The Habsburg jaw

Gerald D. Hart, m.d., f.r.n.s. f.r.c.p.[c], f.a.c.p., Toronto

MEN AND BOOKS

The physician's interest in moneyneed not be limited to the collection offees. Coins and medals may serve as a

prime source for history of medicineand disease. The earliest artistic de-pictions of goitre and trichoepitheli-oma have been demonstrated on an¬cient coins.1,2 It is believed that thesefeatures are factual, and this study ofthe Habsburg jaw was undertaken inorder to demonstrate further the va-

lidity of coin art as a paleopathologi-cal source.The Royal House of Habsburg

dominated the European politicalscene from the 15th to the 17th centu-ries. Many of their contemporaryportraits are available today in themuseums and palaces of Europe. Therealistic style and the quality of paint-ers and sculptors assure us of theauthenticity of the facial featuresshown. The characteristic Habsburgface shows a prominent lower jaw(Habsburg jaw), a humped nose

(Habsburg nose), and a prominentlower lip (Habsburg lip). This artisticmaterial has been studied by bothgeneticists and orthodontists and itgives a firm background for assessingthe authenticity of numismatic ma¬terial (Figs. 1 and 2).The chief facial feature of the

Habsburgs is the protrusion of thelower jaw due to mandibular progna-thism. This anomaly results from in¬creased obtuseness of the angle be¬tween the body and ramus of themandible. Milder forms ofthe condi¬tion are not rare and occur with anestimated incidence of 0.5%.3 Severe

Gerald D. Hart, m.d., f.r.n.s., f.r.c.p.[c], f.a.c.p.,Department of Medicine, University of Toronto.Reprint requests to: Dr. G. D. Hart, Director, Depart¬ment of Haematology, Toronto East General Hospi¬tal, Coxwell at Sammon Avenue, Toronto 13, On¬tario.

FIG. 1.Sculpture of Leopold I displayed at Expo '67showing the Habsburg nose, jaw and lip.

prognathism may result in the lowerincisors overlapping the upper ones,giving rise to a bulldog appearance,lantern jaw or hog mouth (Figs. 2 and3). Those unfortunates with lanternjaw may have impairment of mastica-tion and swallowing as well as dif¬ficulty with speech and inability toclose the mouth. "Your Majesty, shutyour mouth, the flies of this countryare very insolent"4 was a commenthurled at Charles I upon his first visitto Spain. The truth of this remark isshown by Fig. 4.

Mandibular prognathism may notbecome apparent until adolescenceand becomes more marked with age(Figs. 4 and 5). Modern genetic stu¬dies of the condition suggest that thedominant gene has an unknown de¬gree of reduced penetrance, and stu-

FIGS. 2 and 3.Coins of Leopold I showing numis¬matic accentuation ofthe hog mouth or lantern jaw.

dies of the Habsburgs show high butincomplete penetrance.5The Habsburg family tree is most

complicated, and even the tables giv¬en in the index volume of the Cam¬bridge Modern History6 are incom-

FIG. 4.Medal of young Charles I of Spain.

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FIG. 5.Medal ofCharles I ofSpain and Charles V ofAustria showing increase in prognathism with age andappearance of humped nose.

FIG. 6.Medal of Marie of Austria (not mentioned inthe Cambridge History family tree) showing familialprognathism and demonstrating the non-sex-linkednature ofthe condition.

FIG. 7.Medal of Frederick III (1440-93). This is theearliest medallic representation of prognathismamong the Habsburgs. The two lines showing theFrankfort horizontal plane and the fronto-orbitalplane of Simon were added by Rubbrecht.

FIG. 8.King Antiochus VII showing artistic licencetaken by ancient coin engravers which gave a degree ofprognathism to the Ptolemies and the Seleucid mo-narchs.

FIG. 9.Carlos II of Spain, who was one ofthe mostseverely affected. His inability to produce an heirresulted in the Habsburgs' disappearance from theSpanish throne.

TABLE IGenealogy of the House of Habstmg

EraestD.

IFrederick III (P.C.)=j=E!eonora of Portugal

1440-93

Maximilian (P.C.)=^Mary of Burgdndy1493-1519

Philip I(P.C.) =1506 (Spain)

=Joanna of Aragon

Charles V of Austria (P.C.)=^IsabellaI of Spain1519-1556

Spanish succession

Ferdinand I (P.C.)=T=Anne of Bohcmia1556-1564

Philip II (P.C.)^ Anne Mary=«= Maximilian II (P.C.)1556-1598 |\ I 1564-1576

Anne=pAlbert III

Charles=pMary

Philip III (P.C.)ZpMargaret Rudolph (P.C.) Matthias (P.C.) Maria=^= Ferdinand II (P.C.)1598-1621 I\ 1576-1612 1612-1619|1619-1637

Philip IV (P.C.)=r=Maria1621-111-1665

Charles II (P.C.)1665-1700

(P.C.) « Prognathism shown by coins and medals.

