Retrospective diagnosis

A retrospective diagnosis (also retrodiagnosis or posthumous diagnosis) is the practice of identifying an illness after the death of the patient (sometimes in a historical figure) using modern knowledge, methods and disease classifications.^[1]^[2] Alternatively, it can be the more general attempt to give a modern name to an ancient and ill-defined scourge or plague.^[3]

Historical research

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".^[2] The process often requires "translating between linguistic and conceptual worlds separated by several centuries",^[4] and assumes our modern disease concepts and categories are privileged.^[4] 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.^[5] Darin Hayton, a historian of science at Haverford College, claims that retrodiagnosing famous individuals with autism in the media is pointless, as historical accounts often contain incomplete information.^[6]

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.^[3]

The practice of retrospective diagnosis has been applied in parody, where characters from fiction are "diagnosed". Squirrel Nutkin may have had Tourette syndrome^[7] and Tiny Tim could have suffered from distal renal tubular acidosis (type I).^[8]

Postmortem diagnosis

Post-mortem diagnosis is considered a research tool, and also a quality control practice^[9] and it allows to evaluate the performance of the clinical case definitions.^[10]

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.^[11] 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.^[12]

Examples

Did Abraham, Moses, Jesus or Saint Paul have psychotic spectrum psychological symptoms?^[13]
Did Tutankhamun have Klippel–Feil syndrome?^[14]
Did Alfred the Great have Crohn's disease?^[15]
Did botulism cause the religious visions experienced by Julian of Norwich?^[5]
Was the English sweat caused by hantavirus?^[3]
Was the Black Death due to bubonic plague?^[5]
Was "the great pox" syphilis or several venereal diseases?^[3]
Did King George III of the United Kingdom exhibit the classic symptoms of porphyria?^[16]
Were the afflictions blamed on witches at the Salem witch trials caused by ergotism?^[15]
Did Napoleon die from stomach cancer, or was he poisoned with arsenic?^[17]
Could Franklin D. Roosevelt's paralytic illness have been Guillain–Barré syndrome rather than poliomyelitis?^[18]
Did Abraham Lincoln have Marfan syndrome?^[19]
Did Karl Marx have hidradenitis suppurativa?^[20]
Could Burke and Wills have died of thiaminase poisoning?^[21]
Did René Descartes have Exploding head syndrome?^[22]

Retrospective diagnoses of autism

There have been many published speculative retrospective diagnoses of autism of historical figures. English scientist Henry Cavendish is believed by some to have been autistic. George Wilson, a notable chemist and physician, wrote a book about Cavendish entitled The Life of the Honourable Henry Cavendish (1851), which provides a detailed description that indicates Cavendish may have exhibited many classic signs of autism.^[23]^[24]^[25]^[26] The practice of retrospectively diagnosing autism is controversial. Professor Fred Volkmar of Yale University is not convinced; he claims that "There is unfortunately a sort of cottage industry of finding that everyone has Asperger's."^[25]

