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Margarete, Countess of Tyrol, or The Ugly Duchess, lived in the 14th Century. She was the duchess of Tyrol and princess of Carinthia. She has the dubious distinction of being considered by many to have been the ugliest woman in history. There are two famous portraits supposedly of Margaraete by Leonardo da vinci and Quentin Massys. However they may not be wholly accurate for two reasons, one being that they were painted at least 200 years after her death.

The other reason is that Margarete may not have been at all ugly. She was the daughter of Henry, the Duke of Carinthia and Count of Tyrol. She succeeded her father in the county of Tyrolean in 1335. In 1330 she was married at the age of twelve to John-Henry, the Margrave of Moravia. In 1341 she expelled her husband and was "wed" to Louis I, the Margrave of Bavarian. As a result of this civil marriage, Pope Clement VI excommunicated Margarete and her husband from the Church. The scandalous news spread across Europe and thereafter Margarete was branded "whore", and "ugly woman". Margarete died in 1361, just shy of her 51st birthday.

The reference to "ugly" may have referred entirely to Margarete's character upon her excommunication and not to her appearance. However the grotesque image of a duchess in the two portraits is suggested as possibly belonging to Margarete, perhaps as a mockery of her character. Whatever the truth, the woman who sat for the painting had to be very powerful and must have paid the artist a significant sum of money to do it, as it was unlikely that anyone else would have purchased it.

Whoever the woman in the portrait is (and if she did indeed exist), it is now believed that she suffered from a rare and advanced form of Paget's Disease, also known as osteitis deformans. The disease enlarged her jaw bones, extended her upper lip and pushed up her nose, giving her a distinctly apelike appearance. The disease also affected her hands, forehead and eye sockets.

Normally Paget's Disease affects the pelvic region and the femur. When it does affect the head it is usually just the cranium however in this case she must have suffered from a rare form that affected her entire face. Usually the disease does not appear until later in life so it is possible that the subject was an attractive woman before her symptoms appeared. Other than headaches and a damaged pituitary gland the woman likely suffered no other physical side effects of the disease.

John Tenniel, the illustrator for Lewis Carroll's text "Alice in Wonderland", made a caricature of The Ugly Duchess that is believed to be based on the two portraits painted by Da Vinci and Massys. However the chapter that included the Duchess was not part of the original text but rather was added to later versions of the story.

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