School of History and Philosophy (Program in History of Medicine), University of New South Wales, Sydney, Australia.
Clin Exp Rheumatol. 2012 Jan-Feb;30(1):6-11. Epub 2012 Mar 6.
To offer a second opinion on the recently published retrospective diagnosis of Cardinal Carlo de' Medici (1596-1666), a prominent member of the grand ducal family then ruling Tuscany.
Retrospective diagnosis of historical figures is difficult and at times controversial, even with modern technology. It is based on contemporaneous medical descriptions and historical reviews, inherited iconography, and rarely - as in the case of the Medici of Florence - skeletal assessment, completed with radiological, histological and even immunological studies. Modern clinical work is often complemented with a second opinion obtained from specialists in the relevant fields. It is this type of second opinion that our collaborative Australian and Italian team, comprised of an orthopaedic/spinal surgeon, a rheumatologist and two medical historians, now offers.
The authors concur with the first opinion's diagnosis of Klippel-Feil syndrome in Carlo de' Medici, but disagree with the diagnoses of tuberculosis (Pott's disease) and rheumatoid arthritis. We find evidence, instead, for a psoriatic-DISH arthropathy with involvement of Klippel-Feil syndrome.
A psoriatic-DISH arthropathy, previously described by the present authors as the 'Medici syndrome', was commonly found in the males of the primary branch of the family. The diagnosis of this condition in Cardinal Carlo de' Medici represents its first identification in a male of the secondary (grand ducal) branch of the family.
对最近发表的枢机主教卡洛·德·美第奇（1596-1666 年）的回顾性诊断提供第二意见，他是当时统治托斯卡纳大公家族的杰出成员。
回顾性诊断历史人物是困难的，有时甚至存在争议，即使有现代技术也是如此。它基于同时代的医学描述和历史回顾、继承的肖像学，以及很少情况下——就佛罗伦萨的美第奇家族而言——骨骼评估，辅以放射学、组织学甚至免疫学研究。现代临床工作通常通过从相关领域的专家那里获得第二意见来补充。这就是我们澳大利亚和意大利合作团队现在提供的意见，团队由一名矫形外科/脊柱外科医生、一名风湿病专家和两名医学历史学家组成。
作者同意第一意见对卡洛·德·美第奇的克莱佩尔-费尔综合征的诊断，但不同意结核病（波特病）和类风湿关节炎的诊断。我们发现了证据，表明存在银屑病-DISH 关节病，并伴有克莱佩尔-费尔综合征的参与。
银屑病-DISH 关节病，先前由本作者描述为“美第奇综合征”，在家族的直系男性中很常见。枢机主教卡洛·德·美第奇的这种情况的诊断代表了它在家族的旁系（大公）分支中男性中的首次发现。
