The Acute Stroke as Disease Concept, 1960-2015: A Historical Analysis

Abstract

Starting from the 17th century work of Swiss physician J.J. Wepfer and extending to the late 20th century, the related disease concepts of apoplexy, cerebral thrombosis, softening, and ischemia — what we would now call stroke — shared an important commonality in terms of their practical definition for clinicians: they were untreatable. Against this background, we propose that the advent of effective treatment for stroke during the period 1995-2015 created a novel disease concept: the acute stroke. The defining quality of the acute stroke is its treatability. We trace the history of this new concept in reports of individual clinical decision-making, in clinical practice guidelines, and in the organization of systems of care up to circa 2015. This history is an unusually clear example of how diseases are constructed, not found – and we leverage this perspective to explore some of the more interesting ethical and epistemological consequences of the concept’s emergence.