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From: Julio Montes-Santiago, The lead-poisoned genius: Saturnism in famous artists

across five centuries. In Stanley Finger, Dahlia W. Zaidel, François Boller and
Julien Bogousslavsky, editors: Progress in Brain Research, Vol. 203,
Amsterdam: The Netherlands, 2013, pp. 223-240.
ISBN: 978-0-444-62730-8
© Copyright 2013 Elsevier B.V.
Elsevier
 Author's personal copy

CHAPTER

The lead-poisoned genius:

Saturnism in famous artists
across five centuries
Julio Montes-Santiago1
9
Service of Internal Medicine, Complejo Hospitalario Universitario, Vigo, Spain
1
Corresponding author. Tel.: 0034-986-81111, ext. 11541, Fax: 0034-986-811138,
e-mail address: julio.montes.santiago@sergas.es

Abstract
Lead poisoning (saturnism) has been present throughout the history of mankind. In addition to
possible ingestion from contaminated food, one of the most important ways in which poison-
ing caused morbid processes was by occupational exposure. This exposition was pandemic in
the Roman Empire, and it has been claimed that it contributed to its fall, but it also caused
numerous epidemics in Western countries until the nineteenth century. In the case of artists,
and since the Renaissance period, this toxicity has been called painter’s colic or painter’s mad-
ness. The latter term is partly due to the mental disorders displayed by some of the great mas-
ters, including Michelangelo and Caravaggio, although it was long recognized that even house
and industrial painters were prone to the disorder. This chapter examines the historical evi-
dence of recognition of such toxicity and discusses the controversies raised by the possibility
of professional lead poisoning in great artists. In addition to those mentioned above, many other
artists across several centuries will be discussed, some being Rubens, Goya, Fortuny, Van Gogh,
Renoir, Dufy, Klee, Frida Kahlo, and Portinari. This chapter also briefly mentions the possibility
of lead poisoning in two famous composers: Beethoven and Handel. Whether suffering from
lead poisoning or not, about which we cannot always be sure, we should still highlight and
admire such geniuses fighting their disorders to bequeath us their immortals works.

Keywords
lead poisoning, saturnism, Goya, Van Gogh, Michelangelo

1 PREINDUSTRIAL HISTORICAL PERSPECTIVE OF

EXTRACTION AND LEAD POISONING
The use of lead has long been known by mankind. Perhaps, the first records of its use
are the lead-rich pigments used in prehistoric cave paintings. Likewise, lead has been
mined since ancient times. The oldest known mining site is situated in Turkey and
Progress in Brain Research, Volume 203, ISSN 0079-6123, http://dx.doi.org/10.1016/B978-0-444-62730-8.00009-8
© 2013 Elsevier B.V. All rights reserved.
223
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224 CHAPTER 9 The lead-poisoned genius

dates back to 8000–6500 BC. There is a lead necklace from the Anatolian city of
similar antiquity. Lead was widely used by Egyptians, Jews, Assyrians, Phoenicians,
Greeks, and Romans. Furthermore, its toxicity was known in ancient times. It has
been estimated that, throughout history, mankind has extracted nearly 300 million
metric tons of this metal, much of which is still found as environmental pollutants.
Lead production was calculated at 3.5 million metric tons/year during recent indus-
trial era, releasing 126,000 metric tons/year into the atmosphere (Ciudad-Cabañas,
1998; Lewis, 1985; Woolley, 1984). This chapter on the arts, however, will focus
largely on situations and celebrities before the massive occupational poisonings
associated with the industrial and automobile era.

1.1 Ancient times

The first reference to lead toxicity can be traced back to Egyptian medical papyri.
Apparently, it was often used with homicidal intentions at that time. It is curious that
this early use has been tenaciously maintained over the centuries. For example, the
Medicis and the Borgias, to get rid of their enemies, used preparations of this silent
and long-lasting compound to such an extent that the preparations became known as
“succession poudre” in French (succession powder) (Lewis, 1985). At the beginning
of the eighteenth century, the writer and Spanish Minister Jovellanos, a friend of
Goya’s, suffered an attempted assassination using this compound (Rodrı́guez
Torres, 1993).
In addition to its abundance and easy removal, lead shows many properties that
have made it so attractive since early times: it is easy to work, has a low melting
point, a high resistance to corrosion from atmospheric elements, easily retains
pigments, etc. These features have made this metal an essential element in ancient
societies, but also caused epidemics of chronic intoxication (Table 1) (Aufderheide
and Rodrı́guez Martin, 1998; Hernberg, 2000; Needelman, 2004; Warren, 2000).
Although the Corpus Hippocraticum (450–370 BC) already related gout to meals
and wine, Nicander of Cephalonia (250 BC) is credited with being the first to
mention saturnine colic, anemia, and palsy, although he did not relate them to lead
poisoning. The Greek Dioscorides (first century BC), however, brought up lead
toxicity, and a Roman, Pliny the Younger, who edited the works of Pliny the Elder,
described this frequent toxicity among shipbuilders (Hernberg, 2000; Needelman,
2004; Riva et al., 2012; Waldron, 1973).
The Romans produced nearly 60,000 metric tons of lead annually for more than
400 years, both directly and as by-products from refining the gold and silver that they
were mining. Mining was carried out using slave labor, and the pragmatic Romans
became aware of the discomfort and disorders caused by it. Thus, its extraction was
banned in Italy at the end of the Empire, although it continued in the provinces.
Lead was omnipresent in all areas of Roman life: it was released from
chimneys of the houses that liberated lead pollutants into the air; it was in cookware,
in pipelines to carry water, as a sweetener in foods, as a preservative and stabilizer for
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1 Preindustrial historical perspective of extraction and lead poisoning 225

