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Communicating Medicine

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Elisabetta Lonati

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

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1The first edition of the Encyclopaedia Britannica (1768-1771; hereafter EB) and Rees’s Cyclopaedia, or an universal dictionary of arts and sciences (1778-1788; hereafter RCy) are the two general reference works under scrutiny here. They are the most relevant outcomes of this kind in the second half of the century. Rees still answers to a taxonomic approach, derived from Chambers, and is aimed at connecting the different branches of knowledge; the EB, instead, is not interested in this but in highlighting the unity of single independent subjects. In any case, their specific plan along with the alphabetical order enhance the distinction of individual topics: in RCy, many original entries in Chambers are put together under the same headword; in EB, monographic treatises embed disciplinary contents in sub-sections.

2The EB, particularly interested in natural history and science in general, is the first to have the word encyclopaedia in its title and also the first to present it as a national – British – endeavour. In fact, it is a completely Scottish one and the outcome of Scottish Enlightenment (Yeo 2001: 170-173, 176-180). The title page announces – and the preface emphasises – the main features distinguishing this new dictionary of arts and sciences from the previous ones: «[t]he different Sciences and Arts are digested into distinct Treatises or Systems» (title page). The traditional schemes of classification, establishing comprehensive networks among contents disseminated under innumerable headwords, are abandoned:

Instead of dismembering the Sciences, by attempting to treat them intelligibly under a multitude of technical terms, they [i.e. compilers and editors] have digested the principles of every science in the form of systems or distinct treatises, and explained the terms as they occur in the order of the alphabet, with references to the sciences to which they belong. (EB Preface: v)

3This is a truly innovative arrangement: the tree of knowledge is replaced by inclusive treatises (about forty, called ‘systems’) of «high scientific content» (Yeo 2001: 172). So it is no longer merely arts and sciences, or parts thereof, laid out in alphabetical order arbitrarily listing the single headwords and connecting them by cross-references; rather, cohesion is ensured by the many syntheses of the main branches of knowledge emerging and establishing themselves as individual disciplines. Their basic principles are thus explained discursively, as opposed to the fragmentary presentation based upon an alphabetical classification. These treatises are arranged in alphabetical order, but stand out from the rest of the text – the title being at the centre of the page in capital letters – and sometimes are so extensive that they largely exceed the size of an encyclopaedia article (some are more than one hundred pages, others more concise). They are used as disciplinary macro-areas, such as Medicine, Surgery, Midwifery, Anatomy, Botany, and many others. The organising principle at the basis of the EB was a

conscious rejection of Chambers’ model and, ultimately, of all such attempts to classify the sciences covered in an encyclopaedia. The preface [...] to the first edition was brief, reflecting the practical attitude of the owners who were men of business with an interest in science, not philosophers seeking to reorganise the intellectual world. (Yeo 2001: 179)

  • 1   This practical attitude is particularly shared by the editors of the EB (1768-71) and by Motherby (...)

4The plan is thus conceived as having a different epistemological perspective. The aim is strictly practical1. Usefulness for mankind in real life is the crucial assumption, and not philosophical and scholarly arrangements. The need and the effort to classify and unify the whole circle – or, rather, hierarchy – of knowledge in a map are disregarded. However, this choice was not spared bitter criticism, particularly in London where Chambers’s Cyclopaedia (1728 and later editions) still dominated the market, and the intellectual world.

5The first edition of the EB includes very concise entries: the headword is usually followed by an essential, lexical definition and sometimes by a concise expansion of the topic. In the following editions, the innovative plan of the first edition would instead become the starting point for future developments and enlargements, which made the EB a very successful enterprise which is still published nowadays. The principal aim is twofold and in line with a more general attitude of the time, since «UTILITY ought to be the principal intention of every publication», as well as «To diffuse knowledge of Science, [which] is the professed design of the following work» (EB Preface: v). The compilers address to the educated readers, «both gentlemen and literati» (Yeo 2001: 172).

6Medicine, in general, is discussed under three main treatises: Medicine (pp. 58-169), Surgery (pp. 640-679) and Midwifery (pp. 205-245). They are of uneven length, Medicine being the longest and the most relevant. It starts with a concise definition:

Medicine is generally defined to be, The art of preserving health when present, and of restoring it when lost.
[...]
Medicine being thus founded on a powerful instinct in human nature, its existence in some form must have been coeval with the first disease that appeared among mankind. (EB Medicine: 58)

  • 2   Dr. William Cullen (1710-1790) was professor of Medicine at the University of Edinburgh.

