Month: April 2013

The Lancet admits: You knew something, John Snow

Modern(ish)

One hundred years and one month to the day after the birth of John Snow, the first anesthesiologist in the UK, the man who identified that cholera was transmitted by the ingestion of water contaminated by feces and who performed the first modern epidemiological study to defeat that dread disease, the British medical journal The Lancet has finally published a correction to the paltry obituary they ran when he died far too soon at the age of 45 in 1858.

The Lancet wishes to correct, after an unduly prolonged period of reflection, an impression that it may have given in its obituary of Dr John Snow on June 26, 1858. The obituary briefly stated:

“Dr John Snow: This well-known physician died at noon, on the 16th instant, at his house in Sackville Street, from an attack of apoplexy. His researches on chloroform and other anaesthetics were appreciated by the profession.”

The journal accepts that some readers may wrongly have inferred that The Lancet failed to recognise Dr Snow’s remarkable achievements in the field of epidemiology and, in particular, his visionary work in deducing the mode of transmission of epidemic cholera. The Editor would also like to add that comments such as “In riding his hobby very hard, he has fallen down through a gully-hole and has never since been able to get out again” and “Has he any facts to show in proof? No!”, published in an Editorial on Dr Snow’s theories in 1855, were perhaps somewhat overly negative in tone.

:giggle: The modern Lancet appears to have a gift for understatement commensurate with the Victorian-era publication’s gift for hyperbolic metaphor.

The cause of this shameful oversight was Thomas Wakley, founder and editor of The Lancet and avid social reformer whose efforts to shut down noxious polluting factories John Snow had damaged by testifying before a Select Committee of Parliament that miasmic fumes from tanneries and soap factories were not the cause of cholera epidemics. That was the proximate cause of the 1855 editorial excoriating Snow’s gully-hole and it doubtless played a major role in the journal’s editorial decision to publish a weak, two-sentence death notice for a great medical innovator three years later.

Wakley and The Lancet had gone up against Snow on various medical issues from the beginning of Snow’s career when he made his bones as a newly minted member of the Royal College of Surgeons of England by writing letters to the editor rebutting published articles. His letters about the dangers of the use of arsenic as a preservative in cadavers and on the physics of respiration were his first published works. Wakley wasn’t a fan. He was an old school physician who believed in the superiority of the inductive method — accumulation of facts leading to a general conclusion — and found Snow’s rebuttals excessively reliant on his own clinical experience. In the issue of May 25th, 1839, he refused to publish one of Snow’s letters posting instead a rather brutal iceburn:

“The remarks of Mr. John Snow on a recent communication from M. H., on the physiology of respiration, have been received. We cannot help thinking that Mr. Snow might better employ himself in producing something, than to criticizing the productions of others.”

Burned or not, John Snow actually took Thomas Wakley’s advice. He stopped sending letters to the editor and focused on a specialty that would ultimately tie together all the areas that he became known for: respiration, mechanisms and pathologies thereof. That interest was reflected in his first paper, On Distortions of the Chest and Spine in Children, from Enlargement of the Abdomen, published in the London Medical Gazette in April, 1841, which analyses the effect of abdominal deformity on breathing.

Five years later, his interest in respiration led him to investigate the brand new field of anesthesia, which at its heart was a question of how to walk the fine line between pain prevention and the suppression of respiration. When ether first came to England from the United States in 1846, it had a bad reputation. Snow created a delivery system that was more reliable — described in detail in 1847’s On the Inhalation of the Vapour of Ether in Surgical Operations — and became England’s first specialized anesthesiologist.

On April 7th, 1853, Snow was called to Buckingham Palace by Sir James Clark, Queen Victoria’s physician of 19 years, to administer chloroform to the Queen during the delivery of her eighth child, Prince Leopold. Her gave her small doses through a dainty handkerchief every time she had a contraction, enough to provide pain relief but not to render the royal body unconscious. According to Snow’s case book, the Queen was “very cheerful” after the successful delivery and “express[ed] herself much gratified with the effect of the chloroform.”

The Queen’s imprimatur granted chloroform and Dr. Snow a whole new legitimacy in medical circles and in the wider society. The Lancet not only disapproved, but actually refused to believe it had even happened. In an unsigned editorial probably written by Wakely, the Lancet disparaged the “rumor” that the Queen had been given chloroform because it had “unquestionably caused instantaneous death in a considerable number of cases” of surgical anesthesia, and therefore it stood to reason that “the obstetric physicians to whose ability the safety of our illustrious Queen is confided do not sanction the use of chloroform in natural labour.” The editorial made no distinction between analgesic use and anesthetic use.

