Thursday 30 July 2020

The "hideous wen" of Jacques-Louis David

Here is another famous medical affliction, the growth which disfigured the face of the painter Jacques-Louis David. 

Maquette of a posthumous bust of David by François Rude, 22.5 cm.
 High Museum of Art, Atlanta, purchased in 2013

As a student, probably in 1773-4, David was involved in a fencing accident.  His opponent's foil pieced his left cheek which began gradually to swell:  as a result his face became asymmetrical, his mouth was pulled out of shape and  his speech, which was already affected by a speech impediment, became embarrassingly distorted. 
The growth - which earned David the nickname "la grosse joue" - is clearly visible in surviving portraits and self portraits.  In 1965, in a study which is still widely referenced, the art historian Jacques Wilhelm, drew attention to David's peculiar physiology as a means of identifying his image.  [Jacques Wilhelm, "David et ses portraits" Art de France, IV (1964), p.158-173] 

Biographers have generally referred a little vaguely, to a "benign tumour" or an "exostosis" . However, David's affliction has recently come under scrutiny from the medical profession.  One might suppose that a condition of this sort would be easy for modern medicine to diagnose, but, surprisingly, there has been disagreement.  Within the space of a year, in 2007 and 2008, the prestigious Journal of the Royal Society of Medicine published two, quite contradictory, analyses.

A trauma?

The first paper, by Hutan Ashrafian of Imperial College, presents an account of David's "post-traumatic facial pathology".  Ashrafian argues that  David suffered from an "underlying pathology" which was the direct result of his injury rather than a consequence of the tumour which developed.

Ashrafian notes that David received  a "deep left peri-oral" sword wound which led to the loss of the "left nasolabial groove", that is the line between his nostril and the corner of his mouth. 

 Self-portraits show a visible scar at the "left labiomarginal solcus" extending for a short distance laterally into the midface. This is likely to have damaged the buccal branches of the facial nerve, so compromising facial movement around the jaw, lips and nasal muscles.  This would have rendered  David's expression asymmetrical, distorted his speech and made it difficult for him to eat in public

Hutan Ashrafian seems less certain about the nature of David's "tumour". It  arose as a "complications of midface soft tissue injury":  perhaps it was a "foreign body granuloma" or "a post-traumatic neuroma" (ie. an abnormal growth specifically of the nerve tissues)

Hutan Ashrafian, "Jacques-Louis David and his post-traumatic facial pathology",
J R Soc Med. 2007 Jul; 100(7): 341–342..

An adenoma?

The second paper is a collaboration between  Humphrey Wine, then Curator of French Seventeenth- and Eighteenth-Century Paintings at the National Gallery, and  the UCL cancer specialist Michael Baum. Their analysis returns to the tumour, which they diagnose as a "pleomorphic adenoma" or swelling of the parotid gland - a condition totally unrelated to the fencing injury.  It is noted that this possibility was suggested by Jacques Wilheim as long ago as 1961. 

The parotid gland,  the most important of the four salivary glands, is the gland which swells up in mumps.  It is situated at the angle of the jaw, and has two lobes, separated by the facial nerve.  A pleomorphic adenoma or "mixed parotid tumour" usually occurs in the superficial of the two lobes and nowadays can be removed surgically without complication.  David's example gives a rare opportunity to follow the pathology of an untreated case.  The different portraits and self-portraits chart the gradual growth of the accretion.

The study concludes that  David eventually developed a  parotid cancer which resulted in his death.  "In about 10% of untreated cases" (where does that statistic come from?) the adenoma can transform into a malignant tumour ("adeno-carcinoma") which invades the facial nerve and creates a facial palsy. This is what happened to David:  "After about 20 years David's physiognomy changes as he develops the characteristic signs of a facial palsy, a drooping of the lip and flaccidity of the affected side of his face".  The late onset of the palsy makes it unlikely that it could have been caused by the fencing injury.  

 David died on 29th December 1825 at the age of 77.In the previous summer he had begun to experience breathing difficulties.  By November 1825 he was experiencing a continual choking sensation and was unable to walk.  The autopsy concluded that he had died of "hypertrophia" of the heart". The paper deduces that the parotid cancer occluded his airways.

Humphrey Wine, Michael Baum, "Jacques-Louis David’s tumour: an opportunity to study the natural history of a pleomorphic adenoma of the parotid gland", 
J R Soc Med. 2008 Dec 1; 101(12): 583–586


Here are some references which I have collected (with no pretensions to have found everything.) 

