Post on 26-Aug-2020
The Virgin with the Canon Visual disability and societal attitudes as
depicted in the Northern Renaissance
Louis Clearkin
Consultant Ophthalmic Surgeon
Wirral UTH NHS FT
Temporal Arteritis; le maladie de Horton
Bayard Taylor Horton (1895-1980)
• 1932 “definite clinical syndrome…. fever, weakness, anorexia, loss of weight, anemia, mild leukocytosis, and painful, tender areas over the scalp and along the temporal vessels. present for from four to six weeks.”
• chronic periarteritis and arteritis. necrosis of the media …replaced by a granuloma…numerous giant cells.
• 1937 cluster headache
Major-General Sir David Bruce
KCB FRS FRCP FRCS (1855 -1931) • Poly Myalgia Rheumatica
• good health then abrupt onset
• severe pain and stiffness shoulder and hip – difficulty rising from a chair,
– turning over in bed
– raising the arms
• morning stiffness
• protracted ..resulting in disuse atrophy.
• Carpal tunnel syndrome
centre - Sir David Bruce;
the physician responsibilities
• diagnosis 1. History
2. Examination
3. Differential diagnosis
4. tests to refine (3)
Tailored & Parsimonious
• prognostication
• management – Agree treatment
• Set out alternatives
• Material risks and benefits of each
• autonomy
– Manage complications
– In 82% medical history provided enough information to make an initial diagnosis …which agreed with the one finally accepted
– Physical examination added only 15% of diagnoses
– In only 8.75% did the investigations change the diagnosis …reached after history ..and ..examination.
– investigations changed predicted management in 17.5%
• Relative contributions of history-taking, physical examination, and …investigation to diagnosis and management. (BMJ (1975) 2, 5969: 486-489)
Jonathan Hutchinson (1890) Arch Surgery
• “streaks on his
head..prevented him
wearing his hat
..temporal arteries
inflamed and swollen…
pulsation freely
detected..finally ceased…
..lived several years without
other arterial disease”
The Tadhkirat of Ali ibn Isa (c. 940-1010 AD)
• In 1988 Ross recognised Temporal Arteritis from
Casey Wood 1936 translation
• "On Excision of Arteries and their Cauterization;
one treats not only migraine and headache in
those patients ….including those showing heat
in and inflammation of the temporal muscles.
These diseased conditions may terminate in loss
of eyesight….".
Iconography of Blindness Prof Will Ayliffe Gresham College May 2014
• “spectacles, particularly with dark lenses,
• Blind eyes depicted as closed, whitened or asymmetrical.
• hollowed out sockets or eye being touched
• the stance of the subject ... painted with arms held out feeling their way around, with an unsteady gait
• ..with an uplifted head
• or wearing a broad brimmed hat.”.
Tomb of Pa-Aton-Emb-Heb
(1350 BC)
Canon van der Paele;
signs of Temporal arteritis & PMR
– temporal arteries inflamed and swollen.
– loss of hair in front of the left ear
– spectacles shown but discarded
– He alone looks up
– Divergent • longstanding visual loss
– holding up his breviary with difficulty
Grief
The full sadness expression
• Inner corners of
eyebrows drawn up
• Skin below eyebrow
triangulated
• Upper lid raised
• Corners of lips down
St Martin: 15th Century-
Smithsonian
The Romance of Alexander
Jehan de Grise 1339
La Messe de
fondation de l'ordre
des Trinitaires Juan CARREÑO DE MIRANDA
(Avilés, 1614 - Madrid, 1685)
The Merchant’s tale
• She seith nat ones "nay," whan he seith "ye”
• A man may do no synne with his wyf,
• thynges whiche that were nat doon abedde,
• Damian / Gan pullen up the smok, an in he throng
• He swyved thee, I saugh it
with myne yen
Brothels in Bruges (1870)
beguinage
Canon van der Paele
• 1420 retires from Diplomatic
Offices
– Master of The Matins
St Donatian’s Cathedral Bruge
• 1431 Illness
• 1434 retired but retained incomes
– Founded 1st chaplaincy St Donatian’s
• Commissioned Van Eyck
– Founded “perpetual” chaplaincy
Bruges
• 1436 Painting finished
• 1438 Papal approval of bequests
• 1441 Founded 2nd chaplaincy St
Donatian’s
• 1443 died
Kobler-Ross Grief Cycle
In order, the stages are:
1. Shock
2. Denial
3. Anger
4. Desperate
Bargaining
5. Depression
6. Testing
Acceptance
Arnolfini Double Portrait - 1434
Rollin’s purse
St George – 275 - 303
Van Eyck – Ghent Altarpiece 1427
Rembrandt The Blinding of
Samson
St Donatian 8th Bishop of Reims
martyr 390
as a child he was
thrown into a river,
a holy man took five
candles and placed
them on a water
wheel to showed
where the child had
gone, and he was
able to recover the
child
The End