7To this general definition, Dr. Cullen’s classification2 of diseases follows, as presented in his Synopsis nosologiæ methodicæ (Edinburgh 11769, in Latin; 1792 first translation from Latin to English as Synopsis and nosology), containing the arrangement and definition of diseases (Genera morborum præcipua):

The doctor divides diseases into the four following classes, viz.

Class

I.

Pyrexiæ, or Feverish Disorders.

II.

Neuroses, or Nervous Diseases.

III.

Cachexiæ; comprehending such disorders as proceed from a diseased state of the whole or any part of the body, without an original fever, or any nervous complaint.

IV.

Locales; comprehending diseases which affect a part only, not the whole body.

(EB Medicine: 59)

  • 3   As regards medicine and the treatise Medicine in the EB, see also Kafker (1994a: 164-165) and Lon (...)

8Then, each class is further subdivided into orders (a kind of table of contents for the treatise Medicine) and, within each order, diseases are thematically listed and described. Interestingly enough, medicine – as a domain – is not subdivided into further branches as in previous and contemporary dictionaries of arts and sciences. However, most of its sub-branches are defined under their respective headwords, in alphabetical order (except for Hygieina/Hygeina)3:

PATHOLOGY, that part of medicine, which explains the nature of diseases, their causes and symptoms.

PHYSIOLOGY, […] among physicians the term physiology denotes the history of the human body and its several constituent parts, with their relations and functions.

SEMIOTICA, that part of medicine which considers the signs or indications of health and diseases, and enables the physician to judge what is, was, or will be, the state, degree, order, and effect of health or sickness.

THERAPEUTICS, that part of medicine which acquaints us with the rules that are to be observed, and the medicines to be employed in the cure of diseases.
(EB s.v. Pathology, Physiology, Semiotica, Therapeutics)

9These entries – in particular their conciseness – exemplify the definitional strategies as introduced in the preface to the EB. They also reflect the general features of most of them, often limited to the lexical definition or a moderate expansion of it.

10The same subdivision is, instead, traditionally embedded s.v. Medicine in RCy (1778-1788), which is a revised edition, in five folio volumes, of Chambers’s Cyclopaedia (1728).

11Medicine is introduced in general terms as «Medicine, Medicina, the art of healing», and defined as «Medicine popularly called physic, consists, according to Boerhaave, in the knowledge of those things by whose application life is either perceived sound and healthy, or when disordered is again restored to its pristine healthiness». The whole entry, two in-folio columns in length, synthetically introduces the history of medicine (here a very concise one indeed, if compared to Chambers’s 1728 entry or to the long all-inclusive article in the EB) and the traditional subdivision into its five branches:

  • 4   Except for minor differences (ex. cross-references), this section overlaps with Chambers’s 1728. (...)

Medicine is divided into five principal branches. The first considers the human body, its parts and fabric, life and health, and the effects following from them: this is called physiology, the doctrine of the animal œconomy, or of the use of the parts; and its objects, now enumerated, are called res naturales, or things according to nature. The second branch considers the diseases of the human body, their differences, causes, and effects; and is called pathology, as it considers the diseases; ætiology, as it inquires into their causes; nosology, when it examines their differences; and lastly, symptomatology, when it explains their effects. The objects of this part are called res præternaturales, or beyond nature. For the modern method of classing diseases, see Nosology.
The third branch considers the signs or symptoms, and how to apply them to use; so as to judge, both in a sound and a diseased body, what will be the degree, order, and effect, of the health or the disease: this is called semeiotica: its objects are things both natural, non-natural, and preternatural.
The fourth branch considers the remedies, and their use, whereby life may be preserved; whence it is called hygieine: its objects are what we strictly call non-natural. Lastly, the fifth furnishes the materia medica, its preparation, and manner of exhibition, so as to restore health, and remove diseases: and is called therapeutica, comprehending the diætetica, pharmaceutica, chirurgica, and iatrica4. (RCy s.v. Medicine)

12However, everything pertaining to the medical field is disseminated in alphabetical order under the many technical headwords, whether pointing to diseases, remedies, tools, cures, etc. the length of the single entries may vary a lot.

