Abstract
Judith was a legendary Hebrew heroine who beheaded the general Holofernes and saved the children of Israel from destruction by the Assyrian army. In the Book of Judith, which is still present in the Catholic and Orthodox Christian Bibles, Judith is presented as an illustrious woman who defeated the enemy using her virtue and fortitude. The present investigation has revealed 24 portraits in which Judith has been depicted with variable grades of thyroid gland enlargement on the scene where she decapitates Holofernes. There is no doubt that the integration of a slight thyroid enlargement in the paintings is a stylistic hallmark that portrays an idealized female beauty with a balanced neck and graceful body. The large extended goiter was probably depicted by the artists as a symbol of a powerful masculine body and her courage, and at the same time, it probably also reflects better anatomic accuracy and knowledge of artists from that period.
Keywords: Goiter, Judith, medical diagnosis, neck swollen, painting
INTRODUCTION
The Book of Judith is a deuterocanonical book of the Septuagint and Catholic and Eastern Orthodox Christian Old Testament of the Bible. It narrates the story of the beautiful Jewish widow Judith who saved her City of Bethulia from the siege of Holofernes, a general of the Assyrian King Nebuchadnezzar. According to the story in the manuscript, after a banquet at which the general had been drinking, the heroine entered Holofernes’ tent and then seduced and killed him. She beheaded him and presented his head to his fellow citizens (Judith 10:13).
Many artists have immortalized the scene of the decapitation, with the heroin holding the sword on the neck of Holofernes whilst lying on the bed, and the scene with Judith carrying the head of the general as a trophy beside his headless body, often assisted by her maidservant.
A systematic reappraisal of the works representing the bloody scene of Judith and Holofernes has revealed 24 portraits in which Judith is depicted with variable degrees of thyroid gland enlargement. However, there are no spectroscopic or radiographic images available or any written documents attesting the intention of the painters. Therefore, the presence of the goiter can only be judged by an inspection of the portraits. The present investigation explores the accuracy of the findings and the underlying iconographical significance.
THE PAINTINGS
Twenty-four portraits constitute the subject of this review, with particular focus on the neck of the models. The works representing the story of Judith and Holofernes were depicted by 21 painters of various nationalities belonging to the Renaissance, mannerist, baroque, and later artistic movements and were included in the present investigation. For the purpose of illustration, the 24 depictions of Judith in which the goiter is visible are combined as panels [Figures 1–4].
Figure 1.

(a) Judith with the head of Holofernes (c. 1575), by Jan Massys, oil on panel, 115 cm × 80.5 cm, (from the Royal Museum of Fine Arts, Antwerp, Belgium) (b) Judith with the head of Holofernes (c. 1550-75), by Vincent Sellaer, oil on panel, 60.5 cm × 44.4 cm, (from the Davis Museum and Cultural Center, Wellesley, Massachusetts, USA) (c) Judith and Holofernes (1540), by Jan Sanders van Hemessen, oil on panel, 99.1 cm × 77.2 cm, (from the Art Institute, Chicago, Illinois, USA) (d) Judith with the head of Holofernes (c. 1540-50), by Girolamo da Carpi (Girolamo Sellari), oil on panel, (from the Alte Pinakothek, Munich, Germany) (e) Judith (c. 1548-51), by Lambert Sustris, oil on canvas, 95 cm × 113 cm, (from the Palais des Beaux-Arts de Lille, France) (f) Judith with the head of Holofernes (c. 1562), by Lorenzo Sabatini, oil on canvas, 110 cm × 85 cm, (from the Banca del Monte di Bologna e Ravenna, Bologna, Italy)
Figure 4.

