{{short description|Practice of identifying an illness after the death of the patient}} 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>{{cite web |date=2004-01-12 |url=http://www.medterms.com/script/main/art.asp?articlekey=26040 |title=MedTerms: Retrodiagnosis |publisher=MedicineNet.com |access-date=2008-08-08 |archive-date=2012-08-07 |archive-url=https://web.archive.org/web/20120807062838/http://www.medterms.com/script/main/art.asp?articlekey=26040 |url-status=dead }}</ref><ref name=Elmer2004>{{cite book |url=https://books.google.com/books?id=lFi2zHG5XWMC&q=%22more+than+a+game,+with+ill-defined+rules+and+little+academic+credibility%22&pg=PR15 |author=Elmer, Peter |title=The healing arts: health, disease and society in Europe, 1500–1800 |publisher=Manchester University Press |location=Manchester |year=2004 |pages=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>{{cite book |author=Burnham, John C. |title=What is medical history? |publisher=Polity |location=Cambridge, UK |year=2005 |pages=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>{{cite book |author=Kevin P. Siena |title=Sins of the flesh: responding to sexual disease in early modern Europe |publisher=Centre for Reformation and Renaissance Studies |location=Toronto |year=2005 |pages=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 {{cite book |author=Greene, Rebecca |title=History of medicine |publisher=Institute for Research in History |location=New York, NY |year=1988 |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">{{cite web |last1=Hayton |first1=Darin |title=Isaac Newton was Autistic, or Not |url=http://dhayton.haverford.edu/blog/2015/12/31/isaac-newton-was-autistic-or-not/ |website=Darin Hayton, Historian of Science |access-date=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"; e.g., authors have speculated that Squirrel Nutkin may have had Tourette syndrome<ref name=Williams1995>{{cite journal |author=Williams TM, Kim, Williams G |title=Excessive impertinence or a missed diagnosis? |journal=BMJ |volume=311 |issue=7021 |pages=1700–1 |year=1995 |pmid=8541765 |doi=10.1136/bmj.311.7021.1700 |pmc=2539093 }}</ref> and that Tiny Tim could have had distal renal tubular acidosis (type I).<ref name=Lewis1992>{{cite journal |author=Lewis DW |title=What was wrong with Tiny Tim? |journal=Am. J. Dis. Child. |volume=146 |issue=12 |pages=1403–7 |date=December 1992 |pmid=1340779 |doi=10.1001/archpedi.1992.02160240013002 }}</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>{{cite journal | author = Saracci R | year = 1991 | title = Is necropsy a valid monitor of clinical diagnosis performance? | journal = BMJ | volume = 303 | issue = 6807| pages = 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>{{cite journal | author=Hooper, E. | title=Sailors and star-bursts, and the arrival of HIV | url=http://bmj.bmjjournals.com/cgi/content/full/315/7123/1689 | journal=BMJ | year=1997 | pages=1689–1691 | volume=315 | issue=7123 | pmid= 9448543 | pmc=2128008 | doi=10.1136/bmj.315.7123.1689 }}</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>{{cite journal |vauthors=Ikeda S, Tsuru A, Moriuchi M, Moriuchi H |title=Retrospective diagnosis of congenital cytomegalovirus infection using umbilical cord |journal=Pediatr. Neurol. |volume=34 |issue=5 |pages=415–6 |date=May 2006 |pmid=16648007 |doi=10.1016/j.pediatrneurol.2005.10.006 }}</ref>
==Examples== * Did Abraham, Moses, Jesus, Saint Paul or Muhammad have psychotic spectrum psychological symptoms?<ref>{{cite journal |author1=Murray ED. |author2=Cunningham MG |author3=Price BH. | year = 2012| title = The role of psychotic disorders in religious history considered | journal = The Journal of Neuropsychiatry and Clinical Neurosciences| volume = 24 | issue = 4| pages = 410–26 | doi = 10.1176/appi.neuropsych.11090214 | pmid = 23224447 |s2cid=207654711 }}</ref> * Did Tutankhamun have Klippel–Feil syndrome?<ref name="pmid12812942">{{cite journal |vauthors=Boyer RS, Rodin EA, Grey TC, Connolly RC |title=The skull and cervical spine radiographs of Tutankhamen: a critical appraisal |journal=AJNR Am J Neuroradiol |volume=24 |issue=6 |pages=1142–7 |year=2003 |pmid=12812942 |pmc=8149017 |url=http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=12812942}}</ref> * Did Alfred the Great have Crohn's disease?