Mona Lisa

The painting Mona Lisa in the Louvre, Paris, by Leonardo da Vinci (1503-1506), shows skin alterations at the inner end of the left upper eyelid similar to xanthelasma, and a swelling of the dorsum of the right hand suggestive of a subcutaneous lipoma. These findings in a 25-30 year old woman, who died at the age of 37, may be indicative of essential hyperlipidemia, a strong risk factor for ischemic heart disease in middle age.

Read 'Xanthelasma and lipoma in Leonardo da Vinci's Mona Lisa' by Dequeker J, Muls E, Leenders K in sr Med Assoc J. 2004 Aug;6(8):505-6.

An old woman with Pagets disease

A Grotesque Old Woman (or The Ugly Duchess) is perhaps the best-known of Quentin Matsys' works. It served as a basis for John Tenniel's depiction of the Duchess in Alice's Adventures in Wonderland. It is likely a depiction of a real person with Paget's disease, though it is sometimes said to be a metaphorical portrait of the Duchess Margarete of Tyrol-Görz, who was known as Maultasch, which, though literally translated "satchel mouth", was used to mean "ugly woman" or "whore" (because of her marital scandals).

Painting: A Grotesque Old Woman , Oil on wood, 64 x 45,5 cm, National Gallery, London.

Lymphadenopathy in a painting by Marinus Van Reymerswaele.

Does the moneychangers wife have a lymphoma? Or could it be scrofula?

Painting:The moneychanger and his wife, Prado museum

The three graces

Clinical features suggestive of hypermobility syndrome and a positive Trendelenburg sign are described in a painting "The Three Graces" (1638-1640) by Peter Paul Rubens, Prado, Madrid. The most obvious findings are scoliosis, positive Trendelenburg sign, and hyperextension of the metacarpal joints, hyperlordosis, and flat feet. The sitters, presumably Hélène Fourment (second wife of Rubens) and her sisters, support the hereditary familial aspect of hypermobility.

Read the full article at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1753831/

Polymyalgia rheumatica with temporal arteritis, as painted by Jan van Eyck in 1436

See Jan Van Eyck's work in the municipal museum of Bruges depicting the Holy Virgin with Canon Van der Paele (1436).Does the canon have temporal arteritis?
Yes, says Dr J. V. Dequeker.
In one hand he has his glasses, and in the other he is holding up his breviary
with difficulty. His hands are very fine looking, though wrinkled and stiff, as
occurs in rheumatism. Also note his prominet left temporal artery..

Access the free full text (Can Med Assoc J. 1981 June 15; 124(12): 1597–1598_ through pubmed central.

Auenbrugger and the wine barrels

Josef Leopold Auenbrugger or Leopold von Auenbrugg (b. November 19, 1722, Graz, Austria; died May 17, 1809), Austrian physician who invented percussion as a diagnostic technique. On the strength of this discovery, he is considered one of the founders of modern medicine.[citation needed]

Auenbrugger was a native of Graz in Styria, an Austrian province. His father, a hotel keeper, gave his son every opportunity for an excellent preliminary education in his native town and then sent him to Vienna to complete his studies at the university. Auenbrugger was graduated as a physician at the age of 22 and then entered the Spanish Military Hospital of Vienna, where he spent 10 years.

He found out that, by tapping lightly on the chest, one could assess the texture of underlying tissues and organs. This technique had its origins in testing the level of wine casks in the cellar of his father's hotel. With this method, he was able to plot outlines of the heart. It was the first time that a physician could relatively accurately and objectively determine an important sign of diseases. He published his findings in a booklet, but nobody paid much attention to it. The value of percussion in physical examination was later recognized by Jean-Nicolas Corvisart, who popularized it teaching it to his students in France, and by Josef Skoda in Vienna.

During his ten years of patient study, Auenbrugger confirmed his observations on the diagnostic value of percussion by comparison with post-mortem specimens, and besides made a number of experimental researches on dead bodies. He injected fluid into the pleural cavity, and showed that it was perfectly possible by percussion to tell exactly the limits of the fluid present, and thus to decide when and where efforts should be made for its removal.

His name is also associated with Auenbrugger's sign, a bulging of the epigastric region in the thorax, in cases of large effusions of the pericardium, the membrane which envelops the heart.

