For this episode we discuss a tweetorial Avi posted on June 30, 2019. Here’s a link to the full thread:
Background
Avi started off the discussion by reminding us a bit about Vincent Van Gogh, a Dutch post-impressionist painter who lived in France in the second half the 19th century. He actually only was active as a professional painter for the last 10 years of his life, painting much of his most famous output in just the final two years of his life. Virtually unknown during his lifetime, he died of sepsis following a self-inflicted gunshot wound at the age of 37.
What medical problems did Van Gogh suffer from?
Van Gogh seems to have had multiple issues and symptoms that affected him throughout his adult life, including severe bouts of depression, psychosis, mania, and convulsive episodes. We all know about the famous ear cutting incident and he apparently drank a lot of absinthe.
Similar to Beethoven, there are many theories about what ailed him, from acute intermittent porphyria to chronic lead poisoning from nibbling on chips of his paint (which he was known to do), to Meniere’s disease.
The consensus among historians is that he probably had schizoaffective disorder and comorbid epilepsy, both of which would have been worse by all of the absinthe he drank.
When does digitalis come into play?
In the last two years of his life, as his mental health declined, Van Gogh spent a significant amount of time in the St. Remy asylum in the South of France. It is at this time, and after his release, when he came under the care of a homeopathic physician named Dr. Paul Gachet. If he was treated with digitalis, it would have been around this time.
Digitalis is group of plants also known as foxgloves (for the shape of their flowers) that work by inhibiting the Na/K-ATPase pump. We use one type of digitalis (digoxin) for cardiac indications but throughout history many different formulations have been used for various indications. Digitalis was the “standard of care” in late 19th century France for epilepsy, so it’s not inconceivable that he would have received it at some point in these final years.
Plus, Van Gogh painted two portraits of his physician, Dr. Gachet, holding a foxglove plant.
Does digitalis affect color vision?
Digoxin and other types of digitalis can have effects on vision, in two ways: (1) xanthopsia, which is a a yellow discoloration of vision and (2) blurred halos around points of light. Objective color disturbance without subjective xanthopsia has also been reported.
While the mechanism is not clearly understood, it’s thought to be due to effects on the Na/K-ATPase pump in the photoreceptor cells in the retina.
Van Gogh did use a lot of yellow in his paintings in his later years when, if it occurred at all, he would have had his digitalis exposure. In fact, he used so much yellow during this time that it’s referred to as his “yellow period”.
And if you look at perhaps his most famous painting, Starry Night, and others like it, the stars do have hazy halos around them.
The digoxin theory was originally described by a surgeon named Dr. Thomas Courtney Lee in an article in JAMA in 1981, who himself was an accomplished artist.
So, it must be the digitalis, right?
Maybe not. An art blogger named Jason Bailey empirically analyzed the evolution of Van Gogh’s color palette over time and found that, although he definitely used more yellow in his final years, the shift actually occurred in 1888, before he was admitted to the asylum in 1889 (and theoretically might have been exposed to digitalis). Van Gogh’s palette seems to have been brightening and becoming more yellow even in 1887.
And perhaps most definitively, Dr. Gachet tested Van Gogh’s vision with a color wheel used for railroad workers at the time, and found his color vision to be normal.
Take home points
- Some have wondered if Van Gogh’s extensive use of the color yellow was a result of xanthopsia from digitalis toxicity.
- While it’s plausible that he was treated with digitalis, the evidence suggests his vision was not impaired or influenced by anything other than his own artistic sensibilities.
- In the end, Van Gogh simply loved the color yellow.
Learning Objectives
- Learn about the theories surrounding the health of Vincent Van Gogh.
- Appreciate the medical uses of digitalis in the 19th century.
- Recall the mechanism of action digitalis medications such as digoxin.
- Understand the potential visual side effects of digoxin.
CME/MOC
We are excited that The Curious Clinicians have partnered with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Visit VCU Health for more information.
Listen to the episode
Credits & Citation
◾️Episode written by Avi Cooper
◾️Audio edited by Hannah Abrams
◾️Show notes by Tony Breu and Avi Cooper
Cooper AZ, Breu AC, Abrams HR. Why did Van Gogh use so much yellow? The Curious Clinicians Podcast. July 8, 2020. https://curiousclinicians.com/2020/07/08/episode-2-why-did-van-gogh-use-so-much-yellow/
Opening image source: https://www.vangoghmuseum.nl/en/collection/s0049V1962
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