The nineteenth century was a landmark era for medicine in terms of the revolutionary methods of diagnosis and treatment, but also in terms of the advances in medical reasoning and discourse. This paper explores the discourse of the late nineteenth-century case reports in the British Medical Journal in search of the linguistic manifestations of the changes taking place in medicine in that period. More specifically, taking a qualitative, “wide-angle” approach to discourse (Berkenkotter 2009), attention will be paid to the themes marking changes in medical reasoning as well as such aspects as patient’s presence, authorial persona and referential behaviour. The material under analysis constitutes a sample of one hundred and eight case reports published in the professional British Medical Journal. The results demonstrate that, although thematically the reports describe procedures and explanations in accordance with the significant changes medicine was undergoing, discourse-wise the texts still seem to reflect “individually and privately based non-specialised medicine” (Salager-Meyer–Zambrano 2001: 161).