Belly fat or bloating? New insights into the physical appearance of St Anthony of Padua

Over the centuries, iconographic representations of St Anthony of Padua, one of the most revered saints in the Catholic world, have been inspired by literary sources, which described the Saint as either naturally corpulent or with a swollen abdomen due to dropsy (i.e. fluid accumulation in the body cavities). Even recent attempts to reconstruct the face of the Saint have yielded discordant results regarding his outward appearance. To address questions about the real appearance of St Anthony, we applied body mass estimation equations to the osteometric measurements taken in 1981, during the public recognition of the Saint’s skeletal remains. Both the biomechanical and the morphometric approach were employed to solve some intrinsic limitations in the equations for body mass estimation from skeletal remains. The estimated body mass was used to assess the physique of the Saint with the body mass index. The outcomes of this investigation reveal interesting information about the body type of the Saint throughout his lifetime.

The function of the heart is historically contingent

Some philosophers of medicine argue that there are objective facts about the biological function of organs, and that these facts are used to objectively define diseases. The function of the heart is taken to be particularly obvious and well established. Contrary to this, I argue that the function of the heart is not fixed by nature, but rather that it is historically contingent. The disease heart failure results from the dysfunction of the heart. In opposition to the common-sense intuitions of philosophers, medics do not define heart failure simply as a reduced cardiac output, and up to half of patients with heart failure have a normal cardiac output. The present day medical definition of heart failure is thus counter-intuitive. In the early twentieth century, however, medics did define heart failure as a reduced cardiac output. This view was opposed in the 1930s, when a similar definition of heart failure to the one used today was put forward. I look closely at this historical episode, in order to explore the reasons for this development. I use this history to argue that present day knowledge of heart failure is not the inevitable result of careful observation of patients, but rather is historically contingent.

The function of the heart is not obvious

It is widely believed that the function of the heart is obviously to pump blood. I argue here that it is not. The definition, presentation, and pathophysiological explanation of heart failure, as well as the measurement of cardiac dysfunction, are not as might be expected if the function of the heart was simply to pump blood. Far from being obvious, many central features of heart failure are still being investigated. This has important implications for philosophical debates about health and disease. According to naturalists like Christopher Boorse, medical practice is founded on a well-established body of physiological knowledge, which provides the one true account of the biological function of organs. On this naturalistic view, there should only be one account of the pathophysiology of heart failure in use in medical practice. This account of the pathophysiology of heart failure should be well-established, as opposed to uncertain. Medics should use this physiological knowledge to inform their clinical practice, and not vice versa. Clinical considerations, such as whether patients respond to therapy, should not inform debates about what the pathophysiology of heart failure is. I will show this is not the case. The handling of knowledge of the biological function of the heart in medical practice differs substantially from Boorse's account.

Giovanni Boccaccio's (1313-1375) disease and demise: The final untold tale of liver and heart failure

Giovanni Boccaccio's fatal disease(s) and cause of death have long remained a mystery. Now, for the first time, a thorough multidisciplinary reassessment has finally been carried out. By combining philological and clinical approaches, it is at last possible to suggest a solid retrospective diagnosis based upon a study of his correspondence, poetry and iconography, as well as references to his physical decay in coeval and later sources. It would appear that he suffered over the last three years of his life from hepatic and cardiac failure, conditions that resulted in edema and potentially even hepatic carcinoma. Focusing on an unusually well-documented case from the Middle Ages, this analysis of exceptionally high informative value reconstructs the symptoms of his medical conditions and finally permits us to clarify and explain the historical feaures, presentations and evolutionary history of the case at hand.

Bleeding with the artificial heart: Gastrointestinal hemorrhage in CF-LVAD patients

Continuous-flow left ventricular assist devices (CF-LVADs) have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or, more recently, as destination therapy. However, its implantations carries a risk of complications including infection, device malfunction, arrhythmias, right ventricular failure, thromboembolic disease, postoperative and nonsurgical bleeding. A significant number of left ventricular assist devices (LVAD) recipients may experience recurrent gastrointestinal hemorrhage, mainly due to combination of antiplatelet and vitamin K antagonist therapy, activation of fibrinolytic pathway, acquired von Willebrand factor deficiency, and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump. Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions, extended hospital stays, multiple readmissions, and overall mortality. Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients, addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion. Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.