It wasn’t all bad between Snow and The Lancet. In 1846 he wrote a letter to the editor expressing dismay at The Lancet‘s use of the term “allopathy” in an article about homeopathy because it lent legitimacy to the practice. The letter was published and the editor agreed. Snow published 15 papers in The Lancet during his career, eight of them after the 1853 editorial, several of them about chloroform.

In 1849, Snow published his first paper on the cause of cholera. As an expert in respiration, he found the conventional wisdom that the disease was contracted by inhaling the miasmic vapours of decomposition unsatisfying. If the disease is conveyed by inhalation into the blood stream, then why are its symptoms centered in the alimentary system? Ten years before Pasteur and without realizing microscopic bacilli were to blame, Snow recognized that whatever caused cholera was some small, highly reproductive creature swallowed by its victims.

Having rejected effluvia and the poisoning of the blood in the first instance, and being led to the conclusion that the disease is communicated by something that acts directly on the alimentary canal, the excretions of the sick at once suggest themselves as containing some material which, being accidentally swallowed, might attach itself to the mucous membrane of the small intestines, and there multiply itself by the appropriation of surrounding matter, in virtue of molecular changes going on within it, or capable of going on, as soon as it is placed in congenial circumstances

He continued to research the disease for years after the initial publication. He hit the streets, mapping out the affected areas, noting sources of water, sewage, contaminants, population density, overall health of the residents, all the stuff that epidemiologists do today only he did it first. In 1854, a major outbreak of cholera devastated Soho. By interviewing the locals, Snow pinpointed the source as one specific water pump on Broad Street. He convinced authorities to remove the pump handle making it impossible to use. The outbreak ended.

The story of the Broad Street pump handle has become part of the Snow mythos, although he himself noted that the outbreak was already waning when the pump was disabled simply from people fleeing the area. Also, the council just returned the handle after the outbreak was over without doing anything about the cesspits that were contaminating the water being pumped. They were just covering all their bases. They didn’t particularly believe Snow’s theory and they preferred denial anyway because nobody likes to think they’re drinking their neighbors’ shit.

Snow’s research was pretty much dismissed by medical societies and journals too. Miasma theory held strong sway. Finally King Cholera pitted Snow and Wakley against each other in an arena where Wakley had been an intensely passionate advocate since he founded The Lancet in 1823: public health reform. Wakley was a dedicated activist, going up against the medical and political establishment in favor of the downtrodden again and again.

The 1855 Nuisances Removal and Diseases Prevention Act would have greatly reduced the fumes released by the many factories stinking up poor sections of London and other cities in England. Some of them would have had to close altogether. Wakley and many other medical professionals believed the putrid stenches belched by these establishments were sources of illness and epidemic diseases like cholera. The inhalation of effluvia from decomposing matter or diseased flesh, it was widely held, caused disease.

John Snow disagreed. His epidemiological research had shown that the highest concentration of cholera infection happened around water sources, not around glue factories no matter how many dead horses they had lying around. Here’s his testimony before the committee.

Q: “To what points would you desire to draw the attention of the Committee as regards the sanitary question?”
A: “I have paid a great deal of attention to epidemic diseases, more particularly to cholera, and in fact to the public health in general; and I have arrived at the conclusion with regard to what are called offensive trades, that many of them really do not assist in the propagation of epidemic diseases, and that in fact they are not injurious to the public health. I consider that if they were injurious to the public health they would be extremely so to the workmen engaged in those trades, and as far as I have been able to learn, that is not the case; and from the law of the diffusion of gases, it follows, that if they are not injurious to those actually upon the spot, where the trades are carried on, it is impossible they should be to persons further removed from the spot.”

Wakley responded with an eruption of editorial fury. The brief quote cited in The Lancet yesterday doesn’t begin to do it justice.

