ISIS

ISIS International Society of Econo-diagnosis

This Society aims to contribute with the action of its members:
– To the development of icono-diagnosis, that is to say retrospective diagnosis of human representations (sculptures, paintings, engravings, drawings, death masks, films, etc.). This discipline is located at the borders of paleopathology, pathography, the history of medicine and diseases, and the history of art. It makes it possible to increase knowledge on sections of the body not preserved in a skeletal state, and to complete the health data of populations of the past, both on an individual and collective level.
– To the initiation and improvement of icono-diagnosis.
– To the periodic dissemination, by any means, of information on icono-diagnosis, particularly within the community of doctors (including dermatologists), art historians and the general public.
– To organize and support scientific or cultural events related to icono-diagnosis.

Cette Société savante a pour but de contribuer avec l’action de ses membres :
–       Au développement de l’icono-diagnostic, c’est-à-dire le diagnostic rétrospectif sur représentations humaines (sculptures, peintures, gravures, dessins, masques mortuaires, films, etc.). Cette discipline se situe aux confins de la paléopathologie, de la pathographie, de l’histoire de la médecine et des maladies, et de l’histoire de l’art. Elle permet d’augmenter les connaissances sur des sections du corps non conservées à l’état de squelette, et de compléter les données sanitaires des populations du passé, tant sur le plan individuel que collectif.
–       A l’initiation et au perfectionnement de l’icono-diagnostic.
–       A la diffusion périodique, par tout moyen, d’informations sur l’icono-diagnostic, notamment au sein de la communauté des médecins (dont dermatologues), des historiens de l’art et du grand public.
–       A l’organisation, au soutien de manifestations scientifiques ou culturelles en relation avec l’icono-diagnostic.”

 

Composition of the Board of Directors

  • Philippe Charlier, FRANCE (president).
  • Corinne Déchelette, FRANCE (vice-president).
  • Antonio Perciaccante, ITALY (treasurer).
  • Patricia Deps, BRAZIL (secretary).
  • Jacques Aguia Daho, BENIN (board member)
  • Anaïs Augias, FRANCE (board member)
  • Nadia Benmoussa, FRANCE (board member)
  • Raffaella Bianucci, USA (board member)
  • Saudamini Deo, INDE (board member)

ISIS MISSION

Our international society is dedicated to advancing the field of iconodiagnosis, which involves the retrospective medical analysis of artworks to identify clinical signs suggestive of medical disorders and diseases. Iconodiagnosis sits at the intersection of paleopathology, pathography, the history of medicine and diseases, and the history of art. It serves to enhance our understanding of paleomedicine by shedding light on pathologies that may have existed in specific historical periods. Furthermore, it offers a unique and engaging approach to medical education and skill enhancement.

Iconodiagnosis includes not only dermatology/skin, but all medical specialties and organs.

CALL FOR ACTION –

“SKIN&ART” INTERNATIONAL PROJECT

We are excited to present our project, “SKIN&ART”. While famous paintings have been studied , we firmly believe that every museum worldwide, whether local or national, ouses lesser-known or even unknown artworks depicting various skin diseases.

Our project’s objective is to conduct a retrospective diagnosis of skin diseases represented in artworks. The plan is to gather iconographic material from paintings and sculptures found in museums across different countries, accompanied by concise medical/anatomical descriptions.

We kindly request your valuable collaboration in identifying artworks within your museum that may depict “skin disorders.” If you are aware of such pieces, we kindly ask that you provide us with a general photograph of the artwork, a close-up image of the pathological area, and the corresponding caption. This information will enable us to conduct a thorough analysis and propose a diagnosis, including any potential pseudo-pathology.

Please feel free to reach out to us with any uncertainties or for further clarification regarding the project. Your contribution and insights are highly valued and appreciated.

We extend our sincere gratitude in advance for your attention and cooperation in this collaborative endeavor.

ART IN MEDICAL EDUCATION

There has been an increasing effort to incorporate fine art education into medical training, primarily to enhance visual perception skills and empathy. Although there is limited research on its efficacy, and wide variations in study methodologies exist, results consistently indicate that participants find the incorporation of art into curricula beneficial. Further research analyzing which methodologies are most likely to yield statistically and clinically significant improvements in visual perception and empathy may lead to increased utilization of this teaching method.