President Franklin D Roosevelt (1882-1945) and Doctor Frank Howard Lahey's (1880-1953) dilemma: The complexities of medical confidentiality with World Leaders

In the months before the Presidential Election of November 1944, there were serious concerns about the health of President Franklin D Roosevelt. He had lost considerable weight and his once robust appearance had given way to a tired and haggard look. Despite these worrisome observations, Vice-Admiral Ross T McIntire, who served as Franklin Roosevelt's personal physician from 1933 until Roosevelt's death, lied when he proclaimed Roosevelt to be in 'excellent condition for a man of his age'. The truth about Roosevelt's health was further obscured when Roosevelt's medical records disappeared.

Heart failure in Penzance--a cornish enigma

Following his discharge from the Royal Navy at the end of the Napoleonic Wars in 1816, Dr John Forbes (1787-1861) studied at the University of Edinburgh and gained his MD degree in the following year. He moved to Cornwall in September 1817 and started using a primitive stethoscope. In 1821 he translated Laennec's classical De L'Auscultation Mediate (1819) into English.As physician to Penzance Public Dispensary, his clinical experience in the local population is meticulously recorded in a large series of case notes of patients seen by him between 10 April and 4 December 1821. The casebooks are now in the care of Aberdeen University Library.

Heart transplantation

Over the past 40 years, heart transplantation has become a routine treatment for end-stage heart failure. Over 3000 heart transplants are performed annually. Despite improvements in short-term outcomes, long-term survival remains limited. Current efforts remain directed at alleviating the shortage of donor organs, developing effective treatments for chronic rejection, and improving mechanical circulatory support for heart failure.

Ancient Egyptian medicine and the concept of heart failure

BACKGROUND

The cardiac glosses of the Ebers papyrus comprise the concepts and notions of the Egyptian physicians about the heart and its diseases. We sought to analyze some of the cardiac glosses of the Ebers papyrus, focusing on those which may describe early concepts of the syndrome of heart failure.

METHODS AND RESULTS

Review of Joachim's German translation and both Bryan's and Ghalioungui's English translations of the Ebers papyrus. One clinical scenario describes patients with "weakness of the heart" or "cardiac dysfunction:" "His heart is bored," "The heart weakens," "This means that the heart does not speak or that the vessels of the heart are dumb. Its information under your hands normally appears because of the air with which they are filled is missing...." Debility that has arisen in the heart." The other clinical scenario supplies information about patients with heart failure and "fluid retention" or "congestion": "His heart is flooded. This is the liquid of the mouth. His body parts are all together weak"..."His heart is over flooded...."

CONCLUSION

Whether or not Egyptian medicine and the contents of the papyri paved the way for future knowledge, the clinical scenarios included in the Ebers papyrus may represent one of the earliest documented observations of the syndrome of heart failure.

Lunar Society and the discovery of digitalis

William Withering was an established member of the renowned Lunar Society as well as an accomplished physician and botanist. Withering was an obsessive note taker and had a compulsion to observe and record. At the time when bleeding was the most common form of treatment for "dropsy", Withering's discovery of the foxglove and his detailed description of its medicinal purposes represented a major advance in the treatment of patients with heart failure. Withering's scrupulous account of the foxglove's potential for treating conditions of the heart was derived from dedicated study, experimentation, and deep concern for detail. The publication of "An Account of the Foxglove, and Some of its Medical Uses: with practical remarks on dropsy, and other diseases" marks a defining moment in the history of medicine.

Bloodletting as a Cure For Dropsy: Heart Failure Down the Ages

BACKGROUND

Dropsy was a term used to describe generalized swelling and was synonymous with heart failure. Its treatment options were scanty and were aimed to cause "emptying of the system" or to relieve fluid retention. These remedies were rudimentary, erratic in action, and associated with inconvenient side effects.

METHODS AND RESULTS

Bloodletting, either by venesection or by leeches, was a popular way to alleviate symptoms from dropsy. Although bloodletting, purgatives, cauterization, and Southey tubes were drastic, their use demonstrated that physicians were not powerless to help people with severe heart failure. Several centuries of intensive investigations in different areas of heart failure ended with the development of new therapeutic strategies that made bloodletting obsolete.

CONCLUSION

In an era when adequate treatment of heart failure has become a reality, it is appropriate to acknowledge those who paved the way to such great progress.