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Communicating Medicine

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Elisabetta Lonati

0. Socio-cultural background and general aims of the study

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  • 1   Changes in medical education and in the practice of medicine are complex processes which cover lo (...)

1The core of the present study is an investigation on eighteenth-century medical writing, particularly concerning the elaboration and the communication of medicine in reference works such as universal dictionaries of arts and sciences, medical dictionaries, and handbooks. Most of the vernacular texts under scrutiny here were issued in the second half of the century, a period in which the advancements in medical research, medical education and medical practice1, as well as a growing awareness of health issues (Pirohakul-Wallis 2014: 3-4), favoured the circulation of an expanding medical vocabulary and stimulated medical writing as a whole.

  • 2Practica were the outcome of an ancient tradition. Wear (2000 : 116-117) explains that « the cohe (...)

2A vast amount of books – especially instruction books for a vast and uneven readership – was produced for experts and non-experts alike (case studies, accounts, observations, records, short treatises, handbooks, compendia or practica2, medical dictionaries, etc.), and medical topics were common in social settings, in genteel conversation, in personal and communal letters, in specialised journals, in pamphlets and in magazines. In the second half of the century, reference works began to circulate extensively (Lane 2001: 23), encouraged by a lively and expanding book market (Fissel 2007). These works often included the classification of diseases, their denominations – either in Latin, or in English, or both – and definitions, along with the descriptions of symptoms, the development of the disease in time, the available cures or practical remedies. On the one hand, medicine was on its way to specialisation and professionalisation: the approach to medical events was becoming ‘scientific’, strictly based on observation, data collection, and experimentation by an emerging disciplinary and restricted community. On the other hand, medicine pervaded civil society and human interests, as general knowledge and shared experience. It was, in a sense, common ground for everybody, within and outside emerging and developing professional circles. Another key factor was an increasing interest in public health and healthy strategies to improve the average living standards. Towns were crowded with people, hygienic conditions were poor, and the danger of endemic diseases or epidemic outbreaks was elevated. Preventative medicine and environmental approaches thus became a priority, with a view to avoid contagion and infections. Specific plans to maintain or improve hygiene in hospitals – but also in jails, in the army, and aboard the ships – and (over)crowded public places, as well as to spread cleanliness in private dwellings, were frequently issued as practical advice (cfr. Borthwick 1784).

3If the production of books cannot just be considered as a direct consequence of the advancements in medicine on the one hand, or of social changes on the other, all this unprecedented and remarkable activity contributes to the vernacularisation, the popularisation, and the dissemination of medicine in different kinds of works and different text types: «never before had the medical profession so saturated the market with writings, from sixpenny pamphlets to weighty tomes, directed specifically at a health-conscious lay readership» (Porter 1992: 106). These works are generally addressed to a multifarious audience: the lay community shared general notions concerning everyday health and medicine, and was interested in novelties, remedies and cures. The emerging community of practitioners instead was interested in communicating and sharing professional experience with fellow colleagues: recording and framing medical experience, recommending techniques and remedies, updating procedures and cures were the key issues of medical writers. In other words, record, advise, instruct, and inform can be considered the general aims. At least three groups of medical men as regular practitioners were involved in this writing and communication process: university-educated physicians «whose job was to diagnose, and provide attendance and advice» (Porter 1992: 92); trained professionals, such as surgeons whose «job […] was to treat external complaints (boils, wounds, etc.), to set bones and perform simple operations» (Porter 1992: 93); and apothecaries who «dispensed» what the «physician prescribed» (Ibidem). A new professional role – and function – emerged:

The early eighteenth century saw the gradual disappearance of the barber-surgeon […] and the emergence of the surgeon-apothecary, separate from the apothecary, who continued to sell and dispense drugs as he had always done. Physicians, without exceptions, were university men and not apprenticed, although a minority had begun their medical careers as surgeon-apothecaries before seeking the physician’s status. […] The surgeon-apothecary is one of the eighteenth century’s most interesting examples of personal and professional upward social mobility and of steadily enhanced status. (Lane 1985: 57, 58)

  • 3   Lane (2001 : 9, 12) maintains that « The line between charlatan and orthodox was not always clear (...)
  • 4   Loudon also discusses the structure and the role of medical education, as well as the reform of m (...)

4In the late eighteenth century, British Medical Reform was a key factor in expanding regular medicine and in establishing clear boundaries and roles in the practice of medicine, notably concerning the distinction between university-educated physicians and trained practitioners (surgeons and apothecaries) from a multitude of quacks3. Loudon (1992: 219) defines this period as one of «uninterruped progress», producing radical changes in medical institutions, in medical legislation, in medical men, and in the general social context4. Orthodox practitioners needed a formal qualification: a university degree for physicians, private apprenticeship or hospital training for surgeons (for example, army and naval appointments or walking the wards) and apothecaries (for example, visiting the sick with the master or, later, by themselves). Usually, a basic theoretical instruction including anatomy, physiology, medicine, pharmacy, etc. was followed by an intense practical activity.

5The challenge to expel quackery from the medical community at large, not only implied a regulated and institutionalised expansion of medical instruction among medical men, but also the expansion of medical information among the (educated) members of the civil society:

  • 5   For the present analysis the second edition of Buchan’s Domestic medicine (London 1772) was used  (...)

Indeed, the most effectual way to destroy quackery in any art or science, is to diffuse the knowledge of it among mankind. Did physicians write their prescriptions in the common language of the country, and explain their intentions to the patient, as far as he could understand them; it would enable him to know when the medicine had the intended effect; would inspire him with absolute confidence in the physician; and would make him dread and detest every man who pretended to cram a secret medicine down his throat. […] For this reason the prescriptions of physicians, instead of being couched in mystical characters and a foreign language, ought, in my humble opinion, to be conceived in the most plain and obvious terms imaginable. (Buchan 21772: xxv-xxvi)5

6Attention to accuracy and simplicity in language were emphasised, whereas literary rhetoric, figurative language and obscure formulations were gradually abandoned in favour of more comprehensible expressions.

  • 6   Intelligibility becomes the general aim of medical writing at any level : here, it refers to the (...)

7The texts examined in the study are representative of their authors’ effort to expand medical knowledge and to define medicine as an independent science based on observation, as well as to establish intelligibility6 within and outside the disciplinary discourse community, both at a metalinguistic level (general principles regulating writing for a purpose) and at a practical level (rhetorical strategies and linguistic choices to make contents accessible to the readership).