His later studies were devoted to tuberculosis. He pointed out how to detect cavities of the lungs, and how their location and size might be determined by percussion. He also recognized that information with regard to the contents of cavities in the lungs and conditions of lung tissue might be obtained by placing the hand on the chest and noting the vibration, or fremitus, produced by the voice and breath. These observations were published in a little book called Inventum Novum, the full English title being, "A New Discovery that Enables the Physician from the Percussion of the Human Thorax to Detect the Diseases Hidden Within the Chest". It is now considered one of the most important classics of medicine.

Like most medical discoveries, Auenbrugger's method of diagnosis at first met with indifference. Before his death, however, it had aroused the attention of French physician René Laennec, who, following up the ideas suggested by it, discovered auscultation.

Auenbrugger lived to a happy old age. He was especially noted for his cordial relations with the younger members of his profession and for his kindness to the poor and to these suffering from tuberculosis. He is sometimes said to have died in the typhus epidemic of 1798, but the burial register of the parish church in Vienna, of which he had been for half a century a faithful member, shows that he did not die until 1807.

Rene Laennec and the Stethoscope

When Rene Laennec was 5 years of age, his mother died of tuberculosis, and he was sent to live with an uncle who was a priest. At the end of the French revolution, 4 years later, Laennec was sent to live with another uncle, Dr Guillaume Laennec of Nantes, and remained with him until he was 19 years of age. Dr Laennec's was a pious Catholic household with a humanistic cultural environment that, of course, included an interest in medicine.

In 1800, Laennec left for Paris to seek medical education with Corvisart at La Charite Hospital. There he manifested an avidity for anatomy, pathology, clinical medicine, research, and writing papers. He received a degree in 1804, and continued with his mentor.


Laennec accepted an offer in 1816 from Necker Hospital to serve as physician. It was there that he invented the stethoscope. Laennec diligently followed patients with chest ailments from the bedside to the autopsy table, and correlated sounds heard with organ pathology found. He soon reached the conclusion that intrathoracic organs generated specific sounds with speaking, breathing, and coughing in health and in disease; and that these sounds could be conveyed to the ear with a stethoscope. Laennec developed an instinctive skill in the diagnosis of intrathoracic organ disease from sounds heard with the new instrument.

In 1819, Laennec published the results of his research, Traite de l'auscultation mediate et des maladies des poumons et des coeur. The following passage related how the stethoscope was invented and its usefulness: "In 1816, I was consulted by a young woman with symptoms of a diseased heart...percussion was of little avail on account ...of fatness. The application of the ear... inadmissible by the age and sex of the patient. I recollected a fact in acoustics ... the augmented sound conveyed through solid bodies....I rolled a quire of paper into a cylinder and applied one end to the heart and one end to the ear...and thereby perceived the action of the heart...more clear and distinct. I have been enabled to discover new signs of the diseases of the lungs, heart and pleura."

During all his life of 45 years, Laennec was thin and sickly looking, but this did not limit his practice, teaching, research, hospital responsibilities, and writing. Arduous work, however, finally took its toll on his health: "I know that I have risked my life, but the book I'm going to publish will be, I hope, useful enough to be of more value than the life of a man."

Laennec left for Brittany, his birthplace, recovered his health, and returned to Paris in 1822. He succeeded his deceased mentor at the College de France, was appointed professor of medicine at both Necker and La Charite, and was made a Knight of the Legion of Honor. Foreign students flocked to Paris to learn the new medicine and the use of precussion and the stethoscope. Some were Americans who returned home inspired to transform a stagnant medicine.

The second edition of Traite (1826) introduced a nomenclature of auscultatory sounds (rales, fremitus, egophony, pectoriloquy, bronchophony) heard in organ pathology that formerly was called "lung fever." Again arduous work severely taxed Laennec's health and strength. He returned to Brittany and died on August 13, 1826.

It was not until 1821 that The New England Journal of Medicine reported the invention of the stethoscope. In 1885, a professor of medicine in the United States stated, "He that hath ears to hear, let him use his ears and not a stethoscope"; and the founder of the American Heart Association, L. A. Connor (1866-1950) carried a silk handkerchief to place on the wall of the chest for ear auscultation. Nevertheless, this useful substitute for the ear quickly began winning converts.

