A small Flemish panel, painted around 1513, shows an elderly woman in a horned headdress holding a half-opened rose. She has a flat nose, a protruding jaw, and skin that has thickened across her brow and chin. The painting has had four lives — Flemish moralising portrait, Leonardo grotesque exercise, John Tenniel's Alice in Wonderland Duchess, and finally medical diagnosis. The case of a painting that turned out to be a medical record.