Identifying disease in the past: cutting the gordian knot

Abstract

How should we historians approach the issue of the identity of disease in the past?Can we legitimately identify past diseases?Can we legitimately identify past diseases with present diseases?Can we legitimately identify particular epidemics in the past?Can we legitimately talk of the evolution of diseases or pathogens?Can we legitimately reach past people's experience of disease by identifying what they were suffering from?Are our attempts at retrospective diagnosis legitimate?Is retrospective diagnosis either possible or desirable?These questions -surprisingly-virtually never crop up in the work of historians of medicine, who for the most part assume that the identification of past diseases is simply not a problem, since they assume the continuous identity of past diseases with modern diseases.They just get on with identifying past diseases in modern termswhether it is logically, philosophically or historiographically possible or not.Hence my use of the term 'legitimately' in my questions.Certainly we can make such identifications, and we do.But do they mean anything?Do they mean what we want them to mean?Are they logical, sensible, and coherent things for us to do?Most important of all, do they tell us anything at all about the past, or are they simply projections backwards of present-day issues and concerns?Before we can explore these issues we have to ask a fundamental question: what is disease?There has been a lot of confusion on this issue, based on misplaced and un-inspected assumptions.What we can say is that, at its most fundamental, disease is (1) an experience -an experience of debilitation, pain, suffering, together with (2) the spontaneous appearance of non-customary phenomena with respect to the body, such as spots, vomiting, sweating, aches, and (3) with outcomes of recovery, death or disability.In this, disease is something that humans and animals have in common.But there is one big difference.For unlike other animals, humans seem to insist on seeking reasons or causes for disease: for its incidence, its origin, its course, its outcome.Some of the reasons given in the past and in other present-day societies seem

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