13Abraham Rees aimed at updating, and adapting to new needs and perspectives, Chambers’s Cyclopaedia (1728), a work that still kept the market – and the intellectual world – among the multifarious encyclopaedic publications issued around the middle of the century and later. RCy exemplifies the lexicographic interest within the encyclopaedic enterprise, since many entries were reduced and definitions modernised and shortened. Actually, the basic principles structuring the work are the same as in Chambers’s Cyclopaedia. The map of knowledge is included and serves as a unifying network, connecting different ‘disciplines’ and sub-disciplines. However, Rees updated contents and made them more ‘scientific’ and focussed:

Many of the original articles [...] have been either abridged or enlarged, as their respective nature and importance required; and that many new articles have been inserted in their alphabetical order; [...] the number of new Articles amounts to more than Four Thousand Four-Hundred; several of which do not occur in any Dictionary of Science [...] some of them are of considerable length; many comprehend subjects of moment; and the least important were thought too interesting to be omitted. The Original Articles, which seemed to require correction, abridgment, or addition, many of which have been very much altered or enlarged, are more numerous than those that are altogether new. [...] Besides, by [...] the combination of articles under the same title, the abridging of those that were needlesly diffuse, an alteration in the references by cancelling some that were of no importance, and printing the subject of reference in a different character in the body of the article itself, and by a minute attention to many other circumstances, the Editor has made room for introducing a variety of new matter within the same compass. (RCy 1778-1788, Preface 1786: iii)

14His aim was to enlarge the scientific perspective, including «inventions and improvements in trades, industries, and technology» thus giving «prominence to this interest in a reference work conceived of as a dictionary of science rather than as a mere storehouse of knowledge» (Werner 1994: 190). As a consequence, RCy is not just a revision, but it may be considered the starting point of an innovative approach, mirroring issues typical of the enlightened, and rapidly developing, pre-industrial British society.

1.1. Introducing, organising, and defining medical contents

  • 5Here, the expression medical writing refers to those reference works investigated in the present s (...)

15The general and most frequent structure of the entries in the EB and RCy has been discussed in the previous paragraphs. The attention may now focus on a few headwords, the same in the two dictionaries to facilitate comparison. The selection is mainly qualitative, and the terms represent some of the most frequent topics of description and in-depth treatment in medical writing5. The lexical items under scrutiny here are abortion, abscess, absorbent/s, abstergent/s, head-ach, hemicrania, hemiplegia, hemitritæus, parachynanche (parasynanche), palsy, paralysis. The headwords and their respective entries will first be analysed in universal dictionaries of arts and sciences, and further on in medical dictionaries. Further analysis is carried out on a specific topic in chapter four, that is fever. This widespread phenomenon has been chosen for the impact it had both on society, as shared – and more often than not frightening – experience, and on medical practice and research. The following tables include some of the sample entries taken from the EB and RCy.

1.1.1. Encyclopaedia Britannica

16The examples in Table 1 demonstrate that the structure of entries in the EB is not particularly complex. This fact supports and confirms the compilers’ premises in the preface, and seems to fit in with their aims. Complexity obviously regards the treatises on Medicine and Surgery: they are inserted in alphabetical order, like all other headwords, but the articles are absolutely not just normal entries. As regards the entries under scrutiny here, they are transcribed – some of them necessarily shortened – in the table below. Abortion, Abscess, Head-ach (sub-entry), Hemitritæus, Palsy And Parasynanche are included as individual entries: they cross-refer to particular sections in the main treatises where the topic is expanded and explained in detail but, to avoid dispersion, cross-references are not used to connect the single entries among themselves.

17Definitions are the main part of the medical entries in the EB: they are very short and spare – generally two or three column lines (Abortion, Abscess, Abstergent Medicines, Hemiplegia/Hemiplexia, Hemitritæus, Parasynanche). Indeed, most of the entries provide – apart from the headword and label – only a lexical definition (which is more or less condensed):

Table 1

Encyclopaedia Britannica

ABORTION, in midwifery, the birth of a fœtus before it has acquired a sufficient degree of perfection to enable it to perform respiration and the other vital functions. See MIDWIFERY, title, Of abortion.

***

MIDWIFERY

Of Abortions.

A Miscarriage that happens before the tenth day, was formerly called an efflux, because the embryo and secundines are not yet formed, and nothing but the liquid conception, or geniture, is discharged. From the tenth day to the third month it was known by the term expulsion, the embryo and secundines being still so small, that the woman is in no great danger from violent flooding.

