History of medical record-keeping

Forman’s and Napier’s casebooks are probably the most extensive surviving set of medical records from before 1700. Astrology was by definition a written art. Astrologers needed to compute the locations of the celestial bodies and to map them on a chart before they could make a judgment. Astrologers kept records of their consultations from at least the fifteenth century. Few examples survive that predate Forman’s, and they contain little medical content. Other astrologers in seventeenth-century England may have had as many clients as Forman and Napier, or even more. Some of them, such as Nicholas Culpeper (1616–64), the famous astrologer physician, specialised in medical questions, but his records are lost.

Astrology and medicine were cognate disciplines. 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. Medical practitioners seem to have begun keeping written records later than astrologers, and these are more diverse in nature. They fall into roughly three categories.

The most rudimentary were lists of the names of clients and their payments for treatments or prescriptions. These are account books, and need to be understood alongside the broader trends of record keeping which developed in late medieval Europe. Narratives of cures — what we might think of as case histories — were recorded in ancient Greek medical works and the practice was revived in the fourteenth and fifteenth centuries. Some of these recorded advice to patients about diet and recipes, others were framed as testimonials of successful or remarkable cures, autopsies or lessons for surgeons. These elements were expanded and multiplied in the sixteenth century, fuelled by a growing interest amongst scholars in focusing on natural particulars and using observation to obtain knowledge of the natural world. As part of this trend, medical practitioners began publishing collections of cases that they called ‘observations’.

A. L. Rowse referred to Forman’s records as ‘casebooks’ in the 1974 book that popularised the astrologer’s papers. This project has retained ‘casebooks’ as a useful shorthand to mean ‘medical records’. Neither term was used in the early modern period. Around 1750, doctors borrowed the term ‘casebook’ from lawyers. In the following decades ‘case records’ began to be kept in hospitals, signalling the promotion of systematic and objective medical practices. When studying Forman’s and Napier’s casebooks, it is important to remember that their records pre-date modern medical records. 

Early modern medical records exist in a variety of forms. Forman’s and Napier’s are more systematic and extensive than others. In early modern England, extant records of medical practice range from a handful of cases on a few scraps of paper to the collections of the famous Royal physician, Theodore de Mayerne, who filled more than 3000 pages with a selection of some 1000 of his cases (probably around half) from 1603–53. The most comprehensive are headed with a name, date, complaint, then list a history, diagnosis, remedy/therapy and payment. Some seem to have been written at the time of the consultation, others retrospectively — like Mayerne’s, which are elaborate narratives, beautifully written with sketches of trusses, wigs and syringes in the margins. In format, they range from small pocketbooks to grand folios. One practitioner — Dr Barker, who was practising in Shrewsbury c. 1600 and whose casebooks survive in fragments — recorded instructions for keeping medical records. He begins, ‘Note the patients name, day, hour . . . ’. Then he specifies that a variety of books should be kept. ‘Grete long cures note in folio/ shorter common cures that come or send in half side or quarto/ note visiting cuers in a manuell [handbook]’ (British Library, MS Sloane 79). Forman and Napier seem to have followed a variation of this.

Where surviving records are labelled, in the Latin tradition they were called ‘cures’, ‘diaries’, or ‘observations’. Mayerne called his ‘observationes’ and ‘ephemerides’, meaning day by day records. In the English collections they are often referred to as books of one sort or another: bosom book, book of judgments (these two are Forman’s), book of experiment, book of cures. Thomas Willis refers to ‘diaries of diseases’. Efforts to classify and manage these records provide another measure of how they were understood. Some of the astrological and medical records contain indexes of the names of patients, diseases, or both. (Forman and Napier did not make such lists.) Recent scholarship has been concerned with whether early modern medical records focus on the cure, the individual and/or the disease. These categories matter because they reveal aspects of medical epistemology and relate to the formation of the medical subject.

In the English context, Forman’s and Napier’s records are remarkably extensive and systematic. Like other medical records, whether account books or full case histories, they were designed to collect information. All of these records document a process that involved conversation, observation, judgment, and the collection of this material in a written form.

Document last modified: 11 August 2011

Cite this as: Lauren Kassell (ed.), with Michael Hawkins, Robert Ralley and John Young, "History of medical record-keeping", Casebooks Project, http://www.magicandmedicine.hps.cam.ac.uk/on-astrological-medicine/further-reading/history-of-medical-record-keeping, accessed 2014-9-17.