Cases are good to think with. This entry is about their status as carriers of information. For much of the twentieth century, they were considered a literary form, typically used by lawyers and doctors. Modern scientists, in contrast, used evidence in the form of data and rules: *facts, not examples and narratives. Then, philosophers of science and sociologists of knowledge, spurred by the challenges of *artificial intelligence (AI) and rise of bioethics, with its focus on the case as the unit of study, began to question the dominance of evidence-based knowledge and to consider cases as a style of reasoning. We now have histories of cases running from ancient Mesopotamia to the present day, with especially rich bodies of work on the emergence of collections of medical cases in *early modern Europe and China.
We can think with cases, but they are also objects. In this sense a “case” usually means a container or frame and often extends to its contents, such as a case of wine, a suitcase. In most European languages, the term derives from the Latin capsa, a cylindrical container for books, relics, or money. Its obsolete meanings extended to clothing, pelts, and bodies, suggesting a limiting of the term around 1700, as these colloquial usages fell away and legal and medical professions began to use the term more formally. In China, an (案) designated a footed tray or vessel, and later a judgment in the form of a document (in contrast to shi [事], meaning event, often used when narrating history), either paired with gong (公), to mean legal cases, or, in a sixteenth-century innovation, yi (醫), to mean medical cases. Like bureaus and tables, cases conflate the act of producing the record and the record itself.
Cases are a central part of how we understand the histories of scholarship, bureaucracy, and information. As an object of study, they allow us to slip between a focus on the conventions of collecting multiple cases and of documenting particular cases, whether in the moment, like account books, or after the fact, as case histories and observations. These are different, though related practices. In fact, as we will see, the relationship between recording a series or collection of cases and describing a single anomaly or exemplar is a central feature of their history. It could even be considered the pivot at which the material record, the document, meets the episteme. Accordingly, before describing the history of cases, we need to consider cases as a style of reasoning.
John Forrester’s 1996 article “If P, Then What? Thinking in Cases” has informed much of the scholarship on cases over the past two decades. Following Ian Hacking and others, Forrester proposed that “thinking in cases” is a “style of reasoning.” He set out three tangled threads: the psychoanalytic case history, the historical sociology of the sciences, and the individual in the human sciences. In disentangling these, he traversed the whole history and philosophy of Western science, beginning with Aristotle, who teaches us that there is no science of the individual at the same time as laying down the gauntlet for a future science of the individual. Individuals and populations, particulars and generalizations, examples or experiments and rules or laws, the personal and the scientific, inductive and deductive logic are all thrown into relief when considering the history of the case. The genealogy of the psychoanalytic case history, Forrester’s ultimate concern, leads him to test Michel Foucault’s account of “the examination” in Discipline and Punish (1975). Toward the end of the eighteenth century, Foucault posits, the emergent clinical sciences admitted the individual into scientific discourse, through objective examinations and their associated procedures of writing and registration, and thus created cases, making individuals both objects of knowledge and subjects of power. Cases, previously the purview of priests and lawyers, became instruments of medicine and the state. Forrester challenged Foucault’s story of a shift from theological and legal cases to clinical ones with a discussion of medical ethics and the analogical arguments, and the forms they take, of modern casuistry. Ultimately he concluded with a question that can be parsed: what work do cases do in the disciplines and practices that we recognize as the domain of the professional expert?
This survey follows up on Forrester’s work. It traces the history of cases, paying particular attention to practices of recording, retaining, and using them.
China, with its awesome imperial bureaucracy and even longer tradition of written practices, has much to teach us about cases. The first comprehensive *code of imperial law was established in the Tang dynasty (618–907). Under the Song dynasty (960–1279), with the expansion of the legal apparatus, massive numbers of legal case records accumulated in local and central government archives. As magistrates engaged with this body of cases and navigated elaborate legal code, they produced more cases. Add in imperial memos, edicts and commentaries, and supplementary legal rulings, and the result was a volume of summary compilations too unwieldy for working jurists to use.
