Retrospective diagnosis
Encyclopedia
A retrospective diagnosis (also retrodiagnosis or posthumous diagnosis) is the practice of identifying an illness in a historical figure using modern knowledge, methods and disease classifications. Alternatively, it can be the more general attempt to give a modern name to an ancient and ill-defined scourge or plague.
Retrospective diagnosis is practised by medical historians, general historians and the media with varying degrees of scholarship. At its worst it may become "little more than a game, with ill-defined rules and little academic credibility." The process often requires "translating between linguistic and conceptual worlds separated by several centuries", and assumes our modern disease concepts and categories are privileged. Crude attempts at retrospective diagnosis fail to be sensitive to historical context, may treat historical and religious records as scientific evidence, or ascribe pathology to behaviours that require none. The understanding of the history of illness can benefit from modern science. For example, knowledge of the insect vectors of malaria
and yellow fever
can be used to explain the changes in extent of those diseases caused by drainage or urbanisation in historical times.
The practice of retrospective diagnosis has been mocked in parody
, where characters from fiction are "diagnosed". Squirrel Nutkin may have had Tourette syndrome
and Tiny Tim
could have suffered from distal renal tubular acidosis
(type I).
The term retrospective diagnosis is also sometimes used by a clinical pathologist
to describe a medical diagnosis
in a person made some time after the original illness has resolved or after death. In such cases, analysis of a physical specimen
may yield a confident medical diagnosis. The search for the origin of AIDS
has involved posthumous diagnosis of AIDS
in people who died decades before the disease was first identified. Another example is where analysis of preserved umbilical cord
tissue enables the diagnosis of congenital cytomegalovirus
infection in a patient who had later developed a central nervous system
disorder.
Retrospective diagnosis is practised by medical historians, general historians and the media with varying degrees of scholarship. At its worst it may become "little more than a game, with ill-defined rules and little academic credibility." The process often requires "translating between linguistic and conceptual worlds separated by several centuries", and assumes our modern disease concepts and categories are privileged. Crude attempts at retrospective diagnosis fail to be sensitive to historical context, may treat historical and religious records as scientific evidence, or ascribe pathology to behaviours that require none. The understanding of the history of illness can benefit from modern science. For example, knowledge of the insect vectors of malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
and yellow fever
Yellow fever
Yellow fever is an acute viral hemorrhagic disease. The virus is a 40 to 50 nm enveloped RNA virus with positive sense of the Flaviviridae family....
can be used to explain the changes in extent of those diseases caused by drainage or urbanisation in historical times.
The practice of retrospective diagnosis has been mocked in parody
Parody
A parody , in current usage, is an imitative work created to mock, comment on, or trivialise an original work, its subject, author, style, or some other target, by means of humorous, satiric or ironic imitation...
, where characters from fiction are "diagnosed". Squirrel Nutkin may have had Tourette syndrome
Tourette syndrome
Tourette syndrome is an inherited neuropsychiatric disorder with onset in childhood, characterized by multiple physical tics and at least one vocal tic; these tics characteristically wax and wane...
and Tiny Tim
Tiny Tim (A Christmas Carol)
Timothy Cratchit, called "Tiny Tim", is a fictional character from the 1843 novella A Christmas Carol by Charles Dickens. He is a minor character, the young son of Bob Cratchit, and is seen only briefly, but serves as an important symbol of the consequences of the protagonist's choices...
could have suffered from distal renal tubular acidosis
Renal tubular acidosis
Renal tubular acidosis is a medical condition that involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine. When blood is filtered by the kidney, the filtrate passes through the tubules of the nephron, allowing for exchange of salts, acid...
(type I).
The term retrospective diagnosis is also sometimes used by a clinical pathologist
Clinical pathology
Clinical pathology , Laboratory Medicine , Clinical analysis or Clinical/Medical Biology , is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids, such as...
to describe a medical diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
in a person made some time after the original illness has resolved or after death. In such cases, analysis of a physical specimen
Laboratory specimen
In medicine, a laboratory specimen is a medical sample, that is, gathered matter of a medical patient's tissue, fluid, or other material derived from the patient used for laboratory analysis to assist differential diagnosis or staging of a disease process...
may yield a confident medical diagnosis. The search for the origin of AIDS
AIDS origin
AIDS is caused by the Human immunodeficiency virus , which originated in non-human primates in Sub-Saharan Africa and was transferred to humans during the late 19th or early 20th century....
has involved posthumous diagnosis of AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
in people who died decades before the disease was first identified. Another example is where analysis of preserved umbilical cord
Umbilical cord
In placental mammals, the umbilical cord is the connecting cord from the developing embryo or fetus to the placenta...
tissue enables the diagnosis of congenital cytomegalovirus
Cytomegalovirus
Cytomegalovirus is a viral genus of the viral group known as Herpesviridae or herpesviruses. It is typically abbreviated as CMV: The species that infects humans is commonly known as human CMV or human herpesvirus-5 , and is the most studied of all cytomegaloviruses...
infection in a patient who had later developed a central nervous system
Central nervous system
The central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...
disorder.
