Here is real medicine.  This is what we are supposed to be good at.  The management of every disease follows this pathway.  All of the facts that are chunked out and hurled at the listeners by the “experts” are the result of seeing, asking, examining and considering the sick patient.

HIV has now become an illness with fairly well standardized protocols.  One of the reasons that medicine needs its elders is to give accounts of what the disease was like beforehand.  My Rheumatology teacher in residency, had done his own residency in NYC during the first outbreak of AIDS, before it got its name or anyone knew what it was.

They used the politically-dicey name “SQuID” for these men who rolled in with peculiar and incredibly rare disease manifestations seen only in cases of severe T-cell immunodeficiency, usually in children.  Nobody knew if this was a toxin exposure, and epidemic disease – and if epidemic, how it was transmitted.  All they knew was they had Sick QUeers with ImmunoDeficiency.  In the matter of the taxonomy of disease, this was an optimal name, for it described the illness as best understood at the time.

Now, it is understood in great detail, and the term SQuID is quaint.  In fact, the plethora of diseases we used to search for in AIDS have once again subsided into the arcana of the oncologists and pediatricians who deal with immunodeficiency.

The academic presentation of HIV new is mostly lore, observational ideas and conclusions borne out at the bedside.  They are as unfamiliar as the term “morbiliform rash” which almost nobody in America recognizes – certainly not as well as when the term was used seventy years ago.

POLIO is long-vanished.  Now, public heath study has discovered a set of symptoms in various places with a polio-like presentation, and are following under the familiar rubric of flaccid enterovirus paralysis.  It will be discovered and described and turned into PowerPoint, of course.  But the process of doing so is medicine, not the final process of posting the disease on WebMD for internet hobby-docs to study.  That is merely the skeleton of disease, not the disease-in-action.  We have nearly forgotten that without a person, medicine has no disease.

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