Adele Bloch-Bauer (1881-1925): Possible diagnoses for Gustav Klimt's Lady in Gold.

One of the most famous works by the Austrian symbolist painter Gustav Klimt and one of the most widely reproduced works of art worldwide, Adele Bloch-Bauer I which portrays the beautiful wife of Austrian magnate Ferdinand Bloch-Bauer. Adele was the only woman painted by Klimt on more than one occasion. Apart from the beauty and value of the painting, the daring sea of gold that surrounds Adele and the gentle intimacy with which her fragile figure is portrayed have shrouded the history of this painting in mystery. Beyond speculation as to a special bond between artist and model, observation of the painting with a keener, clinical gaze yields evidence of potential illness in the model: facial erythema which, if not produced artificially by makeup, could represent a malar rash; pallor or cyanosis of the hands; and her draped fingers, which seemingly attempt to hide a deformity. This paper seeks to provide a biographical review both of the painter, Gustav Klimt, and of the subject, Adele Bloch-Bauer; to analyse Klimt's two portrayals of her in a search for evidence of a potential intimate relationship between artist and muse and, finally, to compile clinical evidence of possible diagnoses for the Lady in Gold.

Snippets From the Past: Imaginative Designs--Separating Hereditary From Environmental Effects in pre-DNA Times.

In an attempt to reproduce the results of an inconclusive 1927 report by the British Medical Research Council on the hereditary versus social origins of rheumatic fever, Read, Ciocco, and Taussig, from Johns Hopkins University, with the support of Frost, conducted a case-control study in 1935 and 1936. Their study, which appeared in the American Journal of Hygiene in 1938, was outstanding for its clear and tidy rationale for separating hereditary from environmental causes. The authors compared the prevalence of rheumatic fever among the relatives of 33 children admitted for "incident" rheumatic fever and 33 control children admitted in a tuberculosis clinic for reasons other than rheumatic fever. Both rheumatic fever (cases) and tuberculosis (controls) were diseases of the poor. All family members of both cases and controls, including uncles, aunts, and grandparents, were eligible for interview and physical examination. The results were compatible with the presence of an "inherited predisposition" to rheumatic fever because the disease was more prevalent among the uncles, aunts, and grandparents of case patients than among those of control patients. Methodologically, the paper by Read, Ciocco, and Taussig is an important but almost completely forgotten milestone in the evolution of case-control studies and of genetic epidemiology.

Heart lesion after the first attack of the rheumatic Fever 22 years experience in single centre.

BACKGROUND: Acute rheumatic fever and its sequels, rheumatic heart diseases, remain major unsolved preventable health problems in Kosovo population, particularly among the disadvantages indigenous Albanian and Egyptians people. In Kosovo, despite of performing secondary prophylaxis with benzathine penicillin, acute rheumatic fever hospitalization rates have remained essentially unchanged for the last 20 years. The role of echocardiography in the diagnosis of acute rheumatic carditis was established over the last 20 years. AIMS: In this study we aimed to determine the prevalence of rheumatic heart disease in children from Kosovo population with first attack of acute rheumatic fever. Also, we presented that echocardiography examination detects a greater prevalence of rheumatic heart disease than other diagnostic procedures. We aimed to compare the sensitivity and specificity of cardiac auscultation, ECG record, lab analysis to echocardiography and to determine the feasibility of specific age in this setting. METHODS: To optimize accurate diagnosis of rheumatic fever and rheumatic heart disease, we utilized two group models. In the first group of 388 children, hospitalized and treated before 1999, diagnosis of rheumatic fever was decided basing on the clinical and laboratory findings whereas in second group (221 children treated from1999 to 2010) clinical and lab diagnosis were amplified also on the detection by echocardiography. CONCLUSION: In second group, using echocardiography as a method of diagnosis and assessment children with rheumatic fever, we found high rates of undetected rheumatic heart disease in this high-risk group population. Echocardiographic examination of children with rheumatic fever for rheumatic heart disease may over diagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.

Historical aspects of rheumatic fever.