Table 1 Recognition of lead poisoning: a struggle of centuries

Ancient age

Egypt (2500 BC) Medical Papyri. Poisoning

Hippocrates (IV BC) Colics in mining
Nicander (II BC) Saturnine palsy
Celsus (I BC) Description of toxins and some remedies
Dioscórides (I AC) Lead toxicity
Pliny, Vitrubio (I AC) Toxicity in buildings, pipes, etc.
Roma Wines with ↑ content, ↑ bones of patricians. Nero: tube to
fine-tune voice. Domitian: fountain with lead pipes. Infertility,
asthenia, malformations
Pablo Egina (VII AC) Byzantium. Epidemic of lead poisoning with paralysis
Middle Ages/Renaissance

Alchemy Saturn. Earthen color destroys metals

Daily activities Conservative and sweetening of wines
Avicenna (eleventh Transmission by food
century)
Gutenberg (fifteenth Plates of lead in printing
century)
Borgia, Medici Venom: the poudre succession
(sixteenth century)
Epidemics Colic in Madrid (painters), Poitou, Devon (cider), etc.
Description of poisoning

Paracelsus (fifteenth The miner’s disease

century)
Bauer G (n. Agricola) De Re Metallica. Medical metal use, health problems in miners
(1556)
Citois F (1616) Colic of Poitou (painters). France
Stockausen S (1656) Description of symptoms in potters
Sydenham T (1693) Palsy and colic. No cure
Gockel E (1697) Colica Pictonum. Colic wine due to the addition of litharge
Ramazzini B (1713) Painter’s colic in Venice
Tronchin T (1767) Industrial and iatrogenic poisoning
Baker G (1772) Inquiry on colic of Devon. Contaminated cider
Franklin Benjamin Observation on saturnism in plumbers, glaziers, painters, etc.
(1786)
Laennec (1831) Anemia
Thackrah (1832) Plumbism in plumbers and piping manufacturers
Tanquerel des Planches “Traité des maladies de Plomb or saturnines”: 1217 cases
(1839)
Esquirol (1838), Tuke Observations on lead encephalopathy
(1840)

Continued
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226 CHAPTER 9 The lead-poisoned genius

Table 1 Recognition of lead poisoning: a struggle of centuries—cont’d

Garrod A (1854, 1898) Saturnine gout, increased porphyrin excretion in urine
Behrend (1899) Basophilic stippled erythrocytes
Vigliani and Angeleri Synthesis of heme impaired
(1934)
Sheets RF (1951) Shortened life span of erythrocytes
Haeger-Aronsen B Excretion of ↑ALA in urine
(1960)
Bonsignore D (1965) Lead inhibits delta-ADA
Contemporary Era

Brisbane (Australia) Saturnine encephalopathy in children

(1892) Abortions, nephropathy, occupational exposure, etc.
1898 Industry inspections
1921 International Conference of Labor (ILO): prohibition of
paintings with lead indoors
1924 Apply treaties in Europe (e.g., in Spain). USA refuses
Fight for prohibition (e.g., H. Zangger—Einstein’s doctor)
1927 Tetraethyl lead: antiknock in gasoline
1972 Federal law on prohibition of lead in paintings
1990 Ban of lead in gasoline

wines, etc. It was even used as a component in makeup (Eisinger, 1982; Hernberg,
2000; Nriagu, 1992; Winder, 1994; Woolley, 1984).
With respect to the consumption of wine, it was used as a stabilizing agent, “sapa”
or “defrutum,” a kind of sweet syrup obtained by heating the grape juice in lead
containers. This product, in addition to sweetening the wine, was used as an additive
for other seasonings. Thus, some historians attributed the decline of the Roman
Empire to chronic lead poisoning causing sterility, abortions, and premature births
among the elite Romans, who were the almost exclusive consumers of these wines
(Nriagu, 1983; but see Scarborough, 1984). This consumption would have contrib-
uted to the frequent presence of gout and would be a cause of the deterioration of
mental capabilities, which was highly evident in some of the Romans emperors.
In this context, we might remember the follies of Caligula, Nero, and Commodo,
the depressions suffered by Tiberius, and the extravagances of the last representative
of Flavian dynasty, Domitian (81–96 AC), who installed a fountain with lead pipes in
his garden that continuously spouted wine. High levels of lead have been found in the
bones taken from the tombs of the Romans. These levels were significantly higher in
patricians than in plebeians. It has even been estimated that the intake of lead in
patricians in the Roman Empire approached 1 mg/day (in contrast to 0.3 mg/day
in United States during the 1980s). However, its global rate of use from all sources
of lead could be as high as 550 g per person each year (Lewis, 1985; Needelman,
2004; Nriagu, 1992; Woolley, 1984).
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1 Preindustrial historical perspective of extraction and lead poisoning 227