They have “scientific” evidence! They bring before the Committee a doctor and a barrister. They have formed an Association. They have a Secretary, a bone merchant, who has read the writings of Dr. Snow. Now, the theory of Dr. Snow tallies wonderfully with the views of the “Offensive Trades’ Association” — we beg pardon if that is not the right appellation — and so the Secretary puts himself in communication with Dr. Snow. And they could not possibly get a witness more to their purpose. Dr. Snow tells the Committee that the effluvia from bone-boiling are not in any way prejudicial to the health of the inhabitants of the district; that “ordinary decomposing matter will not produce disease in the ‘human subject.'” He is asked by Mr. Adderley (of the Committee), “Have you never known the blood poisoned by inhaling putrid matter?” (Snow’s response) “No; but by dissection-wounds the blood may be poisoned.” (Adderley asked) “Never by inhaling putrid gases?” (Snow responded) “No; gases produced by decomposition, when very concentrated, will produce sudden death; but when the person is not killed, if he recovers, he has no fever or illness.”

Dr. Snow next admits that gases from the decay of animal matter may produce vomiting but says this would not be injurious unless frequently repeated.

Is this scientific evidence? Is it consistent with itself? It is in accordance with the experience of men who have studied the question without being blinded by theories? […]

It will be very difficult to persuade us that the long-continued action of gases known to have such lethal powers, if concentrated, is not injurious to health, when in a state of dilution … and we presume that there is hardly a practitioner of experience and average powers of observation who does not daily observe the same thing. Why is it then, that Dr. Snow is singular in his opinion? Has he any fact to show in proof? No! But he has a theory, to the effect that animal matters are only injurious when swallowed! The lungs are proof against animal poisons; but the alimentary canal affords a ready inlet… The fact is that the well whence Dr. Snow draws all sanitary truth is the main sewer. His specus, or den, is a drain. In riding his hobby very hard, he has fallen down through a gully-hole and has never since been able to get out again. […]

In that dismal Acherontic stream is contained the one and only true cholera germ, and if you take care not to swallow that you are safe from harm. Smell it if you may, breathe it fearlessly, but don’t eat it.

The bill eventually passed, but the provisions against the “offensive trades” were significantly weakened. Although in 1856 The Lancet did publish two of Snow’s papers on how cholera is spread (The Mode of Propagation of Cholera and On the Supposed Influence of Offensive Trades on Mortality), Wakley’s rage against Snow still hadn’t dissipated sufficiently three years later to grant the man a proper obituary, something The Lancet did often for professionals of far less consequence who nobody remembers anymore.

Programming note

Ex Cathedra

The blog is on the move again. We’re switching to a new host with unlimited bandwidth because two bandwidth exceeded shutdowns in three months is more than I can tolerate. The data transfer will begin shortly. Any comments posted after the transfer has begun may be lost, so steel yourself.

Once the content has moved, DNS propagation might make the site unavailable for as long as 48 hours depending on where you are. In my experience, it has never taken anything close to that much time, but forewarned is forearmed and all that.

Whatever happens, don’t freak out. It’ll all be cool in the end. 😎

Digital imaging reveals history of moai carvings

Ancient, Modern(ish)

Researchers at the University of Southampton have used digital imaging to examine in greater detail the carvings on the back of Hoa Hakananai’a, an Easter Island statue in the British Museum. Eight feet high with the oversized head, prominent eyebrow ridge, long nose, longer ears and downturned mouth characteristic of the moai (meaning “statue” in the Rapa Nui language), this particular specimen some unusual features. Most of the moai — 834 out 887 — were carved out of tuff, a soft volcanic stone that is easily carved. This is one of only 13 that was made of hard basalt, a much more difficult material to carve, which suggests this statue was commissioned by someone of wealth and rank. Its body was once painted in red and white, but all the paint was lost during the long ocean voyage from Easter Island to England in 1868.

The back of the statue is covered in intricate ceremonial imagery connected to the birdman cult, a religion that grew on the island starting around 1400. Hoa Hakananai’a was made around 1000-1200 A.D., so those carvings were added hundreds of years later. By the 17th century with the culture under pressure from ecological disaster, the ascendance of the birdman seems to have come at the expense of the moai and the traditional ancestor worship that generated them. The monoliths began to be toppled. There were still some standing when Captain James Cook crew arrived in 1774 — a landscape painted by William Hodges, Cook’s artist, depicts several standing moai wearing their red stone hats — but only a few. The last report of upright statues came in 1838. When Hoa Hakananai’a was removed from Rapa Nui in 1868, there were none left standing.

In the transitional period between the moai and the birdman, at least some of the old statues were carved with symbolism from the upstart cult. The soft tuff statues were easily eroded, so little evidence remains on their bodies. The carvings on the basalt statues, therefore, are important sources of information about the profound cultural changes on Easter Island from the 15th century onward. Yet, they have not been thoroughly studied by archaeologists, not even Hoa Hakananai’a who has been sitting in the British Museum for 145 years.