Examples
- Was the English sweat caused by hantavirusHantavirusHantaviruses are negative sense RNA viruses in the Bunyaviridae family. Humans may be infected with hantaviruses through rodent bites, urine, saliva or contact with rodent waste products...
? - Was the black deathBlack DeathThe Black Death was one of the most devastating pandemics in human history, peaking in Europe between 1348 and 1350. Of several competing theories, the dominant explanation for the Black Death is the plague theory, which attributes the outbreak to the bacterium Yersinia pestis. Thought to have...
due to bubonic plagueBubonic plaguePlague is a deadly infectious disease that is caused by the enterobacteria Yersinia pestis, named after the French-Swiss bacteriologist Alexandre Yersin. Primarily carried by rodents and spread to humans via fleas, the disease is notorious throughout history, due to the unrivaled scale of death...
? - Was "the great pox" syphilisSyphilisSyphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
or several venereal diseases? - Could Franklin D. Roosevelt's paralytic illnessFranklin D. Roosevelt's paralytic illnessFranklin D. Roosevelt's paralytic illness began in 1921 at age 39, when Roosevelt got a fever after exercising heavily at a vacation in Canada. While his bout with illness was well known during his terms as President of the United States, the extent of his paralysis was kept from public view. After...
have been Guillain-Barré syndromeGuillain-Barré syndromeGuillain–Barré syndrome , sometimes called Landry's paralysis, is an acute inflammatory demyelinating polyneuropathy , a disorder affecting the peripheral nervous system. Ascending paralysis, weakness beginning in the feet and hands and migrating towards the trunk, is the most typical symptom...
rather than poliomyelitisPoliomyelitisPoliomyelitis, often called polio or infantile paralysis, is an acute viral infectious disease spread from person to person, primarily via the fecal-oral route...
? - Did botulismBotulismBotulism also known as botulinus intoxication is a rare but serious paralytic illness caused by botulinum toxin which is metabolic waste produced under anaerobic conditions by the bacterium Clostridium botulinum, and affecting a wide range of mammals, birds and fish...
cause the religious visions experienced by Julian of NorwichJulian of NorwichJulian of Norwich is regarded as one of the most important English mystics. She is venerated in the Anglican and Lutheran churches, but has never been canonized, or officially beatified, by the Catholic Church, probably because so little is known of her life aside from her writings, including the...
? - Did King George III of the United KingdomGeorge III of the United KingdomGeorge III was King of Great Britain and King of Ireland from 25 October 1760 until the union of these two countries on 1 January 1801, after which he was King of the United Kingdom of Great Britain and Ireland until his death...
exhibit the classic symptoms of porphyriaPorphyriaPorphyrias are a group of inherited or acquired disorders of certain enzymes in the heme bio-synthetic pathway . They are broadly classified as acute porphyrias and cutaneous porphyrias, based on the site of the overproduction and accumulation of the porphyrins...
? - Did Abraham LincolnAbraham LincolnAbraham Lincoln was the 16th President of the United States, serving from March 1861 until his assassination in April 1865. He successfully led his country through a great constitutional, military and moral crisis – the American Civil War – preserving the Union, while ending slavery, and...
have Marfan syndromeMarfan syndromeMarfan syndrome is a genetic disorder of the connective tissue. People with Marfan's tend to be unusually tall, with long limbs and long, thin fingers....
? - Could Burke and WillsBurke and Wills expeditionIn 1860–61, Robert O'Hara Burke and William John Wills led an expedition of 19 men with the intention of crossing Australia from Melbourne in the south to the Gulf of Carpentaria in the north, a distance of around 3,250 kilometres...
have died of thiaminaseThiaminaseThiaminase is an enzyme that metabolizes or breaks down thiamine into two molecular parts.The old name was "Aneurinase".There are two types: -Sources:Source include:* Bracken , Nardoo and other plants.* Some fish including carp and goldfish....
poisoning? - Did TutankhamunTutankhamunTutankhamun , Egyptian , ; approx. 1341 BC – 1323 BC) was an Egyptian pharaoh of the 18th dynasty , during the period of Egyptian history known as the New Kingdom...
have Klippel-Feil syndromeKlippel-Feil syndromeKlippel–Feil syndrome is a rare disease, initially reported in 1912 by Maurice Klippel and André Feil from France, characterized by the congenital fusion of any 2 of the 7 cervical vertebrae....
?
See also
- Samuel Johnson's healthSamuel Johnson's healthSamuel Johnson's health has been a focus of the biographical and critical analysis of his life. His medical history was well documented by Johnson and his friends, and those writings have allowed later critics and doctors to infer diagnoses of conditions that were unknown in Johnson's day.His...
- List of people with epilepsy (includes notes on retrospective diagnosis and misdiagnosis of historical figures)
- Historical figures sometimes considered autistic