Ferdinand III (P.CV^=Mary1637-165]

Leopold I (P.C.)=pEleonora Magdalena of Neuburg1658-1705 X

Joseph I1705-1711

Charles VI (P.C.)1711-1740

Dates shown are dates of reign.

plete! For example, Marie of Austria,Regent of Hungary, sister of CharlesV and daughter of Philip I, is notmentioned, although a medal existsshowing her familial prognathism(Fig. 6). Table I shows an abbreviatedversion of the Habsburg family tree;(P.C.) after a name indicates the ex-istence of a coin or medal demon¬strating prognathism. From coinsand medals one must conclude thatfrom 1440 to 1705 the prognathism ofthe Habsburgs was due to a dominanttrait (Fig. 7). This conflicts with evi¬dence from other sources. Perhapsthe position of the jaw in artisticmaterial is not suitable for accurateassessment, whereas coins and med¬als characteristicahyshow profiles ofthe face. An alternative explanationwould be the artistic licence taken bythe coin designers such as is evident insome ofthe second- and third-centuryB.C. Greek coins which attributeprognathism to most of the Ptolemyand Seleucid monarchs (Fig. 8). Thecomparative similarity between coinsand artistic presentations suggeststhat this assumption is not a reliableone.Two Habsburgs, Leopold I of

Austria and Carlos II of Spain, were

more severely affected than the others(Figs. 2 and 9). It is possible that morethan the usual amount of consan-

guinity contributed to the geneticbackground of Leopold I (Table II).When Carlos II failed to produce an

heir the abnormality disappearedfrom the Spanish line. Perhaps othergenetic defects explain the lack of anheir for the Spanish Habsburgs, withthe result that the distantly relatedBourbons assumed the throne. In theAustrian line the defect disappearsnumismatically with Joseph I(1705-11) but reappears in his brotherCharles VI (1711-40). Was this an

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artistic blunder or a social mis-demeanour on the part of their moth-er Eleanora Magdalena? When theprognathism trait was so dominantfor 200 years, it seems strange that itcould be missing in one son but cropup in another.Money supplies the answer to the

question "Would a mandibular os-teotomy have altered the history ofthe world?" This question, naturally,was raised by a plastic surgeon whowondered if such an operation hadbeen available in the 16th centurywhether there would have been animprovement in the personality andactions of the Habsburgs.7 The largenumber of portraits and statues por-traying the abnormality suggests thatthe family was not ashamed of theabnormality. If they had wanted torestrict the knowledge of their ap-pearance they could have prohibitedthe appearance of their profiles oncoinage. At that time coins frequentlyshowed crests or religious symbols. Inthe Holy Roman Empire this was thecustom, but periodically coins wereminted showing the profile ofthe kingand displaying the prognathism evenmore obviously than did portraits. Ifit was considered good politics toappear on the coinage, then the kingscould have insisted on the use of afrontal view which would have ren-dered the prognathism less apparent.That this was not the case is shown byFigs. 2, 3, 10 and 11. The coin stylessuggest that the Habsburgs were nei-ther depressed by, nor ashamed of,their abnormality and, indeed, theirmany portraits extant imply the re-verse. It seems unlikely that even

TABLE HIConsanguinity of Leopold I

MaximilianPhilip I Joanna of Aragon

Anne Ferdinand I Charles V

Mary Charles Maximilian II Mary

I Anne Philip

Ferdinand II Margaret Philip III

Ferdinand III Mary

Leopold I

FIG. 10-Rudolph II quarter-thaler, 1612.

*' ..:... ..... ... :..

FIG. Il-Ferdinand II ducat, 1630.

FIG. 12-Medal of Philip II of Spain.

modern-day plastic surgery couldhave altered Philip II's (Fig. 12) deci-sion to launch the Armada and thuschange the balance of world powerwhich followed its defeat.

This study shows that coin art inthe depiction of disease is a reliablesource for medical history. The nu-mismatic custom of portraying pro-

FIG. 13-Medal showing family group of progna-thism: Charles V, Philip II, Maximilian II and Marie.

tile views of the reigning monarchsprovides better evidence for the diag-nosis of prognathism than the tradi-tional poses of portraiture. The prog-nathism of the Habsburgs is shown tobe a dominant trait (Fig. 13). Theabsence of the deformity in Joseph Iraises the question as to who was atfault-his mint or his mother?

The author is indebted to Mrs. Joan Martin,Department of Coins and Medals, British Mu-seum, for her time and interest, and to theTrustees of the British Museum for permissionto reproduce Figs. 3, 4, 5, 6, 7, 9, 10, 11, 12and 13.

Fig. 1 is reproduced from the catalogue"Man and His World, International Fine ArtsExhibition, Expo '67", Montreal, Quebec;Fig. 9 is reproduced from the American Jour-nalofOrthodontics, Vol. 25, 1939.

References1. HART GD: Canad Med Ass J 94: 547, 19662. Idem: Canad Med Ass J 96: 1432, 19673. STILES KA, LUKE JE:J Hered 44: 241, 19534. LANGDON-DAVIES J: Carlos: King Who Would

Not Die, Englewood Cliffs, NJ, Prentice-Hall,1963, p 21

5. RUBBRECHT 0: A merJ Orthodont 25: 751, 19396. Cambridge Modern History, vol 13, Genealogi-

cal Tables and Lists and GeneralIndex, edited byWARD AW, PROTHERO GW, LEATHES SL,Cam-bridge, University Press, 1911

7. GRABB WC, HODGE GP, REED BF, et al: PlastReconstr Surg 42: 442, 1968

[Editor's note: For further commenton the Habsburg jaw see LondonLetter, p. 563. ]

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