Paleopathology of rheumatism in paintings 



Jan Dequeker 



The pathology and history of rheumatism and especially of 

 rheumatoid arthritis are still poorly understood. Insight re- 

 garding the pathology may be enhanced through perspectives 

 provided by the history of disease. Short (1974), in his re- 

 view of the historical documents and reports published on 

 paleopathological specimens, was unable to find convincing 

 evidence for rheumatoid arthritis earlier than the 1 7th century 

 A.D. prior to Sydenham's description of the disease in 1676. 

 This observation led him and many others to speculate that 

 rheumatoid arthritis is a recent disease, perhaps reflecting 

 recent changes in the human environment. Thus the clarifica- 

 tion of the history of rheumatoid conditions in human popula- 

 tions is of considerable anthropological interest. 



Ankylosing spondylitis and some types of erosive poly- 

 arthritis were present from earliest times (Onner and Uter- 

 mohle 1981). A few examples of what could have been mild 

 rheumatoid arthritis have been discovered, but the prolifera- 

 tive, erosive disorders with spinal involvement (possibly 

 psoriasis or Reiter's syndrome) seem more common. Have 

 the rheumatic diseases changed? is rheumatoid arthritis diffi- 

 cult to identify? or is it a relatively recent disease? Because 

 the question remains open I have directed my interest in 

 paleopathology of rheumatism to paintings, which may dis- 

 close soft tissue evidence of diseases of ancient time, which 

 are poorly seen in skeletal remains (Dequeker 1977). The use 

 of the visual arts, for example paintings, as a tool for paleo- 

 pathology research has advantages and disadvantages which 

 should be kept in mind clearly. 



The advantage is that rheumatic diseases affect primarily 

 soft tissue (synovia, tendons and cartilage) and only sec- 

 ondarily after many months and years of disease can bone 

 lesions be detected. In paintings and sculptures the defor- 

 mities due to soft tissue swelling, tendon contractions, and 

 joint subluxations, resulting in discomfort and disabilities, 

 can be discerned and detected by an experienced clini- 

 cian. 



The disadvantage of visual arts is that the artists do not 

 necessarily make portraits of their subjects and may alter 

 anatomical characteristics according to their "feeling" at the 

 time of their work. While a visit to a museum may seem to 

 yield a rich trove of medical illustrations, things are not 

 always what they seem. Diagnostic acumen applied to paint- 

 ings can be misleading if not tempered with a knowledge of 

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artistic conventions (as mannerisms) and historical context 

 (Ehdich 1987). 



Taking into account the above restrictions, 1 have the priv- 

 ilege to study paintings made by famous Flemish medieval 

 artists who lived in the area where I practice my speciality of 

 clinical rheumatology. 



Paleopathological findings of rheumatism in paintings will 

 now be reported. The adage that one only sees what one 

 knows is certainly applicable to this field of research. A large 

 clinical background in rheumatology is necessary to recog- 

 nize early clinical features, and to put them in context to 

 make a firm diagnosis. 



Rheumatoid arthritis 



Perhaps the most convincing evidence of rheumatoid arthritis 

 in paintings is the arthritis of the housemaid of Jacob Jordaens 

 ( 1 593- 1 678) as seen in the painting of Jordaens's own family 

 (Figure 1). 



In order to convince people inexperienced in this field, I 

 have chosen a picture (Figure 2) of a hand of one of my 

 rheumatoid arthritis patients of about the same age, disclos- 

 ing the main features: swelling of the metacarpophalangeal 

 joints, the proximal interphalangeal joints, and the wrist. 

 This example of rheumatoid arthritis is sufficiently demon- 

 strative so that it has been chosen to illustrate the latest, 

 authoritative textbook of rheumatology in Great Britain 

 (Scott 1986). 



Another yet unpublished but very characteristic hand and 

 wrist deformity of rheumatoid arthritis is one I found recently 

 at the Escorial Museum near Madrid in the painting of an 

 anonymous artist of the Dutch school of the mid 1 5th or early 

 16th century. 



A number of other deformities resembling features seen in 

 rheumatoid arthritis have been discovered in the painting of 

 Jan Rombauts (ca. I5(X)) "Christ appearing to St. Peter" 

 (Leuven, Stedelijk Museum); in the portrait by Joos (Justus) 

 Van Gent (1430-1475) of Federigo de Montefeltre (Urbino, 

 Ducal Palace); in the drawing by Jan Van Eyck (ca. 141 1) of 

 John IV, Duke of Brabant; and in the painting "The Dona- 

 tors" (Brussels) (1525-1530) by Jan Gossaert, also called 

 Mabuse, showing flexion contraction of the second, foUrth, 

 and fifth finger of the left hand (Figure 3). 



Zagreb Paleopalhology Symp. IV8S 