Imaging technology can help bridge that knowledge gap. The University of Southampton researchers deployed photogrammetric modelling, wherein an object is photographed hundreds of times from different angles to create a composite digital model that can be viewed in 360 degrees, and reflectance transformation imaging which takes hundreds of high resolution pictures under different angled lights to illuminate details with light and shadow, a far more agile digital version of an analog archaeological practice done with flashlights and head tilts.

Using these techniques, Mike Pitts and the team made some fascinating discoveries, perhaps the most significant being the apparently simple recognition that a carved bird beak is short and round, not long and pointed as previously described: this allowed the two birdmen on the back to be marked as male and female, unlocking a narrative story to the whole composition relating to Easter Island’s unique birdman cult. They also realised that the statue is one of the few on Easter Island that did not stand on a platform beside the shore. It is now believed to have always stood in the ground, where it was found, on top of a 300 metre cliff.

Mike comments: “Study of the tapering base suggests that rather than being the result of thinning to make it fit into a pit, as often suggested, it is more likely part of the original boulder or outcrop from which it was carved. This may also explain why, as we now see it in the British Museum, it appears to lean slightly to the left – its uneven end resulted in its being incorrectly set into its 19th century plinth.”

There are several phases of carving on the back, separated by centuries. The carving around the waist of three bands is a maro, a symbolic loincloth which, along with the ring just above it, were part of the original design. Later, once it was half-buried in debris, four komari, inverted V shapes representing female genitalia, were carved from top to bottom on the back of the right ear.

Even later than that, the central story of the birdman — a male fledgling with an open beak reaching out of the nest while two birdmen with the head of a bird and human hands and feet stand watch on either side of him — was carved on the back. The human-bird hybrid on the right has a rounded beak, indicating femaleness. That suggests the two birdmen are actually the chick’s mom and dad. Underscoring the gendering of the birdmen, the female is on the side of the komari, while the male is flanked by a carving of a ceremonial dance paddle called an ‘ao, a symbol of male authority.

The digital imaging has also revealed a rounded shape near the bottom half of the female birdman which could be the egg the fledgling has just hatched from, and the remains of what may have been fingers around the statue’s navel that were later removed.

Creating digital models of such complex surfaces is a complex process. The project is ongoing, so the team hopes to reveal even more details as they continue to work on it.

First book printed in US could make $30 million

Modern(ish), Treasures

The Bay Psalm Book, the first book printed in British North America 136 years before it became the United States, is one of the rarest books in the world. There are only 11 copies known to have survived, and they are all held in libraries: the John Carter Brown Library, the Yale University Library, the Bodleian Library, the Library of Congress, the New York Public Library, the Henry E. Huntington Library, Harvard University Library, the American Antiquarian Society, the Rosenbach Library & Museum and two copies in the Boston Public Library which belong to Boston’s Old South Church. One of those copies, known as the Beta Copy because it’s slightly less pristine compared to the Alpha Copy, will be going on the auction block at Sotheby’s in November.

It’s been two generations since the last time one of these psalters was offered for sale. In January of 1947 it sold at auction for what was then a record $151,000 to rare book dealer Dr. Abraham Simon Wolf Rosenbach. Rosenbach had set the previous record for a book in the English language sold at public auction when he bought a First Folio of Shakespeare for $72,000 in 1933. He also held record for the most expensive book period bought at a public sale, a Gutenberg Bible he had purchased in 1926 for $106,000. This little six-by-five-inch hymnal of psalms blew them all away. Rosenbach turned out to be acting as an agent for a group of Yale alumni who in September of that year donated the Bay Psalm Book to the university library.

Old South Church has decided to part with one of their copies because it might make as much as $30 million, a princely sum that will allow it to remain solvent while fulfilling its Vision for the 21st Century (pdf), a mission statement that covers everything from building renovations to art programs to support for the poor. The church will still retain ownership of the Alpha Copy and that one is governed by a number of restrictions on sale so it’s not going anywhere.

In 1640, 20 years after the Pilgrims landed in Plymouth, the good folk of the Massachusetts Bay Colony decided the books of Psalms they had brought with them from England just wouldn’t do anymore. They thought the translations were too distant from the original Hebrew, and since the colony now had a printing press imported from London and operated by an indenture locksmith named Stephen Daye, they set about making their own psalter. A group of 30 “pious and learned” ministers, all literate in Greek, Latin and Hebrew, each translated a section of the Book of Psalms into English verse. John Eliot, Thomas Weld and Richard Mather (grandfather of the Cotton Mather of Salem Witch Trials fame) edited the volume.