ICONODIAGNOSIS RECOMMANDATIONS

Iconodiagnosis consists of a retrospective medical diagnosis carried out on a work of art depicting a human person. For a hundred years, physicians have embarked on this practice, making it possible to supplement epidemiological data on the existence of diseases in ancient periods or past populations, but also to train physicians in their clinical and semiological sense. Faced with the exponential increase in publications in this field, it was necessary to propose clear rules and a precise and rigorous methodology allowing a serious practice of iconodiagnosis.

  • Step 1. Ideally, an artwork should be observed in persona. Since this precondition cannot be always fulfilled, Iconodi-agnosis shall be performed exclusively on high-resolution images provided by the museums where the artworks are kept.

Step 2. The reconstruction of the history of the artwork should be performed with help of the museum curators or previous detailed descriptions. Before proposing a series of differential diagnoses, scholars need to investigate whether the work of art underwent restoration and if so to observe pre- and post- restoration images to identify small changes that may mislead.

Step 3. An artwork has to be examined in its entirety. In the case of sculptures, all angles need to be carefully examined to avoid misdiagnosis. After having care-fully observed the work of art, if a possible pathological sign is detected and a medical hypothesis is formulated, a diagnosis by exclusion can be proposed.

  • Step 4. Whenever possible, artworks should be controlled by comparing parallel representations by the same or by different artists. This step should identify any potential peculiarity of an artist’s way to produce their art work e.g. Leonardo da Vinci did not paint eyelids, so the lack of eyelids in the Mona Lisa is not pathological.
  • Step 5. An artwork needs to be contextualized in the historical-artistic period in which it was created. Artworks by the same author and by other contemporary authors have to be examined to rule out any possible stylistic wave or fashion that could be mistaken for pathological findings.
  • Step 6. In the case of historical individuals, a perusal of all other available sources, especially written documents i.e. letters, biographies, medical reports and autopsy reports, should be performed to confirm or discard a given diag-nostic hypothesis.
  • Step 7. The medical knowledge at the time in which the work was created should be also considered, to ascertain the potential degree of medical knowledge of each artist.
  • Step 8. Where applicable, theological meanings and pagan symbolisms that may influence the artwork should be elicited.
  • Step 9. Having accomplished the aforementioned steps, the presumed pathological lesion should be evaluated by a panel of medical practitioners with expertise in the area of the presumed disease e.g. a dermatologist should be involved in the diagnostic process of most skin disorders.
  • Step 10. Ideally, after having formulated a diagnostic hypothesis and any differential diagnoses, a consensus diagnosis should be reached among the members of the iconodiagnostic team.
  • Step 11. During this final step (step 10) the expert team may provide an estimation of the ‘‘level of evidence’’ for their diagnosis in order to provide an estimation of the certainty of diagnosis. A simplified of Franco’s classifica-tion is proposed (Table 1).
  • Iconodiagnosis: Guidelines and recommendations. P. Charlier, A. Perciaccante, N. Kluger, A.G. Nerlich, O. Appenzeller, S.T. Donell, V. Asensi, P.A. Mackowiak, V. Ferrara, R. Bianucci, Ethics, Medicine and Public Health 31 (2023) 100951, http://dx.doi.org/10.1016/j.jemep.2023.100951
  • Diagnosis of exclusion in works of art. R. Bianucci, A. Perciaccante, O. Appenzeller. Journal of the Neurological Sciences. S0022-510X(17)30369-6. http://dx.doi.org/10.1016/j.jns.2017.05.062
  • Icono-diagnosis: a challenge between medicine and art. Senses Sci 2019: 6 (2) 747-752. http://doi.org/10.14616/sands- 2019-6-7477

ICONODIAGNOSIS BIBLIOGRAPHY & GALLERY

DERMATOLOGICAL ICONODIAGNOSTIC

Here some well known dermatological iconodiagnosis paintings (legends below).

