This article deals with early modern surgical case literature, more specifically with printed collections of observations in surgery. It examines the work of late seventeenth- to late eighteenth-century Italian practitioners from different backgrounds and of different statuses, and highlights the complexity of cognitive and social purposes pervading the genre, besides that of sharing empirical knowledge. These can be apprehended through a second look at texts and contexts, by analysing the ways in which authors selected, penned, and arranged their narratives. As the anthologies under examination show, collected observations varied significantly in focus and scope, with some seemingly designed to sustain the authoritative legacy of learned surgery, others defying a professional ethos for non-academic practitioners, and others still surveying ailments in light of hospital statistics. In fact, as this article suggests, the genre was flexible enough – and the narratives malleable enough – to adjust to changes in surgical theory and practice. In spite of new intellectual expectations, however, it was not plastic enough to take on new epistemic functions, such as reframing surgical nosology.