visible signs of illness from the 14th to the 20th century systematic review of portraits objectives to see whether a collection of portraits depicting inhabitants of a defined geographical region and covering several centuries is a useful source for studying the sociocultural significance and epidemiology of particular visible diseases such as goitre which is known to have been common in this regiondesign systematic review of portraits and description of visible signs of illnesssetting the burgerbibliothek archives of the burghers community in berne switzerlanddata sources 3615 portraits 2989 of individuals whose identity is known and 626 of individuals whose identity is unknownmain outcome measures visible signs of illness evaluated by means of a standardised visual assessmentresults visible signs of illness in portraits were common and appeared in up to 82 451553 of paintings from the 17th and 18th centuries the most common findings were signs of goitre in women and overweight in men in only the portraits where the neck region could be evaluated 41 of women with known identities 139343 had goitre compared with 24 of men with known identities 2186 the prevalence of goitre was even higher in sitters whose identities were unknown 63 in men 58 and 68 in women 82121 overweight in people with known identities was more common in men than in women 30 3461145 v 44 8111844 overweight was most common in sitters aged 40 than in those aged 40 or younger other conditions such as missing teeth amputated limbs or osteoarthritic deformations were surprisingly rare in the portraits under evaluationconclusions goitre and other diseases are underrepresented in the people depicted in these portraits artistic idealisation is a likely explanation for this observation what was reproduced depended on what was considered pathological or shameful at the time and therefore depended on age and sex stigmatising details may have been omitted further artistic skills and contemporary fashion may have influenced the way in which people were reproduced people depicted are possibly not representative of the general bernese population as they constituted a socioeconomically advantaged group