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] 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 mocked in parody, where characters from fiction are "diagnosed". Squirrel Nutkin may have had Tourette syndrome[6] and Tiny Tim could have suffered from distal renal tubular acidosis (type I).[7]

Postmortem diagnosis

Post-mortem diagnosis is considered a research tool, and also a quality control practice[8] and it allows to evaluate the performance of the clinical case definitions.[9]

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.[10] 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.[11]


See also


  1. "MedTerms: Retrodiagnosis". 2004-01-12. Retrieved 2008-08-08.
  2. 1 2 Elmer, Peter (2004). The healing arts: health, disease and society in Europe, 1500-1800. Manchester: Manchester University Press. pp. xv. ISBN 0-7190-6734-0.
  3. 1 2 3 4 Burnham, John C. (2005). What is medical history?. Cambridge, UK: Polity. pp. 76–78. ISBN 0-7456-3224-6.
  4. 1 2 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 0-7727-2029-0.
  5. 1 2 3 Getz, Faye M. Western Medieval Medicine in Greene, Rebecca (1988). History of medicine. New York, NY: Institute for Research in History. ISBN 0-86656-309-1.
  6. 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 2539093Freely accessible. PMID 8541765.
  7. 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.
  8. 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
  9. Saracci R (1991). "Is necropsy a valid monitor of clinical diagnosis performance?". BMJ. 303 (6807): 898–900. doi:10.1136/bmj.303.6807.898.
  10. 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 2128008Freely accessible. PMID 9448543.
  11. 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.
  12. 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. PMID 14562158. Retrieved 2008-03-02.
  13. 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 1843211Freely accessible. PMID 5323262.
  14. Young I (December 1991). "Understanding Marfan's syndrome". BMJ. 303 (6815): 1414–5. doi:10.1136/bmj.303.6815.1414. PMC 1671667Freely accessible. PMID 1773142.
  15. 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.
  16. 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.
  17. Murray ED.; Cunningham MG; Price BH. (2012). "The role of psychotic disorders in religious history considered". J Neuropsychiatry Clin Neuroscience. 24 (4): 410–26. doi:10.1176/appi.neuropsych.11090214. PMID 23224447.

Further reading

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