Hektoen International

A Journal of Medical Humanities

Quentin Massys – The Ugly Duchess

The Ugly Duchess, c. 1513
Quentin Massys
Oil on oak
62.4 x 45.5 cm

Flemish artist Quentin Massys (1465–1523) was born in Louvain and worked in Antwerp, where he painted many exquisite works of art. In 1513, he painted the portrait of An Old Woman, popularly known as The Ugly Duchess. Perhaps the best known of his works, it may be a portrait of Margaret, countess of Tyrol and princess of Carinthia. Also known as Margarete Maultasche (pouch-mouth), she has been called the ugliest woman in history. Carlyle described her as a terrible dragon, wanting in female charms, but having immense possessions that after her abdication in 1363 were handed over to the Habsburg family. As she lived some 150 years before Massys, he would have had to paint her from imagination or surviving records.

Recently Michael Baum, emeritus professor of surgery and visiting professor of medical humanities at University College London, and his student Christopher Cook studied the painting and proposed that the sitting woman had an advanced form of Paget’s bone disease (osteitis deformans). Paget’s disease is a chronic condition characterized by the enlargement and distortion of bone. In bones affected by Paget’s disease, their form is abnormal, making them brittle and prone to fracture. The National Gallery in London, which owns the painting, accepted their conclusion.

Baum and Cook deduced that the woman’s dominant forehead and prominent orbital ridge make the eyes appear deep-set, and the image shows a disproportionate distance between the nose and upper lip, suggesting enlarged maxillary arches common with the disease. The strange furled and puckered lips also suggest tooth loss, which is often an indirect result of Paget’s disease of the jaw. Mr. Baum also believes the sitter would have been a very powerful woman and may even have been a real duchess.


  1. Cook, Christopher. 2009. “Diagnosis in Painting.” Student BMJ 17:b497. doi: 10.1136/sbmj.b497. http://student.bmj.com/student/view-article.html?id=sbmj.b497.
  2. Sawer, Patrick. 2008. “Art Mystery Solved: The Ugly Duchess had Paget’s Disease.” The Telegraph, October 11. http://www.telegraph.co.uk/culture/art/3561937/Art-mystery-solved-The-Ugly-Duchess-had-Pagets-disease.html.
  3. The National Gallery. 2012. “An Old Woman (The Ugly Duchess).” The National Gallery. Accessed February 7. http://www.nationalgallery.org.uk/paintings/quinten-massys-an-old-woman-the-ugly-duchess.

GEORGE DUNEA, MD, Editor-in-Chief

Highlighted in Frontispiece Winter 2013 – Volume 5, Issue 1, and Spring 2012 – Volume 4, Issue 2

Spring 2012



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