title: Visible signs of illness from the 14th to the 20th century: systematic review of portraits.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Systematic review of portraits and description of visible signs of illness.
  
  
  METHODS
  The Burgerbibliothek (archives of the burghers' community) in Berne, Switzerland.
  
  
  METHODS
  3615 portraits; 2989 of individuals whose identity is known and 626 of individuals whose identity is unknown.
  
  
  METHODS
  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.
authors.affiliation: Chemical Laboratory, Inselspital, University of Berne, CH-3010 Berne, Switzerland. claudine.als@insel.ch
authors.forename: C
authors.initials: C
authors.lastname: Als
authors.forename: Y
authors.initials: Y
authors.lastname: Stüssi
authors.forename: U
authors.initials: U
authors.lastname: Boschung
authors.forename: U
authors.initials: U
authors.lastname: Tröhler
authors.forename: J H
authors.initials: JH
authors.lastname: Wäber
mesh_terms: D005260:Female; D006042:Goiter / Q000266:history*; D049668:History, 15th Century; D049669:History, 16th Century; D049672:History, 19th Century; D049673:History, 20th Century; D049691:History, Medieval; D006801:Humans; D008297:Male; D008512:Medicine in the Arts; D009765:Obesity / Q000266:history*; D011173:Portraits as Topic / Q000266:history*