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doi: 10.1227/NEU.0b013e31821985a5

Concerning the Concealed Anatomy in Michelangelo's Sistine Separation of Light From Darkness

Tamargo, Rafael J; Suk, Ian

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Baltimore, Maryland

To the Editor:

We thank Dr Bondeson and Dr Bondeson for their interest in our article and acknowledge their thoughtful and important contributions to this topic. We certainly did not mean in our article to “dismiss [their] interpretation summarily” because we have read their articles with much interest and appreciate the validity of their arguments. We disagree with their conclusions, however, in the same spirit with which we welcome their disagreement with ours, given that we fully recognize that modern interpretations of art done 500 years ago are necessarily subjective. We similarly welcome the opportunity to participate in any discussion of Michelangelo's art and thus are responding to their letter in which the Bondesons reaffirm their opinion that in the Separation of Light From Darkness, Michelangelo painted a multinodular goiter in God's lower neck instead of the ventral medulla, as we propose in our article.1 Their argument can be summarized in the following syllogism: (1) because Michelangelo himself had a goiter2 and (2) because Michelangelo created a self-portrait in the image of God in the Separation of Light From Darkness,3 therefore (3) Michelangelo depicted God with a goiter in this fresco. We discuss our disagreement with their 2 premises and thus with their conclusion.

As to the first premise, despite extensive written and pictorial contemporary documentation of Michelangelo's life and his achievements, there is no factual evidence to confirm that Michelangelo had a goiter. Michelangelo's life is extensively documented in 2 biographies written and published during his lifetime, in almost 1400 letters written by or to the artist, in more over 300 pages of his personal and professional ricordi, in more than 400 letters written by his close relatives,4 and in more than 300 of his sonnets, madrigals, and other poems.5 Giorgio Vasari (1511-1574), Michelangelo's first biographer and friend, specifically wrote about Michelangelo's health but never mentioned a goiter. He wrote “Michelangelo had a strong, healthy constitution,…as a man he only suffered two serious illnesses, and he always withstood every kind of hardship and had no ailments, except that in his old age he suffered from gravel in the urine which finally turned into kidney stones.”6

To support their claim that Michelangelo had a “goiter,” the Bondesons cite a single word that appears in a sonnet written by Michelangelo in 1509 or 1510, during the period in which he was painting the Sistine Chapel, and highlight the arched neck depicted in the side sketch on the same page. Michelangelo wrote “I o gia facto 'ngozo in questo stento” (“I've already grown a goiter at this drudgery ”).7 To correctly interpret Michelangelo's line, however, it is important to recognize that whereas the modern Italian word gozzo is primarily a medical term that defines a hypertrophied and diseased thyroid gland (ie, a goiter), Michelangelo's 16th-century term gozo did not have a strictly medical definition and was probably used by Michelangelo to mean simply either a swollen neck or a neck deformity, which he probably developed from extending his neck intermittently over 4 years to paint the Sistine vault. When Michelangelo wrote this sonnet, the thyroid gland had not yet been described as an organ and its pathological degeneration into a goiter was not even suspected. (In 1619, more than 100 years later, Fabricius ab Acquapendente [Girolamo Fabrizo, 1537-1619] was the first to state that a goiter was an enlargement of the glandula laryngis [ie, thyroid gland],8 and in 1656 Thomas Wharton [1614-1673] provided the first modern description of the thyroid gland).8,9

The etymology of the word “goiter” sheds further light on the early folkloric and purely descriptive meaning of this word. Before the Renaissance, goiters had been described by Greek, Roman, and medieval authors. The Hippocratic corpus (5th-4th centuries bc) contains 3 terms (struma, choiron, and gongrona) that probably refer to swollen “glands of the neck.”9,10 The Latin word guttur (from which “goiter” and “goitre” are derived) means neck, throat, or gullet. The Roman writers Vitruvius (Marcus Vitruvius Pollio, ca. 80 bc to ca. 15 bc) and Juvenal (Decimus Junius Juvenalis, ca. ad 55 to ca. ad 127 ) were undoubtedly referring to goiters when they wrote about “turgidis gutturibus” (“a swelling of the neck”) and tumidum guttur (“swollen neck”), respectively.9 Pliny the Elder (Gaius Plinius Secundus, ad 23-79) specifically linked water to goiter when he wrote in his Naturalis Historiae: “Guttur homini tantum et subus intumescit, aquarum quae potantur plerumque vitio” (“Only men and swine are subject to swellings in the throat, which are mostly caused by the noxious quality of the water they drink”).11 By the Middle Ages, the Latin terms used to refer to a goiter were botium or bocium.8,9 For instance, in the popular Medieval surgical text Post mundi fabricam (ca. 1180), Roger Frugardi of Salerno (Rogerius Salernitanus, ca. 1140 to ca. 1195) dedicated an entire chapter to goiter titled De cura botii.9,12 The Medieval Latin terms botium and bocium persist in the Spanish word for goiter, which is bocio. To this day, the Spanish term bocio and the Italian term gozzo are often used to refer to simply a swollen neck (as seen in aging or overweight men) as well as a goiter.

