Eye (1991) 5, 503-510

Xanthopsia and van Gogh's Yellow Palette

WILFRED NIELS ARNOLDI and LORETTA S. LOFTUS2 Kansas City, USA

Summary A survey of van GOj!h'1j worli from 1886 tQ 189Q indicated that paintinss with a yellow dominance were numerous, episodic, and multi-regional. His underlying ill­ ness, by his own admission, affectedhis life and work; furthermore, episodes of mal­ nutrition, substance abuse, environmental exposure, and drug experimentation (all evident from correspondence) exacerbated his condition. Accordingly, we reviewed plausible agents that might have modified the artist's colour perception. Xanthopsia due to overdosage of digitalis or santonin is well documented elsewhere, but evidence of useage of either drug by van Gogh cannot be substantiated. It is unlikely that age­ ing of the human lens was an influence because of the artist's youth. Sunstroke is too restrictive to fit the multiplicity of regions and motifs. Hallucinations induced by absinthe, the popular liqueur of the period, may explain particular canvases but not the majority of 'high yellow' paintings. Van Gogh's proclivity for exaggerated colours and his embrace of yellow in particular are clear from his letters and, in con­ tradistinction to chemical or physical insults modifying perception, artistic prefer­ ence is the best working hypothesis to explain the yellow dominance in his palette.

Vincent van Gogh died by suicide in 1890 at exacerbated his condition, even if it were her­ the age of 37 years. He was a full-time artist editary; for example, Hemphill! reached the during the last ten years of his life but received conclusion that van Gogh was a manic­ little recognition during his lifetime. A wider depressive who developed confusional epi­ appreciation of his work was slowly realised sodes and fits which were due to excessive during the early years of this century, and has consumption of a popular liqueur called now grown into enormous popularity. There absinthe. Several other working hypotheses have been numerous attempts to define van posit medical problems having some influence Gogh's innovations, to suggest the mechan­ on his art; analyses of neurological, nutri­ isms of their genesis, and to identify influen­ tional, environmental, and chemical factors ces upon his creativity. have all received some discussion. These ele­ It is generally thought that Vincent* had a ments influenced his life, and some of them mental illness, although consensus has not probably shortened it, but did they affect his been reached on a specific diagnosis. Most vision, his style, his palette? commentators suggest that additional factors Chromatopsias are usually reversible but

'van Gogh preferred the use of the first name professionally; those paintings which he signed (a fraction of the total) were simply inscribed Vincent.

From: 'Department of Biochemistry and Molecular Biology, University of Kansas Medical Center, Kansas City, Kansas, USA 66103. 2Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA 64108.

Correspondence to: WilfredN. Arnold, PhD, Department of Biochemistry and Molecular Biology, University of Kansas Medical Center, Kansas City, USA 66103. 504 WILFRED NIELS ARNOLD AND LOREITA S. LOFfUS would change one's view of the world and Van Gogh's 'high yellow' paintings might impress an artist for later rendition on From 1886 to 1890 van Gogh produced at least canvas. Lee2 was the firstto propose that van 638 paintings . .J We have examined 276 paint­

Gogh may have suffered from digitalis intox­ ings from this period . .J-1O These works were ication, noticed the golden and coronal symp­ produced in Paris (2o'}"0), Aries (39%), St. toms and, when these side effects Remy (24%) and Auvers-sur-Oise (17%). In disappeared, purposefully continued to paint order to distinguish between realistic rep­ with a yellow dominance. There is no record resentation of a particular scene compared of Vincent taking the drug. Nevertheless we with the same under perception modification thought it worthwhile to explore other chemi­ it is essential to define 'high yellow' pictures as cals which can induce xanthopsia. not only being rich in yellows, but virtually The dominance of vibrant yellows and the lacking blues, violets and white. We empha­ red end of the spectrum in several paintings sise that the exclusion of the blues is just as after 1886 was declared by the artist himself as important as the dominance of the yellows in a 'high yellow note' (letter 581).3 Was it a arguments invoking xanthopsia. We found reflection of Vincent's new perception of his 10% in this category. There are other can­ subject matter or was it artistic preference? vases within this time frame which are rich in The thrust of this review is to examine existing yellows, greens, and reds but have a blue or claims, to explore new possibilities, and to violet swath; in this category we found 30%. resolve the issue between perception and The warmer hues pervade many of the preference. remainder, but they have a more general,full-

