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The “Delivery”of Adam: A Medical
Interpretation of Michelangelo
Stefano Di Bella, MD; Fabrizio Taglietti, MD; Andrea Iacobuzio, DVM;
Emma Johnson, MBBS; Andrea Baiocchini, MD; and Nicola Petrosillo, MD
Abstract
This article describes what we believe to be the key to interpreting the concept represented by Michel-
angelo’s painting the Creation of Adam. This fresco, one of his most famous masterpieces, is situated in the
heart of the Sistine Chapel and is viewed by millions of people every year. A man of many talents,
Michelangelo’s proficiency in anatomical dissection is reflected in his artwork. As such, analyses of hidden
meanings in this fresco have been ascribed, including the concept of the “Brain-God.”However, we see a
postpartum uterus and adjacent anatomy, justifying our interpretation that Michelangelo was depicting
something far more fundamental: the birth of mankind.
ª2015 Mayo Foundation for Medical Education and Research nMayo Clin Proc. 2015;90(4):505-508
Michelangelo di Lodovico Buonarroti
Simoni, commonly known as Michel-
angelo, was an Italian sculptor, painter,
architect, poet, and engineer of the High Renais-
sance. He was born on March 6, 1475. He died
in 1564 at the age of 88 years.
Michelangelo is widely considered an inimi-
table genius of the 16th century, and his world-
renowned masterpiece painted onto the ceiling
of the Sistine Chapel attracts millions of visitors
a year to the Vatican. This extraordinary creation
was commissioned by Pope Julius II and took
Michelangelo 4 years to complete (1508-1512).
However, despite being one of his most famous
pieces, Michelangelo initially refused to accept
this invitation because he considered himself
an inadequate painter for such a vast and com-
plex work: “Michelangelo., believing the vault-
ing of that chapel to be a great and difficult
labour, and considering his own want of practice
in colours, sought by every means to shake such
a burden from his shoulders, and proposed Raf-
faello for the work. But the more he refused, the
greater grew the desire of the Pope, who was
headstrong in his undertakings.”
1, p28
Interpretation of a historical work is chal-
lenging because contemporary context is diffi-
cult to reproduce, and we believe that this
fresco is no exception. The “heart”of the
Sistine Chapel reveals the Creation of Adam,
one of the best-known and most reproduced
works in the history of art. The depiction of
the Hand of God giving life to Adam is thought
to be purposefully central, representing the pri-
mum movens: the creation of the human being.
Initially commissioned to depict the Apostles,
Michelangelo negotiated more freedom and
went on to illustrate a plethora of biblical scenes.
How far he extended such freedom is fervently
debated, and armed with the knowledge of
Michelangelo’s enduring interest in anatomy
and the human body, many medically orientated,
adjunctive interpretations of these scenes exist.
2
Justifiedherein,weseeGodsituatedinapost-
partum uterus while Adam lies on a woman’s
torso. For years, varying medical interpretations
of the imagery depicting the Creation of Adam
have been proposed. For example, nephrologists
can detail the sections that resemble kidneys, and
historical evidence of Michelangelo’sstruggle
with renal stones only adds to this curiosity and
wonderment.
3,4
The most common interpretation, however,
is the concept of the “Brain-God,”which is
based on the similarity of the shape painted
behind the figure of God with that of a human
brain.
5,6
However, in our opinion, this inter-
pretation does not marry with the painting
title, and the proposed significance remains
to be fully explicated.
Other suggestions have been made, and in
1955, Adrian Stokes, a prolific art historian,
wrote: “.on the Sistine ceiling the anomaly
of the issue of Eve from Adam’s side, beckoned
forth by the Almighty midwife, dissolves; and
we realize with awe that the keen, the sublime,
From the 2nd Infectious
Diseases Division,
National Institute for
Infectious Diseases,
“Lazzaro Spallanzani,”
Rome, Italy (S.D.B., F.T.,
A.B., N.P.); freelance
anatomical painter, Mug-
giò, Italy (A.I.); and
Department of Molecular
Biology and Biotech-
nology, University of
Sheffield, Sheffield, United
Kingdom (E.J.).
Mayo Clin Proc. nApril 2015;90(4):505-508 nhttp://dx.doi.org/10.1016/j.mayocp.2015.02.007
www.mayoclinicproceedings.org nª2015 Mayo Foundation for Medical Education and Research 505
SPECIAL ARTICLE
God the Father of the Creation of Adam con-
trols about him an uterine mantle filled with
attendants who clamber close, souls yet to be
born, attributes as yet of his own essence.”
7, p89
This obstetric-themed context was unique,
but more recently, a group of Italian scientists
proposed a congruous obstetrical interpreta-
tion of the painting.
8
We support their conjec-
ture about the true significance of the painting
but seek to further the theory by offering addi-
tional pieces to such a captivating puzzle.
We believe that in such a great artist’spaint-
ing, nothing is casual: everything has its specific
place and explanation. From this premise and
with the help of anatomical drawings, we expose,
step by step, what we believe is the real interpre-
tation of this inspired centerpiece (Figure 1).
1. The first clue to understanding the central sec-
tion of the fresco is the small oval shape in the
right upper part of the painting (burgundy ar-
row). In fact, it appears to be like the stalk of
an apple (the apple would be the large dark
red oval [brown arrow]). Looking with an
anatomist’s eye, one can recognize the small
oval as a section or cut of a hollow pipe (eg,
a large artery). However, we see this hollow
organ as the fallopian tube.
2. The color and shape of the large oval
(brown arrow) could resemble that of a
heart chamber or a cloak. However, look-
ing at it carefully, one can perceive that
even this is a hollow organ. The large
oval is the uterus, but not one under
normal physiologic conditions; rather, it
is a postpartum uterus.
