The wow-effect of visual art; works of art that inspired the naming of diseases

INTRODUCTION

Medicine and art are most significantly different areas of human activity. Nevertheless, there are overlaps, and there is a mutual inspiration. Bridging this divide between the science in medicine and the subjective experience in art allows for life, which honestly defines itself and faces difficult human truths. The preoccupation with the incarnate and the detailed observation are strong links between painting and medicine. Visual art can be used to improve the didactics of medicine and medical competence.^[1] Learning anatomy and artistic endeavors have a mutually beneficial relationship.^[2]

Paintings and drawings were the first opportunities for the pictorial documentation of diseases before photography. On the other hand, iconodiagnosis, a retrospective medical diagnosis carried out on a work of art depicting a human person, has gained increasing interest among physicians.^[3]

For the present review, we have chosen a different perspective. Our focus is on the phenomenon of doctors being inspired by works of fine art to the naming of clinical disorders.

MONA LISA SYNDROME

Leonardo Vinci (1452–1519) was one of the greatest painters in the history of western art and is often credited as the founder of the High Renaissance. He was also interested in (human) anatomy and was given permission to dissect human corpses at the hospital. He attempted to identify the source of “emotions” and their expression. According to him, painting is a science media.^[4]

The Mona Lisa portrait is one of the most famous paintings in the world [Figure 1]. It represents a young woman, probably the Italian noblewoman Lisa del Giocondo, in a half-length portrait painting in oil on a white poplar panel. It is believed to have been painted between 1503 and 1506. Robert Wallace commented on Mona Lisa’s portrait, it is “a beauty into which the soul has entered with all its diseases! […] All the thoughts and experiences of the world have engraved their traces there... the sensuality of Greece, the voluptuousness of Rome, the mysticism of the Middle Ages... the return of the pagan world, the sins of the Borgia.”^[4] Reading facial expressions is of most importance in social life. Expressions are often the result of subtle changes in facial appearance. The subtle ambiguity of her smile is fascinating. He used the sfumato painting technique, a fine shading meant to produce a soft transition between colors and tones, to achieve a more believable image.

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Figure 1:

Leonardo da Vinci: Mona Lisa (Portrait of Lisa del Giocondo), between circa 1503 and circa 1506, oil on poplar panel. Public domain. (a) Overview with the asymmetric smile. (b) Detail of the asymmetry demonstrating the sfumato style of painting.

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Mona Lisa‘s asymmetric smile could represent a ruse the painter used to hold cryptic and enigmatic messages. Some authors have speculated that this smile represents a facial muscle contracture that develops after Bell’s palsy. Bell’s palsy is the most common peripheral paralysis of the seventh cranial nerve. It is known that Da Vinci’s model had given birth shortly before the painting was made.^[4]

Bell’s palsy disproportionately affects pregnant women. The third trimester is the most common time for Bell’s palsy to occur. Preeclampsia is the most common comorbidity reported.^[5] Due to the asymmetric Mona Lisa smile, the name Mona Lisa syndrome was coined to reference pregnancy-related Bell’s palsy.^[6,7]

BRUEGHEL SYNDROME

Pieter Brueghel the Elder (1525–1569) was a Flemish painter and a printmaker. He was considered to among the most significant artists of Dutch and Flemish Renaissance painting.

He belonged to the first generation of painters to grow up when religious subjects had ceased to be the natural subject matter of painting.^[8] Peter Brueghel the Younger (1564–1638) was the son of Pieter Brueghel the Elder. He was considered an excellent copyist of his father’s works.

Brueghel syndrome, a subtype of cranial dystonia, was named after some paintings of the Brueghel painter family depicting different dystonic facial expressions [Figure 2].^[9,10] Brueghel syndrome is characterized by involuntary jaw movements. Typically, the jaw remains open for various lengths of time (as if the person were yawning). The neurological condition is often associated with Meige’s syndrome, described as involuntary closure and movement of the eyelids. A critical historical evaluation of the cranial dystonia supports the separation of the dystonia of the motor trigeminal nerve producing a widely opened mouth (Brueghel syndrome) from the more common facial dystonia with blepharospasm (Meige’s syndrome). In Brueghel syndrome, paroxysmal hyperpnea can coincide with dystonic gaping.^[11] The etiopathology of dystonia remains a unsolved; it is a collection of different syndromes.^[12]

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Figure 2:

Pieter Brueghel the Younger (1564–1638) De Gaper (Yawner) (ca. 1558); oil on oak wood. Royal Museums of Fine Arts of Belgium.

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STRAW PETER SYNDROME

The German psychiatrist, poet, and children’s book author Heinrich Hoffmann (1809–1894) wrote the children’s book, “Lustige Geschichten und drollige Bilder für Kinder von 3–6 Jahre” (Funny stories and funny pictures for children aged 3–6). Its 1^st edition appeared in 1845, and in 1847, the title was changed to “Struwwelpeter” (Haggy Peter), which gained immense popularity, not only in Germany. The book contains 10 short stories about 10 children with undesirable behavior. These cautionary tales are intended to teach children supposedly important moral lessons. Struwwelpeter marks the beginning of modern picture book design through its interplay of picture and text, a predecessor of the comics.^[13]

Straw Peter syndrome describes a hyperactive child syndrome, an attention deficit hyperactivity disorder.^[14] However, Fidgety Philip (Zappel–Philipp) is a character who best represents hyperactivity in the tales. He refused to sit quietly at the table at family dinner and kept rocking his chair despite his parents’ repeated exhortations [Figure 3].^[15] He excellently represents all main features of hyperactive child syndrome such as hyperkinesias, difficulty in sustaining attention, impulsiveness, aggressiveness, and learning difficulties.^[14]

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Figure 3:

The Fidgety Philip (Zappel–Philipp) from Heinrich Hoffmann’s Der Struwwelpeter. On a stamp from 2011 from the German Federal Post (Deutsche Bundespost): For the youth, 100^th death anniversary of Heinrich Hoffmann, Writer. Public domain.

