Do not delay: breast cancer and time, 1900-1970.

Until the 1960s, the central public health message about breast cancer was that women should not delay seeking medical attention for breast problems. Epidemiological, pathological, public health, and clinical writings, movies, and doctor-patient correspondence are analyzed in order to understand the durability and centrality of this "do not delay" message. Problematic assumptions about the natural history of cancer, the efficacy of surgery, and individual responsibility for disease contributed to the durability of the "do not delay" message. More important, the message catalyzed or sustained changes in the routines of ordinary women, general practitioners, surgeons, and pathologists, which led to the perception that the campaign against cancer was working. Thus a powerful set of reinforcing perceptions and behaviors maintained the centrality of the "do not delay" campaign until the era of mammography.

When do symptoms become a disease?

When do symptoms become a disease? Are there rules or norms, currently or in the past, that tell us when a particular collection of largely symptom-based criteria has enough specificity, utility, or plausibility to justify the appellation disease ? The history of numerous symptom-based diagnoses in use today suggests partial answers to these questions. The 19th-century shift to understanding ill health as a result of specific diseases, increasingly defined more by signs than symptoms, led to a loss of status for illnesses that possessed little clinical or laboratory specificity. Nevertheless, clinicians then and now have used symptom-based diagnoses. Some of these diagnoses owe their existence as specific diseases to the norms and practices of an older era much different from our own. Others have not only thrived but have resisted plausible redefinition done by using more "objective" criteria. Many strategies, such as response-to-treatment arguments, quantitative methods (for example, factor analysis), and consensus conferences, have been used to find or confer specificity in symptom-based diagnoses. These strategies are problematic and have generally been used after symptom-based diagnoses have been recognized and defined. These historical observations emphasize that although biological and clinical factors have set boundaries for which symptoms might plausibly be linked in a disease concept, social influences have largely determined which symptom clusters have become diseases.

Lyme disease: the social construction of a new disease and its social consequences.

American medical researchers who investigated Lyme disease in the 1970s conceived of the disorder as a categorically new entity. Other interpretations emphasizing the continuities between Lyme disease and its epidemiological antecedents, nevertheless, were possible. Clinicians, patients, and advocacy groups continue to contest the character, significance, and appropriate treatment of Lyme disease. Highly publicized discussions among the interested parties reflect American society's ongoing concern with new legitimating diagnoses, personal responsibility for acute and chronic disease, and the authority of science.