With the advent of print in the tenth century, the earliest surviving collections of printed legal cases began to be produced. These drew on cases from dynastic histories that illustrated the actions and achievements of important officials. Forms of written and printed cases (an) proliferated in the Ming (1368–1644) and Qing (1644–1912) dynasties. These included various sorts of legal handbooks, anthologies, and memoirs. As part of the economic growth, urbanization, increase in social mobility, and decline of the state that makes the late Ming period distinctive, the school system expanded, and printed books circulated more widely as recognized sources of authority and expertise. Bureaucratic positions became more competitive, and printed examination primers, including collections of legal and medical cases, were targeted at aspiring civil servants. The model of the judge, and the act of judgment, was adopted by other late imperial experts, especially doctors, as they began to produce case collections of their own.
Cases are foundational to the modern practices often called Traditional Chinese Medicine, and they feature in a legitimating history that begins with Shang oracle bones in the second millennia BCE and arrives at a fully developed form in the sixteenth century that persists to the present day. Individual medical cases do date from antiquity, and the form underwent marked changes in the sixteenth century, but this is more a story of socially embedded changes than of disciplinary continuities.
Chinese physicians may have recorded details of their consultations from around the third century BCE. As part of an idealized account of government structures, Zhouli (Rites of the Zhou) includes a medical master who provides annual reckonings of successful cures. A thousand years later, Song dynasty regulations for medical students similarly prescribed annual submissions of case records.
Evidence of actual practices of recording cases seems to have been common from at least the Han dynasty (206 BCE–220 CE). The Shiji (Records of the grand scribe), a universal history completed around 90 BCE by Sima Qian, records the troubles of the physician Chunyu Yi. When questioned about his expertise, Chunyu Yi allegedly produced twenty-five case histories and declared, “In every case where your vassal has conducted a medical consultation, he has always made a consultation record” (chapter 105, 2813, Cullen, 305). Chunyu Yi used the term zhenji (診籍), meaning consultation record, not yi’an, a later designation meaning case history or case statement. By the third century CE, detailed accounts of seventeen cases of the physician Hua Tuo (ca. 141–208) began to circulate in histories. Various texts dating from the seventh century onward included medical cases to illustrate successful prescriptions or provide instances amid theoretical discussions of diseases. This trend was amplified with the growth of a scholarly apparatus of government under the Song dynasty, as thirteenth- and fourteenth-century physicians included cases in their writings. Thus, individual medical cases were recorded in private practice or, like legal cases, within bureaucratic contexts before the Ming dynasty. Then things changed.
The collection of medical cases (yi’an) was a Ming innovation; the phrase seems not to have been used before the sixteenth century. This innovation was part of an increase in *publishing more generally. In the case of medicine, it marked a shift in authority from hereditary physicians whose reputation rested on lineage to scholarly physicians who demonstrated their expertise in writing. Collections of cases, focused on particulars, joined *canonical works, in which particular cases illustrated general rules. The *genre was self-consciously new, intended, as authors reflected, on establishing a standard process for conducting consultations and recording cases. For instance, in a treatise published in 1522 the physician Han Mao listed the six stages of a consultation and specified, “Whenever you treat any disease, make a case statement on a piece of paper in this format” (Cullen, 313). Medical cases, like legal cases, were to take a prescribed format. Formats became forms: a senior Ming bureaucrat, in guidance for good governance, recommended providing qualified physicians with a blank volume of yi’an to be completed by the physician and patient then, as we saw hundreds of years before, subjected to annual reckonings. Whether or not provincial governors actually reviewed yi’an annually, physicians considered recording cases good practice. Individual cases could be shared with patients and their families to enable them to choose between the recommendations of different physicians, and later printed, either by physicians or by their families and followers, in didactic collections. Whatever the audience, cases were intended to demonstrate a physician’s expertise.
The practice of writing cases for a patient and her or his family, complete with prescription, rationale, and the physician’s name, continued through the twentieth century. Such cases were central to Chinese medical encounters, though we should be cautious about generalizing from elite, literate families to less privileged spheres. During the Republican period (1912–49), some physicians took efforts to revise the format of cases in line with biomedical categories, an appropriation of, rather than a capitulation to, Western medicine aimed at unifying and bolstering Chinese medicine and ensuring the support of a government with inclinations to scientism. Han Mao had specified that a case should set out what a physician knew from conventional diagnostic methods: looking, listening, smelling, and questioning the patient, feeling the pulse, reasoning through this information, and providing a treatment. In contrast, He Lianchen (1861–1929), one of the leading modernizers of Chinese medicine, specified that a case should follow Western standards: the patient, the disease name, the disease cause, the symptoms, a diagnosis, treatment method, prescriptions, and results. He Lianchen rewrote case records by esteemed physicians from across the centuries into this new format. Most notably, old cases were organized by symptoms, new ones by diseases. This was a new medicine in the name of the old.