If she parted with her burden betwixt that period and the seventh month, she was said to suffer an abortion; in which case she underwent greater danger, and was delivered with more difficulty than before; because the uterus and vessels being more distended, a larger quantity of blood was lost in a shorter time, the fœtus was increased in bulk, and the neck of the womb is not yet fully stretched: besides, should be the child be born alive, it will be so small and tender that it will not suck, and scarce receive any sort of nourishment.

When delivery happens between the seventh month and full time, the woman is said to be in labour: but, instead of these distinctions, if she loses her burden at any time from conception to the seventh or eighth, or even in the ninth month, we now say indiscriminately, she has miscarried.

The common term of pregnancy is limited to nine solar months, reckoning from the last discharge of the catamenia: yet in some, though very few, uterine gestation exceeds that period.

ABSCESS, in medicine and surgery, an imposthume, or any tumor or cavity containing purulent matter. See SURGERY, title, Of tumors or abscesses.

***

SURGERY

Of Inflammations and Abscesses.

As almost all abscesses are the consequences of inflammations, and these produce a variety of events, as they are differently complicated with other disorders, it will be proper first to make some enquiry into their disposition. Inflammations from all causes have three ways of terminating; either by dispersion, suppuration, or gangrene.

But though every kind of inflammation will sometimes terminate in different shapes, yet a probable conjecture of the event may be always gathered from the state of the patient’s health. Thus inflammations happening in a slight degree upon colds, and, without any foregoing indisposition, will most probably be dispersed: those which follow close upon a fever, or happen to a very gross habit of body, will generally imposthumate: and those which fall upon very old people, or dropsical constitutions, will have a strong tendency to gangrene. […]

ABSORBENT Medicines, testaceous powders, as chalk, crabs-eyes, &c. which are taken inwardly for drying up or absorbing any acrid or redundant humours in the stomach or intestines. They are likewise applied outwardly to ulcers or fores with the same intention.

ABSTERGENT Medicines, those employed for resolving obstructions, concretions, &c. such as soap, &c.

Head

[…]

Head-ach, a most troublesome sensation in the head, produced by various causes, and attended with different symptoms, according to its different degrees, and the place where it is seated. See Medicine.

***

MEDICINE

Of the Head-Ach.

The head-ach is a most troublesome sensation in the nervous membranes of the head, produced by various causes, and attended by different symptoms, according to its different degrees, and the place where it is seated.

The most common seat of this disease is the pericranium; a membrane which invests the skull, coheres with the muscles next the skull, and is joined to the dura mater by some fibres which pass through the sutures. It is a thin nervous membrane of exquisite sense. It may be likewise in the skin that covers the skull, and in the dura matter [sic]. This last but seldom happens; but when it does, it is very dangerous. There may likewise be a very acute pain in the thin membrane which covers the sinus of the os frontis.

If the head-ach be slight, and affects a particular part of the head, it is called cephalalgia; if the whole, cephalæa; if one side only, hemicrania; if there is a fixed pain on the forehead, which may be covered with the end of the thumb, it is called clavus hystericus.

The general cause of the head-ach is a hindrance of the free circulation of the blood through the vessels of the head.

[…]

HEMIPLEGIA, or Hemiplexia, among physicians, a palsy of one half of the body.

HEMITRITÆUS, among physicians, a kind of intermitting fever, being a semitertian. See MEDICINE.

***

MEDICINE

Of the Semitertian Fever.

This is an epedemic [sic] fever, compounding of an intermitting tertian and a continual quotidian.

It generally makes its onset before noon, with coldness, shaking, and a contracted pulse; to which succeeds a frequent pulse, with heat, which continues some hours till a warm sweat appears, without a complete intermission. The heat, after a slight chillness, increases towards night, with a quick pulse; which is more moderate the next day, without thirst, till the evening, when a slight shivering comes one [sic], and the symptoms return. On the third day, the shaking fit appears again with more intense heat, and proceeds in the same track as before; so that the fever is never quite off, but has an exacerbation in the evening: however, the shaking fit is most conspicuous every third day in the morning.

Besides the foregoing symptoms, […].

PALSY, in medicine. See MEDICINE, p. 97.

***

MEDICINE

Of the Palsy.

A Palsy is a lax immobility of any muscle, not to be overcome by the will of the patient. Sometimes the sensation of the part is absolutely abolished, and sometimes there remains a dull sense of feeling, with a kind of tingling therein.

