Bmj Usa: Letter


BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E33

This article originally appeared in BMJ USA

Two e-letters posted on in response to the paper by Mimouni et al are reproduced below (after editing). Web links to some of Raphael's artwork referenced below are available in the original rapid responses at—Editor

More examples of polydactyly in Raphael's paintings

  1. Alfio Cantini, director (cantini{at}
  1. Department of Neurology, City Hospital, Prato, Italy
  2. Servicio de PediatrÍa, Hospital de Cabuenes, GijÓn, Spain

    This article originally appeared in BMJ USA

    Editor—The first work of Raphael known to us is a fresco representing the “Virgin with child” (Urbino, Italy, Raphael House). The right foot of the child unmistakably has six toes. I came across this detail about two years ago when viewing a poster of the painting in a waiting room in my hospital. The poster is still there, and I can't help looking at the child's digits whenever I step into the room. I had never thought, however, that it was anything more than an isolated curiosity.

    After reading the paper by Mimouni et al, I did a quick search on the Internet, and I found a fourth instance of polydactyly in a Raphael painting. It is the pope's right hand, which is pointing at the beholder in “La Madonna Sistina” (see figures at right), which is in the Gemaldegalerie in Dresden. How many additional cases might be discovered through a systematic survey?

    Mimouni et al suggest that polydactyly may have been present in the people who served as models for Raphael—perhaps relatives sharing the autosomal dominant trait. But this hypothesis becomes less tenable as the number of Raphael's subjects with polydactyly increases. The paintings come from the Urbinian, Florentine, and Roman periods of the artist. Therefore, Raphael would have been dependent on the same genetic pool of models providing at least four different subjects in three different towns and periods of the artist's life.

    Max Heindel (1865–1919), in his book Ancient and Modern Initiation (pp 65–66), interprets Raphael's portrayal of polydactyly as follows: “By the six fingers in the Pope's picture and the six toes of Joseph, Raphael wants to show us that both possessed a sixth sense such as is awakened by Initiation” (http://www.etext/. org/Religious.Texts/Rosicrucian/ami.txt).

    I've also found references to polydactyly in the Bible. In 2 Samuel 21:20 and in 1 Chronicles 20:6, there are references to “a man of great stature” with six fingers on each hand and six toes on each foot.* I'm not sure if these biblical citations are pertinent to the paintings of Raphael, but perhaps the depictions of hexadactyly in the Bible and in these paintings will be a source of pride to people with this anomaly.


    “La Madonna Sistina” (painted in 1483 or 1520). Does the extra finger point for emphasis?


    Detail of “La Madonna Sistina”

    1. J M Fernandez-Menendez,
    2. C Perez-Mendez (ihjmfmdj{at}
    1. Department of Neurology, City Hospital, Prato, Italy
    2. Servicio de PediatrÍa, Hospital de Cabuenes, GijÓn, Spain

      Editor—We were excited to read the paper by Mimouni et al pointing out the presence of postaxial polydactyly of type A in St Joseph in the painting “The Marriage of the Virgin” as well as in the infant John the Baptist in the painting “La Belle JardiniÈre,” both by Raphael. The authors hypothesize that the two people who served as models for Raphael were relatives, probably father and son.

      We would like to add further data to support this hypothesis, as we have identified more characters with polydactyly with varying degrees of expressivity in Raphael's work: in one of the children in “La Madonna del Passeggio” (Edinburgh, National Galleries of Scotland), in the infant in “La Madonna del Pez” (Madrid, Museo del Prado), and in the child in “Madonna in the Meadow” (Wien, Kunsthistorisches Museum). In addition, the figure of Christ in “The Transfiguration” (Roma, Pinacoteca Vaticana) shows bilateral postaxial polydactyly.

      Because postaxial polydactyly of type A is an autosomal dominant trait with variable expressivity, we believe that Raphael may have recruited the models for his paintings from among the members of the same family.


      • *** This “man of great stature,” according to the scripture, was the son of a “giant.” The name of this giant was Rapha (Dake's Annotated Reference Bible, 1971). Could there be a connection between the polydactyly in Rapha's son and the polydactyly in Raphael's paintings?—Editor