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Visible signs of illness from the 14th to the 20th century: systematic review of portraits.

ABSTRACT: OBJECTIVES: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. DESIGN:Systematic review of portraits and description of visible signs of illness. SETTING:The Burgerbibliothek (archives of the burghers' community) in Berne, Switzerland. DATA SOURCES:3615 portraits; 2989 of individuals whose identity is known and 626 of individuals whose identity is unknown. MAIN OUTCOME MEASURES:Visible signs of illness evaluated by means of a standardised visual assessment. RESULTS: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 v 44%, 811/1844). Overweight was most common in sitters aged >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. CONCLUSIONS: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.

SUBMITTER: Als C

PROVIDER: S-EPMC139054 | biostudies-literature | 2002 Dec

REPOSITORIES: biostudies-literature

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Visible signs of illness from the 14th to the 20th century: systematic review of portraits.

Als C C Stüssi Y Y Boschung U U Tröhler U U Wäber J H JH

BMJ (Clinical research ed.) 20021201 7378

<h4>Objectives</h4>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.<h4>Design</h4>Systematic review of portraits and description of visible signs of illness.<h4>Setting</h4>The Burgerbibliothek (archives of the burghers' community) in Berne, S ...[more]

PMID: 12493682

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Project description:BackgroundSerious mental illnesses (SMI) such as schizophrenia and bipolar disorder first develop between ages 14 and 25. Once diagnosed, young peoples' health can deteriorate, and it is therefore vital to detect this early to prevent severe outcomes including hospitalisations and deaths by suicide. The main study aim is to describe and discuss observational studies that examine signs of deterioration in young patients with SMI.MethodsA systematic review guided by the published protocol was conducted. Cumulative Index to Nursing and allied Health Literature (CINAHL), MEDLINE, Embase, PsycINFO, Health Management Information Consortium (HMIC) and Web of Science were searched against pre-defined criteria until 1 March 2021. Observational studies were extracted according to design, country, participant, indicator, outcome and main finding categories. Quality was assessed independently using the Newcastle Ottawa Scale (NOS).ResultsOf the 15,788 publications identified, 5 studies were included and subjected to narrative synthesis. Two indicators of mental health deterioration were identified: cognitive functioning (decline, worsening and poor school/academic performance) and expressed emotion status. Indicators revealed mixed views on predicting deterioration. Worsening cognitive functioning and expressed emotion status significantly predicted medication non-adherence and relapse respectively. However, a decline in cognitive functioning (poor academic performance) was not found to significantly correlate to deaths by suicide. Study quality was mostly poor and associations between indicators and varied outcomes were weak. The heterogeneous nature of the data made comparisons difficult and did not allow for further statistical analysis.ConclusionTo our knowledge, this is the first review of observational studies to identify indicators of deterioration in young patients with SMI. Worsening cognitive functioning and expressed emotion status could indicate non-adherence and relapse in young patients with SMI but larger sample sizes in good quality studies are needed. The dearth of observational studies means further research is required to ascertain other indicators of deterioration before serious outcomes occur.FundingThis work was supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre via an NIHR programme grant. The authors are also grateful for support from the NIHR under the Applied Health Research programme for North West London and the NIHR Imperial Biomedical Research Centre. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Trial registrationThis systematic review has been registered on PROSPERO (registration number: CRD42017075755 ).

Project description:IntroductionSome ultra-high exposure boxers from the 20th century suffered from neurological problems characterized by slurred speech, personality changes (e.g., childishness or aggressiveness), and frank gait and coordination problems, with some noted to have progressive Parkinsonian-like signs. Varying degrees of cognitive impairment were also described, with some experiencing moderate to severe dementia. The onset of the neurological problems often began while they were young men and still actively fighting. More recently, traumatic encephalopathy syndrome (TES) has been proposed to be present in athletes who have a history of contact (e.g., soccer) and collision sport participation (e.g., American-style football). The characterization of TES has incorporated a much broader description than the neurological problems described in boxers from the 20th century. Some have considered TES to include depression, suicidality, anxiety, and substance abuse.PurposeWe carefully re-examined the published clinical literature of boxing cases from the 20th century to determine whether there is evidence to support conceptualizing psychiatric problems as being diagnostic clinical features of TES.MethodsWe reviewed clinical descriptions from 155 current and former boxers described in 21 articles published between 1928 and 1999.ResultsMore than one third of cases (34.8%) had a psychiatric, neuropsychiatric, or neurobehavioral problem described in their case histories. However, only 6.5% of the cases were described as primarily psychiatric or neuropsychiatric in nature. The percentages documented as having specific psychiatric problems were as follows: depression = 11.0%, suicidality = 0.6%, anxiety = 3.9%, anger control problems = 20.0%, paranoia/suspiciousness = 11.6%, and personality change = 25.2%.DiscussionWe conclude that depression, suicidality (i.e., suicidal ideation, intent, or planning), and anxiety were not considered to be clinical features of TES during the 20th century. The present review supports the decision of the consensus group to remove mood and anxiety disorders, and suicidality, from the new 2021 consensus core diagnostic criteria for TES. More research is needed to determine if anger dyscontrol is a core feature of TES with a clear clinicopathological association. The present findings, combined with a recently published large clinicopathological association study, suggest that mood and anxiety disorders are not characteristic of TES and they are not associated with chronic traumatic encephalopathy neuropathologic change.

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Visible signs of illness from the 14th to the 20th century: systematic review of portraits.

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Visible signs of illness from the 14th to the 20th century: systematic review of portraits.

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