0.1. Introducing and contextualising source material

8The following sections introduce the two groups of source materials selected for the analysis. The first group includes two dictionaries of arts and sciences, The Encyclopaedia Britannica (1768-1771), and Abraham Rees’s Cyclopaedia (1778-1788), as well as two medical dictionaries, Robert James’s A medicinal dictionary (1743-1745), and George Motherby’s A new medical dictionary (1775). The second group is constituted by a set of handbooks and compendia (practica) on the practice of medicine, some of them are especially focussed on infectious and contagious diseases. Among them, the most relevant are Buchan’s Domestic medicine: or, a treatise on the prevention and cure of diseases by regimen and simple medicines (21772), Borthwick’s The method of preventing and removing the causes of infectious diseases (1784), Fisher’s The practice of medicine made easy (1785), Black’s Comparative view of the mortality of the human species (1788), Clark’s Observations on fevers, especially those of the continued type; and the scarlet fever (1780), Grant’s An enquiry into the nature, rise, and progress of the fevers most common in London (1771), Grant’s An essay on the pestilential fever of Sydenham, commonly called the gaol, hospital, ship, and camp-fever (1775), Millar’s Observations on the prevailing diseases in Great Britain (1770), Sims’s Observations on epidemical disorders, with remarks on nervous and malignant fevers (1776), and Wallis’s The art of preventing diseases and restoring health, founded on rational principles, and adapted to persons of every capacity (1793). The two sections put forward the general features of the texts included in the two groups, contextualising them in the socio-cultural background of the period.

0.1.1. Universal dictionaries of arts and sciences and specialised medical dictionaries

9The eighteenth century is characterised by the compilation and the publication of many dictionaries of arts and sciences or, in other words, encyclopaedic dictionaries including the terms of multifarious branches of knowledge and emerging disciplines. The encyclopaedic principle, that is to say the expansion of the lexical meaning of a term to include further details and contents belonging to the extra-linguistic world, is first introduced in universal (or general) dictionaries of the English language since the very beginning of the century. However, the encyclopaedic inclusion goes back to the seventeenth-century hard-word dictionary tradition and later stimulates the production of a new type of reference works completely based on it. These reference works constitute a new emerging genre which develops throughout the century as a repository of many branches of knowledge: in this case, they are issued as universal dictionaries of arts and sciences; when they focus on a single discipline, they are known as specialised dictionaries, such as, for example, medical, medicinal or physical dictionaries.

10Usually organised in alphabetical order for a quick reference, the universal dictionaries of arts and sciences aim at systematising contents in the tree of knowledge. In connecting topics and sub-topics, this kind of organisation establishes and emphasises hierarchical relationships among them instead of circular ones as the encyclopaedic perspective – and the word encyclopaedia itself – would suggest. Of this kind are Chambers’s Cyclopaedia (1728 and following editions), and Rees’s Cyclopaedia (1778-88). In addition, the use of cross-references across entries helps establish, and further enhance, connections among topics and sub-topics.

  • 7   Interesting introductions to the Encyclopaedia Britannica (1768-1771) may be found in the followi (...)

11Quite the opposite, the Encyclopaedia Britannica (1768-1771) is conceived on a new principle7. Relationships and connections across single entries (and the multifarious disciplines) are reduced to a minimum with the introduction of long, inclusive, monothematic treatises systematising each single discipline separately. In general, the various strategies adopted by compilers at different times are used to avoid the structural dispersion and parcelling out of information across entries, and to suggest the idea of a comprehensive and coherent whole:

The alphabet thus gave scientific dictionaries the flexibility to absorb the new findings of the Scientific Revolution without having to assess the implications for traditional doctrines in long treatises. But eighteenth-century encyclopaedists rarely linked the choice of alphabetical order with an attack on systematic organisation. One reason for this was that the alphabet had not been seen as necessarily incompatible with classification. (Yeo 2001: 25)

12Unlike encyclopaedias, specialised dictionaries, medical dictionaries among them, focus on single, independent disciplines and their emerging or well-known sub-disciplines, as well as on medical history, medical events (diseases and health issues, etc.), and medical vocabulary. Their terminology and key concepts are organised in alphabetical order. In this case, neither tree of knowledge, nor long all-inclusive treatises are used to systematise contents. Once again, the semasiological approach and cross-references are the two organising principles. However, some entries are particularly long and expanded, combining sections and sub-sections on single, detailed aspects of the subject treated (ex. the entries Abortus, Abscessus, Cephalalgia, Fever, Paralysis, etc. are many pages long).

  • 8   R. Yeo (2001 : 47) : « The scientific dictionaries that came to be known as encyclopaedias were m (...)

13Encyclopaedic reference works, whether universal or specialised, are traditionally addressed to a vast educated readership, neither necessarily an expert one nor university educated. Within this conventional frame, the target always depends on the specific aims of individual compilers, or medical writers in the case of medical dictionaries. Universal dictionaries of arts and sciences often refer to the ‘curious reader’, interested in discoveries, experimentation, research and new perspectives in investigating everyday human experience, but also interested in a more general outlook on present and past knowledge and learning. The emerging disciplines, for their innovative contribution and appeal, often become the topic of conversation in genteel society. Thus, on the one hand, reference works answer the needs of the society in which they are produced and, on the other hand, their publication stimulates these needs and, as a result, their consumers and «the commercialization of knowledge» (Yeo 2001: 46)8. Useful universal knowledge and specialised medical knowledge are not only a social and cultural opportunity for many educated readers, but also a disciplinary opportunity: the need to select and organise contents implies their definition and distinction between topics and sub-topics. According to Yeo (1991: 25-26), this phenomenon «rather than being a force against specialization» highlights how «encyclopedias have reflected and facilitated the crystallization of natural knowledge into disciplines from the late eighteenth to the mid-nineteenth century».

14Dictionaries of arts and sciences were originally conceived and compiled as kinds of «inventor[ies] of facts […] storehouse[s] of knowledge» (Werner 1994: 189-190), particularly those which included a vast amount of topics. These universal encyclopaedic dictionaries become a fundamental and interesting cultural, social, disciplinary and linguistic commodity:

In the case of scientific dictionaries, apparently quite suitable for quick consultation [...] there was an emphasis on the need to read closely and methodically. [...] alphabetical order was not regarded as an invitation to superficial reading. [...] Knowledge presented in condensed and summarised form was not necessarily regarded as light or inferior. For this reason, a scientific dictionary could be said to have a lasting value for those readers who either used its cross-references to study a single science or to appreciate the connections among various subjects chartered in the map of knowledge. (Yeo 2001: 76)

15Throughout the century, universal dictionaries and encyclopaedias expanded their subjects and their treatment, updating their contents; whereas specialised ones added disciplinary details according to new methodological perspectives and well-established practices. The spread of ideas through encyclopaedic dictionaries also helped establish the vernacular as a form of communication among scholars, besides being the medium of popularisation. However, it would be a very simplistic and partial perspective to consider dictionaries of arts and sciences only as a vehicle of popularisation. They actually helped focus and distinguish the many different subjects selected and included, and their peculiar features (Yeo 1991: 26).