Color Plate. 'The Night Cafe' by Vincent van Gogh, Aries, 1888. Oil on canvas, 72.4 x 92.1 cm. Yale University Art Gallery, New Haven. Bequest of Stephen Carlton Clark. XANTHOPSIA AND VAN GOGH'S YELLOW PALEITE 505 spectrum palette that includes the blues, Here less blue and more grey and green in the skies we found 161 (60%) of which only 13 were of older landscape painters because of yellow­ judged to be sombre, [Van Gogh 'touched up' ing of the lens.13 Pokorny et al. 14 summarised many of his canvases, sometimes months the available data on healthy eyes of different later, and perhaps on occasion towards a more ages, and with their equations we calculated balanced palette, but we have not attempted that the loss in lens transmission between ages to evaluate this aspect]. The Table provides 27 and 67 is a significant 28% at 460 nm. But examples of each of the three, operationally­ for Vincent, over his artistic career (ca 27- defined categories. 37), the predicted change for healthy eyes is

In addition, a group of self-portraits was less than 7% , and this degree of 'yellowing' of analysed as a separate class based upon Bona­ the lens is insignificant compared with the foux's book!! of 37 canvases by van Gogh. impact that attends the unnatural condition of Twenty-eight of them were created in Paris. xanthopsia, a pathology of the colour sense We deem eight of these portraits to be high which elicits yellow vision. Walsh and HoyeS yellow paintings and only one, 'Self-portrait mention at least thirteen chemicals that can dedicated to friend Laval', 1888, was painted cause xanthopsia; some are 20th century in the South. Thus 'high yellow' paintings drugs, others include digitalis and santonin were not only significant in number, but their which were used in France during the period execution was episodic, and they were pro­ of interest. duced at multiple locations. Was this a reflec­ tion of an occasional, reversible change in the Digitalis intoxication Withering's book (1785) on the medical uses artist's perception of his subject matter? of foxglove (Digitalis purpurea) reported Colour perception and ageing yellow vision in patients who received large The perception of the full range of colours is and sustained doses of foxglove decoctions.16 subject to a multitude of influences.One natu­ Purkinje (1823) described his own symptoms ral example concerns ageing. The fraction of after self-administration of digitalis.17 Lely incident light energy which reaches the retina and van Enter!8 reported a large-scale digi­ decreases with age; this is primarily due to a toxin intoxication in 1969 due to an error in gradual loss in transmittance by the lens.12 tablet manufacture, and they observed seri­ The attenuation is more pronounced for the ous eye conditions in 170 (95%) of the shorter wave lengths and is maximal between patients. As well as episodes of amblyopia 450 nm and 470 nm, which are centered about and diplopia, and experiences of light flashes the colour responses of violet and blue and scintillating scotomata, patients and respectively, and may be the explanation for volunteers complained of aberrancies in

Examples of the Three Palettes Each painting is identified by origin, year, title, de la Faille (F) number," and present location. See text for operational definitions of the three categories.

1. 'High Yellow' Paris (1887) 'Sunflowers' F376, Kunstmuseum Bern Aries (1888) 'Thc Night Cafe' F463,Yale University Art Gallery St Remy (1890) 'Roses' F681, W. Averell & Pamela C. Harriman Collection Auvers (1890) 'Trces' F817,Joseph H. Hazen Collection

II. 'Blue Swath' Paris (1887) 'The Bathing Boat' F311,Mellon Collection,Virginia Museum Aries (1888) 'Wheat Field' F411, Rijksmuscum Vincent van Gogh,Amsterdam St Remy (1889) The Reaper' F618,Rijksmuseum Vincent van Gogh,Amsterdam Auvers (1890) 'Sheaves of Wheat' F771, Dallas Museum of Art

