Ricerc@Sapienza

Art can serve as a powerful resource for medical students to both train the so
called “clinical eye” and to better understand disease [1]. Herein a paleopathological
analysis is performed on one of Ruben’s final artworks, “The Three Graces” (1630-
1635; oil on oak panel; 220.5 x 182 cm; Museo del Prado, Madrid). Rubens depicts
the three Graces beside a fountain, under a garland of flowers in a landscape. The
circular rhythm and elegant undulation are based on classical sculpture. Painted
shortly after his marriage, it bears witness to the happiness of the artist’s life. The
figure on the left is directly inspired by his second wife, Hélène Fourment (23 years
old); the central and right Graces probably illustrate Rubens’ sisters-in-law. Besides
overweight, scoliosis, and hyperlordosis observed in all three Graces, the left Grace
evidences flat feet; hyperextension of the right metacarpal joints; signs of rheumatoid
arthritis (even fibromyalgia has been proposed); lateral deviation of the nipple
(Mondor’s disease?); varicose thighs, and right hallux vagus. The central Grace (Clara
Fourment?), in turn, shows cellulite and, interestingly, positive Trendelenburg sign.
Finally, the Grace on the right -Susanna Fourment- has been subject of a long debate
on signs of a locally advanced breast cancer in the left external upper quadrant. In
fact, several specialists agree in the observation of signs of an open ulcer; redness of
the surrounding skin (an inflammatory sign); nipple retraction; reduction of the left
breast volume, and enlarged axillary lymph nodes [2-3]. Rubens was one of main
Baroque and realist painters, i.e. he painted whatever his eyes captured. If the Graces
were sisters, then they are likely to share genetic traits. The latter, together with
all the other signs described, favour the working diagnosis of familial benign hypermobility
syndrome. Observation has a key role in clinical medicine; the paleopathological
observation in art show us how artists could record abnormalities long before
doctors did [2]. Therefore, artworks still represent useful teaching tools for refining
visual skills in traditional and innovative medical education.
References
[1] Hinojosa-Azaloa A. & Alcocer-Varela J. (2014) Art and rheumatology: the artist and the rheumatologist’s
perspective. Rheumatology 53: 1725-1731.
[2] Dequeker J. (2007) Medicine and the artist. Age and Ageing 37: 4-5.
[3] Grau et al. (2001) Breast cancer in Rubens paintings. Breast Ca Res Treat 68: 89-93.