Case Notes and Madness

The compilation and use of case notes as a component of clinical method date largely from the second half of the seventeenth century. ¹ Before this period medicine prioritized the judgement of learned authority over observations of the present but Francis Bacon’s (1561–1626) instructions for the creation of an empirical philosophy of science, which for practitioners entailed collecting histories of the diseases they treated, eventually had a practical effect. ² Watching, recording and analysing numerous examples of disease was recognized as a valuable means to extract general principles and the practice made a significant contribution to the decline of humoral medicine. ³ An increasing reliance on both private and published case notes was characteristic of the early nineteenth century onwards, but from the later nineteenth century the focus on the laboratory as the site of medical advancement (and latterly concerns about patient confidentiality) have encouraged the excision of case material from outputs other than the individual patient record, and the generalization and anonymization of printed exemplars.