III. 'Full Spectrum' Paris (1887) 'Restaurant Interior' F342,Rijksmuseum Kroller-Muller,Otterlo Aries (1888) 'Cafe Terrace by Night' F467,Rijksmuseum Kroller Muller, Otterlo St Remy (1889) 'Starry Night' F612,Museum of Modern Art,New York Auvers (1890) 'Crows over the Wheat Field' F779,Rijksmuseum Vincent van Gogh, Amsterdam 506 WILFRED NIELS ARNOLD A!,;D LORETTA S. LOFTUS colour vision wherein all objects appeared pri­ unique, popular, and influential figure in 19th marily green, yellow, or white; the latter century France, had already made appreci­ symptoms disappeared in a few days after able contributions to chemistry, biology, and withdrawal of the drug.[4 There is no unani­ particularly histochemistry when he turned mity on mechanism, but Gibson et al. cO pro­ his attention to the health and welfare of the posed that the yellow vision of digitoxin general population. His system stressed toxicity is related to a selective, reversible hygiene, focused on common medical prob­ effect on receptors rather than the optic lems, and depended on a few chemicals such nerve.2[ as camphor (unfortunately touted as a pana­ Robertson et al. cc emphasised that patients cea) and a handful of crude plant extracts. He are generally reluctant to admit to distorted published 'Manuel Annuaire de la Sante' in colour vision, thus the statistics are possibly pocket-book format starting in 1845, and sales underestimated. Nonetheless a large body of averaged over a hundred copies a day in the literature covering 200 years supports the fact first five years.D It was repeated every year that digitalis intoxication can induce xanthop­ but two until his death, and then it was con­ sia. Leec put forward the case for Vincent van tinued by his descendants till 1935 .. How can I Gogh. Rentchnick2' and Lanthon/.J found consider myself a doctor when all the world is some support for this working hypothesis and going to' become, without much pain, as joined Lee2 in reminding us that digitalis was learned as 1', wrote Raspail on the title page given for epilepsy, mental illness, and other of the Manuel,cK to the chagrin of most other medical problems in the nineteenth-century physicians of the day. Raspail's contentious­ (albeit, inappropriately by modern stan­ ness extended into politics, which landed him dards). These authorsc.cnl were intrigued by in jail for more than two years and exile for the sprigs of foxglove that Vincent incor­ nine, but his publications, speeches and min­ porated into the two 'Portraits of Dr.Gachet', istrations elevated his recognition to a house­ Auvers-sur-Oise, 1890. We are more inclined hold name. to interpret the plant as a symbol for the phys­ Vincent was preoccupied with his own ician rather than as a drug for the artist. health and even wrote to his brother, as early Ravin25 noted that because Gachet was a as July 1880, about the wisdom of self-study in homeopathic physician he was less likely to medicine (letter 133), and expressed some have administered a toxic dose of digitalis. In organised scepticism about prevailing norms any event van Gogh's last attending phys­ of health care (letter 148). Attraction to the ician, Dr.Paul Gachet, was in contact for only low-cost, home-remedies of Raspail (letter two months just before the artist's death. If 576) by someone of Vincent's demeanour is one of his earlier doctors, e.g. Drs. Peyron easily understood. Indeed, he lauded Raspail (St. Remy), Rey (Arles), or Gruby (Paris), and incorporated an image of the Manuel into had been similarly depicted with digitalis, 'Still Life: Drawing Board with Onions', then a more meaningful (but still circumstan­ which was painted between January 8 and 17, tial) case could have been made to infer pre­ 1889. During the same period Vincent wrote scription of the drug. There is also the about his enthusiasm for camphor in over­ possibility of self-administration by van Gogh coming insomnia (letter 570); this was surely although we findnothing about digitalis in his inspired by the book, although Vincent's correspondence; he did mention taking pot­ reckless 'very, very strong dose ... in my pil­ assium bromide at Aries (letter 574) so that he low and mattress' can be compared with was not averse to talking about medications. Raspail's directive of chewing about 50 mg at Perhaps an indirect case can be made for san­ night. tonin because it was recommended by Rasp­ Van Gogh had a copy of the Manuel, con­ ail, whose system of medicine was known to sidered it worthy of a legible title