218 • Jan Dequeker 



Figure 6. St. Blankaart: Front page of book on podagra and 

 gout. The young man sitting in a wheelchair has an ankylosed 

 back and knee joint. 



Ankylosing spondylitis 



During my search for rheumatic diseases in visual arts I have 

 encountered only one example of possible ankylosing spon- 

 dylitis. In the front page of the work of St. Blankaart (1684) 

 "Van het podagra en vliegende jigt" on podagra and gout, a 

 young male sits with a stiff back in a wheelchair with an- 

 kylosed knee and possibly ankylosed hip, while another male 

 sits in a chair with a walking stick near a fire (Figure 6). Of 

 the other two patients, one lying in bed is being bandaged 

 around the legs and receiving medicine in a spoon, while the 

 other in the foreground is undergoing cauterizations at his 

 knee. Although they all seem to suffer from rheumatism, it is 

 only the one in the wheelchair who can be identified as a 

 probable case of ankylosing spondylitis. The others could be 

 polyarticular gout or any other rheumatic disease entity in- 

 volving one or several joints. 



Figure 7. Jan Van Eyck: The Virgin with the Canon (detail); 

 Bruges, Municipal Museum. Temporal arteritis — polymyal- 

 gia rheumatica. 



Polymyalgia rheumatica 



Indirect indications of polymyalgia rheumatica, a rheumatic 

 inflammation characterized by shoulder and hip girdle mus- 

 cle stiffness and often associated with temporal arteritis, are 

 seen in the painting by Jan Van Eyck (ca. 1385-1440) of the 

 Holy Virgin with Canon Van der Paele (Figure 7). The Canon 

 is clearly suffering from temporal arteritis, with scar forma- 

 tion and loss of hair of the eyebrow and in front of the left ear. 

 For the sake of completeness, it should be mentioned that he 

 also has a cellular mole and a sebaceous cyst on the left ear. 

 Historical data on Canon Van der Paele published in the 

 Canadian Medical Association Journal ( Dequeker 1 98 1 ) sup- 

 port my clinical diagnosis of polymyalgia rheumatica. Ac- 

 cording to the minutes of the cathedral chapter, he began 

 having difficulty in attending the morning service in Novem- 

 ber 143 1 . By the time the painting was done ( 1 434), the aging 

 Canon was forced to stay home, first in the morning and later 

 for the whole day, because of rheumatic pain with morning 

 stiffness, general weakness and ill health. This illness was 

 not fatal, however, and he survived the first symptoms for 12 

 years — a history compatible with the natural course of poly- 

 myalgia rheumatica. 



Zagreb Palcopaihology Symp I98S 



