International Journal of Osteoarchaeology

Int. J. Osteoarchaeol. 13: 294302 (2003)

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/oa.701

Luigi Boccherini and the Barocco Cello:

an18th Century Striking Case of
Occupational Disease
R. CIRANNI* AND G. FORNACIARI
Department of Oncology, Transplants and Advanced Technologies in Medicine, Section
of History of Medicine and Paleopathology, University of Pisa, Pisa, Italy

ABSTRACT

The aim of this paper is to elaborate an ergonomic model based on the study of acquired
muscle-skeletal lesions related to Boccherinis intensive activity as barocco cellist. The body
of the famous musician was submitted to external examination, macroscopic analysis and
radiographic study. Palaeopathological studies of the skeleton showed a considerable
number of changes such as severe rhizoarthritis of the right thumb, heavy epicondylitis of
the left elbow, loss of physiological cervical and lumbar spine lordosis and high thoracic left
scoliosis with maximum on T3-T4. A case of tibiae valgae was diagnosed at the level of the legs.
The acquired muscle-skeletal lesions found seemed to be correlated to Boccherinis cello
activity. Direct observation of a present-day cellist allowed us to better understand how
repetitive strain injuries were responsible for the situation which appears in the ergonomic
model described. Copyright 2003 John Wiley & Sons, Ltd.
Key words: palaeopathology; posture; ergonomics; acquired lesions; rachigram

Introduction
Luigi Boccherini (Figure 1), the famous musician
father of the instrumental trios, quartets and
quintets (De Mesonero, 1927), was born in Lucca
(Italy) on 19 September 1743. The third son of a
very large family, he inherited his passion for
music from his father. Luigi was only 13 years old
when he began to play as orchestral cellist and
then travelled to Vienna and Paris, and to various
foreign countries where his talent was largely
appreciated. However, in 1765at the age of
22he started to have health problems and was
badly affected by violent attacks of fever (Della
Croce, 1988). Such was the fame he acquired in
France that it led Don Juan, Infant of Spain and
brother of the King, to invite Boccherini to
Madrid. At the Royal Court of the Bourbon
* Correspondence to: Department of Oncology, University of
Pisa, via Roma, 57-56126 Pisa, Italy.
e-mail: r.ciranni@med.unipi.it

Copyright # 2003 John Wiley & Sons, Ltd.

King Charles III and under Don Juans protection,

the musician was appointed royal composer and
official cellist. Unfortunately, owing to the unstable situation at court and to the death of Don
Juan the musician was forced to leave Spain,
looking for a new patron. The Prince of Prussia,
who was later to become King Frederick II, engaged him as royal chamber-composer, offering
him a generous annual salary. Boccherini held
this position for several years, enjoying material
comfort and high esteem, but his health conditions were becoming more and more serious: in a
letter written in French and sent to an Italian
friend, he wrote that he was frequently suffering
from crachements de sang (expectoration of the
blood), strong enflure de pieds (feet oedema) and
from severe disparasion a` peu pre`s complete de mes forces
(physical and mental weakness) (Di Colo, 1988).
Following the death of Frederick II in 1779, having
lost both protection and money, Boccherini
decided to go back to Spain where he spent his
last years living in solitude and in conditions of
Received 14 January 2003
Revised 17 February 2003
Accepted 14 May 2003

Luigi Boccherini and the Barocco Cello

295
showed a number of acquired muscle-skeletal
lesions correlated to Boccherinis cello activity.
The aim of the present paper is to elaborate
an ergonomic model, peculiar of Barocco cello
performers and to investigate this striking case
of 18th century occupational disease.

Materials and methods

Boccherinis body remains were submitted to
external examination, macroscopic and radiological study.

