Q J Med 2003; 96: 688-690
© 2003 Association of Physicians
Correspondence |
Blessed with exophthalmos in Michelangelo’s Last Judgment
Sir,The Last Judgment is the masterpiece of Michelangelo’s mature years. The fresco depicts the souls of the dead rising up to face the wrath of God. Christ, in the centre of the piece, is seated on a cloud. He raises his right arm above the figure of the interceding Mary to raise the blessed, and holds out a sharply foreshortened left arm to damn those on the right. The blessed souls enjoy perfect happiness in the contemplation of God and are seen rising into heaven.
These figures of the blessed have a look of astonishment and fear, and several of them have their eyes wide open, staring up at God. Michelangelo was very knowledgeable about anatomy and medicine, which he supposedly incorporated into his artwork including two Sistine Chapel frescos: in The Separation of Land and Water, the mantle of the Creator resembles a bisected right kidney;1 and in the Creation of Adam, the image surrounding God and the angels is shaped like a human brain.2 It seems possible that more medical motifs could exist in the Last Judgment.
One figure in the Last Judgment, a blessed woman with a turban on her head has an appearance suggesting the presence of exophthalmos (Figure 1). Most of the classical features of thyroid-associated ophthalmopathy can be recognized here: conjunctival redness, eyelid redness, chemosis, swollen caruncle, eyelid oedema, and increasing proptosis. Due to her position in the painting, one cannot clearly determine whether the exophthalmos is unilateral or bilateral, although clinically it would be likely to be bilateral.
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After the latest restoration of the Last Judgement in the nineties, the presence of a small haemorrhage in the lower corner of the eyelid is now clearly visible. While a number of the figures of the blessed appear wide-eyed in awe and fear, none displays the degree of proptosis of this woman, nor shows the redness characteristic of exophthalmos, chemosis or periorbital oedema. While to date there has been no report of exophthalmos in any of the Last Judgment commentaries, it seems possible that Michelangelo was portraying a woman with exophthalmos 300 years before the first description of thyroid-associated ophthalmopathy in the 1835 by Graves.3 Exophthalmos has, however, been known since the Ancient Greeks.4 Aristotle and Xenophon described it as early as the 5th century BC, and in the 10th century, Byzantine writers were aware of a combination of goitre and exophthalmos.
So who did Michelangelo want to represent in this blessed woman? Why would he have depicted exophthalmos? One possibility is that Michelangelo painted a random subject who had exophthalmos, the signs of which were clearly evident to the artist. Alternatively, he may have depicted a specific blessed figure who he had in mind and had seen previously depicted with bulging eyes. The skin tone of the woman suggests she is not Caucasian, but more likely of North African descent, and she is not the only African figure in the painting. Who might this blessed figure with exophthalmos be? Saint Monica, mother of Saint Augustine, has often been depicted with a turban on her head and with facial features suggesting North African origin. She was born in Tagasta, North Africa in 333 AD, and in a picture from the late XV century, she is depicted with dark skin. In another representation of Saint Monica from the early XVI century, while her abnormal exposure of sclera can not be viewed because her eyes are closed in prayer, her eyes are nonetheless large and swollen with eyelid oedema. Artwork suggests that Saint Monica may well have suffered from exophthalmos.
Saint Monica was one of the matrons of Tagaste. He married life was unhappy, but by her sweetness and patience, she was able to exercise an apostolate amongst the wives and mothers of her native town. The ideal of Christian mothers, she shed many tears over her son, Saint Augustine, until he was finally baptized at age 17 in 387. She certainly seems worthy of being represented among the blessed in the Last Judgment.
Michelangelo’s comment: 'How many people will go crazy over my masterpiece!' seems to have come true. The 'crazy people' began with Romans who first viewed the 391 figures of the Last Judgment and continue to this day, as people of all nations still stop to gaze at the giant fresco, and still sometimes find something new.
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Department of Diabetes & Endocrinology University Campus Bio-Medico Rome Italy and Department of Diabetes & Metabolism St. Bartholomew’s Hospital London e-mail: p.pozzilli{at}unicampus.it
Acknowledgments
I would like to express my gratitude to Father Antonio Iturbe Saíz, who was a great help in locating various pictures and historical texts of Saint Monica. I would also like to acknowledge Professors D. Andreani and R.D.G. Leslie for their useful comments, and Jennifer Nisita and Andrea Stoler for their help in editing and formatting the letter.
References
1. Eknoyan G. Michelangelo: art, anatomy, and the kidney. Kidney Int 2000; 57:1190–201.[CrossRef][Medline]
2. Meshberger FL. An interpretation of Michelangelo’s Creation of Adam based on neuroanatomy. JAMA 1990; 264:1837–41.
3. Sawin CT. Theories of causation of Graves’ disease: an historical perspective. Endocrinol Metab Clin North Am 1998; 27:63–72.[Medline]
4. Marketos SG, Eftychiadis A, Koutras DA. The first recognition of the association between goiter and exophthalmos. J Endocrinol Invest 1983; 6:401–3.[Medline]
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