The word stethoscope comes from the Greek words stethos meaning "chest", and skopos meaning "observer."

Read the original article, The inventor of the stethoscope: Rene Laennec - Journal of Family Practice, August, 1993 by Harry Bloch http://findarticles.com/p/articles/mi_m0689/is_n2_v37/ai_13248765/

Moniz and Lobotomy

António Caetano de Abreu Freire Egas Moniz (November 29, 1874 – December 13, 1955), known as Egas Moniz, was a Portuguese neurologist and the developer of cerebral angiography, best known for introducing the controversial psychosurgical procedure leucotomy (also known as lobotomy), for which be became the first Portuguese national to receive a Nobel Prize.

He wrote broadly on topics within and outside[citation needed] medicine, and also held several legislative and diplomatic posts in the Portuguese government.

Rosemary Kennedy, sister to John, Robert, and Edward Kennedy underwent a lobotomy at age 23, which left her permanently incapacitated. Her sister, Eunice Kennedy Shriver, founded the Special Olympics in her honor in 1968.

Byetta and Gila monster

Exenatide is a synthetic version of exendin-4, a hormone found in the saliva of the Gila monster. It displays biological properties similar to human glucagon-like peptide-1 (GLP-1), a regulator of glucose metabolism and insulin secretion. According to the package insert, exenatide enhances glucose-dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying, although the mechanism of action is still under study. Exenatide is manufactured and marketed by Amylin Pharmaceuticals and Eli Lilly and Company.

The Pacific Yew and the Periwinkle

The chemotherapy drug paclitaxel (Taxol), used in breast, ovarian and lung cancer treatment, is derived from Taxus brevifolia, the Pacific Yew tree.

Vincristine (brand name, Oncovin), also known as leurocristine, is a vinca alkaloid from the Catharanthus roseus (Madagascar periwinkle), formerly Vinca rosea and hence its name. It is a mitotic inhibitor, and is used in cancer chemotherapy.

HeLa cells

The living cells of a woman who died of cervical cancer more than half a century ago could reveal how we might extend our own lifespans.

Secrets of immortality could be tantalisingly close. The woman in question is Henrietta Lacks, whose tragedy has allowed researchers around the world to better understand the links between cancer, when cells seem to be able to multiply indefinitely, and ageing, when they become senescent and lose the ability to divide.

The story of this research dates back to the winter of 1951 when the mother of five underwent a seemingly routine biopsy for a suspicious cervical mass. A portion went to the pathology lab for diagnosis but, unknown to the black 31-year-old, another was diverted for research by two investigators at Johns Hopkins University, Baltimore.

In a review in the journal Nature, Dr Toren Finkel of the National Heart Lung and Blood Institute, Bethesda, and Manuel Serrano and Maria Blasco in the Spanish National Cancer Research Centre, Madrid, conclude: "The small part that remained in the laboratory would forever change the course of science."

George Otto Gey and Martha Gey of Johns Hopkins had spent the better part of the preceding two decades attempting to find a human cell that could grow indefinitely in the lab. That search would end with the arrival of the biopsy sample taken from Lacks.

Although Lacks died eight months later, her fast-growing cells still multiply in vials of red liquid held by laboratories around the world. Known as 'HeLa' cells in her honour, there are probably more alive today than in her entire body when she lived and have conferred on her a kind of immortality. To researchers studying human ageing, they pose a fundamental question: If human tissue cells can live indefinitely, why not people?

Her cells help lead to a clearer understanding of the barriers that separate normal cells from their cancer counterparts, says Dr Finkel. "These same barriers now appear to be intimately connected to how and why we age. Perhaps Henrietta's final gift to us is the growing realisation that somewhere within the curse of the cancer cell's immortality there might also lie the secret of how we might understand and extend our own lifespan."

Researchers have been slowly stripping away the many secrets that endow cancer cells with the gift of immortality. One of the most promising lines of research is into telomeres, protective caps that form around chromosomes - bundles of genes - in cells. Every time the cell divides, the telomeres get a little shorter until the cell self-destructs. But cancer cells can rebuild them with an enzyme called telomerase.

