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OUT of Office: Surgical Scrutiny of the Sistine Chapel Ceiling

By: Stephen M. Zappala, MD, FACS | Posted on: 01 May 2021

Urological surgeons have combined the skills of observation and attention to detail with their clinical passion and a knowledge of human anatomy. Similar skills have been applied to understanding Renaissance art and specifically the exquisite fresco of the Sistine Chapel Ceiling by Michelangelo Buonarroti.

Several travels to Italy had exposed me to an incredible volume of sculpture, art, and architecture, but I didn’t completely appreciate the interpretation. My Italian journeys were always with family and friends, and were enhanced by relationships with Dr. Giacinto Marrocco, Pediatric Urology, Rome and Paolo Ferrini PhD, proprietor of Bravo Viaggi, a renowned authority on Italian history and gastronomy. They astutely commented that if New York is the ‘Big Apple’ then Rome is the ‘Big Lasagna.’ Rome proudly displays 4 individual and unique layers: Imperial, Religious, Baroque, and Renaissance. Michelangelo’s name is synonymous with the Renaissance Layer of the Cinquecento, the 1500s, where his artistic contributions remain as the pinnacle art forms of Western Civilization.

Michelangelo (1475–1564) was born in Caprese, Tuscany and his early years were in the Medici Court of Florence.1 His primary artistic aspiration was sculpting marble. ‘The Pieta’ was carved at age 23 for a French cardinal and is currently on display in St. Peter’s Basilica, Rome. Some commented that the young Florentine could not possibly be the originator. One evening, he returned to the sculpture and carved his name on Mary’s sash. My initial impression was simply the mother Mary supporting her recently crucified son, Jesus. My Roman colleagues responded quickly with additional observations: the marble of her robe was coarse and contrasted with the soft, polished marble on the lifeless body of her middle-age son, and her facial features represented a very young woman. Impressed with their comprehensive descriptions (and my deficiencies), I initiated a personal challenge to understand and more extensively interpret art history.

Figure. Ceiling of Sistine Chapel: “The Creation of Adam,” by Michelangelo (1508–1512). Vatican City.

The understanding of human anatomy, combined with the teachings of Sir Vincent Zachary Cope, MD, MS, FRCS (1881–1974) and Professor Donald Coffey (1932–2017), were the sparks that ignited the tinder to critique Michelangelo’s representations. Cope’s The Early Diagnosis of the Acute Abdomen has served as a principal text for generations of surgeons: the basic premise is the significance of observation during a clinical evaluation. The Theory of Organized Chaos by Dr. Donald Coffey was originally applied to the understanding of large, complex molecular interactions within DNA.2 The double helix initially appeared chaotic but when scrutinized at the level of the 4 basic nucleosides, indeed DNA was transformed as organized. Surgeons possess gifted talents to combine exhaustive observations with their anatomical knowledge, and also dissect the most complex chaotic situations into itemized structures: indeed, these reflect the predicates of critical artistic interpretations.

Michelangelo’s magnificent fresco of the Sistine Chapel Ceiling was created over a 4-year period (1508–1512). My enthusiasm was enhanced by an interpretation of the “Creation of Adam” by Frank Meshberger, MD, a gynecologist, who stated that the Creator was not within a cloud or the heavens but a sagittal section of a human brain.3 A recent 20-year restoration, begun in 1980, revitalized the colors and revealed even further cryptic messages and inspiring revelations. The restoration permitted the generation of intriguing and at times inspiring interpretations.4 The ceiling height is 70 feet and occupies approximately 12,000 square feet, corresponding to the size of a National Basketball Association basketball court. Nine scenes from Genesis are depicted in the large central panels. The central and most famous panel is referred to as “The Creation of Adam.”

First and foremost, there is no optimal vantage or reference point from which to analyze the Ceiling fresco. Indeed, one’s initial impression is a haphazard kaleidoscope of both colors and scenes, described as a “visual cacophony.” Most visitors visit the Chapel at the culmination of a Vatican Museum tour. They are expeditiously escorted out with strained necks by the Chapel monitors who express the seemingly constant commands of “no photos.” Fortunately, improved optics and the Internet have allowed for a more comprehensive scrutiny and critical reviews of the details and messaging within the fresco.