(a) Judith and her maidservant with the Head of Holofernes (c. 1710), by Giovanni Antonio Pellegrini, oil on canvas, 124.7 cm × 102 cm, (from the Barber Institute of Fine Arts, University of Birmingham, Birmingham, England, UK) (b) Judith with the head of Holofernes (c. 1730), by Giuseppe Marchesi, oil on canvas, 149 cm × 116.5 cm, (from the Pinacoteca Nazionale, Bologna, Italy) (c) Judith and Holofernes (c. 1730), by Giulia Lama, oil on canvas, 107 cm × 155 cm, (from the Gallerie dell’Accademia, Venice, Italy) (d) Judith and her Maidservant with the Head of Holofernes (unknown), by Venetian school, oil on canvas, (unknown location) (e) Judith with the Head of Holofernes (1695), by Giovanni Gioseffo dal Sole, oil on canvas, 109 cm × 90 cm, (from the Minneapolis Institute of Arts, Minnesota, USA) (f) Judith (c. 1840), by August Riedel, oil on canvas, 131 cm × 96 cm, (from the Neue Pinakothek, Munich, Germany)
DISCUSSION
Female subjects affected by gland enlargement are widespread in many artworks.[1,2,3,4,5] Goiter was depicted very frequently in works from countries in which iodine deficiency was endemic, and it was only sparsely portrayed by painters living in areas where goiter was not common.[1,2,3] The present investigation aimed to shed further light on the presence of goiter in the works of painters from different regions depicting the beheading of Holophernes by Judith.
It seems unrealistic that the artists inadvertently depicted the goiter unaware of the underlying pathological condition because of their high reputation. However, there may be many other reasons as to why these painters included thyroid enlargement in their depiction of the subjects.[1,2,3,4,5,6,7]
From the Renaissance era onward, painters have been in pursuit of life-like portraits, which led them to study the exact anatomy of the human body. This explains why goiter was realistically depicted from the Renaissance era onward.[6] Indeed, because the neck is one of the visible areas of the body, it became an important focus of attention as well as a decorative element, almost as important as the face.
It is difficult to explain the inclusion of goiter in many portraits of Judith based on the geographic origin of the models, the artists being from various areas, not all with iodine-deficiency. It seems restrictive to suppose that the integration of the goiter was only part of the Renaissance tendency toward a more realistic and precise representation of the subjects or that it was a peculiar hallmark of a precise artistic movement. Indeed, several painters across centuries included in this investigation belong to different artistic waves.
There is no reason why the painters should have used models affected by a swelling of the neck linked to autoimmune postpartum thyroiditis or familial thyroid dyshormonogenesis to immortalize the scene of Judith.[1,2,3,4,7] Moreover, the hypothesis that the goitrous gland was portrayed to arouse pity or revulsion, to mock the represented subject, to present an biographical self-portrait feature, or to indicate a lower social status is not likely in the thematic depictions of Judith.[1,3,7]
An analysis of the evolution of the figures of Judith in the history of art may be useful for our purpose. Indeed, in the early Christian era, Judith was depicted as a cast woman considerably far from being sexual or violent. It is from the Renaissance era onward that the figure of Judith took on an interestingly different meaning for many artists and scholars, and painters began to portray Judith with a sexualized femininity, sometimes contradictorily combined with masculine aggression. During the Baroque period, Judith became a widespread subject of almost all the painters, and her character was portrayed as more overbearing and violent and idealized as a “threatening character to the artist and viewer.” Judith's legend was used as a warning against the captivating dangers of beauty. She became an icon of female power after the Renaissance, and although she was a legendary figure, she was mentioned in 1639 as one of the virtuous women in the masterwork of van Beverwijck about the superiority of women to men.[8] Judith is described as “exceedingly beautiful” in the Old Testament (Judith 8:7), and it is mentioned that “the Lord increased her beauty, so that she appeared to all men's eyes incomparably lovely” (Judith 10:4).[9]
There is no doubt that the inclusion of goiter in the paintings herein is a stylistic representation. Indeed, apart from the almost accurate documentation of goiter by the artists, the sitters in our investigation failed to show further signs or symptoms related to hyperthyroidism or hypothyroidism. Hence, we have two theories with regard to the integration of goiter. The Figures 1a–2c and f, 3d and f, 4b–f show a low-to moderate-grade swelling of the neck without any other physical signs of thyroid disease. The painters may have depicted a slight enlargement of the neck as a stylistic hallmark and may have filled out her neck as an erotic attribute.[10] They may have done this with the purpose of creating an idealized beauty with a more attractive neck. It is also possible that some of the artists were fascinated by strange physiognomies. In Figures 2d and e, 3a–c and e, 4a, a large extended goiter is presented, which may have been symbolic of a more masculine and stronger beauty rather than a delicate and graceful beauty.[5,9] It would be difficult to say whether the artists intentionally added a large goiter to highlight aggressiveness and irritability, because a simple inspection did not reveal any sign of Graves’ disease. On the contrary, the swelling in the eye pouch with slight periorbital and submandibular edema seen in Figures 1e and f, 2d, 3b and c, 4c and e may be a forced interpretation of hypothyroidism. This seems to contradict the intended symbolic representation of Judith. It is likely that we perceive as overweight at the present time what the artists used to perceive as beauty at that time.