This known lead toxicity was almost entirely forgotten during the Middle Ages.
Alchemists used lead widely in their searches for methods to convert metals into
gold. In fact, lead was widely used in all facets of everyday life: in makeup creams,
for manufacturing chastity belts, as a rudimentary spermicide, as a sweetener and
popular condiment, in shipbuilding, in the alloys of silver and gold coins, to manu-
facture all kinds of ammunition, cannons, and other war machines, as well as in
household utensils and cookware, to name but some uses. It was also largely used
in the pigments used to produce beautiful miniated (rubricated or red) codices called
“Beatos” (tenth to eleventh centuries). With the introduction of Gutenberg’s inven-
tion of the printing press (fifteenth century), it became widely used in the preparation
of plates for printing (Hernberg, 2000; Riva et al., 2012).
Given its omnipresence in everyday life through the Middle Ages and the Renais-
sance, it is surprising to observe a paucity of references about its harmful effects
through this time span. Some exceptions are an acute observation from Avicenna,
in a text by Agricola (De Re Metallica; sixteenth century), and a description from
the fifteenth century by Paracelsus, his so-called disease of miners.
It seems worth mentioning how this knowledge led to some early social recog-
nition for Avicenna (980–1037), considered the “Prince of Physicians” of the Middle
Ages (Afnan, 1958). Indeed, at the age of 17, when he was already known for his
erudition in medical topics and philosophy, he was called to assist Ibn Mansur,
the samanid emir of Bukhara (now in Uzbekistan). The emir was seriously ill from
a disease that seemed unidentifiable to his official doctors. Avicenna realized that he
was suffering from serious lead poisoning caused by his habit of drinking a glass of
terracotta from a goblet painted with mineral pigments. Avicenna saved his life, and
with uncommon wisdom only requested unlimited access to the royal libraries of the
Samanids in reward for his work. During the following years, Avicenna wrote over
100 books on diverse subjects. Among them is the famous Canon, a structured
compendium of medical knowledge of his time, which after translating and rewriting
in Latin would serve as the primary medical text in the West until the seventeenth
century. With respect to lead, Avicenna mentions its medicinal use in treating
diarrhea and intestinal ulcerations (Nriagu, 1992).

1.2 Epidemic and modern awareness

Due to its importance, we must now highlight its widespread use as a sweetener (i.e.,
as lead acetate or lead sugar) to preserve the taste of poor-quality wine or as a
preservative for other good wines. There are ancient testimonies of the uprising
of the tribes against the Roman Empire due to the imposition of wine preserved
in this way. Epidemics of colic were a continuous plague in Europe during the
fifteenth to nineteenth centuries. Some states of Germany were aware of this toxicity
and published bans on pain of death in 1498 and 1577 for the addition of lead sweet-
eners in wine. However, perhaps the most famous case was detected in the German
city of Ulm during the seventeenth century when physician Eberhard Gockel learned
about and experienced the deleterious effect of lead-tainted wine (Eisinger, 1982;
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228 CHAPTER 9 The lead-poisoned genius

Pearce, 2007). He stayed in a monastery where he received the hospitality of the

monks: food and wine. There he observed that the monks who drank no wine seemed
healthy, while those who drank were ill with classic abdominal colic pain. He also
experienced the colic pain himself until he realized that it was related to the wine he
drank. This led him to discover that the addition of a sweetener, litharge or white lead
oxide, was responsible. Given that this region’s economy depended heavily on wine
exports, and in order not to ruin this source of wealth, Duke Ludwig of Württemberg
banned on pain of death the mixing of lead additives with wine.
There were some allusions or detailed descriptions of epidemics in lead workers by
famous physicians (e.g., Sydenham, Citois (Richelieu’s physician), Tronchin (Vol-
taire’s physician), etc.; Eisinger, 1982; Pearce, 2007). Another famous example was that
of the doctor at the Court of King George III, Sir George Baker, who, during the eigh-
teenth century, discovered with Benjamin Franklin’s help that the so-called colic of
Devonshire (an entity associated with palsy, encephalopathy, anemia, and abdominal
pains that ravaged England for more than one century and caused many fatalities)
was due to lead contamination of wine from the presses used to crush the grapes
(Finger, 2006). Likewise, and although the classical description of saturnine gout is
due to Sir Alfred B. Garrod in 1854 (Storey, 2001), it was established that the major
epidemics of gout that engulfed England in the eighteenth century had their origin in
the mass consumption of Port and Madeira wines from Portugal, which contained
significant lead concentrations (Hernberg, 2000; Riva et al., 2012; Winder, 1994).
Across the Atlantic, one of the first battles in public health was fought in the
colony of Massachusetts in the eighteenth century, where lead additives were banned
in cider and wines, although some of the poisoning might have been due to the wide-
spread use of medicinal lead preparations, such as litharge, due to the popular belief
in their efficacies for colic pains (Eisinger, 1982).
Not only has this contamination of wines been a cause of great tragedies but also
contamination of foods stored in lead containers. In 1845, the entire expedition of
128 men under the command of John Franklin, who sought the Northwest Passage,
perished. Among other causes, this was thought to be due to the consumption of food-
stored casks sealed with lead. It is supposed that this must have contaminated the
food causing the illness and madness of the crew (National Geographic, 1990). In
modern times, mass media still periodically report severe epidemics (e.g., in
Hungary with red lead oxide mixed with paprika to brighten up the color of this spice;
in India as a preservative from cold in the manufacturing of ice cream; in Nigeria
with soil contamination resulting in thousands of childhood deaths).

