Case Reports

Postal diagnosis: breaking the bad news in the 17th century

BMJ 1995; 311 doi: http://dx.doi.org/10.1136/bmj.311.7021.1694 (Published 23 December 1995) Cite this as: BMJ 1995;311:1694
  1. John Forrester, retired senior medical officer, Scottish Home and Health Departmenta
  1. aEdinburgh EH10 5NS

    On 19 August 1693 a young Italian doctor wrote, unasked, to a senior colleague to tell him that he was suffering from a lethal disorder, although the younger doctor had probably never seen the elder one during the illness. The letter survives and gives full details of the reasoning underlying the diagnosis; the published version included the postmortem findings.

    The younger doctor

    Alexander Knips Macoppe (fig 1) was a native of Padua, although the name hardly suggests his Italian origin; his ancestors were German. He was about 29 when he wrote the letter and had recently acquired a medical doctorate at Leiden on the topic of aortic polyp. For his thesis he had carefully studied the history of cardiac as well as aortic polyp. The term was first used during a necropsy by Tulp at Amsterdam in the 1630s, but so called polyp had been reported not only in the heart but also in various blood vessels since then, and vigorous controversy soon began and long continued over the distinction between postmortem clot and various other findings that represented genuine disease.

    Fig 1

    Alexander Knips Macoppe (1662-1744). Courtesy of the Wellcome Institute Library, London

    The patient

    Charles Patin (fig 2), when he received the letter, was principal professor of surgery at the university of Padua. He was 60 years old and worn out, so it was said, by care and literary work. His earlier career had been precocious, versatile, and stormy. His mother (he wrote years later) had given him 20 months of breast feeding as a good start, and he could read at 3 years old and write at 4, because she taught him. At 6 he could speak Latin to educated people and French to the household. At 14 he became a Master of Arts, but turned to medicine only after a false start in …

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