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December 6, 2000

The Art of Physical Diagnosis

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(21):2721-2722. doi:10.1001/jama.284.21.2717

To the Editor: The striking cover of the August 2, 2000, issue of THE JOURNAL became even more interesting on reading Dr Southgate's disclosure of its title, After Death, Study of a Severed Head, and mention of the recent suggestion that the painting might actually be of a (whole) man on his deathbed.

My vote is for the latter interpretation. The fact that the head seems to be resting on the edge of a pillow, steeply elevated above the neck (and body, if attached) calls to mind a natural response to the orthopnea of end-stage heart failure. Heart failure is further suggested by the elevated cord below the ear at the angle of the jaw, which could be a distended external jugular vein and is not likely to be seen in a severed head.

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