16It is from this shared social and cultural experience «adapted to a very numerous class of readers» (Rees 1778-1788, Preface 1786, vol. 1, B, AS) that gradually a far more restricted and specialised attitude emerges in the last quarter of the century. The fact that encyclopaedias were addressed to a vast heterogeneous audience does not preclude their role in making the single subjects develop and define themselves as emerging disciplinary fields, or sciences, since «encyclopedias have recorded and reinforced the divisions within knowledge, especially science, as much as they have evinced connections and interactions» (Yeo 1991: 25).

17Abraham Rees, in the preface to his new and modernised edition of Chambers’s Cyclopaedia, is well aware of the innovative function of a «Scientific Dictionary» or, «A Dictionary of Science», as he calls it (Rees 1778-1788, Preface 1786, vol. 1, B, AS), in a changed context:

we must not forget to mention, that it records and transmits to future ages many inventions and improvements, which might otherwise sink into oblivion; that it forms a compendious history of science; that it furnishes the outlines of its gradual progress and advancement; and that, by preserving a summary of what has been already done and discovered, it lays a foundation for further discoveries and improvements. In this latter view of its importance and use, it may not be improperly compared to a map of science, in which the line that terminates the terra cognita is distinctly marked out for the direction of those, whose ingenuity and industry are employed in extending the boundaries of knowledge, and in exploring those regions that are still unknown. (Rees 1778-1788, Preface 1786, vol. 1, B, AS)

18The EB, alongside Rees’s revised Cyclopaedia, «highlighted, and possibly reinforced, the transition from eighteenth-century natural philosophy to the specialised scientific disciplines of the nineteenth century. […] the predominant alphabetical arrangement […] contributed to this consolidation of disciplines» (Yeo 1991: 26).

19Dictionaries are moving on, they are not just a static repository, a mere systematisation and codification of what is known: they become a dynamic space, a basis for establishing future perspectives and discoveries in any field. Thus, they help display a more and more scientific outlook in comparison with preceding philosophical approaches to the ordering and connecting of subjects as elements of universal learning. Omni-comprehensive views are perceived as too vague in a scientific perspective, though fundamental in their original scope and function.

20At the same time, disciplinary-bound reference works are compiled by medical men – physicians, surgeons and apothecaries – thus emphasising the new trend which will lead to a clear differentiation among laymen and experts, as well as to the «consolidation of disciplines» (Yeo 1991: 26).

21Except for James’s A medicinal dictionary (1743-45), the other reference works analysed belong to the second half of the century. There is more than one reason for this: first, it is in this period that medical education undergoes dramatic changes, particularly concerning the epistemological approach to medical events and medical practice (ex. clinical observation and training); second, it is a period in which the reading habits change, both stimulating the production, the circulation and the commercialisation of multifarious works and affecting their nature, structure and contents.

22The definition of a disciplinary area in which medical men (independent of their education and/or training, or practice) can identify themselves as professionals, different from a more general context in which medicine continues to be merely empirical and non-professional, runs parallel to the elaboration of distinct but complementary medical discourses, for experts on the one hand, and for non-experts on the other.

23Universal and specialised dictionaries are compiled within the tradition of eighteenth-century British encyclopaedism, and so based on shared principles: from the lexicographic practice of organising non-linguistic contents under linguistic or, rather, lexical items in alphabetical order, to the aim of spreading universal or specialised useful knowledge among educated people in vernacular. However, each of them is also representative of gradual epistemological changes: particularly, from an all-inclusive idea of knowledge as scholarship and erudition to a more defined and specialised, (de)limited idea of disciplinary field. This means the progressive shift from learning to science, which involves a specialised and technical approach to reality (entities and events). This also implies the ongoing separation between an emerging restricted community of experts and a broader community of (educated) laymen. As a result, even though these works originate from the same principles, they operate different – and differentiating – choices in including, arranging and encoding medical contents and terminology (for example the length and the complexity of their entries for the same subject-headword, such as Abortus, Abscessus, Cephalalgia, Fever, Paralysis, etc.).

0.1.2. Handbooks and compendia: the expansion of reference works

24Since the mid-century the role and number of practitioners performing medicine had been changing. This tendency was influenced both by a growing population interested in medical service, and by the spread of new drugs, updated techniques to cure diseases (Lane 2001: 22; this is the case, for example, of inoculation against small-pox), or innovative surgical skills based on improved anatomical research.

25The approach to medical events was more and more practical in nature, and strictly based on clinical observation of phenomena:

Modern medicine has fixed its own date of birth as being in the last years of the eighteenth century. Reflecting on its situation, it identifies the origin of its positivity with a return – over and above all theory – to the modest but effecting level of the perceived. […] it meant that the relation between the visible and the invisible – which is necessary to all concrete knowledge – changed its structure, revealing through gaze and language what had previously been below and beyond their domain. A new alliance was forged between words and things, enabling one to see and to say. (Foucault 2003: xii)

26The collection of data, the observation of recursive symptoms and signs of diseases, the experimentation of cures and remedies all promoted the recording and the communication of case studies to colleagues. Thus, many practitioners at any level became productive authors on medical topics: both university-educated physicians (with a well-established reputation and élite patients in higher society) and unknown practitioners (particularly surgeons, but also apothecaries) published their accounts, case studies, treatments, collections of diseases (Lane 2001: 23), and lectures (ex. Cullen 1789). It was a way to inform and instruct students, colleagues, and a selected lay audience (particularly among the middle classes), and it was also a means to be recognised by potential new ‘customers’, and make a living by the medical profession:

in the consumerist eighteenth century, medicine expanded fastest of all the superior occupations to become […] a recognised and respected profession, with registration, professional journals and a career structure in both private practice and institutional appointments. […] By the 1750s, […] patients increasingly came to spend money on more scientific successful medical attention as part of a higher standard of living, greater disposable income and increased life expectancy. Medicine became […] an occupation which gentry or ambitious parents could choose as a career for their sons. (Lane 2001: 11)

27Another interesting stimulus to the production of reference works was the consolidation of medical education and training. British medical reform, and especially the need for regular training, promoted the expansion of private medical teaching with a strong practical focus, mostly outside the universities. Private schools of medicine offering training courses with a basic theoretical approach were widespread, and particularly developed, in London:

private or commercial teaching and medical education outside universities had come to dominate medical training. Students frequented a number of private schools or ‘walked the wards’ of the city’s hospitals with attending physicians and surgeons.
The great city of London, of course, had no university at the time so it was not possible to link university teaching with metropolitan hospitals or with any of the new voluntary (charitable) hospitals established in the eighteenth century. (Lindemann 2010: 148-149)