Collections published by physicians and their families and associates present a clear, self-conscious lineage from the cases of Wang Ji (1463–1539) gathered by his disciplines in 1531 and those of eminent physicians assembled by Jiang Guan and his son Jiang Yingsu in 1591 to the present. Joined by a further thirty-one works of the yi’an genre in the seventeenth century, and forty-six more in the eighteenth century, they went through many editions in subsequent centuries. In the Republican period, manuscript cases by renowned physicians of previous ages were printed too. These collections advertised physicians’ expertise and provided instruction in their methods. Despite gestures toward standardization, late Ming and Qing cases (manuscript and printed) continued to range in length, detail, and emphasis, reflecting a physician’s individual style and the intellectual lineage with which he aligned himself. By the twentieth century, as we have seen, Republican physicians favored more rigorously standardized, less discursive cases, focused on explaining the theories that informed therapeutic choices. Collections of printed medical cases were brought into line with the government ideals of a standardized, systematic, and internally consistent science.
The history of European cases typically begins in Greece, around 400 BCE, with Hippocrates, the father of medicine. In fact, Mesopotamian cuneiform tablets, some from as early as the fourth millennia BCE, detailed particular legal, medical, and divinatory cases. But these traditions were known only indirectly until relatively recent times, when archaeologists recovered them. Hippocrates, a legendary figure even in his own time, found followers who assembled a heterogeneous body of writings, known as the Hippocratic Corpus. This included the Epidemics, a work that contains more than three hundred cases, some focused on symptoms, others on therapeutics, together with weather observations and general medical rules. The cases date from circa 410 to 350 BCE, take place in various locales, and were probably written by three or more different physicians whose names are not recorded. Epidemics circulated in manuscripts through the Middle Ages in Greek, Arabic, and Latin and was included in a Latin edition of the Corpus printed in Rome in 1525, with a Greek edition the following year in Venice. Sixteenth- and seventeenth-century physicians modeled themselves on Hippocrates, writing cases on paper just as he had written them on wax tablets, or rolls made of papyrus or animal skins. Good doctors wrote cases.
So did good priests. Fourteen hundred lead tablets found at the oracular sanctuary of Dodona, dating from the sixth to the second centuries BCE, set out specific questions for the gods. The public inscriptions at the shrine of Asclepius at Epidaurus (ca. 400 BCE), where patients slept in a dormitory and received advice in their dreams, recorded individual cases, mounted as expressions of thanks to the gods for successful cures. Despite the absence of a theoretical literature, these are instances of thinking in cases.
We do not know whether the doctors who assembled the cases in the Hippocratic Epidemics were motivated by didactic interests, philosophical debates, or other purposes. Given that 60 percent end in a patient’s death, they seem not to be showcasing expertise. The cases recorded at the shrine of Asclepius claim a much higher rate of success. When Galen, the immensely influential second-century Greek physician who worked in Rome, systematized the Hippocratic teachings, he did not collect cases. Rather, he used them selectively, as examples. This suggests that he recorded some cases, perhaps assisted by his slaves, if even just the most exemplary, didactic, cautionary, or self-promoting ones. The Greek Empiricists, defenders of Hippocratic medicine against the Rationalists, seem to have recorded cases in their now-lost works. Twenty-one cases attributed to the first-century Greek physician Rufus of Ephesus survive in an Arabic translation. The famous Arab physician al-Rāzī (854–925) recorded his own cases, modeled on Hippocratic writings and informed by Galen’s teachings. He used them as examples in his treatises and, less formally, for instructing his students, who collected and circulated more than nine hundred of them after his death. Al-Rāzī also collected the cases of other physicians, from works or collections now lost.
