Singularities and Universals: Case Reports, Clinical Trials, and an Enduring Epistemic Tension

This manuscript examines how distinct epistemic attitudes toward singularity and generality have been articulated in medical writing across different historical contexts, offering a conceptual and meta-historical analysis of two enduring genres in biomedical literature: the individualized case report and the systematically aggregated clinical trial. Hippocratic case narratives are considered as a particularly lucid articulation of a mode of inquiry that privileges detailed observation of individual patients, while medieval Aristotelian natural philosophy exemplifies a contrasting emphasis on regularity, intelligibility, and general explanation. Renaissance medical and philosophical traditions are treated as a mediating moment in which attention to anomaly, wonder, and singularity was explicitly re-legitimized within learned medicine. These historically situated articulations are not presented as stages in a progressive narrative, but as recurrent epistemic orientations that are repeatedly reconfigured under different theoretical, institutional, and technological conditions. The paper argues that the tension between attention to exceptional cases and the pursuit of generalizable knowledge continues to structure modern biomedical writing, where case reports remain essential for identifying rare, novel, or anomalous phenomena, while clinical trials formalize strategies for producing reproducible, population-level evidence.