Portal de Periódicos da CAPES

Behind the Glamor of the Circus

1973; Elsevier BV; Volume: 63; Issue: 1 Linguagem: Inglês

10.1378/chest.63.1.34

1931-3543

Andrew L. Banyai,

Theatre and Performance Studies

Spectacular shows of circuses attract all who are thrilled by the menagerie of exotic animals, spine-chilling acts of daring aerialists, acrobatic equestrians, clever jugglers and baggy-garmented white-faced clowns. As part of the main show or one of the side shows there is an array of human oddities, such as midgets, a giant, a fat man or a fat lady of startling overweight. Since the end of the eighteenth century, one of the human freaks exhibited has been the India-rubber man, also known as Human pretzel. They act as contortionists at their stage appearances. With amazing facility, they flex their fingers at seemingly impossible angles and extend the length of fingers to a surprising degree by separation of joint surfaces. On release from this unnatural position, the phalanges snap back into their normal places. These performers are able to position their arms in strikingly grotesque manner. Some will stand on one leg while the other one is lifted upright, placing the respective foot on the nape of the neck. This pronounced laxity and mobility of joints is termed arthrochalasis. Associated skeletal manifestations may include habitual dislocation of the clavicles, shoulders, patellae and radii; genu recurvatum, pectus carinatum, pectus excavatum, scoliosis, kyphoscoliosis and asymmetry of the thoracic cage. In some, abnormally marked sloping of the upper ribs imparts the impression of a very long neck. Hypermobility of joints decreases with age. Because their skin can be stretched to extreme extent, these subjects were publicized as “rubber-faced men.” The skin is easily traumatized and the injury heals with paper-thin scars. McKusick, VA (Heritable Disorders of Connective Tissue [3rd ed], St. Louis, CV Mosby, 1966) emphasized the common occurrence of congenital cardiac malformations and possible marked cardiomegaly in these individuals. The cardiovascular lesions may simulate rheumatic heart disease. In several instances dissecting aneurysm of the aorta was observed. Rupture of blood vessels of the skin and subcutaneous tissue may result in ecchymosis or hematomas (pseudotumors). Also, pulmonary and gastrointestinal hemorrhages may occur. Easy fragility of blood vessels as well as other manifestations of this condition are, according to the convincing histologic findings of Jansen (Dermatologica 110:108, 1955), attributable to defectively twining col lagen fibers in the wicker-work structure of the supportive tissues of the skin, joint ligaments, blood vessels and other structures. Concomitant lesion may occur, such as bronchiectasis, spontaneous pneumothorax, pneumomediastinum, diaphragmatic hernia, eventration of the diaphragm, diverticula of the digestive tract and ectopia Ientis. Although a report on some of the characteristics of this disease was published by Tschernogobov (Monatshefte Prak Dermat 14:76, 1891), it is known as the Ehlers-Danlos syndrome, with due credit to these two clinicians (Dermat Zeitschr 8:173, 1901), (Bull Soc Franc Dermat Syph 19:70, 1908). Even though the syndrome is considered rare, Beighton et al (J Bone Joint Surg 51B:444, 1969) reported on 100 cases from St Thomas' and St Bartholomew's Hospitals of London.