Note-taking and the Rise of Empirical Observation in 16th-century Medical Practice
Michael Stolberg, Universität Würzburg
Discussant: Hannah Murphy, University of Exeter
With the important exception of anatomy and medical botany, 16th-century academic medicine has traditionally been characterized as based almost exclusively on painstaking philological analysis and learned commentary on the works of ancient and medieval authorities. Only fairly recently historians have identified also an increasing appreciation, from the 1550s onwards, of empirical approaches to medical practice, as shown by the growing popularity of the genres of curationes and observationes. It has occasionally been remarked that these publications were probably based on manuscript notes which their authors had collected over time. But so far, to my knowledge, manuscript notebooks of 16th-century physicians have not been analyzed – presumably also for the simple reason that they are quite difficult to find.
In my paper, I want to take a closer look at a small sample of physicians’ handwritten medical notebooks from the period before 1560. At the center of my analysis will be five sizeable manuscript volumes with notes on medical practice which Georg Handsch, a little know Bohemian physician, assembled, from the late 1540s, in Padua and Prague. Some entries offer the complete history of a patient’s disease, sometimes on a day-by-day basis, others are limited to brief, isolated observations or snippets of information acquired from others. I will complement and compare these findings with those from other medical notebooks and handwritten collections of medical observations from that period.
As I intend to show, these notebooks were an important tool of knowledge production. They reflected a vigorous and consistent effort to learn from personal experience at the bedside. We find physicians trying to establish general diagnostic and therapeutic rules, based on what they saw in individual patients. We find them questioning, in turn, accepted medical knowledge – including that of Hippocrates and other revered authorities –, when it conflicted with their own observations. In Handsch’s case, there are also various entries on “errors” he thought he had made with certain cases and which he wished to avoid in the future. Occasionally even controlled experiments in a modern sense are recorded, primarily to assess the effects of poisons and antidotes.
My analysis will, I hope, leave little doubt then that the rise of printed curationes and observationes in the period after 1560 reflected preexisting habits of observing and note-taking among learned physicians. In conclusion, I will also point out some important differences, however, which historians must keep in mind when they work with these sources. Published curationes and observationes served, above all, to provide positive models that readers could imitate, and they offered their authors a welcome opportunity to promote their public standing as extraordinarily successful practitioners. Handwritten, personal note-books, by contrast, – except for those which were composed from other notes and prepared for publication – served above all mnemonic and epistemic purposes. They held the promise of improving diagnostic and prognostic precision and therapeutic outcome through careful recording of personal observations, also and indeed especially in cases of erroneous diagnosis or prognosis, of therapeutic failure and death – which, not surprisingly, were all recorded much more often in personal notebooks than in printed case reports.