What is the place of medico-historical cases in the professional practice of the disciplinary field of medicine and biology? How can these patients from the past be used for teaching and continuing medical education? How to justify their place in biomedical publications? In this article, we explain all the legitimacy of paleomedicine, and the need to intensify such research in the form of a well-individualised branch of paleopathology and the history of medicine.
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Paleomedicine consists of the possibility of making a reliable retrospective diagnosis on a patient from the past, allowing to reconstruct the state of health of an individual, then of a group of individuals, then of a full ancient population. But, why take an interest in historical figures and take a look at their medical problems? How can retrospective diagnoses found in archaeological materials be of interest to the actual biomedical community? The materials are diverse, including skeletal remains,1 mummified cadavers,2 isolated relics,3 death masks,4 painted or sculpted portraits,5 autopsy or medical reports6 and literary descriptions.7 For each one the methodology is the same; apply the rigour of current diagnostic processes to ancient remains, and at the same time integrate the chrono-cultural, epidemiological and technological data (in order to avoid pseudopathologies and misdiagnoses).8
All fields of health are covered by this discipline; obstetrics, infectious diseases, oncology, trauma, inflammation, malformation, neurology. For some, because this deals with ‘famous dead people’, these studies are just sensationalism, a dumbing down of science to attract media attention by creating a ‘CSI effect’.9 In reality, these notables of the past are opportunities to improve our diagnostic acumen for the service of the community of the living.10
Certainly, for some of the historical cases, particularly in the absence of any informative human material (hair, bone, mummy, etc), or because of postmortem contamination or disturbance, no diagnosis is absolutely certain. In this case, such diagnoses are made on the basis of probability11 (including with the contribution of artificial intelligence)12 or by elimination.13 This is also the case in clinical medicine today where the definitive diagnosis is often not made initially, but at the end of a path of hypotheses, which becomes clearer as and when additional investigations are carried out.
Our academic research group specialises in this pathography or biohistory (a branch of palaeopathology for which the identity of ‘patients’ is known or supposed). It is interdisciplinary because many biomedical specialties collaborate to arrive at the most likely diagnosis.14 The specialties include in the first line anatomopathology, legal medicine, biological anthropology, internal medicine, microbiology/infectious disease research, genetics, toxicology and radiology, but may also be extended to clinical specialties such as orthopaedics, dermatology, neurology and many more. For each study, collaboration with other specialists from various natural and social science faculties relevant to the problem for example, (bio) chemistry, molecular biology, but also historians, medical historians, archaeologists, philologists and palaeographers, is undertaken. This makes it possible to minimise the risk of methodological error and to maximise the reliability of the sources.15–17
The case of King Louis IX of France (1214–1240 CE), also known as Saint Louis, is exemplative. By combining a pathographical approach (analysis of different contemporary historical sources and iconography) with the anthropo-paleopathological investigations of the attributed relics (bowels and lower jaw), the medical history of St. Louis could be traced back and re-examined in light of modern medical knowledge. A series of diseases—double tertian malaria (acquired during the Saintonge campaign (1242–1247), severe diarrhoea, recurrent oedema of the right lower leg, scurvy and urinary schistosomiasis (acquired during the seventh Crusade) and finally dysenteria—affecting St. Louis between 1244 CE and the end of his life (25th August 1270 CE), could be reconstructed.18
Reading such articles brings many benefits to the medical and scientific community.10 In medical education, it can train the practitioner or student in a didactic and original way, as in any other ‘case report’ (except that the ‘patient’ be several hundred or thousands years old). It can aid learning a topic by providing an entertaining handle to help remember a presentation of a disease or disorder. It broadens education by improving knowledge of history or historical figures (‘check if History tells the truth’). It can also improve knowledge of the origin of diseases and their evolutionary progress19–23; setting up a kind of evolutionary nosological map, and indicating new ways to investigate or manage them.
Other examples can be chosen to show the efficiency of the method and the diversity of potential cases: the analysis of the case of Mary Shelley allows us to set the diagnostic criteria for hemiplegic migraines and strokes better,24 that of Saint Thomas Aquinas improves knowledge of the symptomatology and semiological chronology of extradural haematoma.25 Others include Maximilien Robespierre with the dermatological and visceral signs of a diffuse sarcoidosis,26 Ugo Foscolo reminds of the clinical signs and diagnosis of an acute decompensation of alpha-1 antitrypsin deficiency,27 Frédéric Chopin for the differential diagnosis between tuberculosis and dilated cardiomyopathy with pleuropulmonary and hepatic repercussions,28 Nikola Tesla in knowing how to recognise the clinical pitfalls of a migraine with aura,29 Lorenzo the Magnificent for a reminder on the radiological and anatomical criteria for acromegaly30 or Franz Kafka for learning the neuropsychiatric consequences of sleep deprivation.31 Of course, one of the disciplinary fields most involved in these medico-historical cases is forensic medicine, when the ‘patients’ are in a skeletal state, a mummy or a body fragment. This explains why some of these paleomedical cases are published in journals belonging to this specialty. But beyond the simple determination of the cause of death and the process of degradation of the corpse, it is all the fields of medicine and surgery that are informed by such publications. For example, traumatic lesions of the skeleton of Australopithecus afarensis, nicknamed Lucy (A.L. 288–1),32 or that of a healed fracture from an Australopithecus left talus found in Sterkfontein (StW 363).33
Each of these cases could be presented in a more different way depending on the teaching context, to students of medicine or biology in university courses (as we already do in our establishments), or discussed with staff members within hospital departments, as with any patient; they hold important and relevant information and this is methodologically reliable.
The study of past diseases and the reconstruction of the state of health and disease of more or less well-known people is useful. It is a methodological challenge. This is the goal. Getting ‘past patients to talk’ helps the medical student learn to listen to today's patients. Thus, paleomedicine is valid and has great value for medicine and biomedical research. It has direct impact on the medical and educational practice of today’s clinicians.
List of learning points
Paleomedicine is the fact of offering a retrospective diagnosis on patients from the past.
All the specialties of biology and medicine, and the same rigor as with a living patient apply to paleomedicine.
This branch of medicine provides a better understanding of the evolution of pathological processes and professional practices (medicine, surgery).
Paleomedicine also helps to train practitioners in the diagnostic process.
Paleomedicine must be integrated into the curriculum of student training and continuing medical education.
Contributors PC wrote the initial manuscript with significant critical input from all coauthors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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