Retrospective diagnosis: use and abuse in medical historiography

Medical papers on diseases of famous persons, sometimes called pathographies, constitute the by far largest section of publications dealing with historical diagnosis. The procedure of attaching modern diagnostic labels to illustrious personalities of the past, i.e. retrospective diagnosis, has stimulated an ongoing theoretical debate among clinicians and medical historians. The purpose of this paper is to clarify some of the issues involved. Key problems of retrospective diagnostics are reviewed and analysed. In addition, the case history of the Polish composer Fryderyk Chopin is used to highlight problems and pitfalls of this method. Whereas contemporary physicians are used to apply present-day nosological categories to individuals of the past or historical epidemics, medical historians are more cautious to do so. They argue that in the absence of definite proofs retrospective diagnoses often are nothing more than mere speculation. Another important counter-argument is that medical knowledge itself varies over time and historical changes in nosology must not be ignored. Future pathographies should use primary sources extensively, focus on historical context and minimize the pursuit of retrospective diagnoses or causes of death. Only with a fundamentally revised method, a more critical approach to retrospective diagnostics, and far more serious objectives will medical biographies be in a position to break new ground.