1.3 Scientific era and saturnism

Although Laennec had already described the anemia in 1831, Tronchin, Trackrah, and
others had made detailed observation on workers who handled lead pipes, and some fo-
cused on the lead encephalopathy (Esquirol, Tuke, etc.). The modern paradigm on lead
poisoning—mainly occupational poisoning—came from the famous Traite´ des mala-
dies de plomb o saturnines by L. Tanquerel des Planches, edited in 1839 in Paris
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2 Poisoned painters 229

(Eisinger, 1982; Lewis, 1985; Pearce, 2007; Riva et al., 2012). This work gives a detailed
description of the abdominal, neurological, and articular manifestations of poisoning in
more than 1200 cases, yet was unable to provide a single explanation for all of them.
Subsequently, Richard Burton described his famous line on the gums in 1895
(Pearce, 2007). Today, it is considered less specific. Behrend, in 1899, described baso-
philic stippling of erythrocytes, employed as a means of detecting lead toxicity in
workers during the first half of the twentieth century, until its abandonment due to being
unspecific. In 1898, Sir Archibald E. Garrod described increased porphyrin excretion in
urine with lead poisoning. In 1934, researchers observed the alteration of iron incorpo-
ration into heme molecules, causing the accumulation of protoporphyrin IX in erythro-
cytes, and later the shortened life span of the erythrocytes in patients with lead poisoning.
In 1960, increased excretion of delta-aminolevulinic acid (delta-ALA) in the urine of
lead workers was noted, and in 1965 it was observed that lead inhibits the enzyme
delta-aminolevulinic acid dehydratase (delta-ALA-D), which leads to the increase in
the excretion of delta-ALA (Hernberg, 2000; Pearce, 2007; Riva et al., 2012) (Table 1).

2 POISONED PAINTERS
I have already mentioned the first ornamental trace of lead use by man found in cave
paintings (Ibrahim et al., 2006). Votive objects made from this metal were found in
Egyptian and Minoan tombs, and in the ancient city (now in Turkey) of Troy
(Waldron, 1973). In relation to painters, the expression “to be as crazy as a painter,”
however, seems to have become popular at a later date, perhaps five or so centuries
ago. In De Morbis Artificum Diatriba, a book published in 1713 by Bernardinus
Ramazzini, regarded as the founder of modern occupational hygiene, we find:
Of the many painters I have known, almost all I found unhealthy. . .. If we search
for the cause of the cachectic and colorless appearance of the painters, as well as
the melancholy feelings that they are so often victims of, we should look no further
than the harmful nature of the pigments. . ..
cited in Rodrı́guez Torres (1993), p. 11

Further, on referring to potters, this author writes:

They suffer from palsied hands, abdominal colic, fatigue, cachexia, and they lose
their teeth. It is, therefore, extremely rare that one can see a potter who does not
have a lead-colored, cadaverous looking face.
cited in Riva et al. (2012), p. 12

In addition, in a famous letter of Benjamin Franklin (1763), written during his stay in
Europe, we find him referring to “dry gripes” (colic) and “dangles” (wrist gout), which
affected tinkers, painters, and typesetters (Eisinger, 1982; Finger, 2006; Pearce, 2007).
The dreaded saturnine colic was, at that time, almost (but not quite) synonymous
with “colic of the painters” or, more generally, artisans and laborers (e.g., tin
workers). Table 2 presents major fine artists along with two great figures from music,
 Author's personal copy

Table 2 Artists and celebrities with possible lead poisoning

Person Disease Likelihooda

Ten to twelfth centuries

Illustrators of the Beatos Exposure to paintings with lead Unknown

(minimum)
Fifteenth to sixteenth centuries

Michelangelo Buonarrotti Saturnine gout. Mental disturbances High

(1475–1564)
Rafael Sanzio (1483–1520) Supposed occupational exposure Unknown
Caravaggio (1571–1610) High levels in tomb. Mental Poor
disturbances
Piero della Francesca Eye illness, blindness Poor
(1463–1494)
Seventeenth century

Peter Paul Rubens Probable rheumatoid arthritis. Poor

(1577–1640) Exposure
Rembrandt van Rijn Rosacea. Supposed exposure Poor
(1606–1669)
Eighteenth century

Francisco Goya Colic, deafness, paralysis. Exposure High

(1746–1828)
Nineteenth century

Mariano Fortuny Colic pains. Malaria. Biting brushes Poor

(1835–1874)
Vincent Van Gogh Madness. Alterations of vision Controversial
(1853–1890)
Auguste Renoir Rheumatoid arthritis. Exposure. Heavy Poor
(1841–1919) smoker
Twentieth century

Alexey von Jawlesnky Rheumatoid arthritis. Exposure Poor

(1864–1941)
Raoul Dufy (1877–1953) Rheumatoid arthritis. Exposure Poor
Paul Klee (1879–1940) Scleroderma. Exposure Poor
Frida Kahlo (1907–1954) Chronic pain. Exposure. Possible Poor
suicide
Candido Portinari Colic. Bleeding. Occupational High
(1903–1962) exposure
Other famous people

Haendel (1685–1759) Gout. Possible depression. Porto Poor

wines
Beethoven (1770–1827) Colic, irritability, deafness. Wines. Controversial
Oinmetric tonsents
a
The degree of likelihood is a subjective author’s assessment of the literature references. Unknown: cited
but without any proof. Poor: quoted but without convincing proofs. High: confirmed or more convincing
arguments. Controversial: contradictory data (see text).
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2 Poisoned painters 231

namely Beethoven and Handel, for whom lead poisoning has been suspected at some
stage. This table is accompanied by subjective assessments, based on the existing
data, about the likelihood of these diagnoses; there being considerable controversy
about these published assessments. I shall now turn to the details of those cases in
which the probability of lead poisoning seems fairly high.