References

^ "MedTerms: Retrodiagnosis". MedicineNet.com. 2004-01-12. Retrieved 2008-08-08.
^ ^a ^b Elmer, Peter (2004). The healing arts: health, disease and society in Europe, 1500–1800. Manchester: Manchester University Press. pp. xv. ISBN 978-0-7190-6734-1.
^ ^a ^b ^c ^d Burnham, John C. (2005). What is medical history?. Cambridge, UK: Polity. pp. 76–78. ISBN 978-0-7456-3224-7.
^ ^a ^b Kevin P. Siena (2005). Sins of the flesh: responding to sexual disease in early modern Europe. Toronto: Centre for Reformation and Renaissance Studies. p. 12. ISBN 978-0-7727-2029-0.
^ ^a ^b ^c Getz, Faye M. Western Medieval Medicine in Greene, Rebecca (1988). History of medicine. New York, NY: Institute for Research in History. ISBN 978-0-86656-309-3.
^ Hayton, Darin. "Isaac Newton was Autistic, or Not". Darin Hayton, Historian of Science. Retrieved 7 May 2019.
^ Williams TM, Kim, Williams G (1995). "Excessive impertinence or a missed diagnosis?". BMJ. 311 (7021): 1700–1. doi:10.1136/bmj.311.7021.1700. PMC 2539093. PMID 8541765.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ Lewis DW (December 1992). "What was wrong with Tiny Tim?". Am. J. Dis. Child. 146 (12): 1403–7. doi:10.1001/archpedi.1992.02160240013002. PMID 1340779.
^ S. Suryavanshi, J. D. Gomez, A. Mulla, J. Kalra, "Prevalence of diagnostic discordance: A retrospective analysis of autopsy findings and clinical diagnoses. Vol 30, No 4 (2007) Supplement – Royal College Abstracts, Official college of the canadian society for clinical investigation
^ Saracci R (1991). "Is necropsy a valid monitor of clinical diagnosis performance?". BMJ. 303 (6807): 898–900. doi:10.1136/bmj.303.6807.898. PMC 1671185. PMID 1933005.
^ Hooper, E. (1997). "Sailors and star-bursts, and the arrival of HIV". BMJ. 315 (7123): 1689–1691. doi:10.1136/bmj.315.7123.1689. PMC 2128008. PMID 9448543.
^ Ikeda S, Tsuru A, Moriuchi M, Moriuchi H (May 2006). "Retrospective diagnosis of congenital cytomegalovirus infection using umbilical cord". Pediatr. Neurol. 34 (5): 415–6. doi:10.1016/j.pediatrneurol.2005.10.006. PMID 16648007.
^ Murray ED.; Cunningham MG; Price BH. (2012). "The role of psychotic disorders in religious history considered". The Journal of Neuropsychiatry and Clinical Neurosciences. 24 (4): 410–26. doi:10.1176/appi.neuropsych.11090214. PMID 23224447. S2CID 207654711.
^ Boyer RS, Rodin EA, Grey TC, Connolly RC (2003). "The skull and cervical spine radiographs of Tutankhamen: a critical appraisal". AJNR Am J Neuroradiol. 24 (6): 1142–7. PMID 12812942.
^ ^a ^b Edge, Joanne. "Diagnosing the past". Wellcome Collection. Retrieved 18 February 2019.
^ Macalpine I, Hunter R (January 1966). "The "insanity" of King George 3d: a classic case of porphyria". Br Med J. 1 (5479): 65–71. doi:10.1136/bmj.1.5479.65. PMC 1843211. PMID 5323262.
^ Hindmarch, J. Thomas; Savory, John (2008). "The Death of Napoleon, Cancer or Arsenic?" (PDF). Clinical Chemistry. 54 (12): 2092–3. doi:10.1373/clinchem.2008.117358.
^ Goldman AS, Schmalstieg EJ, Freeman DH, Goldman DA, Schmalstieg FC (2003). "What was the cause of Franklin Delano Roosevelt's paralytic illness?" (PDF). J Med Biogr. 11 (4): 232–40. CiteSeerX 10.1.1.691.2120. doi:10.1177/096777200301100412. PMID 14562158. S2CID 39957366. Archived from the original (PDF) on 2008-03-07. Retrieved 2008-03-02.
^ Young I (December 1991). "Understanding Marfan's syndrome". BMJ. 303 (6815): 1414–5. doi:10.1136/bmj.303.6815.1414. PMC 1671667. PMID 1773142.
^ Shuster, Sam (2008). "The nature and consequence of Karl Marx's skin disease". British Journal of Dermatology. Blackwell Publishing Ltd. 158 (1).
^ Earl JW, McCleary BV (April 1994). "Mystery of the poisoned expedition". Nature. 368 (6473): 683–4. Bibcode:1994Natur.368..683E. doi:10.1038/368683a0. PMID 8152477. S2CID 6835422.
^ Otaiku AI (April 2018). "Did René Descartes Have Exploding Head Syndrome?". Journal of Clinical Sleep Medicine. 14 (4): 675–8. doi:10.5664/jcsm.7068. PMC 5886445. PMID 29609724.
^ Sacks, Oliver. Henry Cavendish: An early case of Asperger's syndrome? Archived 1 September 2007 at the Wayback Machine Neurological Foundation of New Zealand (Reprinted with permission from the American Neurological Association). Retrieved on 28 June 2007.
^ Sacks O (2001). "Henry Cavendish: an early case of Asperger's syndrome?". Neurology. 57 (7): 1347. doi:10.1212/wnl.57.7.1347. PMID 11591871. S2CID 32979125.
^ ^a ^b Goode, Erica (9 October 2001). "CASES; A Disorder Far Beyond Eccentricity". The New York Times. Retrieved 26 November 2007.
^ James I (2003). "Singular scientists". J R Soc Med. 96 (1): 36–9. doi:10.1258/jrsm.96.1.36. PMC 539373. PMID 12519805.