For example, Adam’s relaxed posture and finger flexion reflect mankind’s minimal effort at the moment of creation. Adam and the Creator’s concealed palms are oriented downward to signify eventual conflict or turmoil. The Creator extends his right arm (dextra) while Adam extends his left (sinistra). The Creator’s domain within the human brain and his exit from the frontal lobe are significant. Is God within one’s brain and can be contacted directly without papal intercession?

A more careful analysis identifies the Creator with a closed pelvis, crossed legs, wearing a dress, and exhibiting 2 breasts suggesting a God with morphological features of both genders. The attire has the grey-white colors of a commoner rather than the regal colors of opulence.

Adam, derived from the Hebrew adamah (soil), has customarily been described as resting on the earth. There are multiple pigments with a contoured topography to the terrain suggesting that indeed mankind is gathering support from a rock. The biblical significance to obtain support from rock (petra in Latin) rather than from another source redirects the viewer’s attention away from the papacy of Julius II to the original pope, Simon Peter. Adam’s distinct umbilicus suggests a maternal origin, incongruous with Old Testament dogma of divine creation. Furthermore, a woman is clearly evident at the epicenter of the Creator’s domain at the moment of the male creation.

Adam’s corpus is devoid of facial, axillary, or pubic hair. He has a micropenis with scrotal hypoplasia that are not commensurate with his exaggerated muscular physique. A peculiar deformity to the great toes are noted on both the Creator and Humankind (hallux varus). The podiatric anomaly was then rediscovered on most of Michelangelo’s art forms before and after the Ceiling, representing his “toe signature.” Indeed, the hallux abduction is noted on the Laocoon Sculpture (1506) and provides compelling evidence that the excavated sculpture is probably a Michelangelo forgery and not a Greek original.

My journeys into the interpretations of Renaissance art continue throughout the pandemic,5 but 2 perplexing questions are constantly raised. What hidden messaging could possibly be identified on a 500 year old fresco? And secondarily, how did a urologist become so involved in this journey? Indeed, one urologist commented that the only ‘cystine’ she previously understood was a urinary calculus. Another teased that the journey must have been arduous since urologists are trained to “look down and not upwards!”

Essentially, both questions can be referred back to the teachings of Drs. Cope and Coffey and our skills of clinical observation, perseverance, and passion. My Roman colleagues have repeatedly instructed, “Visualize with the eyes but imagine with the brain.” I encourage my urology colleagues to heed their guidance, not just in the art history environment but also in our daily lives during these tumultuous times.

Guideline #1

Interpret the ‘Roman lasagna’ as a continuum along a very complex geopolitical timeline characterized by papal control, autonomous city-states, regional competition, and fascism.

Guideline #2

Scrutinize Michelangelo’s artistic representations by understanding his adversarial relations with his primary patron, Pope Julius II, and his professional colleagues, Bramante and Rafael.

Guideline #3

Appreciate Michelangelo’s recognition of the Judaic genealogy of Catholicism and his frustration about the opulence and indulgences the papacy of Julius II.

Guideline #4

Obtain the guidance and services of guides to visit museums and areas of interest. Time is extremely limited and one can maximize efficiency with a professional guide, not simply a guide that professes. These are licensed experts who enhance the memorable experience.

Guideline #5

Respect the autonomous, independent expressions of the artist. The interpretations are personal and predicated on previous experiences, biases, and exposures.

  1. King R: Michelangelo and the Pope’s Ceiling. New York: Penguin Books 2003.
  2. Coffey DS: Self-organization, complexity and chaos: the new biology for medicine. Nat Med 1998; 4: 882.
  3. Meshberger FL: An interpretation of Michelangelo’s Creation of Adam based on neuroanatomy. JAMA 1990; 264: 1837.
  4. Steinberg L: Who’s who in Michelangelo’s Creation of Adam: a chronology of the picture’s reluctant self-revelation. Art Bulletin 1992; 74: 553.
  5. Zappala SM: Pigments, Postures, and Plaster. Boston Museum of Science. Discoverers Society. YouTube January 4, 2021. Available at