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A figurine of Pulcinella with his mask

Physician unravels cause of deformities of famous Punch character

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The disease that causes the bodily deformations of the Pulcinella character (Punch in Britain) have been the subject of speculation among doctors since at least the 19 th century. Pulcinella’s humped back, hooked nose, squeaky voice and paunch are as much his trademark as his angry, lazy, physically abused persona.

In the late 19 th century and again in 1996, doctors speculated that Pulicnella, a Commedia dell’Arte character of the 16 th century with roots in ancient Rome, suffered from acromegaly. This condition includes the humped back and paunch but also enlarged feet, hands and face and emotional disturbances. Acromegaly is caused by overstimulation of the pituitary gland by a tumor and release of too much growth hormone.

Now come Doctors Emanuele Armocida of the University of Bologna along with Thomas Böni, Frank J. Rühli and Francesco M. Galassi with a letter to the editor of the European Journal of Internal Medicine published in November 2015. They say perhaps Pulcinella did not suffer from acromegaly alone.

They write that British academic David Bryson’s 1996 paper describing Pulcinella as acromegalic “seems rather incontestable” but add that “there are still some inconsistencies in the medical characterization which provide grounds for a differential diagnosis.”

First, they say, enlarged extremities are one of the most striking manifestations of acromegaly, but they are not always present in the depictions and representations of the character.

Second, Pulcinella has a shrill, nasal, high-pitched voice, while many acromegalic patients have husky or low-pitched voices. They say his squeaky voice could be because of hypogonadism—or a reduced or absent secretion of testosterone from the testicles, which is found in about 50 percent of patients with acromegaly. Hence, the doctors write, we have Pulcinella’s name, which has been translated as “little chicken.”

But the main point of their letter is to say that Pulcinella’s humped back and other pathologies may also indicate he suffers from tuberculosis.

Punch onstage in Adelaide, Australia

Punch onstage in Adelaide, Australia (Photo by chazzvid/Wikimedia Commons)

“In conclusion, while acromegaly could explain much of the pathology involved in the ‘caricaturo-poiesis’ of the Pulcinella mask, that diagnosis may not be regarded as the sole definitive and all inclusive,” the doctors wrote. “Substantial overlap between the signs and symptoms suggests that tuberculosis may well be involved and have similar deforming effects on the skeleton account for the most patent traits of the discussed character. It may not be excluded that an association of these two diseases—tuberculosis potentially complicating a pre-existing acromegaly, or, though rare, TBC bacilli colonizing the pituitary gland and triggering acromegaly—could have played a role in the mask’s anatomopathogical origins before transformation into myth.”

An excerpt from Jolly Good Productions’ Punch and Judy show: “Mr. Punch did you drop the baby?” “No.” “You have been a very naughty boy. Shall I give him a punch, everyone?” “Yay!” From the video, children still seem to adore the Punch and Judy shows.

The Life In Italy website has an analysis of Pulcinella for those who aren’t familiar with him:

“Apart from being a very famous Carnival mask, what makes Pulcinella really interesting are his social and cultural components: … Pulcinella is a lazy and sneaky servant, who walks in an awkward way, gesticulates excessively and tends to show his happiness by outlandishly dancing, hopping and shouting. He likes living life day by day, exploiting every situation, often pretending to be poor, or rich or a thief, depending on what his aims are. He is spontaneous, simple, friendly, funny, talkative, adventurous, melancholic, feisty and very unreliable.

“… He represents metaphorically the conditions of Naples' lower classes, who rebel against the aristocracy after having been abused and humiliated. He delivers, indeed, quite a strong social message to his public. What makes him so popular and special, though, is the way he decides to rebel: with irony and a smile on his face.”

For articles about Pulcinella Cetrulo ( citrulo means stupid), Commedia dell’Arte and its other characters, see

Pulcinella became Mr. Punch of the violent and naughty Punch and Judy shows, which used to be wildly popular in Britain and still draw appreciative audiences. Punch beats to death the characters one by one as they come on stage with him. Pulcinella has other names across Europe, including Polichinelle in France, Petrushka in Russia and Karagoz in Turkey.

For an interesting article and podcast about the British tradition of Punch with historical references, see this page at Counter Currents.

Featured image: A figurine of Pulcinella with his mask (Photo by mari27454/Wikimedia Commons)

Mark Miller's picture


Mark Miller has a Bachelor of Arts in journalism and is a former newspaper and magazine writer and copy editor who's long been interested in anthropology, mythology and ancient history. His hobbies are writing and drawing.

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