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What is Historical Perspective?


Mark A. Hurt MD

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[i]History[/i] is an account of events that have occurred in the past. [i]Perspective[/i] refers to a point of view of a thing or a group of things or a point of view about body of knowledge concerning a thing or group of things.

Thus, [i]historical perspective[/i] refers to a point of view about a body of knowledge of a thing or group of things over a period of time. Usually, it takes the form of a chronological presentation of concrete examples that have been conceptualized one way in the beginning with modifications of the concept as new insights are discovered. In some cases, this leads to a deeper understanding of the original concept. In other cases, it results in the rejection of the original concept and serves as a tool for reclassification of the concretes under a new concept.

I propose that the understanding diseases in historical perspective is the [i]fundamental[/i] technology of a dermatopathologist. In dermatopathology, as a practical matter, it begins with the clinical history and the H&E sections, then looking backward to the known examples of similar cases that were documented in the past. It precedes, however, the use of any extended technology, such as immunohistochemistry or genetic analysis, because it is the platform upon which those technologies depend. It then allows for one to proceed by using every technology available.

This, of course, doesn't mean that extended technologies are unimportant -- far from it. It means, rather, that one cannot reject historical perspective from the diagnostic process in the face of extended technology -- and vice versa. In fact, the value of understanding historical perspective is that when newer technologies are developed, historical perspective serves as a reservoir of previous knowledge and as a "sounding board" to test the new technologies. In essence, historical perspective is a type of technology that is applied to every case, but extended technologies are applied only to some cases.

Without going into these topics in detail, just consider them as topics for contemplation in historical perspective: melanoma in situ, the so-called dysplastic nevus, mycosis fungoides, Mucha-Habermann disease, and whether to name diseases by eponyms or by generic names.

Historical perspective combines history, philosophy, and science all in one neat package that is difficult to open, to evaluate, and to contemplate -- at least at beginning -- because it has to be unpacked with great care and respect. It is, however, essential to our deeper understanding of dermatopathology and of our application of the knowledge learned from studying all diseases in this manner.
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