Cases, medical and otherwise, featured throughout medieval Arabic literary works. Professional court physicians typically included cases to illustrate how their methods triumphed over another’s. But cases do not feature as examples or anecdotes in Ibn Sina’s (Avicenna) monumental Canon of Medicine, the *encyclopedic synthesis of medical knowledge that was foundational to medical teaching from its composition in eleventh-century Persia through European universities in the 1700s. Cases of a sort do feature in Ibn Sina’s autobiography, completed posthumously by his student al-Juzjani. Within Arabic medical writings more generally, authors recorded muyarrabat, particular remedies or techniques, often with details of the case in which it was tried and proven.
Through the Middle Ages on both sides of the Mediterranean, as Galen’s brand of rational medicine dominated learned teachings, individual cases featured as examples in theoretical works. While experience was valorized in some medieval Latin scholarship—mysticism, alchemy, parts of medicine, and increasingly astronomy (which encompassed astrology and astrometeorology)—in most copies of ancient texts, observed evidence from the natural world, often constituting a case, was noted, if at all, in the margins. Experimenta, like muyarrabat, might include details of a case, and case narratives (narrationes, exempla) typically were written in the margins of medical and religious works. From the early thirteenth century, theologians conducted theoretical debates about the increasing use of this sort of homiletic story in scholarly texts and everyday sermons by the mendicant orders. Surgical textbooks, as pioneered by Rolando Cappellutti in the mid-thirteenth century, used narratio that borrowed tropes from miracle stories to introduce new techniques and demonstrate the surgeon’s skill. Physicians included narrationes and exempla in their practicae, inserting stories into manuals of regimen that reminded the reader of the experiential basis of book learning. By the fourteenth century, medical narrationes appeared independent of surgical textbooks or medical practicae, as the collections by the famous Montpellier physician Arnau of Villanova and the English surgeon John of Arderne demonstrate. In the fifteenth century, Michele Savonarola, physician at the court of Ferrara, used individual cases in his medical and historical writings. Thousands of European manuscripts survive, initially in Latin then in the *vernacular, from the twelfth through seventeenth centuries that include experimenta singly or gathered into collections as the observed and experienced knowledge—the case—moved from the margins to the center of the text.
We need to pause over consilia. A consilium was a consultation, often framed as a response to a question, theological, legal, or medical. In Republican Rome, distinguished jurists delivered consilia on issues that carried the force of judicial opinion. The practice continued into the classical period of Roman law, where consilia were held to have the approval of the emperor, then seems to have lapsed from the third century before emerging again in northern Italy around 1200. Where local judges could not settle a case, an esteemed jurist was consulted. When a person of note fell ill, the case might be put to a learned physician. These cases later became the building blocks of elaborate regimen, treatises on disease, or didactic collections. Whether legal or medical, a consilium typically began with a statement of the case, naming the litigants or patient and narrating the history of the matter to date, including opinions on it by other authorities. In legal cases, the contentious arguments were then set out. In medical cases, the second part was a regimen to prevent illness or restore health and a treatment, often listing numerous remedies, sometimes borrowing the argumentative style of legal cases. In both forms, consilia concluded with a summary describing the outcome. By the end of the fourteenth century, collections of legal and medical consilia were commonplace in Bologna. They soon spread to neighboring universities. Physicians ordered their collections, following other genres of practical medicine, by disease from head to toe; Bartolomeo Montagnana’s is the best-known medieval example (1476). By the fifteenth century, astrologers—many of whom were medical men—were following this example to make collections of horoscopes, again combining details with prescriptions to improve health, avoid danger, and obtain riches.
None of these developments would have been possible without a shift in the balance between memory and written records beginning in the eleventh century. Fragmentary evidence of links between medieval scholarly practices and bureaucratic innovations survive in memoranda of medical and astrological cases from the decades around 1400. A century later, novel habits of account keeping and interests in testimonials and natural particulars converged at bedsides, consulting rooms, and doctors’ desks, framed as an imperative to improve medicine. Some doctors’ records focused on treatments and payments, others on narratives of diseases and cures, often written from rough notes or memory at the end of the day. Practices were local. Professors at Ferrara and Padua in the 1540s encouraged their students to record case histories. Toward the end of the century, Gemma Frisius, the Dutch physician and mathematician, reputedly kept a pair of notebooks, one of observations about the stars and weather, the other for medicine. His compatriot Pieter van Foreest noted that he began recording medical cases when he turned his attention from heavenly observations to microcosmical (earthly) ones. The resulting manuscripts seldom survive: several hundred, ranging from fragments of a few cases to many thousands, have been located, variously labeled diaries, journals, registers, observations, and casebooks.
