Bright’s Disease, ASD, and the Dustbin of History

In 1886 the beloved American poet Emily Dickenson died of “Bright’s Disease”- the popular term in those days for kidney failure. No one dies of Bright’s Disease these days – Not because kidney failure has been eradicated, but because it has been broken down into dozens of specific disorders, each with its own cause and form of treatment, thereby relegating “Bright’s Disease” to the ranks of discarded medical diagnoses, along with ptomaine poisoning , consumption, and falling sickness.  Each of these obsolete diagnoses referred to a specific symptom or set of symptoms (edema, in the case of Bright’s Disease) that was considered the hallmark of the disorder. In each case, however, medical science eventually produced a deeper understanding of the problem: Often, it turned out that a specific biological factor could give rise to many different symptom patterns (or, no symptoms at all, in some individuals). Conversely, sometimes different biological factors produced identical symptoms. Therefore, even though two patients might have identical symptoms their treatments might vary, because of this difference in underlying cause (we don’t give antibiotics to treat viral pneumonia, for example). Eventually, the original, symptom-based diagnoses were discarded, in favor diagnostic formulations based not just on symptoms, but on mechanisms of biological causation.
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