2.1 The Beatos (ninth to eleventh centuries)

In the acclaimed novel The Name of the Rose, with its famous film transposition by
J-J Annaud (1986), Umberto Eco consulted with a biologist friend and chose arsenic
as the poison for the plot. Nevertheless, he recognized that the historical evidence
was poor (Landı́n Pérez, 2008). However, a good candidate for the intoxication of
the copyists of the Beatos (illustrated monastic manuscripts of the ninth to eleventh
centuries commenting on the Revelation of St. John) is lead. Its beautiful illustrations
are made with miniated reddish pigments rich in this metal.

2.2 Michelangelo Buonarrotti (sixteenth century; for dating of

specific artists, see Table 2)
It has long been suspected that the great Florentine painter, author of the admirable
frescos of the Sistine Chapel in Rome and prototype of the Renaissance man (painter,
writer, poet, sculptor, and architect), suffered from gout. One of the more compelling
arguments made stems from the recognition of his probable portrait in the famous
fresco by Raphael in the Vatican’s Loggia The School of Athens. This monumental
fresco depicts important Greek thinkers (e.g., Socrates, Plato, Aristotle, Diogenes),
who were in some instances endowed with the faces of well-known people of the
time (e.g., Leonardo da Vinci as Plato and the architect Bramante de Urbino as
Euclid). The man with a crooked nose in the foreground, sitting on the steps,
and dressed in contemporary clothes and leather combat boots is recognizable as
Michelangelo (Espinel, 1989). The notable realism in his portrait includes a
deformed right knee, with excrescences, but without clear signs of current articular
inflammation. This arthritis, presumably tophaceous, together with the correspon-
dence of Michelangelo that repeatedly alludes to the expulsion of stones and urinary
grind, and even an acute obstruction, has pointed to the possibility of saturnine gout.
This poisoning may also justify the well-documented attacks of melancholy and iras-
cibility or “madness” of this painter (Espinel, 1999; Wolf, 2005). The wine stored in
lead containers that was consumed by Michelangelo has been cited as a source of his
likely contamination. Preservatives rich in tartaric acid, such as fruits, were added to
these wines. This is a recognized solvent of the lead enamels that lined the vats. It is
also known that, when engaged in his work, he followed an almost exclusive diet of
bread and wine. Likewise, he could also have been exposed to airborne particles or
high lead concentrations from handling his paints (Wolf, 2005). And, perhaps, these
ailments led him to paint his aching self-portrait in the St. Bartholomew’s wrinkled
skin at the Last Judgment in the Sistine Chapel.
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232 CHAPTER 9 The lead-poisoned genius

2.3 Raphael Sanzio

Ramazzini mentions him in the De Morbis Artificum Diatriba (Rodrı́guez Torres,
1993, p. 11) as a possible victim of lead poisoning, although his biographers are more
inclined today to attribute his early death to other causes (e.g., syphilis).

2.4 Caravaggio
A retrospective explanation for the violent behavior and attitudes, including murder,
that marked the life of the great painter of Judith Beheading Holofernes and The
Conversion of Saint Paul has been the high levels of lead found in bones that are
believed to be from his tomb in Tuscany. Like in his life, violent themes are often
present in his paintings, which show strong contrasts between light and shadow
(tenebrism). Pigments in his works are rich in lead, and Caravaggio was very chaotic
when painting (Kington, 2010).

2.5 Piero Della Francesca

We know few details of the personal life of Piero della Francesca, author of fine mu-
rals in the Italian Quatroccento, although, according to the Italian artist and historian
Vasari, in his last year, he suffered a serious illness that led to his blindness. This has
also been attributed to lead poisoning (Riva et al., 2012).

2.6 Rembrandt van Rijn

According to some researchers, after the exhaustive analysis of 40 Self-portraits
painted over 41 years, Rembrandt, the great Dutch Master and engraver from the
Netherland’s Golden Age (seventeenth century) died mired in depression and
melancholy. However, the biggest drawback to establishing a diagnosis of his ill-
nesses and death is the lack of reliable biographical references about the signs
and symptoms associated with the painter of the Anatomy Lesson of Dr. Nicolaes
Tulp and The Night Watch. Therefore, the hypothesis that his death is at least partially
due to lead poisoning is at present only one more theory to consider alongside others,
such as temporal arteritis, hypothyroidism, rosacea, etc. Only “advanced age” can be
found on his death certificate as his likely cause of death (Friedman et al., 2007).