  • ALL DERMATOSES :
  • Medicine in the Prado Museum, Madrid, Spain: Signs of illness, and medical procedures in the art works. J. Grau, I. Bartoloméb, C.Garridoc, A. Iranzo. Medidna Clfnica 159 (2022) 497-504, https://doi.org/10.1016/j.medcli.2022.05.015
  • Iconodiagnosis of dermatoses, study of skin care through the arts and contribution to the education of semiology. C.Dechelette, P. Charlier. Ethics, Medicine and Public Health 28 (2023) 100896. https://doi.org/10.1016/j.jemep.2023.100896
  • Skin abnormalities in the Finnish National Gallery. N. Kluger. J Cosmet Dermatol. 2019; https://doi.org/10.1111/jocd.13095
  • ATOPIC DERMATITIS : Pietro Perugino’s atopic facial dermatitis. N. Kluger, A. Remitz, A. Perciaccante, J Cosmet Dermatol. 2021;00:1–3. https://doi.org/10.1111/jocd.14021
  • ALOPECIA : A case of frontal fibrosing alopecia in a 19th century portrait? N. Kluger, J Cosmet Dermatol. 2021;00:1–2. https://onlinelibrary.wiley.com/doi/10.1111/jocd.13948
  • SYPHILIS : The sins of the fathers will be visited upon the children”: Congenital syphilis and leg braces pictorial depiction in eighteenth century Britain. R. Bianucci, A. Perciaccante. Eur J Intern Med 2016 Nov:35:e36-e37. https://doi.org/10.1016/j.ejim.2016.06.036. Epub 2016 Jul 12.
  • SQUAMOUS CELL CARNINOMA : An ulcerated squamous cell carcinoma of the forehead in the artistic heritage of Lam qua, E. Porumb Andresea, C.F. Costeab,⁎, A.I. Cucuc, A. Perciaccanted, B. Costachescue, M.D. Turliucf, Medical Hypotheses 133 (2019) 109383. https://doi.org/10.1016/j.mehy.2019.109383
  • LUPUS : Tribal makeup painting mimicking achromic lupus in a Teke tribal chef: icono-diagnosis is a dangerous art. Clinical and Experimental Dermatology. P. Charlier, N. Kluger, V. Bourdin. https://doi.org/10.1111/ced.15289
  • NEUROFIBROMATOSIS : Painting neurofibromatosis type 1 in the 15th century. R. Bianucci, A. Perciaccante, O. Appenzeller.www. thelancet.com/neurology Vol 15 October 2016
  • ROSACEA : The erythema of Alexander the Great: a cutaneous disease correlated to alcohol intake?
  • A. Perciaccante, F. Scordo, A. Coralli, M.A. Riva, Giornale Italiano di Dermatologia e Venereologia 2018 ;153(2):302-3. https://doi.org/10.23736/S0392-0488.16.05520-6

Legends of the gallery

INTERNAL MEDECINE ICONODIAGNOSIS

  • BREAST CANCER :
  • Breast cancer in Woman Sitting Half-Dressed beside a stove (1658) by Rembrandt van Rijn. Andreas G. Nerlich & all. The Breast 64 (2022) 134–135.
  • Earliest evidence of malignant breast cancer in Renaissance paintings. R. Bianucci, A. Perciaccante, P. Charlier, O. Appenzeller, D. Lippi. www.thelancet.com/oncology Vol 19 February 2018.
  • Mid-19th century Chinese medical portraits depict late-stage female breast tumours. A. Perciaccante, A. I Cucu, A. Coralli, M.D Turliuc, C. F Costea, R. Bianucci. www.thelancet.com/oncology Vol 20 October 2019.
  • The History of Congenital Syphilis Behind The Inheritance by Edvard Munch. A. Perciaccante, A. Coralli, JAMA Dermatology March 2018 Volume 154, Number 3.

Rembrandt. Bathsheba at her Bath (1654). Oil on canvas, 142 × 142 cm (56 × 56 in). Louvre, Paris.