Few diseases have experienced such a remarkable change in their epidemiology over the past century, without the influence of a vaccine, than rheumatic fever. Rheumatic fever has all but disappeared from industrialised countries after being a frequent problem in the 1940s and 1950s. That the disease still occurs at high incidence in resource limited settings and in Indigenous populations in industrialised countries, particularly in Australia and New Zealand, is an indication of the profound effect of socio-economic factors on the disease. Although there have been major changes in the epidemiology of rheumatic fever, diagnosis remains reliant on careful clinical judgement and management is remarkably similar to that 50 years ago. Over the past decade, increasing attention has been given to rheumatic fever and rheumatic heart disease as public health issues, including in Australia and particularly in New Zealand, as well as in selected low and middle income countries. Perhaps the greatest hope for public health control of rheumatic fever is the development of a vaccine against Streptococcus pyogenes, and there are encouraging initiatives in this area. However, an effective vaccine is some time away and in the meantime public health efforts need to focus on effective translation of the known evidence around primary and secondary prophylaxis into policy and practice.

Rheumatic fever in Ireland: the role of Dr Monica Lea Wilson (1889-1971).

In 1869 William Stokes pointed out that the severity of rheumatic fever in Dublin had declined over recent decades. Similar worldwide decline led to the closure of many internationally famous rheumatic fever centres. The discovery by Robert Collis that rheumatic fever was a sequel to haemolytic streptococcal infection and the subsequent discovery of penicillin accelerated the decline. St Gabriel's Hospital in Dublin opened in 1951 under the clinical direction of Dr Monica Lea Wilson. Contrary to contemporary medical opinion a regimen of very prolonged bed rest was enforced. From 1961 the family doctors became concerned at the adverse psychological effects of the unnecessarily prolonged hospital stay. Twenty-seven of the 56 inpatients were re-assessed. None of them showed any evidence of active rheumatic fever and their parents took them home. The hospital closed in 1968. Dr Lea Wilson distanced herself from mainstream medicine and she is best remembered for having presented an unrecognized Caravaggio painting to the Jesuit Order in recognition of their pastoral support at the time of the controversial assassination in 1920 of her husband Percival, an Inspector in the Royal Irish Constabulary.

¿Que causó la temprana muerte de Mozart? / What caused the early death of Mozart?

Mozart junto con Bach, Handel y Beethoven, es uno de los mayores músicos de nuestra historia. Sin embargo existe mucho de leyenda y misterio alrededor de 105 eventos y factores que rodearon su muerte. La siguiente revisión analiza la hipótesis más aceptada sobre la etiología de la enfermedad de Mozart, la cual está basada en evidencia actualizada extraída de literatura biográfica científica. Considerando los datos epidemiológicos de Viena en esos tiempos, y los registros médicos de las atenciones dadas a Mozart, es planteable que sufría de complicaciones derivadas de la Fiebre Reumática, afectando la función renal con glomerulonefritis crónica y finalmente un accidente vascular hemorrágico.

Mozart remains among Bach, Handel and Beethoven, as one of the greatest musicians of the whole history. However, still there is a lot of legend and mystery regarding the faro surrounding his death. In this review, based on current evidence by scientific literature and authoritative biographies, the most accepted hypothesis respecting the etiology of Mozarts disease is analyzed. Considering the epidemiologic data of Viena at that time and the reports of the physicians who gave the musician last medical support suggests that Mozart suffered from complications from a rheumatic fever affecting his kidneys with chronic glomerulonephritis and a final hemorrhagic stroke.

The history of bacteriologic concepts of rheumatic fever and rheumatoid arthritis.

OBJECTIVES: Review of the development of etiologic and pathogenetic concepts of rheumatic fever (RF) and rheumatoid arthritis (RA) from the beginning of clinical bacteriology to the discovery of antibiotics. METHOD: Analysis of English and German language publications pertaining to bacteriology and "rheumatism" between the 1870s and 1940s. RESULTS: Early in the 20th century there was a widely held belief that a microbial cause would eventually be found for most diseases. This encouraged pursuit of the intermittent findings of positive blood and synovial fluid cultures in cases of RF and RA. Development of a streptococcal agglutination test supported the erroneous belief that RA is a streptococcal infection, while the simultaneous development of other immunologic tests for streptococci suggested that a hemolytic streptococcus was etiologic in RF. Table 1 provides a chronology of major events supporting and retarding resolutions. CONCLUSIONS: Much of the conflicting data and inferences regarding the etiology of RF and RA can be attributed to the absence or inadequacy of controls in observations of clinical cohorts and laboratory experiments.