the book of judith is a deuterocanonical book of the septuagint and catholic and eastern orthodox christian old testament of the bible . it narrates the story of the beautiful jewish widow judith who saved her city of bethulia from the siege of holofernes , a general of the assyrian king nebuchadnezzar . according to the story in the manuscript , after a banquet at which the general had been drinking , the heroine entered holofernes tent and then seduced and killed him . she beheaded him and presented his head to his fellow citizens ( judith 10:13 ) . many artists have immortalized the scene of the decapitation , with the heroin holding the sword on the neck of holofernes whilst lying on the bed , and the scene with judith carrying the head of the general as a trophy beside his headless body , often assisted by her maidservant . a systematic reappraisal of the works representing the bloody scene of judith and holofernes has revealed 24 portraits in which judith is depicted with variable degrees of thyroid gland enlargement . however , there are no spectroscopic or radiographic images available or any written documents attesting the intention of the painters . therefore , the presence of the goiter can only be judged by an inspection of the portraits . twenty - four portraits constitute the subject of this review , with particular focus on the neck of the models . the works representing the story of judith and holofernes were depicted by 21 painters of various nationalities belonging to the renaissance , mannerist , baroque , and later artistic movements and were included in the present investigation . for the purpose of illustration , the 24 depictions of judith in which the goiter is visible are combined as panels [ figures 14 ] . ( a ) judith with the head of holofernes ( c. 1575 ) , by jan massys , oil on panel , 115 cm  80.5 cm , ( from the royal museum of fine arts , antwerp , belgium ) ( b ) judith with the head of holofernes ( c. 1550 - 75 ) , by vincent sellaer , oil on panel , 60.5 cm  44.4 cm , ( from the davis museum and cultural center , wellesley , massachusetts , usa ) ( c ) judith and holofernes ( 1540 ) , by jan sanders van hemessen , oil on panel , 99.1 cm  77.2 cm , ( from the art institute , chicago , illinois , usa ) ( d ) judith with the head of holofernes ( c. 1540 - 50 ) , by girolamo da carpi ( girolamo sellari ) , oil on panel , ( from the alte pinakothek , munich , germany ) ( e ) judith ( c. 1548 - 51 ) , by lambert sustris , oil on canvas , 95 cm  113 cm , ( from the palais des beaux - arts de lille , france ) ( f ) judith with the head of holofernes ( c. 1562 ) , by lorenzo sabatini , oil on canvas , 110 cm  85 cm , ( from the banca del monte di bologna e ravenna , bologna , italy ) ( a ) judith and her maidservant with the head of holofernes ( c. 1520 - 30 ) , by guido reni , oil on canvas , 234 cm  150.3 cm , ( from galleria spada , rome , italy ) ( b ) judith and holofernes ( a copy from original of guido reni ) ( 1625 ) , by carlo maratta , oil on canvas , 110 cm  85 cm , ( from the musei capitolini , rome , italy ) ( c ) judith and holofernes ( c. 1610 - 40 ) , by sigismondo coccapani , oil on canvas , 99 cm  76.2 cm , ( from private collection ) ( d ) judith with the head of holofernes ( c. 1605 - 10 ) , by giuseppe cesari aka cavalier darpino , oil on canvas , 48 cm  61.3 cm , ( from the berkeley art museum , ucla , berkeley , california , usa ) ( e ) judith and holofernes ( c. 1600 - 20 ) , by antiveduto grammatica , oil on canvas , 190 cm  159 cm , ( from the derby museum and art gallery , derby , england , uk ) ( f ) judith with the head of holofernes ( c. 1610 - 15 ) , by carlo saraceni , oil on canvas , 90 cm  79 cm , ( from the kunsthistorisches museum , vienna , austria ) ( a ) judith and her maidservant ( 1608 - 9 ) , by orazio gentileschi , oil on canvas , 160 cm  136 cm , ( from the nasjonalgalleriet , oslo , norway ) ( b ) judith and her maidservant ( 1610 - 12 ) , by orazio gentileschi , oil on canvas , ( unknown location ) ( c ) judith and her maidservant ( 1613 - 4 ) , by artemisia gentileschi , oil on canvas , 114 cm  93.5 cm , ( from the palazzo pitti , florence , italy ) ( d ) judith and her maidservant with the head of holofernes ( c. 1623 - 5 ) , by artemisia gentileschi , oil on canvas , 184 cm  141.6 cm , ( from the detroit institute of arts , detroit , michigan , usa ) ( e ) judith slaying holofernes ( c. 1614 - 20 ) , by artemisia gentileschi , oil on canvas , 158.8 cm  125.5 cm , ( from the museo capodimonte , naples , italy ) ( f ) judith ( 1678 ) , by eglon van der neer , oil on oak , 32 cm  24.6 cm , ( from the national gallery , london , uk ) ( a ) judith and her maidservant with the head of holofernes ( c. 1710 ) , by giovanni antonio pellegrini , oil on canvas , 124.7 cm  102 cm , ( from the barber institute of fine arts , university of birmingham , birmingham , england , uk ) ( b ) judith with the head of holofernes ( c. 1730 ) , by giuseppe marchesi , oil on canvas , 149 cm  116.5 cm , ( from the pinacoteca nazionale , bologna , italy ) ( c ) judith and holofernes ( c. 1730 ) , by giulia lama , oil on canvas , 107 cm  155 cm , ( from the gallerie dellaccademia , venice , italy ) ( d ) judith and her maidservant with the head of holofernes ( unknown ) , by venetian school , oil on canvas , ( unknown location ) ( e ) judith with the head of holofernes ( 1695 ) , by giovanni gioseffo dal sole , oil on canvas , 109 cm  90 cm , ( from the minneapolis institute of arts , minnesota , usa ) ( f ) judith ( c. 1840 ) , by august riedel , oil on canvas , 131 cm  96 cm , ( from the neue pinakothek , munich , germany ) goiter was depicted very frequently in works from countries in which iodine deficiency was endemic , and it was only sparsely portrayed by painters living in areas where goiter was not common . the present investigation aimed to shed further light on the presence of goiter in the works of painters from