At the same time, within scholarly publications, as Gianna Pomata has argued, observationes developed as a distinct “epistemic genre.” Instead of dropping examples into theoretical works, humanist physicians collected what they termed curationes or observationes medicinales (medical treatments or observations respectively). *Philological works similarly assembled notes on discrete, disputed parts or words of an ancient text, producing observationes with a whiff of ritualized observances. While earlier legal consilia were collections of a single jurist, observationes legales or forenses were collections of cases decided by a court of law, connected to the development of case law and the publication of reports of tribunal rulings, all of which grew through the seventeenth and eighteenth centuries. In England, where common law originated and from whence it spread to her colonies, these were standardized as the Law Reports from 1865.
From the sixteenth century, medical professors harnessed print to extend their case-based methods of teaching from face-to-face meetings with their pupils to the nascent *Republic of Letters. Amatus Lusitanus, a Jewish physician living in Italy, published seven hundred cases, a hundred at a time between 1551 and 1566. His Centuriae curationum (Hundreds of treatments) established a new genre. Other collections, like al-Rhasis’s, were eclectic by design: Johan Schenck von Grefenberg’s Observationes medicae, rarae, novae, admirabiles et monstrosae (Rare, new, admirable and monstrous medical observations, 1585–97), the most significant late sixteenth-century collection, combined observationes from ancient and medieval texts, his network of correspondents, and his own practice. Producing observationes was an epistolary and bibliographical exercise, an instance of the drive to collect that shaped sixteenth- and seventeenth-century inquiry. By 1700, around a hundred authors had published collections of cases. Individual cases became staples of the new periodicals published by Europe’s *learned societies. Collections of cases continued to be produced through the eighteenth century, some following old head-to-toe orders, others ordered by diseases. Thus, despite innovative technologies—physical examinations, quantitative testing, postmortem investigations—doctors relied on a vast medical library, reaching back through the centuries, to classify diseases. Medical knowledge, as Volker Hess and Andrew Mendelsohn have argued, was produced through the study of published cases, old and new.
We have arrived at the point where we began. Cases were an integral part of authoritative legal, medical, and theological traditions in eighteenth-century Europe and its empires. Collective investigations, predicated on standardized cases, were fundamental to the rise of scientific medicine and clinical sciences. This is when the examination, as Foucault argues, conducted in institutions like schools, prisons, legal courts, and hospitals, came to regulate social norms. An individual became a case to be described, judged, measured, and corrected according to norms and classifications. From the middle of the nineteenth century, practices of recording and collecting cases exploded. We now know much more about the histories of particular aspects of cases. To the formalizing of case histories in the Paris hospitals from admission to autopsy, we can add, for instance: the ways that male practitioners and their female patients negotiated authority and experience through manuscript casebooks and printed observations; increasingly rigorous hospital documentation through the 1800s, including standardized recording of pulse and temperature at regular intervals; competing models of case writing in nascent disciplines from sociology to neurology; the introduction of the case method of teaching at Harvard Law School in the 1870s and to medical education several decades later; subtle, extended psychoanalytic and postpsychoanalytic case narratives, and readings of them; the genesis of the unitary patient record—when patients became file numbers—in the early twentieth century; the aesthetics of fictional representations, written and pictorial; and the importance of case-based studies in biology, medicine, sociology, and business and case-based logic in AI. Debates are ongoing about whether computer-assisted case records will allow doctors to return to an idealized medical encounter before writing tools ostensibly diverted the medical gaze, or whether *digital tools are simply part of a continuous tradition, with advantages and shortcomings, of other information technologies. This sketch of the history of cases, East and West, has also been an account of how techniques to produce, share, and archive knowledge relate to notions of an individual as a constructed entity. Cases matter most when rules and those who maintain them are being challenged. If we are living in an era when the notion of the individual is legally, medically, and morally in crisis—think about, for instance, health inequalities, immigration, data protection, and reproductive rights—what constitutes a case matters more than ever.
Lauren Kassell
See also bureaucracy; documentary authority; governance; knowledge; learning; memos; notebooks; professors; teaching