Rheumatology Advance Access originally published online on September 2, 2005
Rheumatology 2005 44(11):1464-1465; doi:10.1093/rheumatology/kei096
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LETTER TO THE EDITOR |
Re: Style versus substance in artistic depiction
Northeastern Ohio Universities College of Medicine, 5500 Market, Youngstown, OH 44512, USA
Correspondence to: bmr{at}neoucom.edu
SIR, Appelboom [1] suggests artistic rendition of rheumatoid arthritis by Rubens, predicated upon identification of swan-neck deformity and metacarpophalangeal and proximal interphalangeal joint swelling. While I did not recognize a swan's neck deformity in The Three Graces, the proximal and distal interphalangeal joint swelling in The Miracle of St Ignatius of Loyola is impressive. The prominent nodular appearance of those interphalangeal joints seems, however, more in keeping with a diagnosis of severe osteoarthritis of the hands. I was unable to determine whether apparent slight metacarpophalangeal joint swelling might simply be a visual artefact related to positioning of the hand.
The real challenge, however, is distinguishing substance and style [2, 3]. Do the renditions of Rubens accurately depict disease phenomena (as Appelboom suggested for The Three Graces in 1987) [4] or are they simply stylistic, as suggested by Louie's analysis of the work of Renoir [3]? The conference that Appelboom chaired in 1987 provided great insights to the difficulties of distinguishing style and substance and did much to advance perspectives of this problem [4].
Leonardo da Vinci is perhaps considered one of the most accurate illustrators of his time. His depictions of an in situ fetus in RL19101r, K/P 197v from the Royal Collection (also known as ‘Illuminismo’) provides important insight [5]. The apparent metacarpophalangeal joint and irregular finger swelling must be stylistic, as actual fetal disease of this nature is unknown. If some of Leonardo's renditions are stylistic, how can the work of other artists be confidently attributed? As Appelboom noted, confident historical documentation is obtained from examination of the skeleton [1]. Such analysis documented rheumatoid arthritis as a North American disease with only relatively late penetrance into Europe [6, 7]. Appelboom's appropriate placement of a question mark at the end of the title of his article [1] highlights his attention to the style–substance question.
The author has declared no conflicts of interest.
References
- Appelboom T. Hypothesis: Rubens—one of the first victims of an epidemic of rheumatoid arthritis that started in the 16th–17th century? Rheumatology 2005;44:681–3.
[Free Full Text] - Philippot P. Stylistic and documentary understanding of fine arts. In: Appelboom T, ed. Art, history and antiquity of rheumatic diseases. Brussels: Elsevier, 1987:12–6.
- Louie JS. Renoir, his art and his arthritis. In: Appelboom T, ed. Art, history and antiquity of rheumatic diseases. Brussels: Elsevier, 1987:43–5.
- Appelboom T, Preaux T. Rubens' rheumatism approached by his correspondence and painting. In: Appelboom T, ed. Art, history and antiquity of rheumatic diseases. Brussels: Elsevier, 1987:41–2.
- Anon. Rappresentare il corpo. Arte e anatomia da Leonardo all'Illuminismo. Bologna: Bononia University Press, 2004:240.
- Rothschild BM, Turner KR, DeLuca MA. Symmetrical erosive peripheral polyarthritis in the Late Archaic period of Alabama. Science 1987;241:1498–501.
- Rothschild BM. Rheumatoid arthritis at a time of passage. J Rheumatol 2001;28:245–50.
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