28This professionalising attitude was the effect of middle class values and commercial interests applied to a traditional domain of knowledge: this also implied further change as regards the doctor-patient relationship (Cunningham-French 1990: 3). The doctor extends his experience coming out of his closet and changing the attitude towards his patients: the one-to-one relationship is gradually substituted by a one-to-many relationship which focusses on the disease itself (its symptoms, signs, typical observable manifestations, etc.) and not on the personal account of the individual patient. The cures and remedies are thus based on facts and on the professional experience and outlook of the physicians or practitioners, and not negotiated with patients. The individual professional experience expands to become the shared experience within an emerging disciplinary community of colleagues who exchange information, experimentation, ideas and perspectives. This also allows preventative medicine to emerge and make «rational social planning to eliminate diseases» possible (Cunningham-French 1990: 3), particularly after the mid-century:

advances in medicine [...] like most other aspects of improvement, were most marked after the mid-century; the early decades of the eighteenth century represented the more or less stagnant ground-level against which the post-1750 take off could be favourably compared. (Wilson 1990: 9)

29The hospitals (but also infirmaries and dispensaries) that were established in London and elsewhere became the institutional places of clinical observation. Hospitals already existed but new ones were built and, more importantly, they were medicalised (Fissel 1991: 93, 99-100). They became a medical workplace: the context in which medicine was systematically practised by professionals. Hence, the role of the hospitals changed and, with it, the role of the practitioner as an expert of scientific experimental medicine. Obviously enough, this also changed the epistemological foundations of medicine:

The voluntary hospitals […] constructed a new political space for the practice of medicine; and as a result they produced and fostered many new medical initiatives in the eighteenth century and afterwards. […] they were certainly the site of an independent London medical revolution […]. It was certainly a large-scale development: by 1750 there were seventeen of them in England, when in the 1718 had been none. (Wilson 1990: 10-11)

30Hospitals were also the places in which preventative medicine was made effective, since crowding stimulated the establishment of clear norms to avoid the spreading of infections and contagious diseases. Hygienic rules governed daily and weekly cleaning practices to improve sanitation and asepsis, thus favouring inpatient recovery. Instruction books on these topics were frequently issued and most of them were the outcome of the army – or the navy – surgeons: that is, those practitioners who were constantly performing medicine in overcrowded spaces and contexts of poor hygiene conditions (cfr. Borthwick 1784). According to Riley (1987: x), «It is the origin of a medicine of avoidance and prevention, a medicine that sought to show mankind which diseases-conductive circumstances to evade, and to determine what aspects of the environment might be modified to weaken or eliminate their capacity to cause disease».

31It is in this context that public health reforms were planned and aimed at cleansing the environment «to reduce its pathogenic properties and its capacity to promote epidemics» (Riley 1987: 151), so dangerous and scary at the time: many medical writers and their works described and discussed fevers (of any kind) and infectious diseases in general. This, for example, is the focus of such works as Clark’s Observations on fevers (1780), Grant’s An enquiry into the nature, rise, and progress of the fevers most common in London (1771), Grant’s An essay on the pestilential fever of Sydenham, commonly called the gaol, hospital, ship, and camp-fever (1775), Millar’s Observations on the prevailing diseases in Great Britain (1770), Sims’s Observations on epidemical disorders, with remarks on nervous and malignant fevers (1776), to name just a few. If the aim was to avoid the spreading of terrible and devastating diseases ‘among mankind’, then it was necessary to inform and instruct people on the preventative measures to adopt. This also meant the writing and the ‘dissemination’ of handbooks for a general audience, or textbooks and practica for colleagues. The marketplace of print (cfr. Fissel 2007) and book trade helped and supported the commercialisation of medicine to an «health-conscious lay readership» (Porter 1992: 106), since «the flood of self-care literature clearly fostered people’s involvement in, and care for, their health» (Porter 1992: 108). Among the most known works addressed both to a lay and professional audience, there is Buchan’s Domestic medicine (11769), which underwent many editions throughout the century since it treated all the most relevant pathologies of contemporary society. According to Whitey (2011: 86-87) «the growing importance of medical books was argued to be an increasing source of orthodox medical knowledge […]. The compiling of medical information was obviously a logical and necessary means of accumulating sufficient medical acumen to tackle a range of conditions within the home» in a new perspective, one in which the two roles of expert-practitioner on the one hand, and non-expert-patient on the other were clearly distinguished. The writer is a professional expert having and dispensing disciplinary know-how: he can interpret and cure diseases, or give advice to the lay people. The doctor-writer and orthodox medicine thus assume a more definite social function than in the past.

32Medical knowledge pervades everyday discourse, and discourse is constructed, promoted and developed in multifarious medical texts, culturally and historically situated:

The production of scientific texts, then, is a process of situated rhetorical action, in which writers have an active role, constructing scientific knowledge through texts with particular reading audiences in mind, and at the same time positioning themselves and their commitments and ideological debts within the field of knowledge they represent, within the broader scientific community, and within society at large. (Pahta 2011: 335)

33The social context is the setting in which medical professionals perform their activity, as practitioners and writers, and interact with lay people through texts. Discourse emerges as a complex network in which heterogeneous texts variously contribute to the construction of meaning. Scientific popularisation is then the surface level of an in-depth «epistemological shift from scholasticism to empiricism with its new methods and tools of observation, [...] for enquiry» (Pahta 2011: 339), which makes the communication and the dissemination of medical contents and notions to a large audience definitely possible.

34These reference works are usually organised into subsequent thematic sections, focussed on specific topics (single diseases, groups of diseases, case studies, etc.), or more general issues (climate, environment, living conditions, non-naturals, etc.) according to the aims of the writer. Some include many diseases and their general causes (Buchan 21772), their description and possible cures (Millar 1770; Buchan 21772; Fisher 1785), and their categorisation, or classification, along with many case studies (Millar 1770). Others only introduce, describe and discuss more specific diseases, such as infectious and contagious diseases, and their causes (Borthwick 1784; Black 1788), their mortality rate (Black 1788), or the nature, rise, and progress of the most common fevers (Grant 1771, 1775; Sims 1776; Clark 1780).