Radiological study
Figure 1. Physiognomic reconstruction of Luigi Boccherinis head
based on the skull and produced by Alessandro Carpita (by courtesy of the Istituto Storico Lucchese, Lucca, Italy).

deep indigence. He was choked to death by a

haemorrhagic coughing fit (De Rotschild, 1962)
on 28 May 1805 at 62 years of age. His body was
buried in the Pilgrims Crypt of Saint Giusto in
Madrid.
At the beginning of the Italian Fascist regimen
the Mayor of Lucca asked the Spanish Government for restitution of Boccherinis body. In
1927, the sarcophagus containing the well preserved mummy of the musician was transferred
from Madrid to Lucca and was buried, with great
ceremony, in the Church of San Francesco (Lencioni, 1997).
In 1993, on the two hundred and fiftieth anniversary of his birth, the body was exhumed and
submitted to palaeopathological study. Exploration of the tomb revealed a corpse entirely wrapped in cloth according to the Franciscan funerary
practice. The remains were those of a badlybut
originally very well-preservednatural mummy
(Figure 2(A)). The environmental conditions of
the secondary burial had caused severe degradation of most of the soft tissues since the ground
water table under the floor of San Francescos
church, where the sarcophagus was immersed,
produced partial skeletonization of the body
(Figure 2(B)). The skeleton was instead very well
preserved: macroscopic and radiographic studies
Copyright # 2003 John Wiley & Sons, Ltd.

The specimen was X-rayed by a portable X GIL

S.G. type (70 kV; 7 mA) apparatus produced by
Gilardoni (Italy), using Du Pont, CRONEX 4
Blue Base film, 30  40 cm. Negative films were
manually developed, using Agfa solution and a
fixative. About 10 X-rays with antero-posterior
and latero-lateral projection were performed.

Results

External examination
The body presented some areas of preserved soft
tissue in the thoraco-abdominal cavity and at the
level of the thighs and tibiae. The studies concerning the residual soft tissues will be discussed
separately as soon as the results are ready.
The well-kept skeleton belonged to a male
individual older than 60 years of age, of medium
height (165 cm tall) (Angel, 1980) and lean build,
anthropologically belonging to the Mediterranean coast type, presenting some features consistent with those of the human Lucchese
Biasutti type (Biasutti, 1967). The anthropological age (Angel, 1980) agrees with the radiological
one and with the literary sources.
The macroscopic and radiological studies performed on Boccherinis skeleton made it possible
to detect a large number of lesions.
Study of the entire skull revealed a severe wear
resulting in destructive caries and a high degree
of periodontal disease. Most of the teeth had
been lost before death. The temporomandibular
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R. Ciranni and G. Fornaciari

Figure 2. (A) The well mummified body of Boccherini during exhumation in Madrid in1927. (B) The partially skeletonized body after exhumation in Lucca in 1993.

joint was affected by severe bilateral arthritis,

probably due to sub-total loss of the teeth and/or
to a phenomenon of malocclusion.
Bilateral cartilaginous ossification of the sternum and the ribs was observed; the sternum
appeared deformed; the pectoral girdle was intact
with the left muscle stronger than the right
muscle insertions.
The bones of the upper limb were all well
preserved; some distal phalanges of the right
hand were missing while the left hand was intact
with no alterations.
The coxal bones were normal; the pubic symphysis was levelled, assuming the typical shape
present in people over 50 years of age (Krogman,
1986). The bones of the legs were present,
Copyright # 2003 John Wiley & Sons, Ltd.

but some of the distal bones of the feet were

missing.
The following is a description of the pathological alterations found.

Right hand
The right carpo-metacarpal joint showed severe
arthritis of the trapezium bone (Figures 3(A) and
3(B)), with the production of an enormous girdle
of pathological bone characterized by rough
marginal osteophytes; the first metarcapal bone
was also affected by severe arthritis with joint
eburnation (Figure 3(C)). This picture is typical
of rhizoarthritis of the right thumb (osteoarthritis
at the root of the thumb; the left one is not
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297

Figure 3. (A) Skeletal segments of the right hand: severe rhizoarthritis (osteoarthritis of the root) of the thumb is evident; (B) X-ray of
the same hand shows marked osteosclerosis and bone pseudocystis (arrows); (C) the trapezio-metacarpal joint appears levelled and
eburnated (large arrow); the articular margins are masked by new bone with osteophytes (thin arrows).

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R. Ciranni and G. Fornaciari

Figure 4. Epicondyle of the left humerus: (A) some bumps (arrow); and (B) irregular grooves and lateral cicatrical dimples are well evident
(arrow).

involved), a well known pathology. Insertions of

the opposer and of the long abductor muscles of
the thumb were exceptionally strong. Finally, the
interphalangeal joint of the right thumb revealed
moderate arthritis.

