Customize your JAMA Network experience by selecting one or more topics from the list below.
Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
To the Editor: The artwork displayed on the
cover of the August 2, 2000, issue of THE JOURNAL is unlikely to represent
either a victim of the guillotine or a postmortem subject. The painting appears
to represent an elderly man with his head propped up on a pillow. The laryngeal
prominence appears to be intact. Because this structure begins at about the
level of the fifth cervical vertebra, it is unlikely that so much tissue below
it would be spared the perpendicular cut of a guillotine. The anterior cervical
muscles, particularly the omohyoid, also stand out quite prominently, something
that would not be expected if the muscles had been detached from their origins.
A careful examination of the painting reveals a sign that would not
be expected in a corpse—jugular venous distension. Could this sign provide
a clue to the cause of this man's illness? Right-sided heart failure is the
most common cause of jugular venous distension. Before the advent of effective
treatments for right-sided congestive heart failure, the elevated venous pressure
commonly led to bowel wall edema, malabsorption, and death due to malnutrition.
Perhaps it is this condition that accounts for the severe emaciation that
is evident in this subject.
Nasir L. The Art of Physical Diagnosis. JAMA. 2000;284(21):2721–2722. doi:10.1001/jama.284.21.2717
Coronavirus Resource Center
Create a personal account or sign in to: