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The history of medical diagnosis began in earnest from the days of Imhotep in ancient Egypt and Hippocrates in ancient Greece but is far from perfect despite the enormous bounty of information made available by medical research including the sequencing of the human genome. The practice of diagnosis continues to be dominated by theories set down in the early 20th century.

Ancient Egypt

An Egyptian medical textbook, the Edwin Smith Papyrus written by Imhotep (fl. 2630-2611 BC), was the first to apply the method of diagnosis to the treatment of disease.[1]

Ancient Babylonia

A Babylonian medical textbook, the Diagnostic Handbook written by Esagil-kin-apli (fl. 1069-1046 BC), introduced the use of empiricism, logic and rationality in the diagnosis of an illness or disease.[2] The book made use of logical rules in combining observed symptoms on the body of a patient with its diagnosis and prognosis.[3] He described the symptoms for many varieties of epilepsy and related ailments along with their diagnosis and prognosis[4] which both played significant roles in the practice of Babylonian medicine.[5]

Ancient China

Predated by Babylonian and Egyptian medicine, traditional Chinese medicine (TCM) was described in an ancient Chinese text, the Yellow Emperor's Inner Canon or Huangdi Neijing which dates to the first[6] or second[7] century BCE. The four diagnostic methods of TCM[8] which are still being practiced today are inspection,[9] listening and smelling,[10] inquiry[11] and palpation.[12]

Egyptian medical textbook, the Edwin Smith Papyrus written by Imhotep (fl. 2630-2611 BC), was the first to apply the method of diagnosis to the treatment of disease.[1]

Ancient Babylonia

A Babylonian medical textbook, the Diagnostic Handbook written by Esagil-kin-apli (fl. 1069-1046 BC), introduced the use of empiricism, logic and rationality in the diagnosis of an illness or disease.[2] The book made use of logical rules in combining observed symptoms on the body of a patient with its diagnosis and prognosis.[3] He described the symptoms for many varieties of epilepsy and related ailments along with their diagnosis and prognosis[4] which both played significant roles in the practice of Babylonian medicine.[5]

Ancient China

Predated by Babylonian and Egyptian medicine, traditional Chinese medicine (TCM) was described in an ancient Chinese text, the Yellow Emperor's Inner Canon or Huangdi Neijing which dates to the first[6] or second[7] century BCE. The four diagnostic methods of TCM[8] which are still bein

A Babylonian medical textbook, the Diagnostic Handbook written by Esagil-kin-apli (fl. 1069-1046 BC), introduced the use of empiricism, logic and rationality in the diagnosis of an illness or disease.[2] The book made use of logical rules in combining observed symptoms on the body of a patient with its diagnosis and prognosis.[3] He described the symptoms for many varieties of epilepsy and related ailments along with their diagnosis and prognosis[4] which both played significant roles in the practice of Babylonian medicine.[5]

Ancient China

Predated

Predated by Babylonian and Egyptian medicine, traditional Chinese medicine (TCM) was described in an ancient Chinese text, the Yellow Emperor's Inner Canon or Huangdi Neijing which dates to the first[6] or second[7] century BCE. The four diagnostic methods of TCM[8] which are still being practiced today are inspection,[9] listening and smelling,[10] inquiry[11] and palpation.[12]

Ancient GreeceOver two thousand years ago, Hippocrates recorded the association between disease and heredity. In similar fashion, Pythagoras noted the association between metabolism and heredity (allergy to Fava beans). The medical community, however, has only recently acknowledged the importance of genetics and its relevance to mainstream medicine.

Islamic world

The Arabic physician, Abu al-Qasim al-Zahrawi (Abulcasis), wrote on hematology in his Al-Tasrif (1000). He provided the first description on haemophilia, a hereditary genetic disorder, in which he wrote of an Andalusian family whose males died of bleeding after minor injuries.[13]

The Persian physician, Ibn Sina (Avicenna, 980-1037), in The Canon of Medicine (1025), pioneered the idea of

The Persian physician, Ibn Sina (Avicenna, 980-1037), in The Canon of Medicine (1025), pioneered the idea of a syndrome in the diagnosis of specific diseases.[14]

Physicians used many different techniques to analyze the imbalance of the four humours in the body. Uroscopy was most widely used for diagnosing illness. Physicians would collect patients urine in a flask called “matula”.[15] The matula was specific in shape and had four regions – circulus, superficies, substantia, and fundus – that corresponded to regions of the body. The circulus corresponded to the head; the superficies corresponded to the chest; the substantia corresponded to the abdomen; the fundus corresponded to the reproductive and urinary organs. Urine was inspected based on four criteria: color, consistency, odor, and presence of precipitate.[16] Physicians analyzed the urine for the four criteria and used that to point out where there was an imbalance of the four humours based on the location in the matula.[17] Physicians also examined blood via phlebotomy, they would observe the viscosity and color of the blood as it was draining from the patient and/or contained in a vial. The color and viscosity denoted whether the patient had an acute, major, or chronic disease; which also assisted the physician with the next course of action.[18] Physicians would also observe a patients pulse by palpation; this technique was performed by carefully noting the rate, power, and tempo of a pulsing artery. By interpreting the pulse of the physician could diagnose the type of fever the patient had.[19] Astrological diagnosis was the least used technique for diagnosing illness. Diagnosis was based on the position of the moon in relation to the constellations, which were associated with different regions of the body (head, arms, chest, etc.).[20] Physicians would diagnose illness with the combined knowledge of zodiac signs and humoral medicine.[21]

19th century

In the first half of the 19th century, the well-known British physiologist Marshall Hall emphasized the necessity of maintaining a close relationship between the theory and practice in medicine.[22] He wrote On diagnosis (1817) and The Principles of Diagnosis (1834).

The Oslerian ideal<

In the first half of the 19th century, the well-known British physiologist Marshall Hall emphasized the necessity of maintaining a close relationship between the theory and practice in medicine.[22] He wrote On diagnosis (1817) and The Principles of Diagnosis (1834).

The Oslerian idealWhereas Osler laid the founding principles by which medicine should be practiced, Garrod placed these principles in a greater context of a chemical individuality that is inherited and is subject to the mechanisms of evolutionary selection. The Oslerian ideal of medical practice continues to dominate medical philosophy today. The patient is a collective of symptoms to be characterized and analyzed algorithmically in order to draw a diagnosis and subsequently produce a strategy of treatment. Medicine is about problems based solutions. In keeping with this philosophy, today's pathology reports provide a momentary snapshot of the patient's biochemical profile, highlighting the end result of the disease process.

Influence of DNA technology

Gar

Garrod's conception of biological individuality was confirmed with the advent of the sequencing of the human genome. Finally the subtle relationship between inheritance, individuality and environment became apparent via the variations detected in DNA. In each patient's DNA lies a script for how their bodies will change and become ill as well as how they will handle the assaults of the environment from the beginning of their life to its end. It is hoped that by knowing a patient's genes that the biological strengths and weaknesses in respect to these assaults will be revealed and disease processes can be predicted before they have the opportunity to manifest. Although knowledge in this area is far from complete, there are already medical interventions based on this. More importantly, the physician, forewarned with this knowledge can guide the patient towards appropriate lifestyle changes to anticipate and mitigate disease processes.

References

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