Hektoen International

A Journal of Medical Humanities

Hadrian and Frank’s sign

Vittoria Sabatini
Florence, Italy


Bust of Hadrian with view of creased ear. Capitoline Museums. Via Wikimedia. Public domain.

It is difficult to remain an emperor in the presence of a physician, and difficult even to keep ones essential quality as man. The professional eye saw in me only a mass of humors, a sorry mixture of blood and lymph. This morning it occurred to me for the first time that my body, my faithful companion and friend, truer and better known to me than my own soul, may be after all only a sly beast who will end by devouring his master.1


These words are quoted in Marguerite Yourcenar’s masterpiece Memoirs of Hadrian as supposed to have been part of a poem written by the emperor Hadrian himself in the last moments before his death. Hadrian reportedly suffered from hypertension, nosebleeds, anemia, asthenia, and dropsy. He would ask his servants to bring him mountain snow to stop his frequent nosebleeds, and often asked those around him, including his physician Hermogenes, to help him end his life. At last, after abandoning his scrupulous dietary regime, he went to Baia, near Naples, where he died, as narrated by Dione Cassio in his Historia Augusta.

Dione Cassio, writing about eighty years after the death of the emperor in 138 CE, reported in his Historia Augusta2 that Hadrian’s disease started to worsen around 136 CE, when he was sixty. His condition was marked by frequent nosebleeds and by the aggravation of a temper always characterized by impatience and ambition, with occasional outbursts of anger.

In ancient times, making a diagnosis was difficult. Medicine was mainly based on theories, such as the humoral theory, which ascribed disease to an imbalance of the four humors of blood, phlegm, yellow bile, and black bile. But an important clue may exist in artistic representations of Emperor Hadrian. A diagonal earlobe crease was first noticed by Max Wegner in 1956 and is shown in each original statue of the emperor. This includes a bust of Hadrian in the Uffizi Gallery in Florence that dates to around 117 CE. Because this earlobe crease is not a conventional feature of early Roman works, it is assumed to be a physical feature specific to Hadrian himself.

This crease, also known as Frank’s sign, has been linked to an increased risk of cardiovascular disease. Named after Dr. Sanders T. Frank, an American pulmonologist, the bilateral or unilateral creases extend at an angle of forty-five degree across the earlobe. It is thought to be caused by a loss of collagen and elastin fibers, affecting both auricular and coronary blood vessels.

Frank described this connection in 1973 in the .4,5 He noted the earlobe crease in a group of twenty patients affected by angina pectoris and suggested that it might be a diagnostic clue for coronary artery disease. 6 4 Moreover, there seems to be a genetic predisposition to Frank’s sign, which may explain why it is also present in statues of Hadrian’s second cousin, who probably died of a stroke.7

The presence of Frank’s sign in artistic representations of Emperor Hadrian gives us more information on the probable cause of his condition, and coincides with the symptoms described in ancient sources.



  1. Yourcenar, M. Memoirs of Hadrian. New York: Farrar, Straus & Giroux; 2005.
  2. Dione, LC. Historia Augusta.
  3. Galassi, FM, et al. “Paleopathology of the earlobe crease (Frank’s sign): New insights from Renaissance art.” Int J Cardiol 2017;236:82-84. doi: 10.1016/j.ijcard.2017.02.128.
  4. Conti AA, Lippi D, Gian Franco Gresini GF. “Per una malattia complessa.”
  5. Frank, ST. “Aural sign of coronary artery disease.” New England Journal of Medicine 1973;289(6):327-8. doi:10.1056/nejm197308092890622.
  6. Kaukola, S. “The diagonal ear-lobe crease, a physical sign associated with coronary heart disease.” Acta Medica Scandinavica Supplemental 1978;619:1-49.
  7. Herrero-San Martin A, Villarejo-Galend A. “La decision de Trajano: un punto de vista neurologico.” Revista de Neurologia 2020;70(7):264. doi:10.33588/rn.7007.2019510.
  8. Petrakis, NL. “Diagonal earlobe creases, type A behavior and the death of Emperor Hadrian.” West J Med 1980;132(1):87-91.



VITTORIA SABATINI is a first-year medical student at the university of Florence, Italy, pursuing a globe-spanning medical career. She is currently fascinated by the worlds of cardiology and pulmonology, but she awaits what medicine will make her discover.


Submitted for the 2022–23 Medical Student Essay Contest

Winter 2023  |  Sections  |  History Essays

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