in his paint­ the artist [(letter 576), and ref. 26]. ing, and joined thousands of compatriots in consulting this book of home remedies.We do RaspaiJ not know which edition Vincent had, but we Francois-Vincent Raspail (1794-1878), a consulted the 1863, '72 and '86 versions XANTHOPSIA AND VAN GOGH'S YELLOW PALETTE 507 wherein we found the same entry (pp 133-4of or were given by relatives, 35 santonin-contain­ the 1886 edition28) on semen-contra (called ing preparations. Van Gogh frequently com­ santonica in the 1886 U.S. Dispensatorl9), plained of gastrointestinal problems and may which contained santonin as the active have suspected worms; his penchant for principle. excess, as exemplified with camphor, may have led to overdosage on santonin. Arnold Santonin has suggested that van Gogh's affinity for This sesquiterpene lactone is found in several absinthe developed into a pica for terpenes, Artemisia species although the commercial the documented examples being thujone, source is primarily A. maritima. 30 Santonin, as camphor, and pinene.36 a crude decoction or powder and later as pure crystals, was used effectively as an anthelmin­ Absinthe tic for several centuries until displaced by Indulgence in alcohol adding to van Gogh's drugs with less side effects.Xanthopsia due to illness and the injurious effects of absinthe in santonin overdosage was probably encoun­ particular have been emphasised.1,36,37 This tered almost as soon as its efficacy against liqueur was very popular in 19th century ascariasis was established and was docu­ France; the per capita consumption was mented31 as early as 1806. It may also be particularly high in Paris and Arles in van important for the present discussion to note Gogh's time,38 and there are several indica­ that while bright objects are yellow, dark sur­ tions that he developed an affinity for it.. He faces sometimes have a violet appearance also painted 'Absinthe Glass and Carafe', under santonin xanthopsia.32,33 The visual Paris, 1887, and included a green absinthe symptoms may occur in the absence of all bottle into 'Still Life: Drawing Board with other toxic manifestations, which in extreme Onions', Arles, 1889. Vincent said that he cases include convulsions. 33 painted 'The Night Cafe on the spot, staying A single dose of 200 mg santonin (about the up three nights in a row and sleeping during upper limit of the therapeutic range) is suf­ the day (letter 533). It is tempting to speculate ficient to cause yellow vision in some individ­ that he consumed absinthe during the execu­ uals after two hours, and with 500 mg or more tion of this painting; he certainly had access, the effect is noted in a half hour.32 Duke­ and the landlord was apparently pleased with Elder19 reported that doses as small as 100 mg the whole event. Vincent surmised that Ter­ santonin commonly caused yellow vision. steeg (an Art Gallery manager in Holland) Raspail suggested up to 2 g daily of semen­ would surely judge Vincent as having 'delir­ contra, the unexpanded floraheads of A. mar­ ium tremens' while painting this picture (let­ itima, as often as required; this would have ter 534). Apart from the possibility of special been equivalent to about 80 mg santonin cases such as this we do not imply that van according to our calculation, although the Gogh painted while intoxicated. We feel that concentration would have varied with the his creations occurred while lucid, but that dried herb. More importantly, Raspail's novel experiences of relative sizes, shapes, direction, 'a pinch with three fingers equals and colours perceived under the influence of one gram,' is a bit imprecise. The large vari­ absinthe may have been recalled later and ations in actual amount taken, the small incorporated into new and daring com­ difference between therapeutic and toxic positions, perspectives, and palettes. doses, and individual differences in sensitivity Absinthe contained high concentrations of to santonin are sufficient to account for the both alcohol and essential oils from herbs; the incidence of intoxication. 