It may be caused by all things that bring on an apoplexy; that render the nerves unfit to transmit the animal spirits; that hinder the entrance of the arterial blood into the muscle. Hence the nature of a paraplegia or hemiplegia, and the palsy of a particular part, may be understood.

Hence a palsy may proceed […].

PARASYNANCHE, in medicine, a kind of angina, or quinsey. See MEDICINE, p. 84.

***

MEDICINE

Of the Quinsey.

A Quinsey is an inflammation of the fauces, with a burning pain, tumor and redness; a difficulty of breathing or swallowing; and a fever, proceeding from a stasis of blood, or a viscid acrid serum in the sanguineous or lymphatic vessels.

It begins with a fever, which is followed with a pain and inflammation of the fauces, causing the uvula, tonsils, and larynx to swell; whence great difficulty of breathing and swallowing ensues.

This disease may be seated at the root of the tongue near the os hyoides; the soramina of the nostrils opening to the bone; the beginning of the œsophagus; the muscles of the pharynx; the internal and external muscles of the larynx; the greater and lesser glands; the tonsils, or the muscles moving the jaws.

When the quinsey affects the internal muscles […].

18Mainly, the approach is that of a language dictionary, usually providing lexical definitions. Sometimes, though rarely, definitions are moderately expanded by explanations merged with them – or sometimes following them – as is the case with Absorbent Medicines and Head-ach. In the case of Palsy, instead, the definition is completely omitted, and the headword is directly cross-referred to Medicine.

19In the EB’s medical entries the etymology is never included. The compilers did not consider the etymology a necessary requirement in a work that aims to present the world through language. The absence of etymology is a more or less clear reflection of the compilers’ epistemological approach as regards their work as a whole. Indeed, the compilers maintain in the preface (p. v) that «they have had recourse to the best books upon almost every subject, extracted the useful parts, and rejected whatever appeared trifling or less interesting». This also applies to linguistic data, which add nothing to the body of the argument. The information must be pertinent. Only what is indispensable to the stated aim has the right to be included and, obviously, the etymology of a term is not essential in explaining the phenomena under consideration. In the management of the work, it is merely extra information.

20As regards spelling variants (hemiplegia~hemiplexia, palsy~paralysis) and lexical variants, or equivalents (abortion~miscarriage, absorbent medicines~testaceous powders, parasynanche~angina/quinsy, abscess~imposthume/tumor/cavity), few are included in the EB. Headwords usually have one single form, which can be either in Latin, or English, or both. In the case of lexical variants, most of them are translation equivalents generally used to gloss the headword before its definition, if present, or replacing it, if missing. Equivalents may also be used to categorise and organise contents; in this case, equivalence shifts towards hyponymy (parasynanche~a kind of angina).

21Symptomatological defining is present s.v. Hæmitritæus-Semitertian Fever and s.v. Parasynanche-Quinsey. S.v. Hæmitritæus-Semitertian Fever, specific and detailed symptoms are framed within the progress of the disease. The process is strictly defined by time markers: «onset […] coldness, shaking, and contracted pulse»; «succeeds […] frequent pulse, with heat, which continues some hours till a warm sweet»; «heat, after […] chillness, increases […] with a quick pulse […] moderate the next day, without thirst, till the evening, when», etc. S.v. Parasynanche-Quinsey, symptomatological defining is preceded by the explanatory equivalence «inflammation of the fauces», and characterised by two phases: one introduces general symptoms such as «burning pain, tumor and redness; difficulty of breathing or swallowing; and a fever»; the other frames symptoms in time «begins with a fever, which is followed with a pain and inflammation of the fauces», and space, the seat of the disease «the uvula, tonsils, and larynx […] disease may be seated at the root of the tongue near the os […] the beginning of the œsophagus; the muscles of pharynx; the internal and external muscles of the larynx; the greater and lesser glands; the tonsils, or the muscles moving the jaws».

22Examples of categorisation and denomination may be found under the sub-entry Head-ach. In this case, after a general introduction on the multifarious causes, on the complexity of the «most troublesome sensation in the nervous membranes», and on «the most common seat of this disease», the different kinds of head-ache are provided. Various denominations are introduced according to the circumstances defining and characterising each of them: «if the haed-ach be slight […] cephalalgia; if the whole [head], cephalæa; if one side only, hemicrania; if there is a fixed pain […] clavus hystericus.»