Left arm
Unlike the right one, the joint of the left elbow
revealed some bumps, irregular grooves and lateral cicatrical dimples at the level of the epicondyle of the humerus (Figures 4(A) and 4(B)).
This is the typical picture of severe chronic
epicondilytis. The forearm, as well as the left
pectoral girdle, showed a strong insertion of the
extensor carpi radialis brevis muscle, of the extensor
carpi ulnaris muscle, and of the supinator and
anconeus muscles.
Legs
The superior third of the tibiae showed bilateral,
symmetric and external bending, shaping a typical picture of genu valgum (Figure 5).
Spine
The macroscopic and radiological study of the
spine revealed the loss of cervical and lumbar
Copyright # 2003 John Wiley & Sons, Ltd.

Figure 5. Bilateral tibiae valgae. Arrows show the maximum valgism.

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299

Figure 6. (A) The spine reveals loss of cervical (arrow) and lumbar lordosis; (B) scoliosis is lateral, left-convex with the maximum onT3 and
T5 (arrows); (C) Arrows underlined severe arthritis of the articular facets.

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R. Ciranni and G. Fornaciari

Figure 7. Rachigram of Boccherinis column: sagittal, frontal and transversal indexes were evaluated.

lordosis (Figure 6(A)); the thoracic column was

affected by severe scoliosis characterized by
lateral left-convex deviation with the maximum
on T3 and T5 (Figure 6(B)); X-rays underlined a
severe arthritis of the articular facets (Figure
6(C)). The lack of cervical and lumbar lordosis
is described in detail in the rachigram (Figure 7).

Discussion
Repetitive strain injuries (RSIs) are caused by
strenuous and repeated movements which produce damage to the tendons, nerves, muscles
andindirectlyto the bones. Musicians represent a group of people who have characteristic
RSIs resulting from the type of instrument they
play. Since all the above reported skeletal lesions
of Boccherini are not real pathologies, but
changes acquired in the course of life in response
to environmental circumstances, they need to be
ergonomically evaluated (Culf, 1988; Shell, 1995).
Rhizoarthritis of the thumb, chronic epicondylitis, lesions to the column and genu valgum were
studied by analysing the muscular movements of
a cellist during the performance of one of Boccherinis adagios (Figures 8(A)(C)).
When the cellist is pushing the bow, from tip
to heel, the thumb tends to stretch out; on the
other hand, when he is pulling it, from heel to tip,
it bends by flexion of the phalanges (Figure
8(C)). Boccherini, composer and concert player,
Copyright # 2003 John Wiley & Sons, Ltd.

spent most of his life playing the cello and

therefore submitted the thumb joint to this continuous and repeated movement which gradually
evolved into rhizoarthritis of the right thumb.
This disease usually arises after the age of 50 and
is often due to overexertion of the trapeziometacarpal joints. In living people the disease is
characterized by strong pain of the radial area
of the hand and generally evolves into ankylosis,
producing the typical square-hand shape. All
these bibliographic descriptions (Kohler & Zimmerman, 1970) agree with the macroscopic and
radiological observations made on Boccherinis
skeleton. The joint eburnation of the first metacarpal bone diagnosed on Boccherinis right
hand demonstrates that the musician continued
to play the cello despite the pain, thus preventing
ankylosis.
Our conclusions are strongly supported by
differential diagnosis; for instance rheumatoid
arthritis, which involves the metacarpophalangeal and proximal interphalangeal joints, is erosive and symmetric; gout, as well as rhizoarthritis,
is asymmetric and could involve the carpo-metacarpal joint of the thumb but it is destructive and
characterized by geodi formations which are not
present in our case. Boccherinis thumb pathology is certainly a monoarticular arthritis, there
are no Herberdens nodes and the distal interphalangeal joint is not involved.
Observing the movements of the cellist, the
left hand sustained the neck of the cello and, at
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301

Figure 8. (A) Professor Carlo Benvenuti, cellist, during the performance of one of Boccherinis adagios. (B) The position of the body, legs,
shoulder and left arm, and (C) the handling of the bow are well visible.

