Down syndrome diagnosis at the Adoration of the Christ Child

adoration of the christ child

Ten years ago, two researchers noted that a painting from almost 500 years ago depicted some surprising visitors in a Nativity scene. In their article, “An Angel With Down Syndrome in a Sixteenth Century Flemish Nativity Painting,” Andrew Levitas and Cheryl Reid explain the significance of historical paintings in documenting certain types of disability.

In the 1960’s, there was a discussion in the academic literature over whether Down syndrome was a relatively modern condition, given that it was only identified in the mid-1800’s by John Langdon Down. In support of this “modern theory,” one commentator noted how individuals with Down syndrome were not portrayed in ancient art. Others responded with their own examples of paintings that appeared to depict subjects with Down syndrome.

Levitas and Reid add yet another painting to the discussion: “The Adoration of the Christ Child.” The painting is in the collection of the New York Metropolitan Museum of Art (last displayed in 1999). The identity of the painter is in some dispute, but the Met lists the artist as “Follower of Jan Joest of Kalkar.” The painting is dated as circa 1515. According to the Met’s description:

The fourteenth-century mystic Saint Bridget of Sweden recounted Christ’s birth after experiencing a vision. The “great and ineffable light” she described as emanating from the Child is the most compelling feature of this picture.

No mention is made in the Met’s description that the painting may be one of the earliest depictions of Down syndrome in Western art. That is what Levitas and Reid contribute.

Levitas and Reid examined the painting and the portrayals of the individuals in it. They focused on the angel immediately to Mary’s left and to the right of the angel in the center of the painting. The authors noted the tell-tale facial features of Down syndrome and that the fingers, particularly those on the left hand, appear shorter. Levitas and Reid further considered the image of the shepherd directly above the angel in the middle, who also has facial features suggestive of Down syndrome. Here are those images enlarged:

The Adoration of the Christ Child 2

Levitas and Reid expressed particular confidence in their conclusion that the angel to Mary’s left is depicted with Down syndrome, and very likely the shepherd as well, after comparing the above painting with another one. The other painting is a virtually identical scene, with the individuals in the same arrangement, e.g. Joseph and Mary on the left-side of the painting, same number of angels surrounding the Christ child. But, this painting takes place in the daytime. Here is an image of that painting:

Adoration Day

Comparing the two, B matches up with E and C with F, and it is clear they are paintings of different faces.

It was enough for me simply to see that the artist in the nighttime Adoration painting knew how to paint faces of “typical” individuals. Clearly, the artist made a choice to paint the angel to Mary’s left with facial features distinctive from the other angels (and from Mary), and so, too, with the shepherd. But, seeing the nearly identical scene in the daytime version with individuals that are not portrayed with the facial features associated with Down syndrome establishes that the painting of the angel and the shepherd in the nighttime scene was purposeful. The artist meant to portray individuals with distinctive features from the other faces shown.

Credit should be given to John M. Starbuck and his article “On the Antiquity of Trisomy 21: Moving Towards a Quantitative Diagnosis of Down Syndrome in Historic Material Culture,” for both the additional analysis, and for providing the comparisons of the two paintings. Further, Starbuck mentions the same thing I noticed upon reviewing the nighttime Adoration: that several of the cherubs at the top of the painting also have facial features suggesting Down syndrome (particularly, for me, the cherub on the right hand side of the painting).

Given that it is Christmastime, I thought this diagnosis of Down syndrome in a nearly 500-year old painting of the Nativity was appropriate to feature. Tomorrow, I’ll examine what Levitas and Reid consider to be significant about the portrayals of individuals with Down syndrome in a medieval painting and the meaning I think that they missed.

UPDATE: Part 2 of this post can be read at this link; it discusses the significance of the painting The Adoration of the Christ Child.


  1. Jake Morrison says:

    This painting is currently on display at the Met. You can see it here:

    But if you want to view it, be sure to call ahead as that gallery is not open every day.

  2. No eye skin folds , eyes are not slanted, cant see ears, tongues do not protrude, the only clue that these may be downs syndrome individuals is pug noses. All in all a ridiculously weak case.


  1. […] previous post discussed how one of the earliest representations of Down syndrome in Western Art had been […]

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