35Chapters, parts, sections and sub-sections may be titled with

  • descriptive headings, such as Of the continued fever which prevailed in Newcastle, in the latter part of the year 1777 and Description of the scarlet fever attended with ulcerated sore-throat (Clark 1780), Of diseases which partake both of a putrid and inflammatory nature (Millar 1770), etc.
  • explicative headings, such as Comparative view of the above epidemic with the scarlet fever of authors, and the angina maligna, etc. (Clark 1780), Variety of symptoms to be met with the pestilential fever with aphthæ (Grant 1775), Precepts and cautions necessary to be observed, when the fever hath either been mitigated or removed by the Peruvian bark (Millar 1770), Diseases of the stomach and intestines, and organs of digestion (Black 1788), etc.
  • narrative headings, particularly ‘case studies’ and accounts on the progress of diseases, such as Case of a dysentery (Grant 1775), Pleuritic cases […] Case I. Case II. (Millar 1770), Cases of continued fevers, and An account of the success of the practice which has been recommended in the scarlet fever (Clark 1780), Weather of 1765, 1766, and part of 1767 (Sims 1776), etc.
  • the names of individual diseases as headings: headings partially overlap with the notion of headwords, and with their function, as in lexicographic works (especially in Fisher 1785).

36In this last case, diseases may appear in alphabetical order as in dictionaries, Appetite, want of, Apoplexy, Asthma, Bit of a mad dog-Hydrophobia, Black disease, Bleeding at the nose, Bleeding piles, Blind piles, Blood-spitting, Blood-vomiting, etc. (Fisher 1785), or in thematic groups according to their nature, symptoms and signs, cures, etc. Diseases of the lungs and organs of respiration, Pulmonary hæmorrhage, Pulmonary phthisis, […], Asthma, Dyspnœa and coughs, Catarrh, Hooping cough, Croup (Black 1788).

37Other interesting sections at the end of some books are appendices, indexes, and tables of diseases, remedies, and data, previously discussed in the works. These sections are usually included for a quick reference. This may suggest that some of these writings were addressed to a semi-expert or expert audience of trained practitioners who performed medicine and needed to find solutions in haste. Appendices are organised as tables and focus on multifarious topics, Tables of the diseases of the patients admitted to the Newcastle Dispensary, with remarks on the method of improving medical returns (Clark 1780); they may be commented translations adding material to the main text, Translation of some Latin quotations, with remarks (Millar 1770); or they are mere lists of words and glossaries, A glossary, explaining the terms of art (Millar 1770), etc. Indexes may include lists of medicines and remedies in alphabetical order and cross-refer to the sections and pages in which they are treated (Buchan 21772).

0.2. Methodology

38The reference works under scrutiny here are investigated from two complementary perspectives: the lexicographic and the textual ones. The lexicographic perspective is based on McConchie-Curzan’ (2011) approach, which focusses on definitional strategies in medical entries. This perspective highlights those textual, rhetorical and linguistic features typical of dictionaries and the way lexicographic works usually elaborate knowledge and discourse. The textual perspective focusses on the rhetorical and linguistic-stylistic features of the various texts exemplified. This latter perspective aims at discussing their dimensions of variation (ex. involved vs. informational, narrative vs. non-narrative, abstract vs. non-abstract, etc.), according to the approach elaborated by Biber (1988), Biber-Finegan (1989), and Biber-Conrad (2009).

0.2.1. Lexicographic approach: systematising and defining medical contents

39Definitional Patterns & Symptomatological Defining. According to McConchie-Curzan (2011: 77), in a study on Early Modern English medical writing, «the word ‘definition’ […] encopass[es] a wide range of means for helping readers to understand and to use a term.» This perspective may also be applied to later texts, such as those at the core of the present analysis: it is relevant at a theoretical level as reference point, and appropriate at a practical level to collect, examine, and organise data.

40The expression extended definition is used in this study to represent complex definitional patterns. These include basic – and complementary – components (taken and adapted from McConchie-Curzan 2011), such as

a. definition proper
or lexical definition, word meaning as usually expressed in dictionaries

b. etymology
introducing meaning and giving authority, thus supporting definition itself

  • 9   For the notion of equivalence, see Adamska-Sałaciak 2010 : 393-395 and 397-399.
  • 10   The term headword is used here to refer to the main topic of the discussion which, more often tha (...)

c. glossing
mostly overlapping with the notion of equivalence9, either
i. translational equivalence (that is to say, insertable; it may consist of single-word lexemes and/or multi-word lexemes, both between English and a foreign language, either classical or modern and between different registers within the same language), used to establish a one-to-one correspondence between the ‘topic-headword’10 and its (more prestigious, if Latinate) variant denomination, or
ii. explanatory equivalence (that is to say descriptive), used to reformulate-paraphrase the ‘topic-headword’ (an ‘in-other-words’ expression, descriptive in nature)

d. categorisation
organising principle, mainly genus-differentia patterns, sense relation of hyponymy

e. concise description
the lexical definition is expanded (but not to the extent of symptomography, cfr. f. below), encyclopaedic contents are included such as the main symptoms and/or shared knowledge to make the context/situation more transparent to the average reader)

f. definition in relation to symptoms
elaborate descriptions (sometimes many pages long) characterised by accurate and all-encompassing lists of symptoms and disease details, alongside the course of illness (sub-sequent steps in the process are emphasised by (chrono)logical transition markers, verb phrases, etc.). This is known as «symptomatological defining, ‘symptomography’», that is to say «the listing of symptoms to understand disease» (McConchie-Curzan 2011: 85-86)

41These strategies are not only exploited within dictionaries but adapted to different uses in different text typologies across genres, particularly handbooks and compendia: the relationship and exchanges between these two ‘macro’-genres (dictionaries vs. handbooks) are rather tight. Hence, the analysis considers the nature of such lexicographic features and their dynamic potential in organising and communicating contents, and in discussing similarities and differences across genres and text types.

0.2.2. Textual approach: rhetorical context and linguistic features

42Dimensions of variation. The analysis is based on the following dimensions of variation (cfr. Biber 1988 and Biber-Finegan 1989; Biber-Conrad 2009), each dimension being characterised by two poles along a continuum. Polarity is highlighted between brackets:

  1. Involved (face-to-face interaction) vs. Informational (academic prose)
  2. Narrative (fiction, account, etc.) vs. Non-narrative (academic prose, official document, etc.)
  3. Abstract (academic prose) vs. non-abstract (face-to-face conversation)
  4. Situation-dependent (listener’s knowledge of immediate context: place, time, other adverbs, etc., ex. personal letters) vs. Elaborated/Explicit Reference (official documents, professional letters, academic prose, etc.)

