‘Medicine in the Stars: Medical Casebooks in Early Modern England’

Astrology plays a surprisingly important role in the history of medical record taking.

Last month Dr Lauren Kassell presented a paper on medical casebooks (c. 1550-1700) at King’s History of Health and Medicine Seminar. Today people tend to take record keeping almost universally for granted, with digital documentations gradually replacing handwritten notes. But Dr Kassell invites her audience to take a fresh look at record keeping and to imagine what it was like for Renaissance astrologer-doctors to keep pen and paper in hand. She tells us that, in the mid-sixteenth century, the medical practitioners who wrote down their observations of patients, and few they were, did not use the terms ‘medical record’ or ‘casebook’. Only two hundred years later (ca. 1750) did doctors draw nominal inspiration from lawyers by starting to refer to their notes as ‘casebooks’. Subsequently the term ‘case records’ found its way into medical practice as part of a growing trend towards objectivity.

The project by Dr Kassell and her collaborators, available in the public domain under http://www.magicandmedicine.hps.cam.ac.uk/on-astrological-medicine/further-reading/history-of-medical-record-keeping , opens our eyes for the importance of astrology in the development of the medical practice of record keeping: ‘unlike astrologers, other medical practitioners had no need to work with a pen in hand. They read the signs of disease from a patient’s complexion, pulse or urine’. And so it comes as no surprise that the casebooks of two astrologers, Simon Forman and Richard Napier, preserved at the Bodleian Library in Oxford, represent the extant ‘most extensive surviving set of medical records before 1700’ in Britain. These casebooks appear as early hybrid texts through their crossover of astrological aspirations to art and the medical drive towards nosology. Having said that, the mercantile dimension of these casebooks is not complicated: the size of casebooks (folio, quarto, octavo) corresponded directly to the importance (i.e. the wealth) of the patient. The purely medical casebooks of the period by anonymous doctors are less informative than the hybrid ones. One of the most distinctive trademarks of medico-astrological records concern temporality: the astrologer-doctor combined the retrospective record of the conversation with, and observation of, the patient with a health prediction. Over five hundred years later, patients’ desire to hear about their future health still persists although the stars no longer have a part in health prognosis.

Dr Kassell’s original research links with recent work jointly edited by Lorraine Daston and Elizabeth Lenbeck in Histories of Scientific Observation (2011): http://press.uchicago.edu/ucp/books/book/chicago/H/bo10303424.html . In the Renaissance, the revival of Hippocratic medicine on the Continent entailed, according to the essay by Gianna Pomata, an increase in medical record taking, so much so that case histories became such an integral part of medical knowledge that they were integrated in printed medical books as free-standing entities.

Inspired by the talk, I consulted a booklet with the title Animadversions on the Medicinal Observations of the Heidelberg Palatinate, Dorchester Practitioner of Phsyick, Mr Frederick Loss (London 1674), for which Dr Kassell had kindly given me the reference. The text was written by a medical practitioner called Thomas Burwell from Dorchester. Burwell criticized his local competitor the German expatriate and physician Friedrich Loss on grounds of his medical-writing style. Though nasty and, at times, vicious in tone, Animadversions is an excellent example of clashes in the medico-poetic diction of the period. Indeed it illustrates how important questions of form and writing could be for a medical physicians. For the native Englishman Burwell, Loss’s attention to detail went too far. Was Loss a doctor or a geographer? Why did he describe and name each location in such detail? Why include names? Why expand each case into such a long tale? So amplified seemed Loss’s narratives that Burwell mocked them with a macabre ballad including the lines ‘When as this Carter first was taken,/ His skull being crack’t, his Brains were shaken’ (1674, p. 4). Burwell’s point is plain: for him it was a mistake to poeticize medical case records. Literary publications over the next hundred years, however, such as Coleridge’s Gothic ballad ‘The Ancient Mariner’, indicate that writers would not necessarily agree with Burwell. Let’s suffice it to say here that the dispute between Burwell and Loss indicates that even when medical record keeping became independent from astrology it still tempted physicians into elaborated narratives as if trying to reach for the stars.

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