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.


CONCLUSIONS
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.
Dequeker
J
J
Department of Rheumatology, University Hospital, Leuven, Belgium. jan.dequeker@med.kuleuven.ac.be
Fabry
G
G
Vanopdenbosch
L
L
D001847:Bone Diseases / Q000266:history*; D006233:Persons with Disabilities / Q000266:history*; D005197:Famous Persons; D005260:Female; D049668:History, 15th Century; D049669:History, 16th Century; D006801:Humans; D007592:Joint Diseases / Q000266:history*; D008297:Male; D008488:Medical Illustration / Q000266:history; D008512:Medicine in the Arts; D010164:Paleopathology / Q000266:history