This essay examines nineteenth-century medical case histories as they evolved into a recognizably modern form. Analyzing material from the specialist and generalist periodical press in both the United Kingdom and the United States, alongside literary writing by Charles Dickens, Anthony Trollope, and Silas Weir Mitchell, this essay challenges some of the assumptions about clinical narratives that derive from leading commentators Michel Foucault and Oliver Sacks. It traces the emergence of a generic form for case histories in specialist journals such as the Lancet and the Medico-Chirurgical Review and tests the strengths and limitations of this form in relation to more discursive or literary material. It argues that nineteenth-century clinical case histories were porous forms created by diverse and probably irresolvable pressures. Among these pressures were their competing functions as both dramatic narratives and assemblies of clinical data—or, to use metaphors common during that period, the world of the theatre and of the granary.