The testimony of Jules David:

According to the biographical notes compiled by David's grandson Jules: 

It was in his final years as a student that the accident happened which deformed his face.  His children say that he was in a fencing match when a foil wounded his upper jaw.  The injury, which was badly cared for, led to an exostosis which never ceased to enlarge and which added to his difficulties in speech.
Jules David, Le peintre Louis David 1748-1825: souvenirs et documents inédits (1880). p.8.

The incident is generally considered to have taken place in 1773 or 1774.   The passage makes several points clear:
  • The affliction was identified by contemporaries as a tumour or "exostasis".
  • It was the result of a sword wound David had suffered
  • It continued to grow
  • It affected his speech.

James Northcote, 1778/9(?):

The English artist James Northcote made the acquaintance of David in Rome in 1778/9, when the two young artist spent long hours 
sketching in the Vatican together.  Northcote, perhaps with the benefit of hindsight, recalled that David always carried secret-pocket pistols and that "all his conversation was tinctured with blasphemy in respect to religion, and licentiousness in regard to government." Among his manuscript memoirs in the British Library is this sketch, which clearly shows David's enlarged cheek.  

See: William Hauptman, "'The Blood-stained brush':  David and the British circa 1802", The British Art Journal (2009/10) vol.10: p.78-97. [on JStor]

Nathaniel Marchant in 1784/5:
The English engraver Nathaniel Marchant met David in Rome in 1784/5, and later remarked to the artist Farington, that "One side of his face is much larger than the other and appears as if swelled." [Quoted in Wine and Baum (2008)]

A caricature by David from 1786(?)

The Bibliothèque nationale has a lithograph annotated "Mellinet after David" which purports to show a caricature by David himself, dating from 1786, featuring a "huge swelling". 

Reproduced in Ewa Lajer-Burcharth, Necklines: the art of Jacques-Louis David after the Terror (Yale UP 1999), p.38, fig.15.

The self-portraits (1791 and 1794)

The  two attested self-portraits date from 1791 (or possibly May 1790) and from David's period of imprisonment in the Luxembourg in 1794. The artist was then in his early to mid forties. 

Most art-historians think that David chose deliberately to minimise his disfigurement in both canvases by depicting the affected side of his face in shadow.  

This is not quite the same as saying that David falsified his natural appearance. The scarring on his cheek looks faithfully rendered, as does the droop of his mouth. The swelling, though not huge, is plainly visible, particularly in the later portrait.  I think it  quite likely that this is how David looked at the time.

There are various discussions:
T. J. Clark, "Gross David with the swoln cheek: an essay on self-portraiture" in Rediscovering History, Politics, and the Psyche, ed. Michael S. Roth (Stanford 1994) [Not on the internet/ not consulted]

Ewa Lajer-Burcharth, Necklines: the art of Jacques-Louis David after the Terror (Yale UP 1999), p.36-38. [For Ewa Lajer-Burcharth there is  a generalised asymmetry in the 1794 portrait - mouth, hair, eyebrows, cravat - which expresses David's sense of disorientation at this time, a "physiognomic disjunctiveness absent from the 1791 self-image" (p.37)] 

Jessica Cresseveur, "The politics of rebirth:  Jacques-Louis David's 1794 self-portrait" [2012 conference paper; available on Academia]

David's mirror images flipped

A report in the Archives nationales, dated 28th July 1795. 

The concierge at the Quatre Nations reports that his prisoner is ill.  David is suffering from internal pains, dizziness and fatigue and complains of a "humeur scorbutique" which has worsened "the swelling of his bottom lip on the left side".  (Quoted by Ewa Lajer-Burcharth, Necklines, p.322 nt.64)

Comments of English observers in 1802/3:

During the short-lived Peace of 1801-3, English visitors flocked to Paris.  Many took the opportunity to make the acquaintance of David and view his work.  Some have left descriptions of David's appearance, almost invariably highly coloured by political distaste:

 A person who is conversant in the science of Physiognomy, would pronounce the character of this monster at first sight.  With a hideous wen upon his lip, which shews his teeth, and for ever marks him with the snarling grin of a tyger, with features and eyes which denote a lust for massacre, he is savage by instinct, and an assassin by rule. [Henry Redhead Yorke, Letters from France, vol. 1, p.324]

[His mouth is] dreadfully distorted and turn'd almost into one cheek, so that his jaw teeth are discoverable to the front. [Catherine Wilmot, An Irish peer on the Continent, 1801-1803, p.61]

See: William Hauptman, "'The Blood-stained brush':  David and the British circa 1802", The British Art Journal (2009/10) vol.10: p.78-97. [on JStor]

Caricature by Pierre Révoil, after 1803:

This picture is reproduced by Hauptmann (2009/10) p.83.  

