Family history (medicine)
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medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...
, a family history (FH or FHx) consists of information about disorders of direct blood relatives of the patient.
Genealogy Genealogy () is the study of families, family history, and the tracing of their lineages. Genealogists use oral interviews, historical records, genetic analysis, and other records to obtain information about a family and to demonstrate kins ...
typically includes very little of the
medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is information gained by a physician by asking specific questions, either to the patient or to other peo ...
of the
family Family (from la, familia) is a Social group, group of people related either by consanguinity (by recognized birth) or Affinity (law), affinity (by marriage or other relationship). The purpose of the family is to maintain the well-being of its ...
, but the medical history could be considered a specific subset of the total history of a family. Accurate knowledge of a patient's family history may identify a predisposition to developing certain illnesses, which can inform clinical decisions and allow effective management or even prevention of conditions.


Eugenic Origins and Applications

Early mentions of family medical histories in medical literature date from the 1840s. Henry Ancell mentioned inquiring about the family history of a patient in a medical case study in 1842, noting that the patient's presenting concern appears to be present in relatives and remarking on the prolific reproduction of her female relatives. In 1849, W.H. Walshe argued in a lecture at University College Hospital that in addition to a history of the presenting disease itself, a physician should also collect family history. Walshe's lecture does not define or justify the family history, which may suggest that taking one was already in common practice. However, later 19th-century physicians did provide a specific apologia for family histories and in some cases explicitly noted that they were not yet being taken routinely. James Begbie argued that understanding the health of the entire family, including cousins, can help predict otherwise unpredictable illnesses that run in the family. Begbie's use of the family history for both predictive and normative evaluation of the family anticipated
Francis Galton Sir Francis Galton, FRS FRAI (; 16 February 1822 – 17 January 1911), was an English Victorian era polymath: a statistician, sociologist, psychologist, anthropologist, tropical explorer, geographer, inventor, meteorologist, proto- ...
, who championed the routine family history as a
eugenic Eugenics ( ; ) is a fringe set of beliefs and practices that aim to improve the genetic quality of a human population. Historically, eugenicists have attempted to alter human gene pools by excluding people and groups judged to be inferior or ...
strategy in his 1883 text, Inquiries into Human Faculty and Its Development. Galton writes: Francis Galton argued in the early 1900s for the development of eugenic certification based on consulting these histories. Starting in the 1920s, family medical histories were used by government eugenics bodies to evaluate candidates for
compulsory sterilization Compulsory sterilization, also known as forced or coerced sterilization, is a government-mandated program to involuntarily sterilize a specific group of people. Sterilization removes a person's capacity to reproduce, and is usually done throug ...
. Eugenics Boards such as the Eugenics Board of North Carolina also considered family medical histories for the issuance of eugenic certificates marking a candidate as fit for marriage and reproduction. The Disability History Museum includes a mock eugenic certificate from circa 1924 which was intended to be sent as a love note.


Uses

Although sometimes neglected, many healthcare professionals glean information on family morbidity of particular diseases (e.g.
cardiovascular disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, h ...
s,
autoimmune disorder An autoimmune disease is a condition arising from an abnormal immune response to a functioning body part. At least 80 types of autoimmune diseases have been identified, with some evidence suggesting that there may be more than 100 types. Nearly ...
s,
mental disorders A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
,
diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...
,
cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
) to assess whether a person is at risk of developing similar problems. Family histories may be imprecise because of various possible reasons: * Adoption, fostering, illegitimacy, and adultery * Lack of contact between close relatives * Uncertainty about the relative's exact diagnosis * In complex situations, a
family tree A family tree, also called a genealogy or a pedigree chart, is a chart representing family relationships in a conventional tree structure. More detailed family trees, used in medicine and social work, are known as genograms. Representations of ...
or
genogram A genogram (also known as a McGoldrick–Gerson study, a Lapidus schematic or a family diagram) is a pictorial display of a person's family relationships and medical history. It goes beyond a traditional family tree by allowing the user to visual ...
may be used to organize the resulting information. Some medical conditions are carried only by the female line such as X-linked conditions and some
Mitochondrial disease Mitochondrial disease is a group of disorders caused by mitochondrial dysfunction. Mitochondria are the organelles that generate energy for the cell and are found in every cell of the human body except red blood cells. They convert the energy of ...
s. Tracing female ancestors can be difficult in societies that change the woman's family name when she marries. Death records often give the maiden name of the deceased, and possibly also the deceased's mother's maiden name. Some of the most useful records for tracing women are wills and probate records. Other medical conditions are carried only by the male line, though these Y-linked conditions are rare owing to the small size of the Y Chromosome. Tracing male ancestors may be impossible if the conception is due to rape or sexual activity outside of marriage. Attaining the age when family members are diagnosed with a certain disease can also be helpful for screening purposes, like colon and breast cancer.


Consequences

Not all positive family histories imply a genetic cause. If various members of the same family have been exposed to the same
toxin A toxin is a naturally occurring organic poison produced by metabolic activities of living cells or organisms. Toxins occur especially as a protein or conjugated protein. The term toxin was first used by organic chemist Ludwig Brieger (1849– ...
, then they may develop similar symptoms without a genetic cause. If a patient has a strong family history of a particular disorder (or group of disorders), this will generally lead to a lower threshold for investigating symptoms or initiating treatment. This is seen particularly in cardiac disease, where strong family history is considered a significant cardiovascular risk factor. In diseases with a known hereditary component, many otherwise healthy people with a positive family history are tested early, with the aim of an early diagnosis and intervention to prevent the symptoms from developing. This has become accepted in
hemochromatosis Iron overload or hemochromatosis (also spelled ''haemochromatosis'' in British English) indicates increased total accumulation of iron in the body from any cause and resulting organ damage. The most important causes are hereditary haemochromatos ...
and various other disorders.


Definitions


References

{{Medical records Applied genetics Medical terminology