23Hypothesising specific situations is another relevant discourse strategy exploited by the EB for the elaboration and communication of medical events. This approach is useful to build up more complex paragraphs for the description of the disease. The most frequent, and easiest, frame of hypothesising is the use of introductory if and when: «If she parted» (s.v. Abortion); «if the […] if one […] if there is» (s.v. Head-ach). However, more complex structures of thought are signalled by the co-occurrence of linking expressions of cause-consequence and opposition, such as «If she parted […] in which case […] because the […] besides, should be the […] it will be […]; When […] but, instead of […] if […] we now say» (s.v. Abortion); «As almost all abscesses […] inflammations, and these produce […] as they are […] it will be proper […] But though every kind of inflammation […] yet […] Thus inflammations happening […]: those which follow […] and those which fall» (s.v. Abscess).

1.1.2. Rees’s Cyclopaedia, or An Universal Dictionary of Arts and Sciences

24RCy presents a very different situation. The extracts in Table 2, whose headwords correspond to those analysed in the EB, highlight different compiling strategies. The average entry in RCy is longer – sometimes, much longer – than the corresponding one in the EB. The micro-structure is complex, rich in details and encyclopaedic load, which further expand the lexical definition. This is the case with all the examples provided, except for Paracynanche (directly cross-referred to Angina), and testifies to a divergent epistemological approach and lexicographic practice, different from the EB.

25Linguistic information, particularly concerning etymology (s.v. Hemicrania, Hemiplegia/Hemiplexia, Hemitritæus and Paralysis), spelling variants (hemiplegia~hemiplexia, palsy~paralysis) and equivalents (abortion~miscarriage/abortus/abactus, abscess~apostema/imposthume/imposthumation, abstergents~abstersive medicines/detergents, palsy~paralysis), is sometimes provided. The practice of including etymology was widespread in general dictionaries of English and was transferred to dictionaries of arts and sciences as a means to introduce encyclopaedic contents. The original meaning of words, their derivation (both semantic and morpho-syntactic) was, in fact, considered to be the first step to familiarise with a new topic.

26The entry is usually opened by a lexical definition, sometimes preceded or followed by etymology. Definitions unfold and delimit the topic-headword, and may be moderately expanded for reason of clarity: for example, «the unseasonable exclusion of an imperfect human fœtus [definition], either alive, or dead, before the natural time of delivery [expansion]» (s.v. Abortion); «a kind of inflammatory tumor [definition], containing purulent matter, pent up in a fleshy part, and corrupting and consuming the fibres, and other substance thereof [expansion]» (s.v. Abscess); «a species of cephalalgia, or head-ach [definition]; wherein only one hemisphere, or half, or one side of the head, is affected; and owing to a congestion of blood in the vessels of that half [expansion]» (s.v. Hemicrania). Lexical definitions, in their more concise form, may overlap with the notion – and the function – of equivalence: this is the case with abscess~inflammatory tumor, hemiplegia~a palsy of one whole side of the body, angina~an inflammation about the muscles of. In other cases, they start by declaring the nature of the medical entity described: «a disease wherein» (s.v. Palsy), «this disease being supposed» (s.v. Paralysis). Sometimes, they introduce the topic with expressions such as «is used […] for the» (s.v. Abortion), «is used for such things as» (s.v. Abscess), «they are» (s.v. Abstergents).

27No treatises in the manner of the EB are included, hence almost everything concerning a specific topic is gathered and clustered under its respective headword. Cross-references are present but reduced to a minimum, to avoid dispersion of information across many smaller entries: «ABORTION […] See Miscarriage», «HEMIPLEGIA […] See Palsy and Medical Electricity», «PARACYNANCHE […] See Angina».

28The strategy of packing information under a ‘key’ headword (backgrounding sub-topics), and partially reorganising Chambers’s Cyclopaedia (1728 and later editions), helps emphasise individual subjects as disciplinary areas and conceptual units, as announced by Rees in his preface. This focussing process – obtained both by the expansion of the original entry and by the reduction in the number of cross-references – is achieved s.v. Absorbents, Head-Ach, and Palsy. However, more concise entries (lexical definition with moderate expansions), sometimes shortened if compared to Chambers’s original model (Abstergents), or reproducing them (Hemiplegia/Hemiplexia, Hemitritæus), are still present in RCy, but they are not as systematic as in the EB.

29The following entries represent the most typical entry structures in RCy, alongside their most frequent and recurrent features:

Table 2

Rees’s Cyclopaedia

ABORTION, is used, in Medicine, for the unseasonable exclusion of an imperfect human fœtus, either alive, or dead, before the natural time of delivery.