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In contrast, Straw Peter did neither comb his hair nor led cut his hair and nails, a matter of personal hygiene [Figure 4].

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Figure 4:

Erich Hoffmann: Struwwelpeter (1844), original figure. Public domain.

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In the German-speaking world, the syndrome of uncombable hair is also called Struwwelpeter syndrome (synonym: Spun glass hair or pili trianguli et canaliculi).^[16-18]

This leads to structural changes in the terminal hair. Mutations are most commonly found in the genes such as PADI3, TGM3, and TCHH. The proteins encoded by these genes are involved in the cross-linking of hair proteins. Clinically, the affected children have frizzy lustreless silvery-blond to light brown hair, which cannot be combed (Abb. 4).^[19]

PUPPET CHILDREN SYNDROME

Born in Verona, Italy, between 1478 and 1482, Giovanni Francesco Caroto became an artist. He first apprenticed to Liberale da Verona (1441–1526) and later to Andrea Mantegna (1431–1506) in Mantua. He died in 1555 and was buried in the chapel of San Niccolò in the Madonna dell’Organo. In 1523, he painted “Fanciullo con pupazzo” (portrait of a child with a drawing) [Figure 5]. It is one of the earliest depictions of a real child. He breaks away from the usual depiction of the putto. The smile with an open mouth was a revolution in his time.^[20]

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Figure 5:

Francesco Giovanni Caroto “Fanciullo con pupazzo” (Portrait of a Child with a Drawing) (1523), Museo del Castelvecchio, Verona, Italy. (© https://de.m.wikipedia.org/wiki/Datei:Francesco_caroto,_ritratto_di_una_fanciullo_con_un_disegno_infantile_%28verona,_castelvecchio%29_01.jpg).

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There was some dispute about the origin of the painting in the past, and his younger brother Giovanni was thought to be the creator until Bernard Berenson’s attribution to Giovanni Francesco Caroto in 1907.^[21,22] The painting shows a little boy about 10–12 years old against a dark background with a drawing on paper in his right hand. He has an unusual, bright smile on his face.

The Puppet Children syndrome was coined by Harry Angelman who was born in Birkenhead, UK, in 1915. He became a pediatrician and worked after World War II at the Warrington General Hospital until his retirement. Angelman died at the age of 80 years in Portsmouth/UK.

Patients affected by this disease show characteristic symptoms such as a depression in the occipital region of the skull; primary optic atrophy with incomplete choroid development; abnormal air encephalograms indicating cerebral atrophy; mental retardation; paroxysmal laughter; ataxia; and an ability to protrude their tongue. The disease has become better known as Angelman syndrome.

Angelman had a great interest in Italy and its culture. He himself explained the importance of his encounter with Giovanni Francesco Caroto’s painting “Fanciullo con pupazzo”: “The boy’s laughing face and the fact that my patients exhibited jerky movements gave me the idea of writing an article about the three children with a title of Puppet Children. But neither the boy nor the puppet seemed to have Angelman syndrome.”^[23] The word “pupazzo” was erroneous translated in to “puppet,” while its meaning is “caricature.”^[24]

AMBRAS SYNDROME

The Tyrolean Ambras Castle, which was rebuilt in 1570–1571 to house the collection and cabinet of curiosities of Ferdinand II of Tyrol (1529–1595), owns the paintings of an unknown artist. These are full body portraits of Petrus Gonsalvus (1537–1618) and his son Enrico Gonsalvez (Gonsalvus) (born 1876) from Tenerife [Figure 6].^[25,26]

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Figure 6:

Portrait of Enrico Gonzales, son of the hairy man Petrus González (Gonsalvus); son of Haarmann, born 1576 (circa 1850); unknown artist. Schloss Ambras Innsbruck, Austria (Public domain).

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Five of the seven children of Petrus Gonsalvus with his wife Maddalena suffered from hypertrichosis as their father. The initial medical examination was carried out in 1591 by Felix Platter (1536–1614), professor of medicine at the University of Basel, Switzerland.^[27]

After inspecting these paintings in 1993, a group of pediatricians were inspired to describe a distinct type of hypertrichosis universalis congenita after Ambras Castle. Ambras syndrome is characterized by fine, light-colored, long vellus hair, primarily affecting the face (including the forehead, eyelids, cheeks, and nose), ears, and shoulders. It is associated with minor facial dysmorphism, supernumerary nipples, and dental anomalies.^[28] Only 12 recent cases have been reported so far. Newer genetic studies suggest that this hereditary syndrome is based on mutations of various gene loci including 8q22, 17q24.2-q24.3, and Xq24-q27.1 and question the use of the term Ambras syndrome.^[29]

Eponyms are common in medical terminology. Often, they remind us of the first describer of a disease and make unmemorable concepts memorable. Recently, there was an ongoing discussion on the usefulness of eponyms. Eponyms promote a valuable interest in medical history. Despite recognizing both the benefits and drawbacks of eponyms, historical precedent, pervasiveness, and ease of use still support the use of eponyms. Eponyms may help humanize the study of medicine.^[30-32]

CONCLUSION

Here, we discussed eponyms that evolved from the interest of medical experts in visual art. Medical eponyms coined after contact with a memorable artistic representation are uncommon. On the other hand, they illustrate in a unique way how art and medicine cross-fertilize each other. Neurological, behavioral, and dermatological diseases were presented as representatives.