Morality Play

Hieronymus Bosch (1450-1516), a Netherlandish artist, was a painter with a wild imagination. Many of his works, including his famous triptych The Garden of Earthly Delights (above), are populated with fantastic creatures, hybrid monsters, and demons. Deeply religious, even his seemingly secular works often have a moralizing tone. 

A sought-after artist in his own day, after his death Bosch’s fame continued to spread, helped by the rise of prints. In the sixteenth century in northern Europe, printmaking was becoming a major industry. Publishing houses, such Aux Quatre Vents in Antwerp, run by Hieronymus Cock, often produced prints after paintings by famous artists. Pieter Bruegel the Elder was employed by Cock, and created a number of prints inspired by the art of Bosch. Many prints, even if they had no direct connection to the artist, were still inscribed with the phrase “Hieronymus Bosch inventor” to capitalize on the artist’s popularity and marketability. 

This drawing, created by a follower of Bosch and housed in the Albertina Museum in Vienna, shows a series of disfigured characters. On the surface, the drawing appears to be quite playful, but, at the same time, it could also be read as a moralizing tale. The drawing dates from around 1530; later in the century similar-looking prints, featuring a number of crippled figures, were produced by Hieronymus Cock and his Aux Quatre Vents publishing house. One such print is labeled “Hieronymus Bosch drollen,” identifying the characters as fools.

Recent papers have attempted to diagnosis the conditions of the crippled characters. It has been suggested that the drawing may show people with leprosy, ergotism, or Pott’s disease (among other conditions). However, some art historians believe that these figures are not actually cripples at all, but people who are feigning disabilities in order to receive sympathy—and the alms and charity that come with it. The figure at the top left has a fox tail hanging from his waist, a common medieval symbol of suspicious or hypocritical behavior. On the other hand, the figure on one knee (top row, second from the right) is wearing a leper’s cloak, has a recent amputation above his right knee, and is wearing a cloth that is covering his face—perhaps to hide the disfigurement of the face that is common in untreated leprosy.

The stereotype of the leper is of body parts falling off. In reality, body parts and skin do not fall off patients with leprosy. Leprosy is caused by a bacterial infection by a cousin of the tuberculosis bug called Mycobacterium leprae. It is actually not very contagious in spite of its reputation (and the mistaken justification behind millennia of leper ostracization). In addition, it is treatable with a combination of antibiotics. The bug infects the skin and peripheral nerves. This causes a severe loss of sensation, including to pain. It turns out that pain is a very useful protective mechanism. Without it, and with, say, a small cut on your finger, you would continue to use your finger, rather than protecting it. This makes the cut worse and then prone to other skin infections. This in turn, if untreated, can lead to infection of the small bone of a finger tip. Over time, recurrent infections, especially of bone, can lead to scarring and then the slow wearing away of tissue—including skin and bone. Eventually, and over time, the ends of the fingers and toes erode and give the impression that they have fallen off.

The pattern of sensory loss on the skin yielded an important clue to the almost unique biology of M. leprae infection. Careful examination of patients with the disease demonstrated that the sensory loss tended to occur in places where the temperature of the skin is lowest: back of the hand (rather than the palm), ears, nose, and so on. Places that had preserved sensation tended to be warmer—like the inside of the elbow and groin folds. It turns out the M. leprae grows best in cooler temperatures. In the warmer parts of the skin, the bacteria did not grow as well, sparing the small nerves in the skin, and so the sensation. Dr. Thomas Sabin made this clinical discovery in 1969, following meticulous examination and documentation of many patients with leprosy who were housed at the “United States Marine Hospital Number 66” which was the National Leprosarium of the United States in Carville, Lousiana. Dr. Sabin is still teaching residents and seeing patients as a Professor of Neurology, at Tufts Medical Center.