different regions depicting the beheading of holophernes by judith . it seems unrealistic that the artists inadvertently depicted the goiter unaware of the underlying pathological condition because of their high reputation . however , there may be many other reasons as to why these painters included thyroid enlargement in their depiction of the subjects . from the renaissance era onward , painters have been in pursuit of life - like portraits , which led them to study the exact anatomy of the human body . indeed , because the neck is one of the visible areas of the body , it became an important focus of attention as well as a decorative element , almost as important as the face . it is difficult to explain the inclusion of goiter in many portraits of judith based on the geographic origin of the models , the artists being from various areas , not all with iodine - deficiency . it seems restrictive to suppose that the integration of the goiter was only part of the renaissance tendency toward a more realistic and precise representation of the subjects or that it was a peculiar hallmark of a precise artistic movement . indeed , several painters across centuries included in this investigation belong to different artistic waves . there is no reason why the painters should have used models affected by a swelling of the neck linked to autoimmune postpartum thyroiditis or familial thyroid dyshormonogenesis to immortalize the scene of judith . moreover , the hypothesis that the goitrous gland was portrayed to arouse pity or revulsion , to mock the represented subject , to present an biographical self - portrait feature , or to indicate a lower social status is not likely in the thematic depictions of judith . an analysis of the evolution of the figures of judith in the history of art may be useful for our purpose . indeed , in the early christian era , judith was depicted as a cast woman considerably far from being sexual or violent . it is from the renaissance era onward that the figure of judith took on an interestingly different meaning for many artists and scholars , and painters began to portray judith with a sexualized femininity , sometimes contradictorily combined with masculine aggression . during the baroque period , judith became a widespread subject of almost all the painters , and her character was portrayed as more overbearing and violent and idealized as a  threatening character to the artist and viewer . judith 's legend was used as a warning against the captivating dangers of beauty . she became an icon of female power after the renaissance , and although she was a legendary figure , she was mentioned in 1639 as one of the virtuous women in the masterwork of van beverwijck about the superiority of women to men . judith is described as  exceedingly beautiful  in the old testament ( judith 8:7 ) , and it is mentioned that  the lord increased her beauty , so that she appeared to all men 's eyes incomparably lovely  ( judith 10:4 ) . there is no doubt that the inclusion of goiter in the paintings herein is a stylistic representation . indeed , apart from the almost accurate documentation of goiter by the artists , the sitters in our investigation failed to show further signs or symptoms related to hyperthyroidism or hypothyroidism . the figures 1a2c and f , 3d and f , 4b  f show a low - to moderate - grade swelling of the neck without any other physical signs of thyroid disease . the painters may have depicted a slight enlargement of the neck as a stylistic hallmark and they may have done this with the purpose of creating an idealized beauty with a more attractive neck . it is also possible that some of the artists were fascinated by strange physiognomies . in figures 2d and e , 3a c and e , 4a , a large extended goiter is presented , which may have been symbolic of a more masculine and stronger beauty rather than a delicate and graceful beauty . it would be difficult to say whether the artists intentionally added a large goiter to highlight aggressiveness and irritability , because a simple inspection did not reveal any sign of graves disease . on the contrary , the swelling in the eye pouch with slight periorbital and submandibular edema seen in figures 1e and f , 2d , 3b and c , 4c and e may be a forced interpretation of hypothyroidism . it is likely that we perceive as overweight at the present time what the artists used to perceive as beauty at that time . in all the paintings , the swollen neck , when combined with the rest of the body , perfectly reflect the qualities that the painters wanted judith to embody from the renaissance period  courage , ( dangerous ) female power , seduction , beauty and eroticism , physical strength , cunning , and intelligence . judith was a legendary hebrew heroine who saved the jewish people from the armies of the assyrian general holofernes . her depiction changed from early christianity to a recurrent model of civic virtue in the early renaissance , which was often mixed contradictorily with sexual , feminist , and ironic ( captivating danger of beauty ) themes . throughout this evolution , painters have used her story to highlight the dangerous power and style of women , reflecting the contemporary ambivalence toward the seductive wiles she used against holofernes . they tried to represent her courage and determination in plotting and beheading a drunk and besotted general . we can not entirely reject the claim that the artists used a few affected models for judith 's portraits . nonetheless , the inclusion of a slight thyroid enlargement may be most likely a stylistic hallmark that represents an idealized female beauty with balanced proportioning of the neck and a graceful quality to the body . the large extended goiter was probably depicted by the artists as a symbol of powerful masculine body and her courage , and at the same time , it probably also reflected the better anatomic accuracy and knowledge developed in that period .