When Neurology Meets Art History: Tetanus (or Rabies) in a 19th-Century Painting (Neurology and Art)

A 19th-century painting by Franz Paczka, Un cas grave (La leçon de médecine; ca. 1875–1880), depicts a young girl supported by physicians in a striking clinical tableau suggestive of an acute neurological emergency. The scene shows generalized rigidity with cervical extension, abnormal upper-limb posturing, and a cloth placed at the mouth. A small wound on the left hemithorax is historically described as a dog bite. These elements invite a differential diagnosis between generalized tetanus and rabies. Tetanus is supported by the apparent sustained rigidity and possible jaw involvement, and remains biologically plausible after a dog bite through secondary environmental contamination of a devitalized wound. Rabies, recently proposed for this artwork, remains a strong alternative diagnosis, although several defining features such as hydrophobia/aerophobia, hypersalivation, and fluctuating agitation cannot be confidently inferred from a single static image. Rather than claiming diagnostic certainty, this iconodiagnostic analysis argues that the painting is best approached as a structured differential diagnosis exercise illustrating both the clinical reasoning prompted by visual clues and the methodological limits of retrospective diagnosis from art.