Diagnostic algorithm allows for a scientifically robust and reliable retrospective diagnosis using textual evidence from mid-19th century Basel, Switzerland
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引用次数: 0
Abstract
Objective
Diagnosing disease from the past using historic textual sources can be controversial as to its accuracy. To overcome these objections, an empirical approach to the historical clinical data was developed. The approach follows a standardised, objective, and systematic evaluation, satisfying the requirements of the philosophy of science.
Material
Physician-managed medical records of mid-19th century patients reported to have suffered from tuberculosis.
Method
A diagnostic algorithm, quantifying clinical data into a scoring system, was developed based on criteria recorded in the medical sources. The findings were compared to the autopsy results using the Receiver Operating Characteristics method.
Results
The generated scoring system correctly predicted the diagnosis of tuberculosis in 86% of patients in the study. 6% false negatives and 8% false positives were predicted.
Conclusions
It is possible to retrospectively diagnose in a reliable and scientifically robust manner under certain conditions. It is important to embed the clinical data into the historical context. A general rejection of retrospective diagnosis is unsubstantiated. Well-designed, disease-specific, and source adapted medical scoring systems are new approaches and overcome criticism raised against retrospective diagnosis.
Significance
This new approach utilises diverse historic sources and potentially leads to reliable retrospective diagnosis of most common diseases of the past.
Limitations
Selection bias of the records allocated. Quality of the historic sources utilized. Restricted statistical assessment potential of historic sources.
Suggestions for further research
Development of disease- and epoch-specific medical score systems.
期刊介绍:
Paleopathology is the study and application of methods and techniques for investigating diseases and related conditions from skeletal and soft tissue remains. The International Journal of Paleopathology (IJPP) will publish original and significant articles on human and animal (including hominids) disease, based upon the study of physical remains, including osseous, dental, and preserved soft tissues at a range of methodological levels, from direct observation to molecular, chemical, histological and radiographic analysis. Discussion of ways in which these methods can be applied to the reconstruction of health, disease and life histories in the past is central to the discipline, so the journal would also encourage papers covering interpretive and theoretical issues, and those that place the study of disease at the centre of a bioarchaeological or biocultural approach. Papers dealing with historical evidence relating to disease in the past (rather than history of medicine) will also be published. The journal will also accept significant studies that applied previously developed techniques to new materials, setting the research in the context of current debates on past human and animal health.