43To be accurate and reliable, the analysis of a text, the identification of one or more text typologies and their function(s) within the text itself, are based on a set of linguistic features: no single and isolated linguistic items can provide reliable textual evidence. Linguistic features, if considered along a continuum between poles, may be more or less frequent (and thus more or less typical) of a given genre and/or text type, and can tell us a lot about the rhetorical situation in which the text was produced, alongside its rhetorical function(s). In other words, combined linguistic features are a fundamental resource to determine the rhetorical strategies used by medical writers for the elaboration of medical discourse and the dissemination of medical knowledge.

44Text analysis and discussion are essentially carried out in four chapters: chapter 1. and 2. analyse and discuss medical discourse in dictionaries and encyclopaedias; chapter 3. is completely devoted to the presentation and discussion of textual examples drawn from handbooks and compendia; chapter 4. is devoted to the case study fever across genres (universal dictionaries of arts and sciences, medical dictionaries, handbooks and compendia). In the four chapters, the analysis will focus firstly, on the structure and use(fulness) of definitional patterns as communicative strategies in Late Modern English medical writing; secondly, on rhetorical variation and its impact at linguistic, stylistic and textual levels across genres.

45For the general aim of the study, text analysis is always and necessarily related to – and contextualised in – the social, cultural, and historical backgrounds.

0.3. Definition of some key terms

46This section is devoted to the explanation of some key terms as used in this study according to the variety of (con-)texts in which they may be found, their possible references, and their possible meanings. For this purpose, Samuel Johnson’s Dictionary of the English language (1755) will be used to define some of them as appropriately as possible for the period under scrutiny here. This approach is considered a necessary step to avoid anachronistic overlapping(s) with present-day usage for the same terms, since it provides an outlook on eighteenth-century interpretation and representation of medicine. The approach also helps focus on and distinguish some general notions which could be taken for granted, according to the present experience of the world. These notions are designated by terms such as science (and its derivatives), knowledge, learning, disease, symptom, practitioner and physician.

47The first distinction to be made is between (the notions of) science and knowledge. In the eighteenth century these two terms partly overlap, to denote either speculative reasoning, learning, erudition, or more practical skills and experimental, demonstrative approaches to reality:

Kno’wledge. n. s. [from know.]
1. Certain perception; indubitable apprehension.
Knowledge, which is the highest degree of the speculative faculties, consists in the perception of the truth of affirmative or negative propositions. Locke.
2. Learning; illumination of the mind. […]
3. Skill in any thing. […]
4. Acquaitance with any fact or person. […]
5. Cognisance; notice. […]
6. Information; power of knowing. […]

SCIENCE. n. s. [science, French; scientia, Latin]
1. Knowledge.
If we conceive God’s sight or science, before the creation of the world, to be extended to all and every part of the world, seeming every thing as it is […]. Hammond.
2. Certainty grounded on demonstration.
So you arrive at truth, though not at science. Berkely.
3. Art attained by precepts, or built on principles. […]
4. Any art or species of knowledge. […]
5. One of the several liberal arts, grammar, rhetoric, logick, arithmetic, musick, geometry, astronomy. […]

Scie’ntial. adj. [from science.] Producing science.
Scienti’fical. adj. [scientifique, Fr. scientia and facio, Lat.]
Scienti’fick. Producing demonstrative knowledge; producing certainty.
Natural philosophy proceeding from settled principles, therein is expected a satisfaction from scientifical progressions, and such as beget a sure or rational belief. Brown’s Vul. Err.
[...]
The systems of natural philosophy that have obtained, are to be read more to know the hypothesis, than with hopes to gain there a comprehensive, scientifical, and satisfactory knowledge of the works of nature. Locke.
Scienti’fically. adv. [from scientifical.] In such a manner as to produce knowledge.
Sometimes it rests upon testimony, because it is easier to believe than to be scientifically instructed.

48The term knowledge is more comprehensive and also refers to general, shared, notions, and everyday experience; instead the term science as specialised, professional, factual and practical knowledge, belonging to a limited disciplinary community of experts and strictly based on observation, experimentation, collection and interpretation of data is still to come. Johnson’s entries testify to this progressive and complex epistemological change, and its lexicalisation. Knowledge is getting established as learning in general, speculative learning, but also as acquaitance with any fact or person, shared knowledge, and common experience. Science and scientific, instead, more often than not refer to demonstrative and satisfactory knowledge, grounded on facts and experimentation, thus producing ‘scientific’ certainty. Medicine and medical knowledge undergo the same process of distinction and differentiation, at conceptual and lexical levels: medicine as shared, general knowledge, and medicine as speculative learning (i.e. erudition) coexist with the gradual shift of medicine towards a more restricted, disciplined, professional, scientific approach:

Me’dical. adj. [medicus, Lat.] Physical; relating to the art of healing; medicinal. […]
Me’dically. adv. [from medical.] Physically; medicinally. […]
Medici’nal. adj. […]
1. Having the power of healing; having physical virtue. […]
2. Belonging to physic. […]

Me’dicine. n. s. [medicine, Fr. medicina, Latin. …] Physick; any remedy administered by a physician. […]

Phy’sical. adj. [physique, Fr. from physick.]
1. Relating to nature or to natural philosophy; not moral. […]
2. Pertaining to the science of healing.
3. Medicinal; helpful to health. […]

Physi’cian. n. s. [physician, Fr. from physick.] One who professes the art of healing.

PHY’SICK. n. s. […originally signifying natural philosophy, has been transferred in many modern languages to medicine.]
1. The science of healing. […]
2. Medicines; remedies. […]

49The traditional lore of medicine as part of a more general knowledge, as a branch of learning belonging to natural philosophy, is still present in the adjectives physical~relating to nature, and medical~physical; whereas the entry Medicine highlights the shift towards its more specialised, experimental, practical, knowledge as the science of healing~the art of healing, or any remedy administered by a physician, medicines~remedies. Accordingly, the physician is one who professes the art of healing, but whose medical education is still grounded on traditional university learning, also including multifarious branches of knowledge such as botany, chemistry, natural philosophy, and the humanities as well. Performing medicine was the issue of other ‘medical men’, usually known as practitioners, mostly surgeons and apothecaries, regularly trained in private schools and/or institutional contexts since the end of the century. When used in the study, the two terms usually refer to this distinction. However, the activity of physicians and practitioners came closer in time: physicians starting to practice more regularly and frequently, practitioners being provided with a more regular training based on – and also including – fundamental theoretical notions.