2.7 Francisco de Goya

The life of this Spanish Great Master of the eighteenth to nineteenth centuries was
marked by a disorder contracted in 1792 during a trip to Andalusia at the age of 46.
This manifested itself in acutely with abdominal cramp, vertigo, tinnitus and hearing
loss, visual disturbances and tremors, and paresis of the right arm. Therefore, he was
left with irreversible deafness. Without using his fingers, he could not understand
anything, and was thus forced to learn sign language. An allusion to the eye problem
can be seen in the Self-portrait housed at the Museum of Castres (ca. 1794–1797),
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2 Poisoned painters 233

where he is represented (only here and not on other self-portraits) with glasses. Deaf-
ness forced him to resign as Director of Painting of the San Fernando Academy
(Montes-Santiago, 2006).
Such ailment, especially hearing loss, was instrumental in his life and many au-
thors claimed union with ailments that would lead him to the Black Paintings, 30
years later. However, this is improbable because Goya painted luminous works such
as the Majas or the frescoes in Saint Antonio de la Florida, Madrid. Because of this, a
prestigious psychiatrist has argued that such gloomy paintings were the product of a
deep depressive episode within a general framework of bipolar disorder (Alonso-
Fernández, 1999). Anyway, the hypotheses about his ailments have varied, and I
have collected opinions from more than 30 experts from the twentieth century. They
have issued almost 20 possible interpretations of his disorder (e.g., manic-depressive
psychosis, schizophrenia, typhus, malaria, encephalitis, multiple sclerosis, syphilis
or mercury toxicity used to treat it, as well as poisoning by quinine) (Felisati and
Sperati, 2010; Montes-Santiago, 2007; Vargas-Origel, 2009).
One of the most accepted theories is that he had lead poisoning. Many of Goya’s
symptoms are described accurately in medical texts written by his contemporaries,
including Mitjavila’s (1791) On the damage caused by lead preparations to the
human body and Ruiz de Luzuriaga’s (1796) Treatise on the colic of Madrid. The
first phase of asthenia, constipation, and abdominal colic was followed at variable
time by one of arthralgia, trembling hands, and weakness in the limbs with palsy
of the hands (affectations of the radial nerve) or legs (affectations of the peroneal
nerve). This sometimes culminated with hemiplegia and atrophy of the hand flexor
muscles. Other manifestations were blindness, vertigo, tinnitus, and hearing loss.
Research into the pigments used by this painter reveals a high content of lead and
other toxins; among them are white lead (lead hydroxycarbonate), Naples yellow
(lead antimonite), litharge (lead oxide), and extract of Saturn (lead acetate þ lead
oxide þ water or alcohol) (Rodrı́guez Torres, 1993). In adults, once absorbed via
ingestion (10–15% absorption) or inhalation (near 80% absorbed), the lead enters
in blood wherein >99% is found in erythrocytes. Here, delta-ALA-D is the main
binding protein. Around 95% of the total lead concentration is accumulated in
the bones. Of the excretion, 75% is by the kidneys, and other routes are bile,
gastrointestinal secretions, hair, and sweat (Bradberry and Vale, 2007; Goldman
and Hu, 2012).
In Goya’s case, in addition to possible airborne poisoning, presumably caused in
part by unloading large amounts of pigments in his workshop (e.g., more than 45 kg
of white lead from July 1792 to June 1793), there are added testimonials that he
sometimes applied the pigments directly on the canvas with his fingers. His physi-
cians prescribed bathing in Trillo, whose waters were considered beneficial for lead
poisoning. Also in his time, white zinc was already being recommended instead of
white lead (Rodrı́guez Torres, 1993). However, years later, Goya himself confirmed
that he continued to use pigments rich in lead on his portrait of Duke of Wellington,
due to the scarcity of substitutes following the War of Independence in 1808. We
do not know with certainty the cause of the disease in 1819 that motivated his
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234 CHAPTER 9 The lead-poisoned genius

well-known self-portrait showing him alongside his doctor, Arrieta, although lead
should be considered a possibility (Montes-Santiago, 2007).

2.8 Mariano Fortuny

This Catalan painter of the nineteenth century shares significant affinities with Goya
and Van Gogh. Fortuny studied at the Prado and deeply admired Goya. Not only did
he imitate Goya as an engraver—see the well-known Idyll—but also he borrowed
motifs and clothing. In this regard, and in a letter written while he was preparing
The Vicar, his most famous painting, he declared: “Each day I realize the growing
affinity between what he [Goya] wanted and what I am looking for” (Gómez-
Moreno, 1994, pp. 365–379). Van Gogh, for his part, described his admiration for
Fortuny’s engravings in several letters to his brother Theo.
Fortuny would succumb to his beloved but unhealthy Rome, the climate of which
would often cause him bronchitis and arthralgias. Several attacks of malaria, the lat-
ter complicated with intestinal pains from possible lead poisoning—acquired by the
inveterate habit of sucking his watercolor brushes—would result in a bowel perfo-
ration that would kill him within 2 weeks. However, this did not seem to influence his
paintings, which were always associated with kind themes and bright colors. Sym-
bolically, after a massive burial ceremony, his brushes and palettes were deposited in
his coffin, along with his final drawing, which was drawn when he was already ill and
represented the mortuary mask of Beethoven—a musical genius also with suspected
lead poisoning (Vives Piqué and Cuenca Garcı́a, 1994).

