Crutch art painting in the middle age as orthopaedic heritage (part I: the lepers, the poliomyelitis, the cripples).

Throughout time from antiquity, the major objective of crutches was to restore, as close as possible, the functional capacity formerly held by a limb deficient person. The crutch is probably the oldest tool of the orthopaedist. It is probably also the most neglected in terms of progress from antiquity until the 20th century. The aim of this paper is to give a view of the different crutches used in this period by different people and to observe the influence of this period on the progress of the design of crutches.

The plague of the Philistines and other pestilences in the Ancient World: exploring relations between the religious-literary tradition, artistic evidence and scientific proof.

In ancient times the term pestilence referred not only to infectious disease caused by Yersinia pestis, but also to several different epidemics. We explore the relations between references in the Bible and recent scientific evidence concerning some infectious diseases, especially the so-called Plague of the Philistines and leprosy. In addition, some considerations regarding possible connections among likely infectious epidemic diseases and the Ten Plagues of Egypt are reported. Evidence suggesting the presence of the rat in the Nile Valley in the II millennium BC is shown; a possible role of the rat in the plague spreading already in this historical period should be confirmed by these data. While the biblical tale in the Book of Samuel may well report an epidemic event resembling the plague, as to date this infectious disease remains unknown, it is not conceivable to confirm the presence of leprosy in the same age, because the little palaeopathologic evidence of the latter disease, in the geographic area corresponding to Egypt and Palestine, is late, dating back only to the II century AD.

Skin disease in antiquity.

Dermatological conditions and treatment in antiquity can be assessed by studying ancient skin, artefacts illustrating medical disorders and literature from the classified period as well as Egyptian papyri, cuneiform tablets and the Bible. It is often more useful and informative to study naturally preserved skin rather than artificially mummified skin. Great care must be taken in making retrospective diagnosis. Skin manifestations of internal diseases are, and have always been, of the greatest clinical importance. Study of the past may give an insight into the epidemiological aspects of diseases such as TB, leprosy and syphilis which have spread across the world with serious social consequences.

The image of a leper (?): a paradigm of hidden fears of contagious diseases (exemplified in a wall painting of Saint Elizabeth of Hungary).

This is a brief study on the popular ideas about leprosy based on an 18th century wall painting in north-western Croatia portraying Saint Elisabeth healing a sick man, possibly a leper. The analysis uses examples from the history of medicine, semantics, toponymy and iconography.

[Space perception: the history and its significance for art]. / Rumperceptionen, dens historie og betydning for kunsten.

Some aspects of the opthalmologic history of Denmark are briefly mentioned. Lens extraction in 1667 in Copenhagen, Edmund Hansen Gruts stereoophtalmoscopy in 1857, Ludvig Panums area in 1858 (single vision) space perception and outside this area double vision), squint treatment, Marius Tschernings periscopic spectacle lenses, Henning Rønnes stereoortograph and keiroscope and Gerhard Rønnes stereoscope. Space perception depends mostly on binocular function (convergens), but in fact some space perception occurs in vision due to perspective, accommodation, parallaxe, blurring, colours and shadows. The Danisk Poet, Hans Christian Andersen, has in his novels mentioned latent squint. The German poet Rainer Maria Rilke was much interested in perspective in connection with the development of impressionism, especially Paul Cézanne. Rilke in his later period developed the view that concentration on perspective removed those essential aspects from the world, in which he found God or a fourth dimension, as exemplified in the presence of ghosts.

The image of a leper (?): a paradigm of hidden fears of contagious diseases (exemplified in a wall paitung of Saint Elizabeth of Hungary)

This is a brief study on the popular ideas about leprosy based on an 18th century wall painting in north-western Croatia portraying Saint Elisabeth healing a sick man, possibly a leper. The analysis uses examples from the history of medicine, semantics, toponymy and iconography.

