Skin disease in the Medici family and the illness of Contessina de' Bardi de' Medici: a dermatological puzzle

Authors


  • Conflicts of interest: None.

Historical background

For over 300 years, from the early fifteenth to the mid-eighteenth century, the Medici family was one of the most important dynasties in Italy. As wealthy bankers, patrons of the arts, and as the rulers of Florence throughout most of this period, the leading members of this family have attracted the attention of historians, political theorists, and students of Italian culture. The Medici family has also been the subject of medico-historical interest, as many of its most prominent figures were known to have suffered from debilitating illnesses throughout their lives.

There were two lines of the Medici family, descended from the two sons of Giovanni di Bicci (1360–1429). The progenitor of the senior (primogenito) line was the Cosimo il Vecchio (1389–1464), a line that died out in the early sixteenth century. Cosimo's younger brother Lorenzo (1395–1440) founded the cadet branch, which continued until the eighteenth century and from which the Grand Dukes of Tuscany came. Although the diseases of the males in the family are better known, the illnesses of the Medici women have been less studied.

Prominent diseases in Medici family members

On previous occasions, we have discussed the longevity and causes of death in the two lineages of the Medici males and identified a complex syndrome that could be identified among them. What we have described as the “Medici syndrome” comprises three entities, progressing from acute into chronic stages, intensely symptomatic, and possibly contributing to the sharp decline of longevity in primogenito males over six generations, which we have shown elsewhere. This pathological syndrome has cutaneous, articular, and axial components.[1, 2]

The cutaneous entity within the syndrome is a skin inflammation, often described as rognie or rogne, an erythematous condition called eczema of the skin, encountered over unspecified areas of the body, often associated with pruritus. This entity is an essential part of the syndrome, hence the importance of its definition. An early description of this skin condition, using the dialect term scabbia, was given by Crescenzi in 1320.[3]

A later description by Baretti in 1760 stated that rogna is a scab, an itch, while the Italian version refers to an umor putrefatto, mandato della natura alla pelle (a putrefied humor, directed by nature toward the skin).[4] According to the present interpretation,[5] rogna is a crust on the skin, and the Italian version for scab is rognoso. The acceptable description for eczema pruriginosa was given by Pieraccini in the 1920s: Rogna, si doveva intendere … affezione cutanea pruriginosa, forma eruttiva subacuta o cronica, come ad esempio un eczema….[6]

The diagnosis of the Medici skin disease was supported by parallel macroscopic, microscopic, and radiological data on joints presented by Costa and Webber in 1955.[7] The conclusion reached by our team in 2010 was deduced after a long process of differential diagnosis.[1] Most likely it was cutaneous psoriasis associated with psoriatic arthritis with axial involvement.

Information on the Medici women, members of the family by birth or by marriage, is remarkably scarce. Medici women nonetheless contributed to the success of the family. The two women at the extremes of the lineage are particularly remarkable: at the start is Contessina de Bardi dei Conti di Vieri, in her role as a pillar of support for her husband Cosimo il Vecchio pater patria, the head of the family who first established its political significance. The last in the dynasty was Anna Maria Luisa, who before her death in 1734 bequeathed the entire Medici property, including their exceptional collection of artworks, to the State. A stipulation in her will prohibited the sale or export of any part of this art collection out of Tuscany. It is the first of these two women, the Contessina, who is the focus of our present study.

The books that have been specifically dedicated to the Medici women[8-11] and the larger studies dedicated to the entire dynasty[6, 12, 13] have devoted very little attention to Contessina's life and even less to her medical condition. Pieraccini in his monumental work on the dynasty, out of several hundred pages has just over one page on Contessina, mentioning her need for balneotherapy but providing little specific information on the skin disease for which this treatment was required.

Contessina's facial skin disease

The Contessina was not included in the extensive pathological and radiological investigations conducted on the exhumed skeletons of the Medici at the end of WWII.[7] Her life was long, but it has a short story: a daughter of impoverished aristocrats, the Conti de' Vieri, she was born in 1390 and married Cosimo, aged 26. She was an astute woman, judging from the numerous extant letters that she sent to various members of her family. These showed her affection for her husband even while he was in exile and her skillful management of the Villa Cafaggiolo, in the hills of Mugello, north of Florence, the original land of the Medici. Her particular care was projected toward her sons, Giovanni and Piero (as well as her husband's illegitimate son, Carlo), and her grandsons, Lorenzo and Giuliano. Her care also extended toward her own Vieri family members and their descendants in the Strozzi family. She probably died at age 80, molte vecchia,” with mental lucidity maintained to the end of her life.[6, 8-11]

Medical data on Contessina are scarce. It was reported of her as a young woman: Contessina a tanta rogna che non puo stare, and she requires cura presso stazioni balnearie[6] (“she is so itchy that she can't endure it”, and she requires “the cure given in the baths”). The extent of her rogna and its regional distribution was not indicated. Pieraccini's description refers to it simply as an itchy erythematous eczema.[6]

Where written descriptions are incomplete, however, Renaissance artworks have often proved to be an additional source of information for medical history if prudently interpreted, and it is from this area that we can now add to the understanding of Contessina's skin disease. One terracotta bust and two portraits of the Contessina survive from her lifetime, which permit us to recognize some of her facial features.

The bust, by Donatello, however, allows for no skin assessment. The first portrait image (a black and white etching), probably dating from the time of Contessina's marriage, shows a young woman, decoratively and richly dressed, with an intense look, intelligent eyes, and smooth facial skin.[10, 11]

The second portrait, in color, shows her as the only female figure among over 100 males in the Procession of the Magi by Benozzo Gozzoli (1421–1497), a magnificent fresco in the chapel of the Palazzo Medici-Ricardi, on the Via Larga in the center of Florence (Figs. 1 and 2).[14, 15] Protected by double walls, the fresco is perfectly preserved, the colors are vivid, and the facial features are clear.[15] The biographies on Gozzoli and the catalogs of his works do not mention Contessina,[16, 17] but she can be recognized in the Procession wearing a light purple headdress that covers her hair, ears, and neck.

Figure 1.

Image of Contessina in the “Procession of Magi” by Benozzo Gozzoli, fresco in the chapel of Palazzo Medici-Riccardi, in the Via Larga, Florence (photograph in public domain)

Figure 2.

Detail. Image of Contessina in the “Procession of Magi” by Benozzo Gozzoli, fresco in the chapel of Palazzo Medici-Riccardi, in the Via Larga, Florence (photograph in public domain)

Her face is left uncovered and can be easily observed. Since the fresco is dated 1459–61, she is aged about 70, with well-preserved facial features but a sad expression. The upper eyelids are slightly drooped, but not swollen; the nose is thin, and the lips are well-defined. On the nose and cheeks, an erythematous eruption is observed with some telangiectasia. The redness is also present of the glabella region but spares the skin around the eyes and mouth. These periorbital, peribuccal white areas and at the tip of her nose are even more evident on black and white images, easily converted (on the computer) from the colored image (Fig. 1).

The medical condition seen on the image of Contessina de Bardi in the Gozzoli fresco appears most likely to be telangiectatic rosacea.[18, 19] Nevertheless, as this condition was connected with “rogne” and Contessina was undergoing balneotherapy to relieve the discomfort, it is also possible to hypothesize atopic dermatitis. Facial erythema sparing the perioral area is typical of children, however, and not adults with atopic dermatitis; therefore, telangiectatic rosacea remains the more probable diagnosis. As there is no information about disease history and no extant skin available for precise investigations, the illness remains in the theoretical field of a retrospective medico-artistic diagnosis.

Ancillary