Did the Pigeon Chested Man' have Marfan's syndrome?

Abstract

When the Bavarian artist Christian Schad (1894-1982) painted Agosta der Flugelmensch und Rascha die schwarze Taube in 1929, he formed part of the ‘Neue Sachlichkeit’ (New Objectivity). This was a German artistic movement which combined social criticism with near-photographic realism1, including the representation of the human body with exact reflections of malformations or disease. The title of this painting (Figure 1), which can currently be seen in the new Tate Modern gallery in London, has been incorrectly translated as ‘Agosta the pigeon-chested man and Rasha the black dove’, when the dominating feature is pectus excavatum rather than pectus carinatum (pigeon chest). More importantly, the translation takes no account of the model's main characteristic—a ‘man with wings’ (Flugelmensch). There might be more to this painting than a mere skeletal deformity. Figure 1 Agosta der Flugelmensch und Rascha die schwarze Taube, 1929 (Oil on panel, private collection) In the picture, both Agosta and his companion are looking out at the spectator with the serene expression of those used to public scrutiny. Our attention is immediately drawn to Agosta's deep pectus excavatum with outward deformities of the lower halves of the anterior rib cage. A long and thin thorax and a relatively long left arm can be observed. In addition, there is an obvious kyphosis or kyphoscoliosis affecting his shoulder girdle. The second and third fingers of his right hand are awkwardly positioned with hyperextension of proximal and distal interphalangeal joints suggesting joint laxity. His face is straight with slant-down eyes. The man who stood model for this painting is known to have earned his living by displaying his body as an anatomical curiosity in Berlin funfairs as Flugelmensch, suggesting a large armspan. Although a wide armspan is found in a large proportion of men2, the span must have been exceptional to provide this man's income as a circus curiosity. He was also frequently invited for teaching purposes to the Charite, Berlin's university hospital, and was said to have an ‘altered position of his heart’1, perhaps secondary to the deformity of his thoracic cavity. His extraordinarily large arm span, chest and back deformities together with the possibility of joint and tissue hypermobility as well as his facial appearance suggest the diagnosis of Marfan's syndrome. Formal diagnosis of Marfan's syndrome demands characteristic skeletal, ophthalmological and cardiac abnormalities, or alternatively two of these three together with a clear family history of Marfan's syndrome3. Physicians in the Charite in 1929 were probably aware of this diagnosis, since Marfan's syndrome was first described in 18964. Unfortunately the hospital's medical records of the time no longer exist, so the final diagnosis has to remain a matter for speculation.