ICONODIAGNOSIS : breast cancer

  • CROUZON MALFORMATIONS :
  • Icono-diagnosis, a medical-humanistic approach detecting Crouzon’s malformations in Cook island’s prehistoric arts. A. Pontius. Perspectives in Biology and Medicine, Volume 27, Number 1, Autumn 1983, pp. 107-120. https://doi.org/10.1353/pbm.1983.0030
  • A Crouzon syndrome for the calssic period of Maya civilisations ? P. Deps, P. Charlier. Surg RadiolAnat 2019 Dec;41(12):1525-1527. https://doi.org/10.1007/s00276-019-02287-8. Epub 2019 Jul 26. https://doi.org/10.1097/SCS.0000000000006583

“Fisherman’s god,” collected in the Cook Islands. It received its name from a missionary who reported that fishermen placed figures like this on canoes and offered sacrifices to them before fishing expeditions. (Photo: Hillel Burger, Peabody Museum, Harvard University, Cambridge, Mass. Reprinted here with permission.)

ICONODIAGNOSIS : crouzon syndrome

  • CRANIOSYNOSTOSIS : Craniosynostosis in a Painting by Hans Suess Kulmbach. A. Perciaccante, N. Kluger. The Journal of Craniofacial Surgery, Volume 31, Number 6, September 2020. https://doi.org/10.1097/SCS.0000000000006583
  • CRANOFACIAL DISORDERS : Icono-Diagnosis of Craniofacial Disorders: The Eye of the Plastic Surgeon. D. Montadon, The Journal of Craniofacial Surgery  Volume 31, Number 6, September 2020. https://doi.org/10.1097/SCS.0000000000006498
  • CRYTORCHIDISM : Unilateral cryptorchidism in a 16th Florentine painting. D. Lippi, L. Masieri, A. Perciaccante, P. Charlier, V. Asensi, O. Appenzeller, R. Bianucci. The Journal of Maternal-Fetal & Neonatal Medicine. 1476-7058 (Print) 1476-4954. https://doi.org/10.1080/14767058.2019.1698542
  • CUSHING SYNDROME : Evidence of Cushing’s syndrome in a pre-Columbian Mexican statue? P. Charlier, V. Bourdin. Ann Endocrinol (Paris). 2022 Dec;83(6):475-478. Epub 2022 Sep 30. PMID: 36183806.
  • DIGITAL CLUBBING : Fourteenth Century Iconography of Digital Clubbing in Prince William II of Aragon (1312-1338). P. Charlier, L. Palozzi, 155 #4 Chest April 2019.
  • ENDOCRINOLOGY : Medicine in the Prado Museum, Madrid, Spain: Signs of illness, and medical procedures in the art works. J. Grau, I. Bartoloméb, C.Garridoc, A. Iranzo. Medidna Clfnica 159 (2022) 497-504, https://doi.org/10.1016/j.medcli.2022.05.015
  • ERGOTISM : Issenheim’s altarpiece: does the disease depicted on the altarpiece correspond to ergotism? M. Faure. Hist Sci Med. 2010 Oct-Dec;44(4):383-8.

Matthias Grünewald, Isenheim Altarpiece. Musée d’Unterlinden, France.

