Retrospective diagnosis

A retrospective diagnosis (also retrodiagnosis or posthumous diagnosis) is the practice of identifying an illness after the death of the patient (sometimes a historical figure) using modern knowledge, methods and disease classifications.<ref name=MedTerms>"MedTerms: Retrodiagnosis". MedicineNet.com. 2004-01-12. Archived from the original on 2012-08-07. Retrieved 2008-08-08.</ref><ref name=Elmer2004>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.</ref> Alternatively, it can be the more general attempt to give a modern name to an ancient and ill-defined scourge or plague.<ref name=Burnham2005>Burnham, John C. (2005). What is medical history?. Cambridge, UK: Polity. pp. 76–78. ISBN 978-0-7456-3224-7.</ref>

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".<ref name=Elmer2004/> The process often requires "translating between linguistic and conceptual worlds separated by several centuries",<ref name=Siena2005>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.</ref> and assumes our modern disease concepts and categories are privileged.<ref name=Siena2005/> 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.<ref name=Greene1988>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.</ref> 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.<ref name="Hayton">Hayton, Darin. "Isaac Newton was Autistic, or Not". Darin Hayton, Historian of Science. Retrieved 7 May 2019.</ref>

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.<ref name=Burnham2005/>

The practice of retrospective diagnosis has been applied in parody, where characters from fiction are "diagnosed". Squirrel Nutkin may have had Tourette syndrome<ref name=Williams1995>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)</ref> and Tiny Tim could have had distal renal tubular acidosis (type I).<ref name=Lewis1992>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.</ref>

Postmortem diagnosis

Post-mortem diagnosis is considered a research tool, and also a quality control practice<ref>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</ref> and it allows to evaluate the performance of the clinical case definitions.<ref>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.</ref>

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.<ref name=HooperBMJ>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.</ref> 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.<ref name=Ikeda2006>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.</ref>

Examples

• Did Abraham, Moses, Jesus or Saint Paul have psychotic spectrum psychological symptoms?<ref>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.</ref>
• Did Tutankhamun have Klippel–Feil syndrome?<ref name="pmid12812942">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. PMC 8149017. PMID 12812942.</ref>
• Did Alfred the Great have Crohn's disease?<ref name="DiagPast">Edge, Joanne. "Diagnosing the past". Wellcome Collection. Retrieved 18 February 2019.</ref>
• Did botulism cause the religious visions experienced by Julian of Norwich?<ref name=Greene1988/>
• Was the English sweat caused by hantavirus?<ref name=Burnham2005/>
• Was the Black Death due to bubonic plague?<ref name=Greene1988/>
• Was "the great pox" syphilis or several venereal diseases?<ref name=Burnham2005/>
• Did King George III of the United Kingdom exhibit the classic symptoms of porphyria?<ref>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.</ref>
• Were the conditions blamed on witches at the Salem witch trials caused by ergotism?<ref name="DiagPast" />
• Did Napoleon die from stomach cancer, or was he poisoned with arsenic?<ref name="Hindmarch">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.</ref>
• Could Franklin D. Roosevelt's paralytic illness have been Guillain–Barré syndrome rather than poliomyelitis?<ref name="Goldman">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.</ref>
• Did Abraham Lincoln have Marfan syndrome?<ref name="pmid1773142">Young I (December 1991). "Understanding Marfan's syndrome". BMJ. 303 (6815): 1414–5. doi:10.1136/bmj.303.6815.1414. PMC 1671667. PMID 1773142.</ref>
• Did Karl Marx have hidradenitis suppurativa?<ref>Shuster, Sam (2008). "The nature and consequence of Karl Marx's skin disease". British Journal of Dermatology. Blackwell Publishing Ltd. 158 (1).</ref>
• Could Burke and Wills have died of thiaminase poisoning?<ref name="pmid8152477">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.</ref>
• Did René Descartes have Exploding head syndrome?<ref name="pmid29609724">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.</ref>

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.<ref name=SacksCavendish>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.</ref><ref>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.</ref><ref name=GoodeNYT>Goode, Erica (9 October 2001). "CASES; A Disorder Far Beyond Eccentricity". The New York Times. Retrieved 26 November 2007.</ref><ref name=JamesSingular>James I (2003). "Singular scientists". J R Soc Med. 96 (1): 36–9. doi:10.1177/014107680309600112. PMC 539373. PMID 12519805.</ref> 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."<ref name=GoodeNYT/>

See also

• Charles Darwin's illness
• List of people with epilepsy (includes notes on retrospective diagnosis and misdiagnosis of historical figures)
• Mental health of Jesus
• Paleopathology
• Samuel Johnson's health

Further reading

• Mackowiak, Philip A. (2007). Post-Mortem: Solving History's Great Medical Mysteries. The American College of Physicians. ISBN 978-1-930513-89-1.
• Historical Clinicopathological Conference