Hieronymus Bosch (1450-1516): paleopathology of the medieval disabled and its relation to the Bone and Joint Decade 2000-2010.

BACKGROUND: At the start of the Bone and Joint Decade 2000-2010, a paleopathologic study of the physically disabled may yield information and insight on the prevalence of crippling disorders and attitudes towards the afflicted in the past compared to today. OBJECTIVE: To analyze "The procession of the Cripples," a representative drawing of 31 disabled individuals by Hieronymus Bosch in 1500. METHODS: Three specialists--a rheumatologist, an orthopedic surgeon and a neurologist--analyzed each case by problem-solving means and clinical reasoning in order to formulate a consensus on the most likely diagnosis. RESULTS: This iconographic study of cripples in the sixteenth century reveals that the most common crippling disorder was not a neural form of leprosy, but rather that other disorders were also prevalent, such as congenital malformation, dry gangrene due to ergotism, post-traumatic amputations, infectious diseases (Pott's, syphilis), and even simulators. The drawings show characteristic coping patterns and different kinds of crutches and aids. CONCLUSION: A correct clinical diagnosis can be reached through the collaboration of a rheumatologist, an orthopedist and a neurologist. The Bone and Joint Decade Project, calling for attention and education with respect to musculoskeletal disorders, should reduce the impact and burden of crippling diseases worldwide through early clinical diagnosis and appropriate treatment.

Oropharyngeal leprosy in art, history, and medicine.

Advanced lesions of the face, nasopharynx, and oropharynx have played an important role in the medical and social history of Hansen's disease. Renaissance artists included detailed portrayals of these lesions in some of their paintings, a testimony not only to their artistic skill and powers of observation but also to the common presence of these patients in European cities and towns of the period. The disease is now understood as a broad immunologic spectrum of host responses to Mycobacterium leprae, with a variety of clinical and pathologic manifestations in nerve, soft tissues, and bone. This review incorporates the findings of 2 extraordinary studies (one from Europe and the other from Japan) of pharyngeal and facial lesions. In the 1950s, studies of skeletal remains from the churchyard of a Danish leprosarium revealed a triad of maxillofacial lesions unique to leprosy and designated facies leprosa. In pre-World War II Japan, before effective treatment had been discovered, a prominent otorhinolaryngologist studying oropharyngeal and nasopharyngeal lesions prepared watercolor illustrations of the natural progression of untreated Hansen's disease. As a result of effective antimicrobial therapy, such advanced lesions are now rarely seen, but the presenting signs and symptoms of leprosy still occasionally arise in the nasal and oral mucosa. The nasopharynx and oropharynx may be important early sites of inoculation and infection by M leprae, and they require additional emphasis in worldwide efforts toward early diagnosis and treatment of Hansen's disease.

Traditional pharmacology and medicine in Africa. Ethnopharmacological themes in sub-Saharan art objects and utensils.

Drawing from the general description that ethnopharmacology studies the human use of crude drugs and poisons in a traditional context, ethnopharmacological themes in native art can be defined as themes visualizing different features of traditional medicines and poisons, such as natural sources, methods of preparation, containers, usage and implements, target diseases and effects. This review documents that native African art objects and utensils are a goldmine of such ethnopharmacological themes by focusing on the following subjects: (a) objects related to the use of medicines (sources as well as tools for their collection, preparation and keeping); (b) objects related to the use of poisons (e.g. for ordeals, hunting and fishing); (c) objects related to the use of psychotropic agents (e.g. alcoholic beverages, kola nuts, smoking and snuffing materials); (d) pathological representations (e.g. treponematoses, leprosy, smallpox, swollen abdomen, scrotal enlargement, goiter and distorted faces); and (e) portrayals of certain types of treatment (e.g. topical instillations, perinatal care, and surgery). To avoid the impression that ethnopharmacology has little else to offer than armchair amusement, an epilogue outlines the medical relevance of this interdisciplinary science for Western and African societies.