2.9 Vincent Van Gogh

This great nineteenth-century Dutch painter constitutes the paradigm of the genius
who has been profusely studied from medical and psychiatric points of view. He has
been diagnosed with a wide range of problems, from schizophrenia to digitalis and
absinthe intoxication, Ménière disease, etc. (Blumer, 2002). Two of the most persis-
tently given retrospective diagnoses are temporal lobe epilepsy, which was supported
by the great French neurologist Henry Gastaut, and manic-depressive psychosis
(Carota et al., 2005). This last diagnosis was also defended by American psychiatrist
Kay R. Jamison, in her well-known book Touched with Fire, about the psychopathol-
ogy of great artists. In the case of Van Gogh, she even suggests the possibility of
having two diseases, epilepsy and bipolar disorder (Jamison, 1995; also see
Naifeh and White Smith, 2012). A stronger case for acute intermittent porphyria
has recently been presented and defended (e.g., Arnold, 2004).
Van Gogh is brought up here due to publications previously in form of a Ph.D. in
the fine arts, and more recently by comparing the artist’s signs and symptoms with
other cases of documented toxic encephalopathy, in both of which the author argues
that saturnism contributed to his problems and ultimate demise (González Luque,
1997, 2012). It has been argued that along with his background of hereditary factors
(exemplified by the supposed mental illness of his brother Theo), often-cited
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2 Poisoned painters 235

environmental factors (e.g., inadequate nutrition, excessive exposure to the sun), and
pathological factors (venereal disease, smoking, absinthe, or digitalis intoxication),
he could have had chronic lead poisoning. This, it is believed, would have contrib-
uted to his stomatitis, anemia, abdominal pains, motor paresis of the hand, as well as
to his many psychiatric symptoms (e.g., irritability, epilepsy, delusions, hallucina-
tions and crepuscular states, sleep disorders, depression, and subsequent suicide).
The origin of this poisoning would supposedly be from the repeated ingestion of
lead-rich pigments (such as lead carbonate or chromate, seen with X-rays of his
canvas), which he favored for its distinctive yellow color (González Luque, 1997,
2012). And lead poisoning produces a similar picture to acute intermittent porphyria.
Whether this thinking is correct or not, it forces us to be wary of simple, one-factor
explanations for a myriad of complex human behaviors.

2.10 Rubens (seventeenth century), and Dufy, Renoir,

von Jawlesnky, and Klee (nineteenth to twentieth centuries)
Epidemiological evidence linking heavy metal intoxication to suffering from rheu-
matic disorders is the main argument for blaming lead poisoning for the diseases of
Peter Paul (Pieter Pauwel) Rubens (probable rheumatoid arthritis), Auguste Renoir
(rheumatoid arthritis), Raoul Dufy (rheumatoid arthritis that improved notably with
prednisone), Alexey von Jawlesnky (rheumatoid arthritis), and Paul Klee (sclero-
derma) (Fields, 1997; Pedersen and Permin, 1988; Sandblom, 1996; Viana de
Queiroz, 2007). Indeed, the bright colors used by these artists are due to the use
of lead-rich pigments, antimony, arsenic, cadmium, cobalt, and other heavy metals.
In the case of Renoir, it is also documented that he was a heavy smoker, which
could result in direct transfer of these pigments by contamination from the cigarette.
Moreover, the preparation and ingestion of food in the studios had the potential for
contamination with dust or paint.
In any case, we should say that such ailments were a source of abundant suffering
for all of them, but that they attempted to overcome their problems with the construc-
tion of a kind of adapted splint (Rubens and Renoir) or by painting on small format
canvases (Jawlensky). Dufy was fortunate, as there was a substantial improvement in
the three final years of his life due to the use of ACTH, cortisone, and aspirin. Paul
Klee tried various treatments, including hot springs, albeit with little success.

2.11 Frida Kahlo

The hypotheses about the sufferings of this Mexican painter, especially known for
her self-portraits, much of them depicting pain, have been varied. In addition to
childhood poliomyelitis, she had a very serious tram accident at the age of 17 years
old that caused her multiple fractures and deformity of the spine, and which confined
her to bed for almost a year. To relieve her boredom, she began to paint, giving rise to
her career as an artist. However, the accident meant that she was subjected to more
than 30 analgesic or corrective operations throughout her life. She had stormy
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236 CHAPTER 9 The lead-poisoned genius

relations with her husband, the Mexican muralist Diego Rivera, and her best-known
works are Self-portraits (i.e., Broken Column), which reflected her moods, some-
times animated and sometimes depressive (Gunderman and Hawkins, 2008;
Herrera, 1983). Kahlo suffered multiple miscarriages, arterial thrombosis, amputa-
tion of a foot, and chronic pain that contributed additionally to her alcohol and opiate
habits. Thus, she has been diagnosed with fibromyalgia, antiphospholipid syndrome,
and spondylolisthesis (Martinez-Lavin et al., 2000). Her death was officially
attributed to a pulmonary embolism suffered while recovering from pneumonia,
but it is quite likely that her death was due to suicide caused by her pains and chronic
depression (Herrera, 1983; Viana de Queiroz, 2007).
The reason for bringing her up here comes from the portrait of her childhood
boyfriend, Alejando Gómez Arias. A chemical study of the pigments used showed
that, at least at that time, Frida used white lead pigment (EFE Agency, 2007). To
what extent her symptomatology was due to lead poisoning is an enigma, and more
seems to be made of this association than is warranted, but it is noteworthy that, by
1942, this pigment had already been replaced by less toxic titanium pigments.