3. The folds of the large oval (yellow arrows),
resembling those of a cloak, are the folds of
the mucosa of the uterus in the postpartum
period. The mucosa of the uterus in normal
physiologic conditions has no folds. These
folds are apparent only after delivery due to
the subsequent retraction of the uterine mus-
cle. Furthermore, the dark red color of the in-
ner aspect of the large oval is typical of the
endometrium after birth.
4. In the lower part of the large oval there is a
ruche (blue arrow), resembling the fold of a
fabric. This fold appears to bend toward the
inner part of the large oval. This is the uter-
ine cervix.
5. Under the small oval there is an unrecogniz-
able stain (purple arrow). This red spot ap-
pears like a “fish out of water,”perhaps
looking like a doodle or an attempt to retouch
something that was not understood during
the several restorations of the Sistine Chapel.
FIGURE 1. The Creation of Adam (Sistine Chapel).
FIGURE 2. Drawings: female body and uterus.
MAYO CLINIC PROCEEDINGS
506 Mayo Clin Proc. nApril 2015;90(4):505-508 nhttp://dx.doi.org/10.1016/j.mayocp.2015.02.007
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It took time and thought for us to understand
what this spot represents. Its position under
the tube and its shape make it clear that it is
the ovary. It is likely that the original painting
had more shades in the image but that these
were lost with the restoration because the re-
storers were not aware of what that stain
represented.
6. Adam seems to be resting on what looks like a
rock. In ancient times, the rock also had the
meaning of a generating mother (eg, many di-
vinities, such as Mithra, are born from a rock).
However, behind the rock there is a back-
ground of different color (blue) that does
not seem connected to the rock. Looking care-
fully one can see a female body outline, with
thenipplejustaboveAdam’s head (orange
arrow).
7. With reference to the female form, the po-
sition of the uterus lies directly above what
would be the lower abdomen of the female,
as if projecting the uterus to its correct
anatomical place.
To emphasize our imagery, we present single
andoverlaiddrawingsinFigures 2,3,and4,
courtesy of the anatomical painter Andrea Iaco-
buzio. It is, of course, no secret that our minds
are powerful and may naturally associate even
unrelated images, yet the incredible similarities
between the painting and the anatomical details
are striking.
Michelangelo, and, indeed, his talented
contemporary Leonardo da Vinci, had early ex-
periences in anatomical dissection. Dissection
was previously forbidden by the Church, but in
the late 15th century, Pope Sixtus IV granted
permission for educational purposes. While Leo-
nardo da Vinci studied corpses at the Hospital of
Santa Maria Nuova, Michelangelo, who was 23
years younger, practiced anatomy on the corpses
in Santo Spirito, thanks to a friendship with the
church prior.
9
In the pre-antibiotic era, peripar-
tum or postpartum sepsis leading to death was
common. Although accurate records of mortality
secondary to childbirth are not available before
the 19th century, 5 to 6 maternal deaths per
1000 births is no doubt a conservative estimate.
10
Compared with the medical students of
today, therefore, Michelangelo had plentiful
opportunity to examine such pathology. Gior-
gio Vasari, a historian of that time, writes about
Michelangelo’s experiences:
“Moreover, in order to be entirely perfect,
innumerable times he made anatomical studies,
dissecting men’s bodies in order to see the prin-
ciples of their construction and the concatena-
tion of the bones, muscles, veins, and nerves,
the various movements and all the postures of
the human body; and not of men only, but
also of animals, and particularly of horses,
which last he much delighted to keep. Of all
these he desired to learn the principles and
laws in so far as touched his art, and this knowl-
edge he so demonstrated in the works that fell
to him to handle, that those who attend to no
other study than this do not know more.”
1, p104
CONCLUSION
The Sistine Chapel is arguably the most visited
room in the world. With mass global tourism
growing every year, some 5 million people, and
up to 20,000 per day in summer, enter the
Chapel and crane their necks upward. So one
may wonder: Why, despite millions of people
having looked at the painting, has this imagery
not been “seen”before? The inspirational artists
of the Renaissance embraced a 360culture, yet
art academics and historians have little medical
or anatomical knowledge and perhaps may inter-
pret the paintings according to their own view-
points. Indeed, even an expert pathologist
might not immediately identify the uterus owing
to its unusual quasi-sagittal section and the
FIGURE 3. Overlapping images: female body.
FIGURE 4. Overlapping images: uterus.
HIDDEN UTERUS IN THE SISTINE CHAPEL
Mayo Clin Proc. nApril 2015;90(4):505-508 nhttp://dx.doi.org/10.1016/j.mayocp.2015.02.007
www.mayoclinicproceedings.org 507
particular paraphysiologic situation, that is, the
postpartum condition. Usually, anatomists and
medics alike study only the normal or the patho-
logic uterus in standard sections. Crucially, how-
ever, irrespective of the origin of the various
interpretations, it is paramount that we purpose-
fully adopt the attitude of the Renaissance period,
a time when those most interested in human
anatomy were, of course, the artists.
We believe that our interpretation con-
siders clues that have been overlooked in other
studies. Scrutinizing this important piece from
an alternative perspective, pursuing the mind-
set of man living through the Renaissance,
allows us to present this view. The “rebirth”
of our contemplations permits a logical and
plausible explanation for this remarkable pièce
de résistance.
ACKNOWLEDGMENTS
In memory of Prof Andrea Tranquilli. We also
thank Prof Monica Emanuelli for her kind help
in reviewing the manuscript.
Correspondence: Address to Stefano Di Bella, MD, 2nd
Infectious Diseases Division, National Institute for Infectious
Diseases, “Lazzaro Spallanzani,”Via Portuense 292, 00149,
Rome, Italy (stefano932@gmail.com).
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