50In the last quarter of the century, medicine was gradually transformed into science, to be definitely established as such, in the following decades. In this study, the expressions medical knowledge and shared medical knowledge are used with their more comprehensive and general meaning; whereas medicine or medicine as science will be used with their restricted, more specialised meaning. However, the distinction between these two semantic notions is extremely complex and not easy to pin down. The effort is to be as clear, coherent and consistent as possible according to the contexts in which the terms – or the multiword expressions – are used to describe, discuss and comment on the original excerpts. Potential ambiguity, or vagueness in use, are always possible because of the polysemic values and clustered senses, embedded into one another, their semantic load blending in with new usage(s).

  • 11   Johnson’s definitions of distemper and disorder still include traditional perspectives tracing ba (...)

51The other set of terms which deserves introduction and explanation here includes disease, distemper, disorder, and affection; symptoms, signs, and phenomena. Disease is the term commonly used to refer to any medical event, of any kind and severity. It expresses an all-inclusive notion which may be variously expressed by near synonyms such as distemper (usually referring to a slight illness caused by a traditional imbalance in the body, predominance of some humour), disorder (usually meaning a slight disease, due to lack of regularity in the animal œconomy, probably homoural imbalance)11, and affection (more general term adopted in medical context):

DISEA’SE. n. s. [dis and ease.] Distemper; malady; sickness; morbid state. […]

Diste’mper. n. s. [dis and temper.]
[…]
2. A disease; a malady; the peccant predominance of some humour; properly a slight illness; indisposition. […]
3. Want of due temperature. […]
4. Bad constitution of the mind; predominance of any passion or appetite. […]
5. Want of due ballance between contraries. […]

Diso’rder. n. s. [dis and order; desordre, French.]
1. Want of regular disposition; irregularity; confusion; […].
5. Breach of that regularity in the animal œconomy which causes health; sickness; distemper. It is used commonly for a slight disease. […]

AFFE’CTION. n. s. [affection, Fr. affection, Lat.]
1. The state of being affected by any cause, or agent. This general sense is little in use. […]
2. Passion of any kind. […]

52In any of the previous definitions, the traditional notion of a disease as an imbalance in the individual body clearly emerges and still predominates. Hence, the terms disease, distemper, disorder appear to be interchangeable in use. The term disease sometimes overlaps with symptoms and effects of a disease proper (as we can conceive it nowadays). This intermittent connection between disease, symptoms, effects relates to the widespread perception of disease as an individual experience, the outer manifestation of an internal humoural imbalance (disease, distemper, disorder, cfr. above) to be cured by traditional remedies such as bleeding, purging, sweating, etc. The notion of disease as an individual entity, with typical characteristic signs, independent of the patient and of occasional symptoms, only emerges toward the end of the period under scrutiny here, and is the consequence of an epistemological shift. This change essentially concerns the approach to the observation of diseases and the «virtues of the clinical gaze» (Foucault 2003: 85):

Analysis and the clinical gaze also have this feature in common that they compose and decompose only in order to reveal an ordering that is the natural order itself: their artifice is to operate only in the restitutive act of the original. (Foucault 2003: 94)

53The clinical gaze focusses on diseases as independent entities, independent of the body hosting them but manifesting themselves regularly and systematically in it: the clinical gaze recognises signs and symptoms in different patients. By analogy, it establishes relations among elements (Foucault 2003: 100). Diseases can be recognised by specific identifiable signs in a number of cases and in similar situations:

Sign. n. s. [signe, French; signum, Latin.]
1. A token of anything; that by which any thing is shown. […]

SY’MPTOM. n. s. [symptome, French; …]
1. Something that happens concurrently with something else, not as original cause, nor as the necessary cause or constant effect.
2. A sign; a token. […]

Symptoma’tical. adj. [symptomatique, French; from symptom]
Symptoma’tick. Happening concurrently, or occasionally.
Symptomatical is often used to denote the difference between the primary and secondary causes in diseases; as a fever from pain is said to be symptomatical, because it arises from pain only; and therefore the ordinary means in fevers are not in such cases to be had recourse to, but to what will remove the pain; for when that ceases, the fever will cease, without any direct means taken for that. Quincy.

  • 12   For a thorough analysis of the terms token, symptom, and sign, a relevant study by Jukka Tyrrkö w (...)

54Signs are the consistent and stable manifestations of a disease, their objective evidence, independent of the patient; whereas symptoms are usually circumstantial phenomena, and sometimes occasional manifestations of it perceived by the patient. However, the use of the two terms varies in eighteenth-century medical reference works. Symptom(s) is more widespread than sign(s), sometimes including both the meaning of occasional symptoms and objective signs, sometimes just focussing on occasional, circumstantial, individual perceptions and manifestations of the disease12.

0.4. General overview of the volume

0.4.1. Chapter 1. Framing medical discourse in universal dictionaries of arts and sciences

55This chapter introduces the two most relevant universal dictionaries of arts and sciences issued in the second half of the eighteenth century, and discusses the role they played in the dissemination of medical knowledge: the Encyclopaedia Britannica (1768-1771) and Rees’s Cyclopaedia (1778-1788). It also investigates the inclusion of medical terminology and the treatment of individual sample entries (Abortion, Abscess, Absorbents, Abstergents, Head-ach, Paralysis, etc.). In particular, the analysis focusses on the lexicographic components structuring them (basic and recurrent components, such as headword, equivalence, glossing, etymology, lexical definition, cross-references to internal sources-headwords), and their contents (more complex lexicographic and textual components, such as symptomatological definition, encyclopaedic expansion of contents, quotations, inclusion of case studies, cross-references to external sources). In other words, the analysis highlights the construction of medical discourse both as general knowledge (for a general educated audience), and as emerging science (for a more professional and restricted readership) in the two works.

0.4.2. Chapter 2. Framing medical discourse in specialised dictionaries

56The analysis of the two specialised medical dictionaries is the focus of the second chapter: James’s A medicinal dictionary (1743-1745) and Motherby’s A new medical dictionary (1775) are introduced starting from their prefaces, in which their individual perspectives on, and their specific approach to, medicine are exposed in detail. James and Motherby declare their aims, define their target audience, explain their plan, and provide the internal organisation of their respective works. As in the previous chapter on universal dictionaries, the analysis focusses on the basic lexicographic components, and on more complex lexicographic and textual patterns in the elaboration of encyclopaedic contents, and medical discourse. A selection of topic-headwords already discussed in the first chapter, such as Abortion, Abscess, Absorbents, Abstergents, Head-ach, Paralysis, etc., are under scrutiny here.