2.12 Candido Portinari

Portinari was a Brazilian painter, son of Italian emigrants, who was born on a coffee
plantation. He is known worldwide for his grandiose murals, especially War and
Peace (1953–1957) painted in the headquarters of the United Nations Building in
New York City. His murals and other well-known works (Coffee, Mestizo) reflect
the most populous social groups in his country and their harsh living conditions
(Blacks, mulattos, emigrants, etc.). In 1928, he traveled throughout England, Italy,
Spain, and Paris. On his return, and from 1936 on, he painted frescoes for the
Brazilian Ministry of Education. In 1942, he painted four frescoes about Latin
American colonization for the library of Congress in Washington (Study for Discovery
of the Land, Entry into the Forest, Teaching of the Indians, Mining of Gold). In 1944,
he painted the famous frescoes and mosaics for the Church of Oscar Niemeyer in the
Brazilian town of Pampulha, Belo Horizonte. In 1950, he participated in the Venice
Biennale. In 1953, already with the first manifestations of lead poisoning, he painted
the two murals of War and Peace, in the United Nations Building (Portinari, 2012).
Portinari was diagnosed with saturnism due to the paints he used 8 years before
his death in 1962. Some of these paints—with arsenic, chrome yellow, etc.—were
very similar to those used by Van Gogh. This caused major colic pains and digestive
system hemorrhages requiring hospitalization in 1954, with subsequent relapses. It is
hard to determine the influence of his disease on his paintings, because few works
reflect more dramatically the despair and death associated with the terrible drought
that ravaged the north of Brazil, and that led to the series Os Retirantes (Migrants),
painted in 1944, some 10 years before his illness was diagnosed. However, after
some time away from painting following medical advice, he tried to recover using
other types of materials and techniques, although finally and contrary to repeated
medical warnings (“They forbid me to live,” he remarked), he restarted using lead
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3 Musician connections 237

pigments—and during his final years presented repeated episodes of abdominal colic
and digestive bleeding that caused him great prostration and his premature death at
58 years old. At that time, he was preparing an exhibition, eventually posthumously,
at the Royal Palace of Milan (Montes-Santiago, 2006; Portinari, 2012).

3 MUSICIAN CONNECTIONS
For the sake of a more complete “picture,” the point should be made that lead
poisoning might also have affected some very famous musicians. Thus, without
overdoing it, a few words should be said about Handel and Beethoven, two master
composers who some historians have been suspected might have suffered from lead
poisoning.

3.1 Handel
Handel’s gout attacks have been attributed to saturnine gout. The origin of the lead
comes from the high lead content in the wines of Porto and Madeira, which were
distilled in lead pipes. However, there is still insufficient data on his purported
mental illness to be able to attribute it to some form of saturnine encephalopathy
(Frosch, 1989).

3.2 Beethoven
The arguments for lead poisoning in Beethoven are based on the finding of unusually
high amounts of lead in Beethoven’s preserved hair by scientists at the Pfeiffer
Research Center in the United States; on high lead concentrations found in fragments
of his skull in the U.S. National Argonne Laboratory; and on the fact that the DNA of
these hair samples and bone fragments match (Mai, 2006; Martin, 2000). The sources
for such poisoning have been attributed to the high content of lead in the Hungarian
wines that the musician drank, the repeated biting of his lead pencils, and lead-rich
medicines (e.g., expectorants) prescribed by his doctor, Dr. Andreas Wawruch.
Another source might have been the lead-rich poultices applied to punctures for
the repeated paracentesis to relieve the hydropic decompensation of his cirrhosis.
The elimination of this poison would have been hindered by his suspected liver
disease, which would have resulted in higher concentrations of the poison.
Cognitive impairments associated with chronic lead intoxication could explain,
to some extent, the compositional hardship of the composer, especially in his final
years and especially months (Reiter, 2007). However, this does not satisfactorily
explain the musician deafness. In Beethoven’s autopsy, conducted by his doctors
Wagner and Wawruch, a specific cause for his deafness was not found, apart from
atrophy of the auditory nerves and hardening of vestibular arteries (Montes-Santiago,
2007). In addition, the latest research performed by A.C. Todd of Mount Sinai
Hospital revealed that the lead levels in Beethoven’s skull were not higher those
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238 CHAPTER 9 The lead-poisoned genius

for any other person of his age. Therefore, it is concluded that, although he could
have suffered from lead toxicity, this did not substantially contribute to his death
(Barron, 2010). The dispute, therefore, about his alleged lead poisoning continues.

4 CONCLUSIONS
At the current time, and although we have advanced much with respect to under-
standing lead poisoning, a danger of exposure still exists (Fields, 1997; Kathuria
et al., 2012; MacDonald, 2004) with significant manifestations (Bellinger, 2011).
In 2005, 10,031 workers in the United Kingdom were exposed to significant amounts
of lead and placed under medical scrutiny (Bradberry and Vale, 2007). In Spain,
there were 91 adults hospitalizations (with 1 death) due to lead poisoning from
diverse sources during the period 2000–2010 (National Statics Institute, 2012).
I have the personal testimony of an artist friend (X. Vázquez Castro, b. 1951),
who informed me that he has met several colleagues intoxicated at work by lead.
In this contribution, I have reviewed the historical discovery of lead toxicity, the
evidence for some of the famous artists who might have been occupationally exposed
to high amounts of lead, and how this might have affected their lives and works.
Sometimes, art hurts, but it also can save. And some artists (e.g., Portinari) have
chosen to succumb to this disease rather than giving up their art. However, regardless
of whether they developed lead poisoning or not, the main highlighted message is
that these individuals fought against their ailments and at least partially overcame
them to bequeath us esteemed and eternal works.

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