The psalms were meant to be sung during services as hymns, but the quality of poetry was clearly not the ministers’ priority. Look, if you dare, at the broken and battered corpse of the 23rd Psalm:

The Lord to mee a shepheard is,
Want therefore shall not I.
Hee in the folds of the tender-grasse,
Doth cause mee downe to lie:
To waters calme me gently leads
Restore my soule doth hee:
He doth in paths of righteousness:
For his names sake leade mee.
Yea though in the valley of deaths shade
I walk, none ill I’le feare:
Because thou are with mee, thy rod,
And staffe my comfort are.
For mee a table thou hast spread,
In preference of my foes:
Thou dost annoynt my head with oyle.
My cup it over-flowes.
Goodness & mercy surely shall
All my dayes follow mee:
And in the Lords house I shall dwell
So long as dayes shall bee.

Yeah. I feel bad for any deity who had to listen to that for hours on end, week after week, while presiding over those interminable Puritan meetings.

After the ministers were done butchering the classics, 1700 copies of the book were published, enough so every family in the colony could have one. It was the third work published by the Stephen Daye press, but the first book. (The first piece printed was a broadside of the Oath of a Freeman, now lost, and the second an almanac in pamphlet form.) Despite its atrocious turns of phrase, the Bay Psalm Book remained popular for decades after that first print run, with multiple revised editions published during the 17th century.

In 1703, bibliophile and historian Reverend Thomas Prince, who was then still at Harvard University, began to build a “New England library,” a collection of every written work, manuscript or printed, pamphlet, paper or book, ever made in New England. Fifteen years later the good reverend was appointed pastor of the Old South Church and remained such until his death in 1758. During his five decades plus of collecting, Prince purchased no fewer than five copies of the Bay Psalm Book, a remarkably prescient choice considering that the books were still fairly widespread at that time.

In his will he bequeathed the entirety of his library to the Old South Church, stipulating that it remain together in perpetuity. That didn’t happen. For 46 years, half of his books were kept at the Massachusetts Historical Society. The collection was reunited at the Boston Public Library in 1866. Or rather, most of his collection was reunited, because somewhere in the penumbra of those decades, three of the five copies of the psalm book had mysteriously moved on.

By the mid-19th century, the Bay Psalm Book was exceptionally rare and certain collectors lusted after it with an unscrupulousness that would have made King David blush. Three private collectors — Edward A. Crowninshield, George Livermore and Nathaniel B. Shurtleff, 20th mayor of Boston — all educated men of wealth and position, had wheedled copies out of Old South Church deacons by offering deceptively dismal trades or simply by flattery. Shurtleff scored the best of the five: Richard Mather’s own personal copy bearing his autograph. Crowninshield secured the copy that would be auctioned in 1947.

Old South Church authorities didn’t cotton on to these shenanigans until 1875. They sued Shurtleff’s estate to get the Mather copy back, but it was too late. The statute of limitations had run out. That copy is now in the John Carter Brown Library at Brown University. Had the deacons not been such saps, Old South Church would be rolling in $30 million books.

Michelangelo’s Cleopatra: profane and profaner

Museums, Renaissance

There are only about a dozen of Michelangelo’s drawings in the United States, so the US exhibit of 26 important drawings from the extensive collection of the Casa Buonarroti, the museum established by his family in a house he once owned in Florence, is a not-to-be-missed event. Michelangelo: Sacred and Profane Masterpiece Drawings from the Casa Buonarroti is an exhibit of figural and architectural drawings by Michelangelo on subjects both religious (sacred) and worldly (profane). It debuted in February at the College of William & Mary’s Muscarelle Museum of Art in honor of the museum’s 30th anniversary and has now moved to the Museum of Fine Arts in Boston where it will run from April 21st until June 30th.

The theme is an exploration of Michelangelo’s personal philosophy, his attitude towards religious and secular matters, as reflected in his drawings. The sacred sphere is represented by his depictions of religious figures like his large scale Virgin and Child and in architectural designs for churches like the façade of San Lorenzo in Florence. His ground plan of the church of San Giovanni dei Fiorentini in Rome, which was too complex and expensive to ever make it out of the planning stage, is one of the largest drawings in the collection and has never been seen before in the United States. The profane architectural pieces are mainly designs for military fortifications, but much like his sacred pieces, the plans are so elaborate they would have been far too expensive and difficult for the conception to become reality.

