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J Endocrinol Invest
J Endocrinol Invest
Journal of Endocrinological Investigation
0391-4097
1720-8386
Springer International Publishing Cham

38678125
2367
10.1007/s40618-024-02367-6
Endo&Art
Lack of hemochromatosis in Saint Augustine in his studio by Sandro Botticelli
http://orcid.org/0000-0002-5225-8316
Kluger N. nicolas.kluger@hus.fi

12
1 grid.15485.3d 0000 0000 9950 5666 Department of Dermatology, Allergology and Venereology, Helsinki University Hospital & University of Helsinki, Helsinki, Finland
2 Société Française des Sciences Humaines sur la Peau (SFSHP), Maison de la Dermatologie, 10, Cité Malesherbes, 75009 Paris, France
27 4 2024
27 4 2024
2024
47 9 23812382
9 3 2024
23 3 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by/4.0/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Keywords

Art
Hemochromatosis
Iconodiagnosis
Painting
University of Helsinki (including Helsinki University Central Hospital)Open Access funding provided by University of Helsinki (including Helsinki University Central Hospital).

issue-copyright-statement© Italian Society of Endocrinology (SIE) 2024
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pmcDear Editor,

I read the recent letter by de Campos that believed to have identified features of hemochromatosis in the fresco painting of Saint Augustine (1480) by Sandro Botticelli in the Church of Ognissanti in Florence [1]. The author based his interpretation solely on the "physical" examination of Saint Augustine outside of any contextualization of the fresco. The author interpreted Saint Augustine’s skin tone as a sign of melanoderma. Saint Augustine or Augustine of Hippo (354–430 AD) was a North African of Berber origin and born in Thagaste, a town located in the far east of what is now Algeria. Therefore, Augustine would be expected to display a darker skin complexion than Europeans. Besides, as the fresco is more than 500 years old, it has inevitably suffered the ravages of time as visible in the figure in the article [1]. Original colors may have faded or darkened with time. Analyzing the colors nowadays as if they were the same at the time of Botticelli is an anachronistic mistake. Only a proper restoration would bring the true original colors back. The author states that Saint Augustine has whitened nails, suggesting Terry nails or total leukonychia, a known sign of liver cirrhosis. A careful examination shows that the nails display a white linear streak on the radial side on the right hand and on the distal lateral part on the left one. Furthermore, the forehead, tip of the nose and dorsum of the right-hand of the saint display similar whitening. These parts of the body seem to be illuminated by a source of light coming from the upper left part of the fresco, towards which the saint’s gaze is directed. The shadows on the clothes and the tablecloth also indicate a source of light from the left side. De Campos sees arthritis on the fingers of Saint Augustine. It is not the first time that Botticelli is suspected erroneously to have depicted arthritis [2]. When it comes to analyzing hands or posture, it is important to rule out a stylistic habit of the artist [2]. In another artwork by Botticelli, the portrait of Youth (c. 1482/1485 National Gallery of Art, Washington), the sitter displays similar finger shapes, and even similar whitening of the nails due to light exposure (Fig. 1). Lastly, the author considers that the dramatic gesture of Saint Augustine is a "discernible sign of malaise and fatigue" [1]. The historical and artistic aspects of the fresco need to be taken into account [3]. Botticelli’s fresco is closely related to Ghirlandaio’s Saint Jerome in his study, painted the same year and facing the fresco in the church [3]. Besides, various interpretations have been given to Botticelli’s fresco. Some see a paradigmatic image of the ideal scholar or sage or the icon of a saint. A more recent interpretation is that Botticelli represented an apocryphal event in Augustine’s life [3]: the miraculous visitation of Jerome at the very same moment he died in Jerusalem. When writing a letter to Jerome, Augustine experienced an indescribable light entering his cell with unknown odors and fragrance [3]. The pose of Saint Augustine, his gaze and the whitening of his skin and nails are in line with this interpretation.Fig. 1 Sandro Botticelli (1446–1510) Portrait of a Youth, c. 1482/1485 (Courtesy National Gallery of Art, Washington). The hands and nails display the same features as Saint Augustine in his studio in the Church of Ognissanti

The practice of iconodiagnosis must respect a certain number of criteria when it comes to publishing a case [4]. The observer cannot simply look at an artwork and interpret it without knowledge of the historical, artistic, cultural, or social context of the period, sitter's patho-biographical information, the style of the artist, or the art history surrounding the work. Overlooking such additional work may lead to erroneous diagnosis. It is very unlikely that Botticelli represented any sign of hemochromatosis.

Funding

Open Access funding provided by University of Helsinki (including Helsinki University Central Hospital). None.

Declarations

Conflict of interest

None declared.

Research involving human participants and/or animals

None declared.

Informed consent

None declared.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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References

1. de Campos D Saint Augustine in his studio by Sandro Botticelli (1445–1510): a representation of hemochromatosis? J Endocrinol Invest 2024 10.1007/s40618-024-02335-0 38627331
de Campos D (2024) Saint Augustine in his studio by Sandro Botticelli (1445–1510): a representation of hemochromatosis? J Endocrinol Invest. 10.1007/s40618-024-02335-038627331 10.1007/s40618-024-02335-0
2. Leden I Doubts about Sandro Botticelli's depiction of juvenile rheumatoid arthritis Arthr Rheum 1984 27 1197 1198 10.1002/art.1780271020 6386006
Leden I (1984) Doubts about Sandro Botticelli’s depiction of juvenile rheumatoid arthritis. Arthr Rheum 27:1197–11986386006 10.1002/art.1780271020
3. Stapleford R Intellect and Intuition in Botticelli’s Saint Augustine The Art Bull 1994 76 69 80 10.1080/00043079.1994.10786575
Stapleford R (1994) Intellect and Intuition in Botticelli’s Saint Augustine. The Art Bull 76:69–80. 10.1080/00043079.1994.1078657510.1080/00043079.1994.10786575
4. Charlier P Perciaccante A Kluger N Nerlich AG Appenzeller O Donell ST Asensi V Mackowiak PA Ferrar V Bianucci R Iconodiagnosis: guidelines and recommendations Ethics Med Public Health 2023 31 100951 10.1016/j.jemep.2023.100951
Charlier P, Perciaccante A, Kluger N, Nerlich AG, Appenzeller O, Donell ST, Asensi V, Mackowiak PA, Ferrar V, Bianucci R (2023) Iconodiagnosis: guidelines and recommendations. Ethics Med Public Health 31:100951. 10.1016/j.jemep.2023.10095110.1016/j.jemep.2023.100951