Figure 2.

(a) Judith and her maidservant with the head of Holofernes (c. 1520-30), by Guido Reni, oil on canvas, 234 cm × 150.3 cm, (from Galleria Spada, Rome, Italy) (b) Judith and Holofernes (a copy from original of Guido Reni) (1625), by Carlo Maratta, oil on canvas, 110 cm × 85 cm, (from the Musei Capitolini, Rome, Italy) (c) Judith and Holofernes (c. 1610-40), by Sigismondo Coccapani, oil on canvas, 99 cm × 76.2 cm, (from private collection) (d) Judith with the head of Holofernes (c. 1605-10), by Giuseppe Cesari aka Cavalier d’Arpino, oil on canvas, 48 cm × 61.3 cm, (from the Berkeley Art Museum, Ucla, Berkeley, California, USA) (e) Judith and Holofernes (c. 1600-20), by Antiveduto Grammatica, oil on canvas, 190 cm × 159 cm, (from the Derby Museum and Art Gallery, Derby, England, UK) (f) Judith with the head of Holofernes (c. 1610-15), by Carlo Saraceni, oil on canvas, 90 cm × 79 cm, (from the Kunsthistorisches Museum, Vienna, Austria)
Figure 3.

(a) Judith and her maidservant (1608-9), by Orazio Gentileschi, oil on canvas, 160 cm × 136 cm, (from the Nasjonalgalleriet, Oslo, Norway) (b) Judith and her maidservant (1610-12), by Orazio Gentileschi, oil on canvas, (unknown location) (c) Judith and her maidservant (1613-4), by Artemisia Gentileschi, oil on canvas, 114 cm × 93.5 cm, (from the Palazzo Pitti, Florence, Italy) (d) Judith and her Maidservant with the Head of Holofernes (c. 1623-5), by Artemisia Gentileschi, oil on canvas, 184 cm × 141.6 cm, (from the Detroit Institute of Arts, Detroit, Michigan, USA) (e) Judith slaying Holofernes (c. 1614-20), by Artemisia Gentileschi, Oil on canvas, 158.8 cm × 125.5 cm, (from the Museo Capodimonte, Naples, Italy) (f) Judith (1678), by Eglon van der Neer, oil on oak, 32 cm × 24.6 cm, (from The National Gallery, London, UK)
In all the paintings, the swollen neck, when combined with the rest of the body, perfectly reflect the qualities that the painters wanted Judith to embody from the Renaissance period – courage, (dangerous) female power, seduction, beauty and eroticism, physical strength, cunning, and intelligence.
CONCLUSION
Judith was a legendary Hebrew heroine who saved the Jewish people from the armies of the Assyrian general Holofernes. Her depiction changed from early Christianity to a recurrent model of civic virtue in the early Renaissance, which was often mixed contradictorily with sexual, feminist, and ironic (captivating danger of beauty) themes. Throughout this evolution, painters have used her story to highlight the dangerous power and style of women, reflecting the contemporary ambivalence toward the seductive wiles she used against Holofernes. They tried to represent her courage and determination in plotting and beheading a drunk and besotted general.
We cannot entirely reject the claim that the artists used a few affected models for Judith's portraits. Nonetheless, the inclusion of a slight thyroid enlargement may be most likely a stylistic hallmark that represents an idealized female beauty with balanced proportioning of the neck and a graceful quality to the body. The large extended goiter was probably depicted by the artists as a symbol of powerful masculine body and her courage, and at the same time, it probably also reflected the better anatomic accuracy and knowledge developed in that period.
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Conflicts of interest
There are no conflicts of interest.
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