We spoke with them about the work.
ResearchGate: What motivated this study?
Raffaella Bianucci & Antonio Perciaccante: This study is part of a larger project on art and clinical medicine. The project is aimed at detecting the pictorial representations of different types of pathological conditions in works of art and training the eye of medical students. With reference to cancer, there is an open debate within the scientific community concerning its prevalence in antiquity. Recent studies have clearly shown that cancer is not a “modern” disease as originally postulated. Although its real burden in past populations is far from being ascertained, more and more evidence is emerging from the paleopathological record.
RG: What did you discover?
Bianucci & Perciaccante: We discovered two of the earliest pictorial representations of breast cancer dated to the 16th century: The Night, painted by Michele di Rodolfo del Ghirlandaio (1503–77), and The Allegory of Fortitude, depicted by Maso di San Friano (1531–71). The first case represents a malignant neoplasia in the central region of the left breast with progressive nipple retraction. In the second case, the feminine figure shows an ulcerated, necrotizing breast cancer and associated lymphoedema.
RG: How confident are you that the women in these paintings were suffering from breast cancer?
Bianucci & Perciaccante: We are very confident that these women suffered from malignant breast cancer. The features displayed by of The Allegory of Fortitude in particular are typical of breast cancer.
RG: Did the artists know what they were painting, that something was wrong?
Bianucci & Perciaccante: It is difficult to answer to this question. The Night by Michele di Rodolfo del Ghirlandaio is based on a marble statue of the same name carved by Michelangelo. The painter reproduces the same anomaly of the breast that was already present in the statue. More generally, Renaissance women had many pregnancies, and breast anomalies due to mastitis or other conditions, like breast rhagades. Artists would have seen these maladies but were not necessarily in a position to distinguish between each specific medical condition.
RG: The Renaissance was also an important time for the understanding of medicine, did this play a role in the paintings?
Bianucci & Perciaccante: Certainly, it did play a role. The Renaissance represented a revolutionary period for medical practice. Universities flourished throughout Europe and scholars started the scientific study of medicine. Dissections enabled knowledge to be gained about human anatomy, and Galen’s animal-based anatomical model was finally rejected. The anatomical concept of disease was established, and this was reflected in the therapeutic approaches used.
Of course, the newly acquired medical concepts had a reflection in the arts. During the Renaissance, artists wanted to make more realistic art, and they used human anatomy to depict an accurate human form and to see how systems worked. Artists were interested in the study of proportion, thus it would not be unusual for artists and physicians to collaborate in producing an artistic and scientific work.
RG: Was breast cancer common in Renaissance Europe?
Bianucci & Perciaccante: No one can give statistics on malignant breast cancer frequencies for Renaissance Europe, nor for earlier or later historic periods. However, given the number of treatises and medical documents treating this pathological condition since antiquity, it is highly likely that significant portion of the female population developed malignant cancer.
RG: How did they treat it?
Bianucci & Perciaccante: Different treatments were applied over time ranging from the application of specific ointments to radical surgery. It is worth noting that advancements in breast tumor surgery were achieved in the 16th century. Barthélémy Cabrol (1529–1603), first surgeon of King Henry IV and professor at Montpellier University, recommended mastectomy, including the removal of the pectoralis muscle and the axillary lymph nodes that appeared to be affected by the disease. His approach paved the way for “radical mastectomy,” which Wiliam R Halsted (1852–1922) would perform three centuries later (1894) in strict aseptic conditions using the newly discovered anesthetics.
However, radical mastectomy was not commonly practiced during the Renaissance. The lack of general anesthesia, absence of aseptic techniques, complications derived from wound infection, and postoperative pain and bleeding represented major hurdles for surgeons. The breast was, and remains, a symbol of femininity, fertility, and beauty. Therefore, mastectomy was considered an inhumane practice by Renaissance standards. Therapeutic nihilism prevailed among the vast majority of Renaissance surgeons resulting in high numbers of visible, advanced breast cancers.
Featured image of Night and Day by Michelangelo Buonarroti courtesy of Miles Berry.