Can medical record keeping be an art? This article examines this highly significant question in the light of ancient medical astrology

1. Can medical record keeping be an art? This article
examines this highly significant question in the
light of ancient medical astrology
Medical Record Keeping as an Art – Improving
Accuracy and Reliability
MOS Medical Record Review Service
8596 E. 101st Street, Suite H
Tulsa, OK 74133

2. www.mosmedicalrecordreview.com (800) 670 2809
Any mundane activity can be made more interesting if it can be artistically done. That is to
say, a creative spark added to a routine activity breeds a new interest in it while also
bringing about better outcomes. This is something that applies to even a process such as
medical record keeping. In the course of providing medical records review, we have come
across artistically and systematically maintained documents as well as many disorganized
and confusing sets. Needless to say, the former are a pleasure to deal with while the latter
make the entire review process a real battle.
A Case of “Casebooks” and Artistry
Speaking of artistry in medical record keeping, the recent Casebooks exhibition in London
held in March – April 2017 was a thrilling experience to many. This exhibition investigated
one of the largest surviving sets of medical records (casebooks) in the world. We are
speaking about the almost 30,000 pages of documented physical symptoms, horoscopes
and religious speculations attributed to the astrologer–physicians Simon Forman and
Richard Napier. These documents comprise some of the most extensive private medical
records in history from before the year 1700. The 64 leather-bound volumes contain
thousands of consultations spanning nearly forty years relating to general health, disease,
and other problems of the body and mind. They also contain questions about romance, sex
and marriage as well as job prospects and economic, political and environmental issues, all
artistically documented.
Six artists who were invited by the curators to take inspiration from Forman and Napier’s
curious practice of charting showcased their artworks in the exhibition. They worked closely
with the University of Cambridge’s Casebooks Project that aims to engage artists and
audiences with questions of interpretation of the astrologer-physicians’ manuscripts within
an ecosystem of contemporary media and practice. These six artists incorporated material
from the casebooks wherever it provided meaning. They used the casebooks as a sounding
board for their art practice, engaging actively with the various layers of the records and the
encounters they document.
Medical Astrology – Adding the Elements of Romance to Medicine
Medicine and astrology were related disciplines. The ancient medical system Medical
Astrology associated various parts of the body, diseases and drugs as under the influence of
the sun, moon, and planets along with the twelve astrological signs. Medical Astrology
flourished most in Europe in the late medieval and early modern periods, 1450 – 1700.
Astrologers such as Forman and Napier assigned zodiac signs to rule over parts of the body,

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planets to rule over organs and systems, and planets to rule over diseases and drugs. They
computed the locations of the heavenly bodies and mapped them on a chart before making
a judgment. Records of astrologers’ consultations exist from at least the 15th
century.
However, only few examples are extant that predate Forman’s, and they do not contain
much medical content. Maybe other astrologers in 17th
century England such as Nicholas
Culpeper (1616-64) may have had as many clients as Forman and Napier had, but those
records are lost. The University of Cambridge has been digitizing Forman and Napier’s
archive for public access for the past 10 years. It is available free of charge and provides for
fascinating reading.
It was A.L. Rowse who referred to Forman’s records as “casebooks” in his 1974 book on
Simon Forman that popularized the astrologer’s papers. In the Casebook project, this name
has been retained to signify “medical records.” It was around the year 1750 that doctors
borrowed the term “casebook” from lawyers. In the subsequent years, hospitals began to
keep “case records” that signified the promotion of systematic and objective medical
practices. Forman and Napier’s case books predate modern medical records.
Forman’s and Napier’s medical records are highly organized, artistic and comprehensive
compared to other early modern medical records.
The Beauty of Medical Records
• In early modern England, medical records ranged from a handful of cases on scraps
of paper to the wonderful collections of Theodore de Mayerne, the famous Royal
physician. Mayerne has to his credit more than 3000 pages of documentation that
show around 1000 of his cases from 1603 – 1653.
• The most comprehensive medical records contain details such as name, date,
complaint, history, diagnosis, remedy/therapy, and payment.
• Some of the medical records have been created at the time of consultation whereas
some others have been written retrospectively.
• Mayerne’s medical records are intricate narratives that are beautifully written. There
are sketches of trusses, wigs and syringes in the margins.
• Medical records ranged in format from small pocketbooks to impressive folios.
• A practitioner in Shrewsbury, Dr. Barker, whose casebooks exist in fragments now
have recorded instructions for medical record keeping. These instructions include
noting down details such as the patient’s name, day and hour.

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The records of Forman and Napier, just as other medical record books, full case histories or
account books were used with the objective of collecting information. The significance of
these records is in that they all document a detailed process comprising conversation,
careful observation, judgment, and collection of the required material in a written form.
The Latin tradition labeled the surviving medical records as “cures,” “diaries,” or
“observations.” Mayerne termed his records “observations” and “ephemerides” meaning
day-to-day records. English collections were named “bosom book,” “book of judgments”
(both Forman’s), “book of cures,” and “book of experiment.” Some of these astrological and
medical records contain indexes of the names of patients, diseases, or both.
Ancient to Modern – the Evolution of the Medical Record
Early medical practitioners began keeping records later than medical astrologers, and these
can be categorized as follows.
• Account books. Names of clients and their payments for prescriptions or treatments.
• Case histories. Some of these recorded advice to patients about diet and recipes;
some others were testimonials of remarkable or successful cures, lessons for
surgeons or autopsies.
• Observations, which were collections of cases published by medical practitioners.
We can see how these ancient medical records evolved into the modern patient records that
form a permanent account of a patient’s illness. Medical documentation needs to be
accurate and clear to ensure effective communication between patients and healthcare
professionals. History, physical examination, diagnosis, investigations, management,
follow-up and referral, patient information, and consent comprise the key information to be
documented in the patient chart. Good note taking is essential and this is where
comprehensiveness and artistry have a significant role to play. Precision is an important
component of art forms whether painting, sculpture or any other. It is this accuracy that
contributes to its artistic excellence. Other important factors are clear vision and a solid
bringing together or organization. These very same features also contribute to the creation
and maintenance of the perfect medical record.