Aetiology case notes and narratives

Medical men of all periods have produced narratives to account for the 'diseases' affecting their charges. Such narratives had to be persuasive. Hippocrates' case notes,(7) written as aides-mémoire, included a personal history and a history of the disease, but lacked crucial information about the cause of the disease. Causal explanations were not incorporated in medical case reports until much later. The medieval concilia (advice for neophytes) contained information on the causes of disease, ranging from 'constitutions' to events considered as relevant to a specific disease. The 'causal events' were more often dictated by tradition and theory than by 'observation and experience' (in the sense given to these terms by Sydenham in the seventeenth century).

The start of postmortem studies in the sixteenth century generated correlational data which led Morgagni and Bichat to place disease within the body. This interpretation of 'cause' provided the foundation for the 'anatomoclinical' model of disease and for modern medicine. By the middle of the nineteenth century, case histories had become full narratives comprising descriptio subjecti, praegressa remota, origo morbi, praegressa proxima, status praesens, and cursus morbid) This narrative style, in turn, influenced the way in which medical 'causality' itself was to be conceived (see below).

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