Moral Judgment in Evaluating Disease: Some Pictures for Discussion

The Glutton

The Glutton, 1813, Thomas Rowlandson, British, 1756-1827, Hand colored etching, Bequest of Clements C. Fry 1955

This 40 year old morbidly obese man presents with acute right upper quadrant tenderness that radiates to his right shoulder and mild nausea. After his usual breakfast this morning, he reports indigestion and belching. (His medical history includes systemic hypertension.) He reports daily alcohol consumption of 8 glasses of wine per meal. Mr. S denies smoking and illicit drug use.

Satirical prints like The Glutton were meant for popular amusement. While many contemporary prints were political, others were analogous to today’s memes in that they sought to humorously portray relatable scenarios. In the 19th century, overeating was a show of wealth. Wine was consumed in immense quantities, a practice that has been linked to the era’s high prevalence of gout.