Ognissanti (his parish church in Florence where he is buried), does one find clear evidence of arthritis in the fingers of the saint, most likely repre- senting osteoarthritis (Figure 2).

It is difficult to identify the subjects of portraits made by Florentine Quattrocento painters, because the artist did not feel bound to preserve the subject’s likeness ( I 1). It is not even known if Botticelli actually had models sit for him. The youth’s face may repre- sent what Hatfield (11) calls a “stock vocabulary of feature types and subtypes” toward an approximation of the subject’s appearance. The expression of “utter abandonment” that Berenson mentions when referring to Botticelli’s characters (9) is clearly found in the “Youth” and is considered the prelude of this tenden- cy in his latter Madonnas (8). The Saint Augustine of the Ognissanti (1480) is also a stereotype, but repre- sents inner strength rather than the sentimentalism represented by the Youth. In both paintings, however, the hands are shown with joint changes suggesting first, that Botticelli worked directly from the model and second, that he probably painted the hands more to the likeness of the model than he did the face, which was idealized and not an actual portrait.

Based on the various sources mentioned, it seems that rheumatoid arthritis had, indeed, appeared several centuries before Landre-Beauvais’ descrip- tion. The young man portrayed by Botticelli may have suffered from the juvenile form; if so, this may have existed long before it was described. That both the adult and juvenile forms of rheumatoid arthritis were not depicted more often may have been due to reluc- tance of the European artists to represent disease. An exception may have been Rubens, who for personal reasons may have done it more frequently (4).

The relative paucity of disease representation in European art contrasts sharply to its frequency in Mesoamerica where at much earlier dates many illness- es, including osteoarthritis, were represented in clay figurines (12,13). In a search of the principal public and private collections in Mexico, we have thus far failed

1268 ALARCON-SEGOVIA ET AL

Figure 2. “Saint Augustine in His Studio” (detail) by Sandro Botticelli, 1480, 152 x 112 cm, mural fresco, Florence, Italy, Church of Ognissanti.

to find an example of rheumatoid arthritis in pre- Columbian art , although w e found examples of other less apparent diseases (14).

Sandro Botticelli, despite his constant striving to represent idealized beauty, may have given us a clue to the antiquity of juvenile arthritis, by means of his unique draftsmanship and more natural depiction of hands.

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Bywaters EGL: The history of pediatric rheumatology. Arthritis Rheum (suppl) 20: 145-152, 1977 Berti L: Botticelli, Historia del Arte. Vol. 5. Edited by J Pijoan. Barcelona, Spain, Salvat Editores, 1977, pp

Mandel G: L’opera completa del Botticelli. Milan, Italy, Rizzoli Editore, 1967, pp 83-1 17 Berenson B: The Passionate Sightseer, The Diaries: 1947 to 1956. New York, Simon & Schuster, 1960, pp 18-20, 175 Secrest M: Being Bernard Berenson: A Biography. New York, Holt, Rinehart & Winston, 1979, p 232 Hatfield R: Botticelli’s Uffizi “Adoration”: A Study in Pictorial Content. Princeton, NJ, Princeton University Press, 1976, p 83 Alarcon-Segovia D: Pre-Columbian representation of Heberden’s nodes. Arthritis Rheum 19: 125-126, 1976 Schumacher R, Alarcon-Segovia D: Osteoarthritic knees in a precolumbian ceramic figure. J Rheumatol

De la Fuente JR, Alarc6n-Segovia D: Depression as expressed in pre-Columbian Mexican art. Am J Psychia- try 137: 1095-1098, 1980

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