The star of the profane figural drawings is Cleopatra. Although a worldly subject, on one page back and front, she incarnates both sides of the show’s theme. The recto or front depicts Cleopatra’s idealized calm in the moment when the serpent strikes her breast. It’s a Madonna-like expression of dignity and resignation. Her elegance and refinement have earned her distinction as one of Michelangelo’s most beautiful figures, but what’s on the back is not serene and not beautiful either, at least according to some beholders. The verso is a drawing of the same Cleopatra, only this one’s expression is sheer agony. The details are nowhere near as refined: she’s a grotesque with empty, wonky eyes and buckteeth. How these contrasting ladies came to find themselves on the front and back of a page is a question that has long intrigued art historians.

The Cleopatra on the recto is one of the rare complete, finished pieces Michelangelo drew. Most of his drawings were studies or sketches for projects that would later come to fruition in another medium. Art historian Johannes Wilde dubbed these finished pieces “presentation drawings,” because they were intended to be given as gifts. Rarely for a Michelangelo drawing, there’s a clearly documented ownership history for Cleopatra that confirms it was a gift from the master to a handsome young friend.

Some time during the 1530s, Michelangelo gave Cleopatra to Tommaso de’ Cavalieri, a Roman nobleman who met Michelangelo in 1532 when the artist was 57 and Cavalieri 23 years old. They became fast friends and remained so until Michelangelo’s death 32 years later. The question of whether Michelangelo’s feelings for his beautiful friend were more than platonic is an open one, but he did dedicate more poems to Cavalieri than to anyone else (see this one for an example; the female pronouns in the translation are not present in the Italian) and gave him at least six completed drawings (The Fall of Phaethon is the most elaborate).

In 1562, two years before Michelangelo’s death, Cavalieri was forced to give Cleopatra to Duke Cosimo I de’ Medici. He had little choice in the matter and made it known in his letter accompanying the “gift” that depriving himself of that drawing caused him as much pain as if he’d lost a son. Half a century later in 1614, Duke Cosimo II donated Cleopatra and several other drawings to Michelangelo Buonarroti the Younger for the gallery he was creating in the family home that would become the Casa Buonarotti museum.

According to an inventory of Medici artifacts, Cleopatra was hanging in a frame from the 1560s, which means the ugly Cleopatra was out of view at least as soon as it left Cavalieri’s possession. At some point, probably in the 19th century, a backing was glued to the drawing, a common curatorial technique at that time to preserve fragile paper works. You could still faintly see there was another drawing on the back if you lifted it to the light, so when the Uffizi gallery was restoring the piece in August of 1988 in preparation for a major show at Washington’s National Gallery, they decided to remove the backing to reveal what was there.

The discovery of the second, much more anguished Cleopatra made international news. Some experts believed it was also done by Michelangelo himself, others that it was clearly not in the master’s hand, others flip-flopped. But what if the ratchet Cleopatra came first and the more accomplished one later? What if in fact the rough, anguished figure is the recto and the finished one the verso? It wouldn’t be the first time Michelangelo turned over a page that had already been drawn on by a student. What if that student in this case were Tommaso de’ Cavalieri himself?

Cavalieri tried his hand by drawing the figure on the verso. Not yet a Cleopatra, the head may have been inspired by an antique sculpture that the two friends inspected together, such as the famous Sleeping Ariadne in the Belvedere Court of the Vatican. Or it may have been inspired by Giovanni Boccaccio’s Famous Women: is this Agrippina, the grieving wife of Germanicus, or the Carthaginian Queen Sofonisba just after draining the fateful cup of poison? However, Cavalieri’s halting effort fell short of its classical inspiration (the display of teeth had especially negative connotations). To demonstrate “buon disegno,” Michelangelo reversed the sheet and performed a miracle of artistic alchemy: ugliness became beauty, harrowing but unbecoming emotion became serene resignation, an indecorous head was transformed into a doomed Cleopatra. We are privileged witnesses of Michelangelo turning base matter into gold.

I like this theory. To my admittedly inexpert eye, the rough Cleopatra doesn’t look like any of Michelangelo’s figural studies which even at their most dashed off are composed and lovely.