ICONODIAGNOSIS : ergotism

  • FACIAL PARALISY : Un nouveau cas de paralysie faciale sur une terre cuite smyrniote hellénistique Icono-diagnostic et paléopathologie des paralysies faciales. P. Charlier, HISTOIRE DES SCIENCES MÉDICALES – TOME XLI – № 1 – 2007.
  • GANGRENE : Gangrene, amputation, and allogeneic transplantation in the fifth century AD: A pictorial representation. A. Perciaccante, M. Frank, J. Rühli, F. M. Galassi, R. Bianucci, J Vasc Surg 2016;64:824-50741-5214. http://dx.doi.org/10.1016/j.jvs.2016.04.042
  • GENETIC DISEASES : Genetic diseases in religious painting. M.G. Buta, MEDICINE AND PHARMACY REPORTS Vol. 94 / No. 3 / 2021: 382 – 389. https://doi.org/10.15386/mpr-1996
  • HYDROCEPHALUS : Hydrocephalus of King Charles II of Spain, the Bewitched King. M. D. Turliuc, A.I. Cucu, A. Perciaccante, G. Tosolini, S. De Luca, B. Costachescu, C.F. Costea. Eur Neurol 2019;81:76–78 https://doi.org/10.1159/000500719
  • HYPOTHYROIDISM : Evidence of hypothyroidism in a portrait by Lorenzo Lotto. V. Asensi, D. Lippi, A. Perciaccante, P. Charlier, O. Appenzeller, R. Bianucci. www.thelancet.com/diabetes-endocrinology Vol 7 January 2019.
  • METASTATIC CARCINOMA : Metastatic Carcinoma with Associated Lymphoadenopathy and Acquired Horner’s Syndrome Portrayed in a Third Century CE Roman Bust. R. Bianucci, C. L. Kirkpatrick, F. M. Galassi, A. Perciaccante,· S. T. Donell, O. Appenzeller, A. G. Nerlich. Head and Neck Pathology (2021) 15:617–620. https://doi.org/10.1007/s12105-020-01252-x
  • NEUROLOGY :
  • Medicine in the Prado Museum, Madrid, Spain: Signs of illness, and medical procedures in the art works. J. Grau, I. Bartoloméb, C.Garridoc, A. Iranzo. Medidna Clfnica 159 (2022) 497-504, https://doi.org/10.1016/j.medcli.2022.05.015
  • Historical evidence supports El Greco’s depiction of a neurological condition in his attributed self-portrait. F.M. Franco & all. Journal of the Neurological Sciences 372 (2017) 316–317. http://dx.doi.org/10.1016/j.jns.2016.11.077
  • PNEUMOTHORAX : Open Tension Pneumothorax in “The Dying Niobid” (Uffizi Gallery). D. Lippi, A. Perciaccante, V. Asensi, P. Charlier, 155 #4 CHEST april 2019.
  • POTT DISEASE : Possible new evidence of pre-Columbian tuberculosis in America: Pott disease in a prehistoric Mexican statue. P. Charlier, P. Deps, Tuberculosis 116 (2019) 35–36. https://doi.org/10.1016/j.tube.2019.03.011.
  • RHUMATOLOGY : Medicine in the Prado Museum, Madrid, Spain: Signs of illness, and medical procedures in the art works. J. Grau, I. Bartoloméb, C.Garridoc, A. Iranzo. Medidna Clfnica 159 (2022) 497-504, https://doi.org/10.1016/j.medcli.2022.05.015
  • TUBERCULOSIS : Possible new evidence of pre-Columbian tuberculosis in America: Pott disease in a prehistoric Mexican statue. P. Charlier, P.D. Deps. Tuberculosis, Volume 116, May 2019, Pages 35-36. https://doi.org/10.1016/j.tube.2019.03.011

OPHTALMOLOGY ICONODIAGNOSIS

  • OPHTALMOLOGY : Medicine in the Prado Museum, Madrid, Spain: Signs of illness, and medical procedures in the art works. J. Grau, I. Bartoloméb, C.Garridoc, A. Iranzo. Medidna Clfnica 159 (2022) 497-504, https://doi.org/10.1016/j.medcli.2022.05.015

Bernardo Strozzi

Tobias Healing his Father”. , 1640–44.

ICONODIAGNOSIS : Alcali caustication in both eyes (arrows).

  • HORNER SYNDROME : A case of congenital Horner syndrome from the 16th century. R. Bianucci, C. L Kirkpatrick, A. Perciaccante, F. M. Galassi, D. Lippi, O. Appenzeller, A.G Nerlich, www.thelancet.com/neurology Vol 19 August 2020

DENTAL MEDECINE ICONODIAGNOSIS

  • MAXILOFACIAL: Medicine in the Prado Museum, Madrid, Spain: Signs of illness, and medical procedures in the art works. J. Grau, I. Bartoloméb, C.Garridoc, A. Iranzo. Medidna Clfnica 159 (2022) 497-504, https://doi.org/10.1016/j.medcli.2022.05.015

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