John Warner (Yale School of Medicine): Bedside Stories: The Transformation of the Patient Record and the Grounding of Modern Medicine

Between the early nineteenth century and the start of the twentieth, the hospital patient chart was transformed. Drawing on surviving manuscript patient charts and focusing on the United States, I first trace how a discursively rich record was supplanted by one that expressed narrative preferences for precision and exactitude, quantification and visualization, impersonality and detachment, uniformity and standardization, and an aspiration to universalism. In the process, the textual presence of the individuated sick person and the individual physician all but vanished, part of a larger program to eradicate ¡°the personal equation¡± of doctor and patient alike. I then explore the epistemological, technical, and moral choices at work in shaping this modern medical case record and how the new version of scientific medicine that the experimental laboratory emblemized brought a new aesthetic preference to the practice of clinical narrative. This transformation in the clinical practice of writing took part in making and expressing a new kind of professional identity, reshaping clinicians¡¯ conceptions both of patients and of themselves and setting in place one cornerstone in the grounding of modern medicine¡ªwith lasting biomedical and human consequences. I close by looking at efforts early in the twentieth century to establish this model for clinical narrative as the norm and at the reaction against this program, which was impelled in part by a move to retrieve the personal equation and constitutive of a broader impulse to reenchant the art of healing in an age of medical science.