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Jusepe de Ribera
1591, Játiva, Valencia – 1652, Naples, Italy
Ribera was a pupil of Caravaggio, and this is evident in his paintings, which display an extremely naturalistic approach and feature the same ‘dark’ light with which he manages to portray his powerful, sculptural figures.
By casting a bright light on certain parts of the painting, he draws the viewer’s attention, whilst at the same time omitting carefully chosen elements and constructing his composition using simple schemes.
Ribera is primarily known as one of the most important painters of ascetic saints, hermits, heroic martyrs and old men with wrinkled faces, consumed by penance and suffering.
♦ The philosopher-writer ♦
♦ Diagnosis
Main symptoms: asymmetrical chest, swollen costal joints, depression above the costal margin, indented sternum.
Associated symptoms: young adult male
Clinical diagnosis: rickets-related chest deformity
♦ Definitie: rachitic chest
Abnormal chest development caused by a vitamin D deficiency, characterised by swollen rib joints – known as the ‘rickets rosary’ – indentations in the lower ribs (Harrison’s groove) and, in some cases, the sternum.
♦ Discussion
Rickets causes significant changes to the shape of the chest.
The active phase of rickets in children and infants results in the so-called ‘rickets rosary’, consisting of swollen rib joints. If the ribs are still soft and malleable during active rickets, they tend to grow inwards, particularly in the event of successive respiratory infections with bronchitis, which cause mild respiratory obstruction.
The chest wall is supported at the level of the costal margin by the viscera, and so a depression forms just above that margin, usually between the 5th and 8th ribs, with protruding edges of the costal margin itself. This deformity persists even after the rickets has been cured and is known as the Harrison’s groove.
Through a similar mechanism, the chest wall also sinks at the level of the costal joints. This often takes the form of an elongated depression running parallel to the sternum, which is usually deeper on the right-hand side than on the left, where the heart still provides some support. This deformity gives rise to what is known as ‘pigeon chest’.
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The condition is characterised by the young age – between 4 months and 3 years – at which it occurs, a history of malnutrition and minimal exposure to sunlight. In addition, other symptoms of rickets include: an enlarged and persistent anterior fontanelle, a protruding forehead, delayed teething, irregular positioning of the ribs, enlargement of the bone ends (epiphyses) at the wrists and ankles, and a swollen abdomen.
Rickets has virtually disappeared since the discovery of vitamin D in 1918 and the recognition of the importance of this vitamin, both in the diet (milk and fish oil) and through exposure to sunlight during childhood and later life. Fish oil was a popular remedy for rickets long before the disease was identified by doctors.
Rickets can also be seen in the painting The Virgin and Child (1509) by Hans Burgkmaier, 1473–1531
The child depicted exhibits the bow legs so typical of rickets, which develop from the moment the legs bear weight, as the child takes their first steps around their first birthday. Of course, one must consider whether there might be other causes for the bowing of the legs, such as Blaunt’s disease, hypophosphatasia or poorly developed bones (dysostosis).
Nevertheless, the degree and symmetry of the lateral curvature of the legs in this child unmistakably point to rickets.
Source: Jan Dequeker