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IMAGES IN THORAX

Pectus excavatum in paintings by Jusepe de Ribera(1591–1652)Davide Lazzeri,1 Fabio Nicoli1,2

1Department of PlasticReconstructive and AestheticSurgery, Villa Salaria Clinic,Rome, Italy2Department of Plastic andReconstructive Surgery,University of Rome ‘TorVergata’, Rome, Italy

Correspondence toDr Davide Lazzeri, PlasticReconstructive and AestheticSurgery, Villa Salaria Clinic, viaFilippo Antonio Gualterio, 127,Rome 00139, Italy;davidelazzeri@gmail.com

Received 20 December 2015Revised 27 January 2016Accepted 29 January 2016Published Online First22 February 2016

To cite: Lazzeri D, Nicoli F.Thorax 2016;71:669–670.

The intensity of realism pursued by Caravaggio incontrast with Mannerism was amplified by his fol-lowers (“Caravaggisti”); these included the Spanishpainter, Jusepe de Ribera, with his tenebristic styleas classified by the early biographers.1 Indeed, deRibera mastered the Caraveggesque chiaroscuro andgained widespread popularity as a result of his life-like naturalism, becoming the most influentialSpanish Baroque painter. He depicted dramatic andsinister scenes of tortured saints with faces con-torted in pain, mutilated and ageing bodiesadorned with sagging flesh, gruesome martyrdomsand societal outcasts.1

The great realism of de Ribera is shown in mas-terpieces in which anatomical abnormalities ormedical diseases afflicted the sitters. Such worksincluded The Clubfoot (arthrogryposis), TheBearded Woman (endocrinological disease), TheAllegory of Touch (blindness) and the drawings ofThe Grotesque Heads of Men (thyroid goitre).Interestingly, we have observed that in three furtherportraits, de Ribera depicted Saint Jerome andSaint Onophrius with chest deformity resemblingpectus excavatum (figures 1–3). He rendered thesaints unkempt, half naked and wearing poorcloths. The cadaverous habitus, dirty fingernails,hollowed cheeks and flesh sagging from their

emaciated frames completes the dramatically realis-tic portraits.The reasons for such depictions could be mul-

tiple and are worthy of discussion. It seems unlikelythat the first medical description of pectus excava-tum and its physiological consequences providedby Schenck and Bauhin at the end of the 16thcentury, a few decades before de Ribera’s depic-tions, exerted a great deal of influence.2 De Riberawas a skilled draftsman and printmaker, leavinghundreds of drawings; therefore, because of hishigh reputation, it seems unrealistic that the artistsinadvertently depicted the chest deformity whileunaware of the underlying abnormal condition,especially as such mistakes would have beenadjusted in the final piece. From the 14th centuryonwards, the depiction of physical deformity wasused as a symbolic celebration of martyrs in thecult of some saints.3 Someone could argue that deRibera may have embraced this tendency and mayhave attempted to highlight the martyrdom and thesufferance of both saints with the inclusion ofpectus excavatum in order to elicit feelings ofempathy, humility and piety. This is unlikelybecause the analyses of the several half-lengthimages of saints that he portrayed did not reveal asimilar pathology, and also because neither Saint

Figure 1 St Jerome and the Trumpet of Doom (1637),by Jusepe De Ribera, oil on canvas (from the GalleriaDoria Pamphilj, Rome, Italy).

Figure 2 Saint Onophrius (1642), by Jusepe De Ribera,oil on canvas (from the Museum of Fine Arts, Boston,Massachusetts, USA).

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Jerome nor Saint Onophrius endured martyrdom during theirlife. Furthermore, we cannot entirely reject the claim that theartist might have been aware of Leonardo’s first anatomicaldrawings of pectus excavatum.2 It is reasonable to debate

whether the saints herein referenced had true pectus excavatumor simply rather cadaverous physiques. However, de Ribera por-trayed further saints (Andrew, Bartholomew and Paul) anddepicted Jerome and Onophrius in further portraits with a clearcadaverous habitus but without sign of chest deformity. This ismeaningful about the intention of de Ribera to include suchdeformity in the portraits of this investigation (figures 1–3).

The most suitable theory is that the Spanish painter soughtout models who were elderly and emaciated and had mild chestdeformity that enabled the painter to depict the contrast of lightand shade on the chest wall. De Ribera could combine hischiaroscuro tenebristic style with the tendency towards a greatrealism in the representation of the sitters, which reflected theincreased anatomical accuracy and knowledge developed duringthat period. Previous dramatic depictions of anatomical abnor-malities and medical diseases by de Ribera may strengthen ourhypothesis.

In conclusion, whether the eventual chest deformity wasdeliberately introduced by the artist or the models were actuallyaffected is speculative, but both explanation underlines the fas-cination of de Ribera in the abnormal and macabre and in theuse of strong tenebristic contrasts between light and dark.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

REFERENCES1 Pérez Sànchez AE, Spinosa N. Jusepe De Ribera. The Metropolitan Museum of Art.

New York: Abrams NH, Inc., 1992:12–5.2 Ashrafian H. Leonardo da Vinci and the first portrayal of pectus excavatum. Thorax

2013;68:1081.3 Hope C. Altarpieces and the requirements of patrons. In: Verdon T, Henderson J, eds.

Christianity and the Renaissance: Image and Religious Imagination in theQuattrocento. Syracuse, NY: Syracuse University Press, 1990:535–71 (p. 554).

Figure 3 Saint Onophrius (1625–1629), by Jusepe De Ribera, oil oncanvas (from the National Gallery, Dublin, Ireland).

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