The controversial case of Cosimo I de’ Medici (1519–1574): reflections on the interaction between anatomy and art (iconodiagnosis vs misdiagnosis)

From Firenze University Press Journal: Italian Journal of Anatomy and Embryology

Raffaella Bianucci, Department of Cultures and Societies, University of Palermo

Elisa Zucchini, Department of History, Archaeology, Geography, Fine and Performing Art, University of Florence

Francesco M. Galassi, Archaeology, College of Humanities, Arts and Social Sciences, Flinders University

Donatella Lippi, Department of Experimental and Clinical Medicine, University of Florence, Florence

In a recent contribution (Pozzilli & Nicolai, 2021) it has been postulated that Cosi-mo I de’ Medici (1519–1574), the second Duke of Florence, was affected by an endocrinological condition (Pozzilli & Nicolai, 2021); the authors maintain to have identified a case of severe Graves’ disease (untreated hyperthyroidism, atrial fibrillation and thyroid eye disease) in the bronze statue of Cosimo I de’ Medici forged by Benv-enuto Cellini in between 1545 and 1547. The statue is currently held by the Museo Nazionale del Bargello (Florence). Following the Authors’ interpretation, the severe Graves’ disease represented a considerable risk factor for the thromboembolic stroke which severely affected Cosimo I’s last months of his life (Pozzilli & Nicolai, 2021).

From a medical point of view, it shall be underlined that Cosimo I’s adult life was plagued by obesity (Arba et al., 2014); this condition is incompatible with a diagnosis of Graves’ disease since severe hyperthyroidism accelerates the body’s metabolism and causes an unintentional weight loss independently from the food intake. The medical history of Cosimo I excludes both pathological slimming and Graves’ ophthalmology (Pieraccini, 1986; Arba et al., 2014; Bahn, 2010). Cosimo I was thick-necked with a well-developed laryngeal prominence of the thyroid cartilage (Adam’s Apple) (Fitzpatrick & Siccardi, 2021) and slightly bulging eyes (Fitzpatrick & Siccardi, 2021); he never suffered of inflammatory disorders of the orbit and periorbital tissues, as attest-ed both by the primary sources (Pieraccini, 1986) and by several portraits of the Grand Duke over the decades. In Giambologna’s bust , the signs of the stroke occurred in 1568 are clearly evident; Cosimo I’s shows a facial asymmetry: the left nasolabial fold is deeper than the left one, the right upper and lower lids are sagging and the right corner of the mouth is turned down. The evidence of post-stroke facial features allows dating the bust between 1568 and 1574.If Cosimo I’s busts by Baccio Bandinelli and by Benvenuto Cellini are compared striking differences emerge. Both portraits are inspired by Roman imperial portraits dating to different centuries. Bandinelli’s bust (circa 1544, Florence, Museo del Bargello) was based on a portrait of Hadrian (Uffizi, Florence). Bandinelli’s shows the same accuracy observable in the portraits of Cosimo I over the years. In these artworks, Cosimo I displays a quiet expression; his eyes are slightly bulging, but not protruding, and a thick-neck with an Adam’s Apple can be appreciated.Benvenuto Cellini’s bust shows a personal artistic interpretation of the features of the duke: Cosimo I’s countenance overflows with a vitality enhanced by the richly decorated cuirass and by the cloak falling over the Duke’s left shoulder and caught up in his right arm. The tousled hair, knitted eyebrows, drilled pupils and tightened lips give an effect of intense concentration and military strength, together with the rapid turn of the head on the powerful neck.

This effect was emphasized by the silvering of the eyes (retrieved through restoration) and the original gilding of the surface (Langedijk, 1981; Pope-Hennessy, 1985; Pope-Hennessy, 2002). Cellini’s bust may have been inspired to a cuirassed portrait of Julius Caesar (Musei Capitolini, Rome); according to one of the authors (EZ), the winged gorgon at the centre of the cuirass and the wide eyes both recall the portrait of Septimius Severus (Museo Nazionale Romano, Palazzo Massimo, Rome). The sharp, furious turn of the neck, the musculature of which is accentuated through the pose to suggest power, might have been modelled on Caracalla’s portraits (Musei Capitolini, Rome, and Museo Pio — Clementino (Vatican Museums) (Gardner Coates, 2004).The artistic analysis confirms the medical interpretation: Cosimo’s eyes and neck are not consistent with severe hyperthyroidism; they rather represent a stylistic choice inspired by 3rd century CE Roman sculpture whose main characteristic was the unnatural enlargement of the eyes coupled with the indomitable vitality (Bianchi Bandinelli, 2002).


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The University of Florence is an important and influential centre for research and higher training in Italy