Lessons From Everywhere

Polydactyly reported by Raphael

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7276.1622 (Published 23 December 2000) Cite this as: BMJ 2000;321:1622
  1. Daniel Mimouni, Rabin Medical Center,
  2. Francis B Mimouni, Lis maternity hospital,
  3. Marc Mimouni, Schneider Children's Medical Center of Israel
  1. Petah Tiqva, Israel
  2. Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  3. Tel Aviv

We were surprised to count six toes on the left leg of St Joseph in Raphael's famous painting of “The Marriage of the Virgin” (Milan, Pinacoteca di Brera), painted in 1504 (below). This is probably not due to the carelessness of this painter, well known for his attention to detail; moreover, St Joseph is the only barefooted figure in the painting. One can easily detect a well formed extra digit (detail of fig 1) articulating with the fifth toe, corresponding to a postaxial polydactyly of type A. This is a relatively rare anomaly in white people, occurring in 1 in 630 to 1 in 3300 live births.1



“The Marriage of the Virgin.” Does St Joseph find shoes uncomfortable because of his polydactyly?

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Detail of “The Marriage of the Virgin”

Puzzled by this finding, we searched for and found another example in Raphael's work—in the infant John the Baptist gazing at the Christ child in “La belle Jardinière” (Paris, Musée National du Louvre) (above). Since postaxial polydactyly is an autosomal dominant trait, we may hypothesize that the two people who had served as models for Raphael were relatives, probably father (“St Joseph”) and son (“the infant”).

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“La belle Jardinière” (painted in 1507 or 1508). The infant John the Baptist (right) exhibits his sixth toe

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Detail of “La belle Jardinière”


We are deeply indebted to Mr Jean-Pierre Cuzin, Louvre museum, Paris, for his artistic advice.


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