Rhinoscleroma

Monogrammist N.N.
1645-1658
Artist from the Netherlands

♦ Old man with a growth on his nose ♦

This unidentified man with a growth on his nose is, judging by his attire (a black skirt, grayish-yellow fur, and a gousen medal), likely a nobleman.

♦ Diagnosis
Main symptoms: Large, flat, and hard swelling of the nose.
Secondary symptoms: An elderly man, richly dressed.
Clinical diagnosis: Rhinoscleroma

♦ Definition: rhinoscleroma
A new growth, almost as hard as stone, affects the nostrils and surrounding areas. The disease begins in the skin of the nasal vestibule and around the nostrils. The lesions consist of flat, isolated, or fused nodules.

♦ Discussion
The diagnosis of rhinoscleroma for the nasal growth depicted in this painting in Stockholm was first proposed in 1923 by E. Hollander in his book *Die Medizin in der Klassischen Malerei* (pp. 260–261).
Today, rhinoscleroma is endemic. The disease predominantly affects individuals living in underdeveloped rural regions of Central Europe, Africa, Indonesia, Egypt, and Central America.
It is caused by Klebsiella rhinoscleromatis, a gram-negative bacterium.
The Polish physician Johann von Mikulich described its histological features in 1877, von Frisch identified the organism in 1932, and Belinov proposed the use of the term scleroma respiratorium, because the pathological process in rhinosclerosis affected not only the upper but also the lower respiratory tract. In 1961, Steffen and Smith demonstrated that Klebsiella rhinoscleromatis conformed to Koch's postulate and was an etiological factor in the typical inflammatory manifestations of scleroma. In 1890, the German physician and bacteriologist Robert Koch established the criteria for determining whether or not a particular bacterium was the cause of a given disease. Koch's criteria brought much-needed scientific clarity to what had hitherto been a very confused area of ​​medicine. In doing so, he succeeded in proving the etiology of anthrax and tuberculosis.

Koch's postulates were as follows:
- the bacterium must be present in every case of the disease
- the bacterium must be isolated from the host of the disease and cultured in a pure culture
- the specific disease must reappear when a pure culture of the bacterium is inoculated into a healthy, susceptible host
- the bacterium must be obtainable again from the experimentally inoculated host

Source: Jan Dequeker

Jan Dequeker
The artist and the doctor look at paintings.

Photo
wikipedia.org

Loes van Damme
MMIZ
ErasmusMC
Rotterdam