Bearing witness to people who refuse to be fragmented by illness ================================================================ * Deborah Kirklin * Art and medicine * public art, history If you've accessed this editorial online then I hope you will take time to go back and look at the cover of this issue. Take time to look at Mark Gilbert's extraordinary portrait of Jarad, which is also featured in this issue's Editor's Choice article (***see page [5](http://mh.bmj.com/lookup/doi/10.1136/jmh.2009.003780)***).1 If you do, then I suspect that the experience of looking at and engaging with this portrait of care will be profound, and, depending perhaps on your perspective and your experiences, even a little disturbing. For some of you this will be the first time you have born witness to someone else's experience of illness, and you may be struck by the introspective quality of Jarad's portrait. Others will already know more than they wish to about being ill or of caring for someone who is ill. One way or another, after looking at this portrait of Jarad, at least some of you may feel that you know something about him, or at least know something about what he has lived through, and how it has affected who he is. This sudden intimacy with a stranger is, for many people, an unfamiliar experience, although for many healthcare professionals it is the best and the most demanding of the work they do. The overwhelmingly positive public response to the exhibition, of which Jarad's portrait is a part, suggests a significant desire among the general public to know more about the very human experiences of caring and being cared for. In choosing *Portraits of care: medical research through portraiture* as the Editor's Choice for this issue we are of course acknowledging the quality of the work done by Virginia Aita, William Lydiatt and Mark Gilbert. By making their paper free access, we are also hoping to help ensure that as many people as possible can learn about and engage with this work. In addition to the painstaking collaborative work of producing the portraits and mounting the exhibition, Aita, Lydiatt and Gilbert employed qualitative and quantitative research methodologies in their attempts to try to understand what the portraits, and the publics' responses to them, revealed about the experience of illness. The authors conclude that using portraiture in this way helps reveal patients as the ‘whole people’ they surely are and not as people who have been ‘fragmented by diagnosis’. This conclusion will, I hope, offer encouragement to those working in this field as well as to those who daily struggle to be seen as more than a disease with a person attached. It will also, I hope, offer encouragement to potential funders of important work like this. Another conclusion from this study, that ‘[c]are givers’ portraits reveal their commitment to care' offers us all a timely reminder of the important and all too often unacknowledged role of carers. Two additional features of this issue are worth drawing readers' attention to. The first is the significant number of historical research papers and the two guest editorials that are also by historians. I hope this trend will continue, reflecting as it does the important role of historical scholarship in medical humanities. The second is the first paper to be published under the new Medical Student (or other) category. Tharu Tharakan's paper, ‘Nutrition in warfare: a retrospective evaluation of undernourishment in RAF prisoners of war during World War II’, reports on research he undertook as part of the Medical Humanities component of his intercalated BSc at Imperial College. The standard of his work is high, showing what can be achieved when the brightest of our students are given an appropriate outlet for their talents. It was not, however, easy to find appropriate reviewers for his paper because, as Emily Mayhew explains in her accompanying editorial, there are not, it turns out, that many historians whose research focuses on nutrition. Why this might be so is an interesting question which is also raised by Gemma Denny, Pia Sundall, Susan Thornton, Jonathan Reinarz and Andrew Williams in their paper *Historical and contemporary perspectives on children's diets: is choice always in the patients' best interest?* Much has undoubtedly improved for children in the UK between 1744 when Thomasina Grace, a 13-year-old girl, was the first inpatient admitted to the Northampton General Infirmary. But as the research undertaken by these authors show, Thomasina, unlike contemporary child inpatients, was not in danger of becoming malnourished while in hospital. By comparing the diet Thomasina received as an inpatient in 1744 with the diet that a child admitted to hospital today would have available to choose from, the authors came to a rather uncomfortable conclusion. A child admitted to hospital today, for a prolonged stay, could, if she and her carers made unwise choices, become malnourished. Thomasina would have had little choice about what she ate. Her diet would instead have been a major part of her prescribed treatment. Importantly, according to Denny, Sundall, Thornton, Reinarz and Williams' analysis, her diet would have met all of her nutritional needs. While we have long known the shocking fact that after a stay in UK hospitals old people are more rather than less likely to be malnourished, and while it is well recognised that malnourishment is a major negative prognostic indicator for hospital in-patients, we seem, at a policy level, painfully unable to respond appropriately. Moreover, malnourishment is not just an in-patient health problem. As a London GP I've become increasingly concerned at how little attention is paid, at a public health level, to nutritional issues. One important consequence is that Vitamin D deficiency is now rife in the UK with osteomalacia and rickets, sadly, no longer a rarity. When I was a child, a daily dose of cod liver oil was on its way out of fashion, a joke our privileged generation didn't really get. Yesterday, in a clinical meeting at my practice, we only half jokingly suggested it might be worth readopting that historic nutritional tip. How quickly it seems we forget. ## Footnotes * Competing interests None. * Provenance and peer review Not commissioned; not externally peer reviewed. ## Reference 1. Aita VA, Lydiatt WM, Gilbert MA. Portraits of care: medical research through portraiture. Med Humanit 2010;36:5–13. [Abstract/FREE Full Text](http://mh.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoibWVkaHVtIjtzOjU6InJlc2lkIjtzOjY6IjM2LzEvNSI7czo0OiJhdG9tIjtzOjE5OiIvbWVkaHVtLzM2LzEvMS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)