0.4.3. Chapter 3. Framing medical discourse in eighteenth-century handbooks

57Handbooks and compendia are the third group of texts at the core of this study: they represent a macro-genre which may display both similarities and differences across individual works. Differences lay in the degree of inclusiveness of contents (topics, diseases, medical events, case studies), and comprehensiveness of treatment (extension and detail). The starting point of the discussion is the analysis of their prefaces, to make their perspective(s) and their plan(s) clearly emerge, and to background further and more in-depth discussion of particular topics. The presentation of recurrent structural patterns in textual organisation follows: the rhetorical and linguistic strategies commonly used to introduce medical events and diseases (denomination, definition, categorisation), and to elaborate contents (symptomography, logical sequencing, embedding), are discussed in a series of thematic examples (inflammation of the lungs and head-ache in particular). The relationship – and the interaction – between widespread lexicographic practices and the elaboration of non-lexicographic text types in the construction of medical discourse is a key feature of this chapter.

0.4.4. Chapter 4. Case study: fever in dictionaries and handbooks

58Chapter four is completely devoted to a single term or topic, that is to say fever, and to the multifarious, complex, clustered realities it represents in the second half of the eighteenth century. Fever, as linguistic and textual evidence of extra-linguistic medical events, is analysed in all the emerging and expanding macro-genres already investigated individually, but here taken together: universal dictionaries of arts and sciences (EB and RCy), specialised dictionaries (MD and NMD), handbooks and compendia. Moreover, before close treatment in selected examples, the lexical definition of the term in mid-century dictionaries of the English language is provided (Martin, 1749; Johnson, 1755; Scott-Bailey, 1755) as background information for further encyclopaedic development. Once again, the lexicographic approach, the textual approach, their relationship and interaction in different medical reference works, along with medical discourse issues, are highlighted and discussed.

0.4.5. Chapter 5. Conclusions

59The concluding chapter summarises the most relevant findings of this qualitative study, as regards medical discourse and the communication of medical contents in different emerging macro-genres. Notwithstanding the particular nature of each individual text, and the use of recurrent linguistic, textual, and discourse features within the same genre (universal or specialised dictionaries vs. handbooks and compendia), the extracts analysed also provide strong evidence of similarities across genres. This may suggest shared needs – and shared habits – in the construction of medical knowledge (and medical knowledge as science), a common disciplinary core which deserves the same techniques to define medicine and to communicate contents. In other words, the discipline itself seems to determine and establish the rhetorical and linguistic strategies to be applied.

Notes

1   Changes in medical education and in the practice of medicine are complex processes which cover long periods of time. Interesting works on the topic are Loudon (1986 and 1995), French-Wear (1989), Wear (1989 : 294-320), Cunningham-French (1990), Wilson (1990 : 4-39), French-Wear (1991), Lawrence (1991 : 45-73), Nutton-Porter (1995), Brown (2011).

2Practica were the outcome of an ancient tradition. Wear (2000 : 116-117) explains that « the coherent medical textbook exposition of the nature of diseases took place in the context of a genre of writing called the practica or compendia on the practice of medicine. These dated from the Middle Ages [...] the practica went beyond naming a disease and giving treatments for it. They also gave its signs and causes. [...] they identified or constructed diseases by selecting salient signs from the huge variety that would be reported by patients or observed upon their bodies.» The format of practica (signs, causes, regimen and treatments) continued to be used later on, and in the eighteenth century plays a key role in organising medical writing and its practical issues, as well as in defining – and delimiting – the roles of practitioner vs. patient. On the one hand, there is the practitioner-observer recording his experience, on the other hand, the patient-observed being informed by a professional on diseases, cures, and remedies.

3   Lane (2001 : 9, 12) maintains that « The line between charlatan and orthodox was not always clear, for a number of qualified practitioners [...] also made lucrative livings as quacks [...]. In addition, some distinguished qualified men, such as Robert James, [...] also promoted remedies bearing their names, usually in the more expensive range of preparations. [...] Early eighteenth-century England saw medicine struggle to be more orthodox and indeed a recognisable medical profession had emerged by the early 1800s. [...] Physicians remained at the apex of the medical pyramid, few in number, practising only in the largest towns and cities, [...] generally never performed manual tasks or dispensed medications. Surgeons and apothecaries, although originally separated occupations, increasingly joined their skills into the title of surgeon-apothecary, the equivalent of the modern general practitioner». On the new professional role of the surgeon-apothecary and the importance of apprenticeship, see also Lane (1985 : 57-103), Bynum (1985 : 105-128), and Lawrence (1991 : 45-73), whereas the relationship between orthodox medicine and medical fringe is treated extensively in Bynum-Porter (1985).

4   Loudon also discusses the structure and the role of medical education, as well as the reform of medical profession, in an interesting paper published in Nutton-Porter (1995 : 229-249), and in Loudon (1986).

5   For the present analysis the second edition of Buchan’s Domestic medicine (London 1772) was used ; the first edition was published in Edinburgh (1769) with the title Domestic medicine ; or, the family physician : being an attempt to render the medical art more generally useful, by shewing people what is in their own power both with respect to the prevention and cure of diseases. Chiefly calculated to recommend a proper attention to regimen and simple medicines.

6   Intelligibility becomes the general aim of medical writing at any level : here, it refers to the effort to be effective in textualising and communicating medical knowledge to a composite audience, including both the professional and the general educated reader.

7   Interesting introductions to the Encyclopaedia Britannica (1768-1771) may be found in the following studies : Kafker (1994a : 145-182 and 1994b : 389-399), Abbattista (1996 : 397-434), Castagneto (1996 : 435-476).

8   R. Yeo (2001 : 47) : « The scientific dictionaries that came to be known as encyclopaedias were more expensive and weighty products, but they are a stunning example of how the trade in knowledge was judged to be worth large capital investment. They also exemplify the assumption that knowledge should circulate freely, that it should be accessible to anyone, irrespective of social rank, who could buy or borrow a copy of such a work».

9   For the notion of equivalence, see Adamska-Sałaciak 2010 : 393-395 and 397-399.

10   The term headword is used here to refer to the main topic of the discussion which, more often than not, is introduced by a short title or the name of the disease, thus resembling the entryword of a lexicographic reference work, either dictionary or encyclopaedia. This terminological choice seems to be appropriate, since other elements typical of lexicographic entries are also exploited in the extracts exemplified (equivalence, etymology, glossing, categorisation, sense relations, description, etc.).

11   Johnson’s definitions of distemper and disorder still include traditional perspectives tracing back to the four bodily humours of ancient Galenic medicine. For this specific aspect and for a detailed analysis of some medical terms in Johnson’s Dictionary cfr. Pireddu 2006.

12   For a thorough analysis of the terms token, symptom, and sign, a relevant study by Jukka Tyrrkö was issued in 2006. The study discusses the use of token, symptom, and sign as signifier terms in English vernacular medical texts from late Middle English to early Modern English (up to 1725), and in dictionaries from 1530 to 1775.

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