Historical Perspectives in Medicine using a Large Language Model: Emulating an 18th Century Physician

Eighteenth-century medical texts document a formative period in the evolution of clinical reasoning, yet their integration into modern medical education is limited. The traditional approach to learning the history of medicine has naturally focused on passive reading, but new approaches using AI could enable learners to interrogate and simulate the historical diagnostic logic and therapeutic paradigms. More specifically, large language models (LLMs) offer an opportunity to create interactive simulations that allow experiential engagement with historical medical reasoning.

We developed a historically constrained LLM-based educational platform designed to emulate the diagnostic reasoning, language, and conceptual frameworks of an 18th-century physician. A modern GPT architecture was customized using strict instruction-based constraints and limited exclusively to a curated corpus of six foundational 17th-18th century medical texts. Guardrails were implemented to prevent anachronistic terminology and modern medical concepts. Model outputs were evaluated qualitatively by comparing the model's diagnoses and treatment plans with published diagnoses and treatment from original 18 ^th century sources. We also applied the simulation to modern clinical vignettes for an illustrative contrast between modern and 18 ^th century approaches.

The model generated responses that closely aligned with 18th-century medical and rhetorical style, as well as therapeutic reasoning. When presented with historical cases, the simulation demonstrated strong concordance with original diagnoses and management strategies. Secondly, when applied to modern cases, the model described period-appropriate reasoning, highlighting clear contrasts with contemporary biomedical reasoning.

AI broadly, and more specifically LLMs configured as historically constrained simulators, can function as effective tools for learning in medical history. This approach could enable active engagement with historical clinical reasoning, fostering critical reflection on the contingent and evolving nature of medical knowledge. Such temporal simulations hold promise for medical humanities education and interdisciplinary teaching.