32 latter contributed to flavour, fragrance, and The drug was also taken in the 19th century toxicity.3 9 The most deleterious constituent as a preventative medicine or in response to was thujone, which can cause auditory and vague and indefinite diagnoses. More visual hallucinations (described as vivid and recently, documented examples involved indi­ terrifying), convulsions, and eventually irre­ viduals sufferingdyspepsia and other gastro­ versible neurological damage.40,41 In the 1920s intestinalcomplaints who self-administered ,34 and 30s, thujone- and camphor-induced con- 508 WILFRED NIELS ARNOLD AND LORETTA S. LOFTUS vulsions were studied as models for epilepsy.39 and I shall not again reach the heights to Subsequently camphor, pentylenetetrazole which sickness partially led me' (letter 570). (Metrazole), and hexafluorodiethyl ether (Indoklon) were used successfully as phar­ 'Too much sun for a nordic head' macologic agents to induce convulsive seiz­ We quote from the mid-thirties, doctoral dis­ ures in certain cases of schizophrenia, i.e. sertation of Beer+R who attributed the diag­ chemical forerunners of electroconvulsive nosis of sunstroke to Dr. Paul Gachet, therapy.39.42 Therapeutic doses of Metrazole without documentation. Our survey indicated commonly evoked xanthopsia43 or varicol­ that 'high yellow' paintings were not restric­ oured visual hallucinations44 in the preconvul­ ted to the south and included some indoor sant period. scenes, still lifes, and self-portraits so that Notwithstanding chemical differences sunstroke or heat exhaustion could not be the between Metrazole, camphor, thujone, and sole contributing factor. santonin, all can act as convulsants; that Nevertheless Vincent remarked upon being Metrazole and santonin cause xanthopsia is 'dazed with the sun,' (letter 512) that 'beats also intriguing. Amblyopia and optic neuritis down on one's head . .. [and] makes one were reported under absinthism/3 but chro­ crazy' (letter B 15,). He noted that sunburn matopsia was not encountered in our liter­ was common around Arles (letter 498a), and ature search. Hilbert wrote about a young, commented upon his own sometimes reckless neurasthenic, male patient who suffered a exposure (letter B 7). The syndrome has been three hour bout of xanthopsia after an recognised since biblical times. According to alcoholic excess, but the liquor was not an 1886 Handbook, vision is sometimes specified.45 affected by heatstroke; sixty cases of chro­ The herbs incorporated into absinthe matopsia were observed in New York City varied with the manufacturer but always about this time. 49 It is curious that more recent included wormwood (Artemisia absinthium) reviews50 of heatstroke do not mention chro­ and Roman wormwood (Artemisia pontica),39 matopsia; perhaps the syndrome is included and we wondered whether they contained under delirium or goes unreported because of santonin (cf. Artemisia maritima). The pro­ the stigma attached to admitting to cedure used, as well as the low concentration hallucinations. 22 of santonin reported for A. absinthium, Duke-Elder19 and CarrollS 1 were of the excused that species; our own analyses of an opinion that the visual disturbances due to alcoholic extract of A. pontica (i.e. simulation digitalis intoxication, and some other chemi­ of the secondary process in absinthe manu­ cally invoked chromatopsias, are actually hal­ facture) indicated that the amount of santonin lucinations, i.e. due to central function was insignificant.46 Nonetheless, van Gogh's impairment caused by the drug. This working over indulgence in absinthe,36 and an hypothesis has the charm of being able to increased susceptibility to its toxic effects due embrace such disparate causes of xanthopsia to inadequate diet,39 may have influenced his as digitalis, santonin, and sunstroke but perception. According to Signac, 'Though he otherwise remains in conflict with hypotheses [Vincent] ate hardly anything, what he drank that depend more on specific chemical or was always too much ... after spending the physical effects on photoreceptors.2o whole day in the blazing sun [painting] ...the We encountered other chemical and absinthes and brandies would follow each environmental causes of xanthopsia,15.33 but , other in quick succession. 47 We are also they were dismissed because they were either reminded of Vincent telling his brother, about isolated and exotic (e.g. picric acid, chromic his early months in Arles, 'Dr. Rey says acid, carbon disulfide, oil of wintergreen) or that . . . I kept myself going on coffee and seemed to be irrelevant to Vincent's lifetime alcohol . . . it is true that to attain the high (e.g. amyl nitrite, streptomycin, sulfona­ yellow note that I attained last summer, I mides, DDT, quinacrine, thiazide diuretics). really had to be pretty well keyed up' (letter Those chemical and physical factors which we 581). 