The inclusion of David's légion d'honneur puts the date at 1803 or thereabouts.  Presumably the piece is a wry comment on David's obsequious service to the Napoleonic regime.

Portrait by Rouget, 1813:

In about 1810 David set about creating a set of family portraits.  Georges Rouget, who had assisted him on Leonidas, painted the portraits of Eugène David and of the master himself.  This painting, probably completed in 1813, hung in the David family home as a pendant to David's own portrait of his wife.

Notice from the Neue Pinakothek, München

Philippe Brodes, Jacques-Louis David: Empire to exile (2007), p.138.

Rouget was not always so discreet.  This sketch attributed to him was bequeathed to the Cleveland Museum of Art and sold at auction in 2009.  It is thought, quite reasonably, to depict David (He is clearly wearing a very similar coat and cravat to the one in Rouget's painting.)

Walter Scott in 1815:

In 1815 Walter Scott was presented to a stranger "whose physiognomy struck him as the most hideous he had ever seen"; his disgust was reinforced when he discovered that this was David "of the blood-stained brush".  (Lockhart, Life of Sir Walter Scott, 1879, p.337)


Portrait by Navel, 1817:

Detail from the Valenciennes portrait
Photograph on Flickr by Renaud Camus
 taken 24.11.2013
This portrait was painted in September 1817 by François-Joseph Navel (1787-1869), a pupil who had followed David into exile in Brussels.  The portrait exists in at least four different versions.  This one, the first to be completed, is now in the Musée des Beaux Arts in Valenciennes.   David appears older than  in the subsequent versions, and the asymmetry of his face is more marked. 

 A note on the reverse in the artist's own hand reads:
  67-year-old Louis David, first portrait painted from life on September 7th, 1817; this one resembles him most.  Mr David made me start over again ....because I had not hidden the flaw on his cheek."  
This statement is the most direct evidence we have that David deliberately chose to conceal the full extent of his deformity.

Notice for the Valenciennes portrait:

Galerie Jean-François Heim, "Portrait of Jacques-Louis David François-Joseph Navel",

Portrait by Langlois, 1825:

Jérôme-Martin Langlois, David's favourite pupil, painted the master in the year of his death:

"Langlois, in his fine portrait of 1825 shows the elderly David as a handsome man who nevertheless cannot close his mouth properly owing to a mass on the inner side of the left cheek which drags it out of shape."  Anita Brookner  Jacques-Louis David (Chatto & Windus, 1980), p.50.

Death mask:
A photograph  of David's death mask was uploaded to Wikipedia in 2013 by Stephen C. Dickson.  There is no information as to where it is - the Edinburgh Phrenological Society collection perhaps?

There is no particular reason to doubt the identification; Jules David testifies that David's body was embalmed and a posthumous cast made of his face:
The task of embalming David's body was entrusted to Van den Corpus Lambert, a pharmacist in Brussels.  A mould was also taken of the head of the defunct, and his pupil Rude took a cast of his hand as though a precious souvenir.
 Le peintre Louis David  (1880) p.607

The evidence provided by the mask is disappointing.  The mouth appears slightly lopsided and the chin droops but, curiously, the tumour is not readily apparent.

Posthumous bust by Rude:

 The bust by François Rude (1794–1855), which exists in various different versions, is the most crucial piece of evidence for David's appearance in his later years.

Since it was posthumous, Rude no longer had the pressure of pleasing David himself though he still had the family to consider. 

Rude knew David well.  A devoted admirer,  he had followed David to Brussels in 1816 and his wife Sophie had been one of David's most esteemed pupils. In 1822 the young couple had mysteriously quarrelled with the master but Rude still acted as a pallbearer at David's funeral.  On 4th March 1825 he wrote to Eugene David soliciting permission to undertake the sculpture.   According to a letter of Sophie Rude, dated 8th May 1825, the bust (presumably a plaster version) had been completed and  approved by David's sons, who thought it "the most beautiful portrait" of their father which existed. Rude now intended to make a marble for the family.