On the day Lacks died, George Gey himself appeared on American TV to announce the dawn of a new era in medical research. For the first time, he explained, it was possible to grow human cells continuously in culture. Since then, her cells have become a standard laboratory tool for studying the effects of radiation, growing viruses and testing medications.

Initially, the cell line was said to be named after a "Helen Lane" or "Helen Larson", in order to preserve Lacks's anonymity.

They helped eradicate polio, flew in early space shuttle missions and sat in nuclear test sites around the world. They have been subject to genetic analysis, revealing the presence of a human papillomavirus now thought to cause the disease and that they probably have the same mutations as present half a century ago, helping to answer many scientific questions.

"Undoubtedly, none of these questions were contemplated on that day in October 1951 when Henrietta Lacks's body was laid to rest in an unmarked grave near her family's small tobacco farm," they write in Nature "Unbeknownst to those who gathered in that Virginia field-but as we now know-not all of Henrietta was buried that day."

The family was not asked for consent, a sad commentary on biomedical research in the 1950s, when it was not uncommon for doctors to conduct research on patients without their knowledge. Because Gey had called them HeLa cells, it was only years later that the family only discovered her strange legacy to modern science

Read more at http://www.telegraph.co.uk/science/science-news/3303912/How-Henriettas-cells-gave-us-new-hope.html

Another interesting read http://www.nytimes.com/2010/02/02/health/02seco.html?em A Lasting Gift to Medicine That Wasn’t Really a Gift by Denise Grady/ NY Times

Legionnaires' disease

Legionellosis refers to the two clinical syndromes caused by bacteria of the genus Legionella. Pontiac fever is an acute, febrile, self-limited illness that has been serologically linked to Legionella species, whereas Legionnaires' disease is the designation for pneumonia caused by these species. Legionnaires' disease was first recognized in 1976, when an outbreak of pneumonia took place at a hotel in Philadelphia during the American Legion Convention. The causative agent proved to be a newly discovered bacterium, Legionella pneumophila, that was isolated from lung specimens obtained from the victims at autopsy

Rx - The eye of Horus

There are several explanations for the symbol Rx.

The symbol Rx is derived from the major lines in the symbol of the Eye of Horus. Horus was an Egyptian god, the god of Nekhen, a village in Egypt, and god of the sky, of light, and of goodness. He was the son of Isis, the nature goddess, and Osiris, the god of the underworld. Osiris was murdered by his evil brother Seth, the god of darkness and evil. Horus sought to avenge his father's death by challenging his uncle Seth to a firght. Seth cut out Horus's eye, but Thoth, a god associated with wisdom and compassion, magically restored the eye. Horus did defeat Seth, finally. The eye of Horus consisted of the sun and the moon, and it was the moon eye that was damaged. This explained the phases of the moon-the waning of the moon was the eye being damaged and the waxing, the healing. The eye of Horus became a powerful symbol of healing in the eyes of the Egyptians. In Egyptian art, the eye of Horus strongly resembles the modern Rx of the physician. Horus's eye, also called he wadjet eye, became a symbol for health.

Anothet common explanation is that it comes from the Latin word recipi or recipere, which means "take" and is abbreviated as Rx. The symbol can also be traced to the sign of Jupiter, which was found on ancient prescriptions to appeal to the Roman god Jupiter.

St Anthony's Fire - Ergotism

Not in years had France seen such rain. Farmers slogged stolidly out to their fields to harvest the sodden crops, mill the grain and send it on its way. In little (pop. 4,400) Pont-Saint-Esprit, perched on a bluff along the River Rhone in southern France, the townspeople sat glumly in their bistros sipping wine, watching the swollen river slip past the medieval bridge which gives the town its name.

Then, without warning, pain and sudden death clutched Pont-Saint-Esprit. On a Saturday night three weeks ago, the town's doctors began getting calls from people complaining of heartburn, stomach cramps and fever chills. At first, they thought it was a mild epidemic of meat poisoning. But the calls kept flooding in. By Monday, 70 houses in the village had become tiny hospitals, with most of their families in bed. Then the doctors found their first clue: every one of the patients had eaten bread from the shop of Baker Roch Briand. All eight of Pont-Saint-Esprit's bakeries were ordered temporarily shut.