We are not, however, the first to doubt that Michelangelo had a goiter. In their comprehensive article on the depiction of goiters in Renaissance art, Vescia and Basso (a medical historian and an endocrinologist, respectively) specifically addressed this issue under the heading “Imaginary Goiters Perceived by the Artist” and stated: “At the time, he [Michelangelo] was working long hours on a scaffolding with his neck hyperextended, painting the Sistine Chapel.… Michelangelo lived 50 more years without signs or symptoms of thyroid disease. What he assumed was a goiter was probably a sore neck caused by cervical radiculitis.”13

As to the second premise, we doubt that Michelangelo painted himself in the image of God in the Separation of Light From Darkness because it would have been markedly out of character for him to do so. In Michelangelo's entire oeuvre, he inserted his self-portrait in 4 paintings and 1 sculpture and then only in secondary characters, never to replace the visage of God or Christ. On the Sistine Chapel ceiling, the spandrel or pendentive Judith and Holofernes depicts the Biblical heroine Judith who has just decapitated the Assyrian general Holofernes. Both De Tolnay14 and Pfeiffer15 suggest that Michelangelo painted his self-portrait in the decapitated head of Holofernes, probably “as an allusion perhaps of his own judgment and punishment.”16 In The Last Judgment (1536-1541) Michelangelo painted the apostle Bartholomew (who was martyred by being flayed alive) holding the knife of his martyrdom and “his flayed skin, into which Michelangelo inserted his suffering and distorted self-portrait.”17 In the Crucifixion of Saint Peter (1546-1550) in the Pauline Chapel in the Vatican, De Tolnay suggests that Michelangelo painted 2 self-portraits; the mounted figure with a blue turban in the left upper section is Michelangelo as a young adult and the standing pilgrim wearing a yellow hood in the right lower section is Michelangelo as an old, disappointed man.18 In the Conversion of Saul (1542-1545) also in the Pauline Chapel, Zöllner writes that Michelangelo painted his self-portrait in Saul, who was blinded by a heavenly light on his way to Damascus to persecute Christians.19 Finally, Michelangelo sculpted his self-portrait in the Florentine Pietà (ca. 1547-1555) in the figure of Nicodemus (the Pharisee who helped Joseph of Arimathaea remove Christ from the cross), as documented in a 1564 letter from Vasari to Lionardo Buonarroti, Michelangelo's nephew and heir.20 In these 5 instances, Michelangelo included his self-portrait in secondary figures. Although it is true, as the Bondesons point out, that Michelangelo displayed his high self-esteem by signing his name on the sash across the chest of the Virgin in the Vatican Pietà, we do not think he would have even considered replacing the face of Christ with his self-portrait in this statue.

Finally, several Renaissance artists depicted goiters in their paintings, but none of these depictions are similar to God's neck in the Separation of Light From Darkness. Vescia and Basso13 and Ferriss21 identified more than 50 pre-Renaissance, Renaissance, and Mannerist paintings, drawings, and etchings in which goiters are illustrated. It is apparent from most of these works that Renaissance painters were able to accurately depict this condition either purposefully or inadvertently. God's neck in Michelangelo's fresco is markedly different from any other contemporary depictions of a goiter, which means that Michelangelo intended to illustrate in God's neck something different and unusual. Moreover, although Renaissance artists sometimes depicted goiters simply because their subjects had one, they often included it allegorically to allude to poverty or low social standing, or alternatively to evoke pity, mockery, or revulsion in the viewer.21 It is extremely unlikely that Michelangelo would have wanted to associate any of these features or feelings with either God or himself.

We therefore do not think that Michelangelo depicted a goiter in God's throat in the Separation of Light From Darkness, but nevertheless understand the thoughtful argument outlined by the Bondesons.

Rafael J. Tamargo

Ian Suk

Baltimore, Maryland

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1. Suk I, Tamargo RJ. Concealed neuroanatomy in Michelangelo's Separation of Light From Darkness in the Sistine Chapel. Neurosurgery. 2010;66(5):851-861.

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