Change and Canonicity in Clinical Case Reports

Celebrating Case Reports and Stories In Health Care Royal College of Physicians May 2009

Brian Hurwitz, King’s College London

The case of the forgotten address

A 39-year-old right-handed community nurse presented to us on the neurology ward in April, 2005. She had appeared subdued before starting the afternoon shift and when asked she could not recall her home address. The nurse's symptoms had begun 48 hours previously, when she woke with a bitemporal headache. Her vision then “flipped 180°” so that all images appeared inverted...

Samarasekera S, Dorman P. The case of the forgotten address. Lancet 2006;367:1290

What is a case?

• Events and occurrences pertaining to individuals

• Case

• Case Report

• Biography, Memoir, Pathography,

Illness Narrative

‘Vision, hearing, nose, touch, tongue and

reasoning arrive at knowledge’

Hippocrates. Epidemics V in Smith WD (Tr) Epidemics II and IV-VII.

Cambridge, Mass: Harvard University Press, 1994,285.

Case report

The foot of Aristion’s female slave spontaneously

ulcerated in the middle of the foot on the inner

side. The bones became corrupted, separated and

came off little by little, eroded. Diarrhoea

developed; she died.

Hippocrates. Epidemics V in Smith WD (Tr) Epidemics II and IV-VII.

Cambridge, Mass: Harvard University Press, 1994,185.

Case reportI was called in to see a woman who was stated to be sleepless at night and to lie tossing about from one position into another. Finding she had no fever I made a detailed enquiry into everything that had happened to her, especially considering such factors as we know to cause insomnia. But she either answered little or nothing at all, as if to show it was useless to question her. Finally she turned away, hiding herself completely by throwing the bedclothes over her whole body, and laying her head on another pillow, as if desiring to sleep...

Galen C. On Prognosis. Brock AJ (Tr) Greek Medicine. London 1929, 213.

Case reportI remember I once had a pain as if I were pierced by a trepan deep in the abdomen, particularly at the exact spot where we know the ureters descend from the kidneys to the bladder. Shortly after [rectal] application of oil of rue and by straining hard to evacuate I excreted it under severe pain together with a transparent humour. Praxagoras would have called it hyaloides. It was similar in consistency and colour to molten glass. I observed this happened also to other people. It is astonishing how cold this humour appears and how even a violent expulsion does not warm it up.

Case report cont.

I believed that a stone was impacted in one of the ureters. At least I had that impression from the piercing type of pain. But when the pain subsided after the discharge of the humour, it became evident that the cause of the pain was nota stone and that neither the ureter nor the kidney was the affected part but that the pain came from the intestines, and most likely the large bowels.

Galen C. On the Affected Parts. Bk II, 46. Trans R E Siegel: S Karger 1976.