This paper is a diachronic analysis of a corpus of 180 titles drawn from Case Reports (CRs) published in the BMJ and BMJ Case Reports between 1840 and 2009. The corpus was divided into three blocks, and the frequency of occurrence of 69 text-internal variables was recorded in each title. Between-block comparisons were carried out, and Student's t-tests
IntroductionSince before Hippocrates, case reports (CRs) have made, and still make, a valuable contribution to the advancement of medical science (Friedell 1973; Morgan 1985;Pascal 1985;Simpson and Griggs 1985;Morris 1989). McCarthy and Reilly (2000) report, for example, that a search of the MEDLINE database from 1996 to 2000, using the Medical Subject Heading term 'case report' , retrieved more than 140,000 citations. More recently a search of Web of Science using the same MSH term retrieved 160 articles from 1953 and 4,011 from (cited in Gawrylewski 2007.
Communication & MedicineGiven the unpredictable nature of medicine, many medical professionals will indeed have come across a patient who has not been a textbook case. The patient may have presented in an unusual way, had a strange pathology, or reacted to a medical intervention in a manner that has not been seen before. The publication of such novelties and curiosities as CRs has for many centuries been a fundamental way of sharing knowledge and conveying medical experience, and throughout history there have been famous CRs that have helped shape the way we view health and disease (Jamjoom et al. 2009;Salager-Meyer 2012).In recent years, though, and especially since the 1990s (Maisonneuve et al. 2010), CRs have come under scrutiny and disfavor among some members of the medical scientific community, and they are now frequently relegated to the lowest rank in the hierarchy of study design. Indeed, there are those who argue, for example, that CRs are 'passé, trivial ' (Rose and Corn 1984), and that they are increasingly irrelevant in current medical practice and education (Yadav 2006) because their obscurity and rarity appeal only to a specialized few, and because they add little to everyday medical practice. What is more, so argue the 'opponents' of CR publishing, their anecdotal nature lacks the scientific rigor of large, wellconducted studies. CRs have therefore fallen down the hierarchical ladder of medical evidence, and many 64 Françoise Salager-Meyer et al. medical journals, for 'shortage of page space' , now refuse to publish CRs (for a thorough analysis of the growing obsolescence of the psychiatric case report as a knowledge-bearing text, see Berkenkotter 2008).Another reason why this 'endangered species' (Rose and Corn 1984) sometimes receives low esteem and 'is frequently dismissed -unfairly so -as unscientific' (Simpson and Griggs 1985: 403) is because CRs are considered to be non-citable items (Morris 1989), thus lowering the impact factor of journals where citation data rule decisions ( Van der Wall and Wilde 2009; Maisonnneuve et al. 2010). Indeed, Patsopoulos et al. (2005) found that ...