Visible signs of illness from the 14th to the 20th century: systematic review of portraits
Authors: C Als
Journal: BMJ (2002)

<h3>Abstract</h3> <b>Objectives:</b> To see whether a collection of portraits depicting inhabitants of a defined geographical region and covering several centuries is a useful source for studying the sociocultural significance and epidemiology of particular visible diseases, such as goitre, which is known to have been common in this region. <b>Design:</b> Systematic review of portraits and description of visible signs of illness. <b>Setting:</b> The Burgerbibliothek (archives of the burghers9 community) in Berne, Switzerland. <b>Data sources:</b> 3615 portraits; 2989 of individuals whose identity is known and 626 of individuals whose identity is unknown. <b>Main outcome measures:</b> Visible signs of illness evaluated by means of a standardised visual assessment. <b>Results:</b> Visible signs of illness in portraits were common and appeared in up to 82% (451/553) of paintings from the 17th and 18th centuries. The most common findings were signs of goitre in women and overweight in men. In only the portraits where the neck region could be evaluated, 41% of women with known identities (139/343) had goitre compared with 24% of men with known identities (21/86). The prevalence of goitre was even higher in sitters whose identities were unknown: 63% in men (5/8) and 68% in women (82/121). Overweight in people with known identities was more common in men than in women (30%, 346/1145 <i>v</i> 44%, 811/1844). Overweight was most common in sitters aged &gt;40 than in those aged 40 or younger. Other conditions, such as missing teeth, amputated limbs, or osteoarthritic deformations were surprisingly rare in the portraits under evaluation. <b>Conclusions:</b> Goitre and other diseases are under-represented in the people depicted in these portraits. Artistic idealisation is a likely explanation for this observation: what was reproduced depended on what was considered pathological or shameful at the time, and therefore depended on age and sex. Stigmatising details may have been omitted. Further, artistic skills and contemporary fashion may have influenced the way in which people were reproduced. People depicted are possibly not representative of the general Bernese population as they constituted a socioeconomically advantaged group. <h3>What is already know on this topic</h3> Reviews of individual portraits from the past have found clinical signs of illness that have led to discussions of underlying diseases Goitre probably affected in excess of 80% of the population of the canton of Berne up to the beginning of the 20th century <h3>What this study adds</h3> In a large series of portraits from the Bernese region, goitre and other diseases are under-represented Findings of age dependent overweight (a survival advantage in times of potential famine) were probably more realistic Likely explanations for this include idealisation depending on sex and age, artistic skills, fashion, and sociocultural significance of illness A decline in depicted signs of illness from the 19th century may indicate progress of preventive medicine and hygiene