'Now if I recover, I must begin again, have discussed are at least reasonable can- XANTHOPSIA AND VAN GOGH'S YELLOW PALETTE 509 didates for causing confusion or distortion in other colour. Yellow also had a special sym­ colour perception, bolism for Vincent: 'The Wheatfield behind Saint Paul's Hospital with a Reaper,' 1889, a Vincent's preference work predominantly in yellow, was described We turn now to 'artistic preference' and the as, 'a vague figure fightinglike a devil ... the key distinction in our operational definitionis image of death ... [and] humanity might be that the artist views the motif accurately but the wheat he is reaping' (letter 604). But, elects to depart from realistic depiction of most important for Vincent, 'there is nothing colours on the canvas, That the artist's choice sad in [this] death, [because] it goes its way in of pigments be conscious, accurate and unin­ broad daylight ... with a light of pure gold' fluenced by external factors is central to this (letter 604). This is reminiscent of Goethe's argument. In 1886 van Gogh declared that, conviction that the colours of yellow, orange, 'true drawing is modelling with colour' (letter and cinnabar (vermillion) evoke quick, lively, 459a). Later , in 'La Berceuse' ('Woman aspiring feelings.52 Later van Gogh hesitated Rocking the Cradle'), Aries, 1889, he strove over the colour rendition of this picture, but for facial modelling by 'naturally broken 'preferred the canvas done from nature [over tones' upon a 'complexion [of] chrome a later copy] ... [because it] makes me recall yellow' and hoped, above all, to paint a 'lull­ the furnace of summer ... it is not so exag­ aby in colours' (letter 571a). Here, and else­ gerated after all' (letter 608). where, the artist invokes a deeper emotional language as well as a new visual technique; the Conclusion preoccupation is with colour. Furthermore, An extensive search of the literature revealed Vincent had earlier embraced 'the artist's lib­ several chemical and physical precipitants of erty to exaggerate, to create ...a world more xanthopsia. Some of these are reasonable beautiful, more simple, more consoling than candidates for Vincent van Gogh, but none ours'; in this artistic licence he claimed no can be supported in depth. We obviated natu­ originality but embellished a prefatory state­ ral ageing of the lens because of Vincent's ment from Maupassant's 'Pierre et Jean' (let­ youth and short career span. Digitalis intox­ ter 470). And elsewhere there is ample ication has sufficient medical underpinning evidence from van Gogh himself to indicate but lacks usage documentation. They physio­ that he was prepared occasionally to depart logical case for overdosage on santonin is as from 'exact' colour (letter 533). His colour good or better than that for digitalis, but the selections for 'The Night Cafe' were sub­ evidence is still circumstantial (Raspail's book sequently described by Vincent as achieving and the terpene connection). Other chemical an '[expression of] the terrible passions of insults are known to induce xanthopsia, but humanity by means of red and green' (letter no relationship could be established with van 533). The disparate reds, greens, orange, and Gogh. Sunstroke does not fit the multiplicity yellows meant, 'an atmosphere like a devil's of motifs or locations for the yellow paintings. furnace' (letter 534). It is interesting to com­ Only a minority of the paintings may have pare Gauguin's rendition of the same room, been directly influenced by absinthe-induced 'In an Arles Cafe', 1888, for the application of hallucinations. Irreversible brain damage a cooler palette. from absinthism is not supported by the epi­ Van Gogh apparently found the Midi a per­ sodic nature of the yellow paintings. Artistic fect environment for his study of colour. preference remains the best working hypoth­ Although the subjects of people and land­ esis to explain the yellow dominance in his scapes were similar in character to Holland, palette, a position which is upheld by his 'the difference [was] in the colour' (letter stated philosophy. 488). 'How lovely yellow is! And how much better I shall [later] see the North!' (letter References 1 His preference can be gauged from let­ Hemphill RE: The illness of Vincent van Gogh. 522). Proc R Soc Med 1961,54: 1083-88. ters (1887-1890) wherein he mentions the 2 Lee TC: van Gogh's vision: digitalis intoxication? yellow of his surroundings more than any JAm Med Assn 1981,245: 727-9. 510 WILFRED NIELS ARNOLD AND LORETTA S. LOFTUS

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