The subsequent history of the sculpture is far from clear. According to Philippe Bordes, writing in 2007, "the status of the various versions has yet to be established". The Louvre has two marbles, one dated 1831, without drapery and one created for the museum's galleries in 1838 which shows David in modern dress.  A bronze in the Musée des Beaux-Arts in Dijon is comparable to the 1831 marble.  Dijon has more recently also acquired a plaster "surmontage". 

The original plaster had long been considered lost but this too has recently re-surfaced.  It was first recorded at the Galerie d'Arenberg in Brussels in 1985-86 and is illustrated in Philippe Bordes's 2007 exhibition catalogue, where it is given as "in private hands".  The work is signed and dated 1826.

In addition, there is the beautiful little terracotta maquette, purchased by the High Museum of Art Atlanta in 2013 (in c.2008 with the London dealers Tomasso Brothers.)

Various possibilities have been put forward for Rude's original model:

1. Jules David records that Rude created a mould of David's hand, which was still in his possession at in 1852.  Perhaps he also made a death mask at this time, though, if so, this is not recorded.
2. There is some suggestion Rude may have created studies for the portrait medal of David cast by Galle on the initiative of Antoine Gros in 1820.  Again the documentation is uncertain.  However, the full face and hairstyle of the bust is very similar to the profile on the medal. 
3. In 1930 Paul Saintenoy speculated that a first plaster bust, in antique drapery, had been made in David's lifetime but rejected by the master due to the frank depiction of his tumour. The subsequent sculptures attenuated the deformity. 
Saintenoy, "Le buste disparu de Louis David par François Rude", Bruxelles : Académie royale des Sciences, des Lettres et des Beaux-Arts, 1930. - ill. [Not available on the internet]
We now have the "lost" bust, dated to 1826, so this hypothesis is disproved.

All the versions of Rude's bust  - importantly including the 1826 plaster and the terracotta maquette - all show a similar degree of facial deformity.  There is a definite rounded growth, more prominent than in the portraits by Navel and Langlois, though by no means overwhelmingly disfiguring.  

Bordes Jacques-Louis David (2007) fig. 110:
Rude, Bust of David in antique dress, 1826
Plaster. 80.5cm. Private collection. 


Nicolas Alpach, "Oeuvres méconnues du Louvre: les portraits sculptés de David" PointCulture, 23.10.2014.
Philippe Bordes, Jacques-Louis David: Empire to exile (2007), No.57, p.334-6: "Portrait of Jacques-Louis David by François Rude (1784–1855)"
Louis de Fourcaud, François Rude, sculpteur: ses oeuvres et son temps (1784-1855), 1904, p.449: "Buste de Louis David" 


The evidence is difficult to interpret: No description of David is simply a description, no portrait simply a portrait.  David sought to conceal or diminish the blemish in approved images; conversely, the pictures and comments of his enemies are coloured by malice and probably exaggerate his deformity.

The conclusions of the medical experts remain speculative:

1. Dr Ashrafian argues that the sword injury damaged to David's facial nerve. This is possible, but  the visual evidence and descriptions concentrate on the tumour itself.

2. There is no secure means to diagnose the tumour.  Prima facie it seems unlikely  that it was unrelated to the sword wound as Wine and Baum contend.  David's family certainly thought it resulted from a "poorly tended" injury.  

6. I t is also difficult to decide how large or debilitating the tumour really was. According to Jules David it continued to grow throughout David's life - though it must have done so quite slowly.  We may surmise that  Rude's posthumous bust shows its full extent but, even this is uncertain.  Presumably it was concealed to some extent within the cheek cavity and was more obtrusive when David tried to eat or speak. 

2. Did David really develop a facial paralysis later in life? According to Wine and Baum, the onset of a palsy, signalling the development of parotid cancer, occurred "after twenty years".  This chronology is vague - when did the adenoma appear in the first place? There is no evidence for a sudden deterioration; nor am I convinced that the portraits really show David's "transition from handsome middle age to a deformed old man".  

3. It cannot be proven that David died from occluded airways; admittedly he suffered bouts of breathlessness, but the autopsy noted only an enlarged heart.  If parotid cancer killed him, it took a long time to do so since he lived to be 77 years old..

To end this post, here is a short video from High Museum, with some good shots of the Rude maquette and some suitably non-committal comments on David's condition:

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