<ref name="DiagPast">{{cite web |last1=Edge |first1=Joanne |title=Diagnosing the past |url=https://wellcomecollection.org/articles/W5D4eR4AACIArLL8 |website=Wellcome Collection |access-date=18 February 2019 |language=en}}</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>{{cite journal |vauthors=Macalpine I, Hunter R |title=The "insanity" of King George 3d: a classic case of porphyria |journal=Br Med J |volume=1 |issue=5479 |pages=65–71 |date=January 1966 |pmid=5323262 |pmc=1843211 |doi=10.1136/bmj.1.5479.65}}</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">{{cite journal |last1=Hindmarch |first1=J. Thomas |last2=Savory |first2=John |title=The Death of Napoleon, Cancer or Arsenic? |journal=Clinical Chemistry |year=2008 |volume=54 |issue=12 |pages=2092–3 |doi=10.1373/clinchem.2008.117358 |url=http://clinchem.aaccjnls.org/content/clinchem/54/12/2092.full.pdf }}</ref> * Could Franklin D. Roosevelt's paralytic illness have been Guillain–Barré syndrome rather than poliomyelitis?<ref name="Goldman">{{cite journal |vauthors = Goldman AS, Schmalstieg EJ, Freeman DH, Goldman DA, Schmalstieg FC |title = What was the cause of Franklin Delano Roosevelt's paralytic illness? |journal = J Med Biogr |volume = 11 |issue = 4 |pages = 232–40 |year = 2003 |pmid = 14562158 |url = http://www.rsmpress.co.uk/jmb_2003_v11_p232-240.pdf |doi = 10.1177/096777200301100412 |access-date = 2008-03-02 |url-status = dead |archive-url = https://web.archive.org/web/20080307005449/http://www.rsmpress.co.uk/jmb_2003_v11_p232-240.pdf |archive-date = 2008-03-07 |citeseerx = 10.1.1.691.2120 |s2cid = 39957366 }}</ref> * Did Abraham Lincoln have Marfan syndrome?<ref name="pmid1773142">{{cite journal |author=Young I |title=Understanding Marfan's syndrome |journal=BMJ |volume=303 |issue=6815 |pages=1414–5 |date=December 1991 |pmid=1773142 |pmc=1671667 |doi= 10.1136/bmj.303.6815.1414}}</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">{{cite journal |vauthors=Earl JW, McCleary BV |title=Mystery of the poisoned expedition |journal=Nature |volume=368 |issue=6473 |pages=683–4 |date=April 1994 |pmid=8152477 |doi=10.1038/368683a0 |bibcode=1994Natur.368..683E|s2cid=6835422 }}</ref> * Did René Descartes have Exploding head syndrome?<ref name="pmid29609724">{{cite journal |author=Otaiku AI |title=Did René Descartes Have Exploding Head Syndrome? |journal=Journal of Clinical Sleep Medicine |volume=14 |issue=4 |pages=675–8 |date=April 2018 |pmid=29609724 |pmc=5886445 |doi= 10.5664/jcsm.7068}}</ref>
== Retrospective diagnoses of autism == <!-- Please do not add your own speculations here - Wikipedia is not for original research. Please add suggested inclusions to the talk page. --> 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. [http://www.neurological.org.nz/html/article.php?documentCode=26 Henry Cavendish: An early case of Asperger's syndrome?] {{webarchive |url=https://web.archive.org/web/20070901095011/http://www.neurological.org.nz/html/article.php?documentCode=26 |date=1 September 2007 }} Neurological Foundation of New Zealand (Reprinted with permission from the American Neurological Association). Retrieved on 28 June 2007.</ref><ref>{{cite journal |author=Sacks O |title=Henry Cavendish: an early case of Asperger's syndrome? |journal=Neurology |volume=57 |issue=7 |page=1347 |year=2001 |pmid=11591871 |doi=10.1212/wnl.57.7.1347|s2cid=32979125 }}</ref><ref name=GoodeNYT>{{cite news |title=CASES; A Disorder Far Beyond Eccentricity |last1=Goode |first1=Erica |date=9 October 2001 |url=https://www.nytimes.com/2001/10/09/health/cases-a-disorder-far-beyond-eccentricity.html |work=The New York Times |access-date=26 November 2007 }}</ref><ref name=JamesSingular>{{cite journal |author=James I |title=Singular scientists |journal=J R Soc Med |volume=96 |issue=1 |pages=36–9 |year=2003 |pmid=12519805 |doi= 10.1177/014107680309600112|pmc=539373}}</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
==References== {{reflist|2}}
==Further reading== * {{cite book |author=Mackowiak, Philip A. |title=Post-Mortem: Solving History's Great Medical Mysteries |publisher=The American College of Physicians |year=2007 |isbn=978-1-930513-89-1 }} * [http://www.medicalalumni.org/CPC/pages/previous.htm Historical Clinicopathological Conference]
Category:Retrospective diagnosis Category:Forensic pathology