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Evidence-based medicine? Patient case studies in English surgical treatises, 1660–1700
  1. S Sandassie
  1. Samantha Sandassie, McMaster University, Hamilton, Ontario, Canada; sandasss{at}


The implications of the presence of case information included in English surgical treatises published from 1660 to 1700 are discussed. While such casework has been frequently examined and cited, the phenomenon of including case information in treatises has yet to be studied in any depth. The context, presentation and origins of the case information are discussed, and the reasons behind the inclusion of casework are explored in terms of “blame-narratives”, teaching models and evidence-based medicine. It was found that, while the reasons behind the inclusion of case information varied, English surgeons practised evidence-based medicine. This finding is significant, as it proposes that evidence-based medicine was practised a century earlier than—and across the Channel from—its supposed first emergence in modern medical practice.

  • history of medicine, modern
  • evidence-based medicine
  • surgical treatises
  • case information
  • professionalisation

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  • Competing interests: None declared.

  • i I include in this study all general surgical treatises published in English identified by Rogal.3 His compilation includes 11 works on surgery, published between 1660 and 1700. Seven of these were published in English by six authors. Though an excellent resource, Rogal’s bibliography does not include all of the treatises published during the period under consideration, and it includes “ghost” publications.

  • ii Wiseman’s 1672 treatise was printed by R Norton, while both his 1676 work and Browne’s of 1678 were printed by E Flesher.

  • iii There was, however, one case noted in which the patient did indeed become a pauper and was financially supported by the surgeon and his associate until he was found dead on the streets.

  • iv The woman, he noted, was 36 years of age in 1613. She would have been dead by the time he was writing in 1699.

  • v Read, however, did not include any patient cases in his section on venereal disease, and thus his approach to patient confidentiality for this affliction cannot be tested.

  • vi Primrose was the famed physician and author of De vulgi in medicina erroribus.