the same time, produced the movement of the

fingers on the stringboard; during this double
action, the left arm and, in particular, the left
elbow, are constantly solicited (Figure 8(B)). In
the case of Boccherini, this continuous solicitation of the muscles and tendons produced, during
an entire life of performances, the severe, chronic
epicondylitis of the left elbow. This disease
usually affects workers, for example shoemakers
and glassblowers (De Se`ze & Ryckewaert, 1979),
who submit their elbows to strong and constant
muscle-tedinous tension. The baroque cello was
different from the present-day instrument: it was
smaller and without the point. The absence of
this metallic point, which forces the musician to
sustain the instrument with a tonic contraction of
the knees and the legs, was responsible for the
aquired tibiae valgae (Figure 8(A)), a deforming
process that started when the child Boccherini
began to play the cello.
The human body was not designed to remain
seated with the knees and hip bent close to a 90
angle, since the maximum free movement of the
thigh in the hip socket is about 60 . This incorrect position of the legs and the stiff posture
produced by sitting upright on a flat chair, with
thighs and torso at an angle of 90 (Figure 8(B)),
produced the loss of cervical and lumbar lordosis,
Copyright # 2003 John Wiley & Sons, Ltd.

flattening of the diaphragm and collapse of the

chest (Roberts, 1995), scoliosis was instead due
to the position of the body on the instrument: its
shortness and the absence of the point forced the
position of the body which was bent at the front
and on the right (Figure 8(B)), producing leftconvex scoliosis which reached its maximum
degree on T3 and T4. The lack of cervical and
lumbar lordosis do not depend on artificial
articulation, as demonstrated by the elaboration
of the rachigram (Figure 7) (Mafart, 1983).
One lesion, less important, was the deformity
of the sternum: it may have been congenital but
was probably produced by the pressure of the
instrument against the breast.
The cartilaginous ossification of the sternum
and the ribs is compatible with age, but can be
worsened by the thorax pressure and incorrect
posture maintained during the performances.
Finally, even if the left forearm as well as the
left pectoral girdle were characterized by hypertrophied muscle insertion, stronger than the right
ones, Boccherini was not a left-handed individual. The greater muscular development of the
upper left body muscles was exclusively due to
the natural conformation of the cello which
requires strenuous work of the left arm on the
neck and on the stringboard.
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302

Conclusions

References

Luigi Boccherini was of medium height, of delicate constitution, anthropologically belonging to

the Mediterranean, coastal variety. Anthropological and radiological age agree with the literary
sources according to which his death dates back
to the year 1805, when he was 62 years old.
The palaeopathological study performed on
his skeleton made it possible to reconstruct the
scenario of his health conditions (unreported
data). On the other hand, macroscopic and radiological studies allowed the elaboration of a very
interesting ergonomic model peculiar to barocco
cellists. As a matter of fact, Boccherini was
affected by a number of lesions acquired in the
course of his life and certainly due to his occupational state of cellist.
Modern acquisition (20th century) of the point
and increased height of the tool have reduced the
possibility of development of genu valgum and
scoliosis, but the cello still forces the performer
to maintain an unnatural position. The stiff posture of the back against the chair, the hip and
knees bent to a degree of 90 (Mandel, 1982;
Norris, 1993), the unchanged use of the bow and
strenuous work of the left arm make the described
ergonomic model partially superimposable to
that of contemporary cello performers. Instrumental musicians generally represent a particular
risk group: they are repetitively submitted to a
number of chronic injuriesincorrect posture,
non-ergonomic techniques, stressthat can
cause pain, disability and, sometimes, the end
of their career as musicians. Boccherini would
probably have suffered a similar fate if tuberculosis had not killed him at 62 years of age.

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Acknowledgements
We would like to thank Professor Carlo Benvenuti, cellist (Academy of Music Luigi Boccherini,
Lucca, Italy) and the Istituto Storico Lucchese for
the picture of Boccherinis head fisiognomic reconstruction.

Copyright # 2003 John Wiley & Sons, Ltd.

Int. J. Osteoarchaeol. 13: 294302 (2003)