Red Flowers & Molten Lead. That night the first man died in convulsions. Later, two men who had seemed to be recovering dashed through the narrow streets shouting that enemies were after them. A small boy tried to throttle his mother. Gendarmes went from house to house, collecting pieces of the deadly bread to be sent to Marseille for analysis. Among the stricken, delirium rose: patients thrashed wildly on their beds, screaming that red flowers were blossoming from their bodies, that their heads had turned to molten lead. Pont-Saint-Esprit's hospital reported four attempts at suicide.

What was the mysterious madness? Pont-Saint-Esprit speculated that the village idiot had hexed Baker Briand's flour, that the flour had been packed in fertilizer sacks, that rats in the grain elevator had contaminated the flour. The police knew better. They had traced the flour back from Briand's bakeshop through the government-controlled flour depot to a mill near Poitiers, nearly 300 miles away.

The Parasite. Last week the word came back from the police laboratory:"We have identified a vegetable alkaloid having the toxic and biological characteristics of ergot, a cereal parasite." Pont-Saint-Esprit had been stricken by ergot poisoning, a medieval disease as old as its proud bridge, so old that it had almost been forgotten. Modern medicine knows about ergot, but has rarely seen it in the form of an epidemic disease.* It is a black fungus that grows on wet grain, contains chemicals that powerfully affect the blood vessels and the nervous system. Doctors often use ergot extracts to start contractions in the uterus in childbirth.

In the Middle Ages, growing uncontrolled in wet summers, ergot was no such helpful friend. The disease was called "St. Anthony's Fire," and raged periodically through Europe. Monastic chroniclers wrote of agonizing burning sensations, of feet and hands blackened like charcoal, of vomiting, convulsions and death. Whole villages were driven mad. That, in effect, was what had happened to Pont-Saint-Esprit in 1951.

By week's end, French police had found the miller who ground the ergot-laden rye and a man who acknowledged selling him the grain, charged them both with involuntary homicide. In Pont-Saint-Esprit, the toll of illness passed 200; four had died, 28 were still on the critical list. France considered itself lucky: all the contaminated grain seemed to have gone into that one bag of flour delivered to Baker Roch Briand


Read more: http://www.time.com/time/magazine/article/0,9171,815355-2,00.html#ixzz0bhDFMQL7

Anthony the Great (c 251–356), (different from St Antony of Padua) also known as Saint Anthony, Anthony the Abbot, Anthony of Egypt, Anthony of the Desert, Anthony the Anchorite, Abba Antonius (Ἀβᾶς Ἀντώνιος), and Father of All Monks, was a Christian saint from Egypt, a prominent leader among the Desert Fathers. He is celebrated in many churches on his feast days: 17 January in the Eastern Orthodox Church and Western churches; and Tobi 22, (January 30) in the Coptic Orthodox Church and the Coptic Catholic ChurchSt.
Anthony was a third century Egyptian ascetic, who lived an unblemished life in the desert near the Red Sea, fasting for long periods, which was probably the reason for the visions and temptations he is said to have experienced. He believed them to be the work of the devil, and resisted steadfastly. In his own lifetime, Anthony had no direct connection with ergotism, however his name was taken by an Order of Hospitallers, founded in France about 1100. The Hospitallers, wearing black robes embroidered with blue crosses, travelled widely across medieval Europe, ringing little bells to attract alms, and the hospitals they thus funded became pilgrimage centres for sufferers from ergotism.6 The Antonite monks were credited with many cures, and thus Anthony's name and life story became attached to the disease. What were said to be the saint's bones were sprinkled with holy water or wine, which was then drunk by the afflicted; however it seems more likely that cures were related to the Hospitallers providing a diet free from contaminated grain. Amputated limbs were frequently left at the sites of shrines to St Anthony as offerings of thanks and evidence of the saint's success

Read more in Lancet. 2002 May 18;359(9319):1768-70.St Anthony's fire and living ligatures: a short history of ergometrine.
De Costa C.

Wiki tells me that erysepelas and zoster are also some times called St Anthony's Fire

Image: temptation of St Anthony/ Dali