In this sense, abortion amounts to the same with what we popularly call miscarriage; the Latins abortus, and sometimes abactus.

This may happen at any time of pregnancy, but if before the second month after conception, it is properly called a false conception, or effluxion.

The causes of abortion are very various. The most usual are, distempers, either acute or chronical; immoderate evacuations, all strong passions, violent exercises, frights, lifting of weights, weakness from any cause whatever, fullness of blood, stimulating medicines, offensive smells, excessive use of venery, and, in general, any thing which tends to promote the menses. But the most frequent causes of abortion are either too great stricture, or laxity of the uterus, which are more particularly pointed out by Hippocrates.

The ancient Greek legislators […] the Romans […].

[…]

The practice of artificial abortion is chiefly in the hands of women and nurses, rarely in that of physicians; who in some countries, are not admitted to the profession without abjuring it. Hippocrates, in the oath he would have enjoined on all physicians, includes their not giving the pessus abortivus; though elsewhere he gives the formal process, whereby he himself procured a maid to miscarry.

[…]

Abortion may be produced by whatever immediately affects the child, the placenta, the membranes, or the mother. When the time of miscarriage is just at hand, the pains are much the same as those in labour.

Abortion is dangerous where the time of pregnancy is far advanced, so that the fœtus must be large, where the cause is very violent, or the patient strongly convulsed, and where a large hæmorrhage precedes, or ensues, or the fœtus is putrefied, &c. Under other circumstances it rarely proves mortal.

Abortion is also used, somewhat abusively, for a fœtus, which, dying in the womb, continues there beyond the natural term; sometimes several years, and even during the whole life the mother.

To prevent Abortion. See Miscarriage.

ABSCESS, in Medicine, a kind of inflammatory tumor, containing purulent matter, pent up in a fleshy part, and corrupting and consuming the fibres, and other substance thereof. Abscess is the same with what the Greeks call apostema, and the English, imposthume, or imposthumation.

Almost all abscesses are the consequences of inflammation.—The ripening of abscesses is promoted by poultices, &c.—Abscesses are opened either by caustic, or incision; but the latter way is in most cases preferable.

Abscesses arise often in women after delivery; and though dangerous in themselves, yet they often appear to be the crisis of the disease, that gave rise to them.—For the cure, if they cannot be discussed, i.e. carried off by proper artificial evacuations, as phlebotomy, purging, &c. with the occasional use of calomel, and gentle perspirative fotuses, liniments, and cataplasms; recourse is to be had to the contrary method, and they must be brought to suppuration.

ABSORBENTS, in a general sense, is used for such things as have the faculty of absorbing, or swallowing up others.

Absorbents, in Medicine, remedies which, by the softness or porosity of their component parts, become proper to sheath the asperities of sharp pungent humours; or to imbibe or dry away, as with a sponge, superfluous moistures; and are of divers kind; simple, compound, saline, cinnabarine, marine, fixed, earthy, acid, alkaline, &c. In the Pharmacopœias, we meet with several forms of absorbents; such are the testaceous powder, hartshorn, coral, crabs eyes and claws, calcined bones, burnt ivory, terra sigillata, and even iron itself: also divers woods; as sanders, mastic, guaiacum, sassafras: and divers roots; as china, sarsaparilla, &c.

[…]

Absorbents consume the humors without fusing them, and have sometimes the effect of strengtheners, sometimes of purgatives, oftener of calmers, to allay fermentations. They are of use for tempering acrimonies, […] Absorbents have also their ill effects; […].

They are generally prescribed as the only remedy for the acute diseases of infants […].

They are sometimes applied to ulcers; but it is to be observed that […]. Monro, in Med. Ess. Edinb. vol. V art. 24. […] See Phil. Trans. N°. 459. sect. 2. Van Swieten, in his comment to Boerhaave’s Aphorisms, observes […] M. Homberg has a discourse on the quantity of acids absorbed by […] M. de la Hire gives an experiment for ascertaining the quantity of water absorbed by plants. Mem. Acad. R. Scien. an. 1700, p. 81.

ABSTERGENTS, or Abstersive Medicines, more usually called among physicians Detergents; they are cleansing medicines of a saponaceous nature, capable of dissolving concretions formed of earth and oil, which water simply, as an abluent, cannot effect.

Head

[…]

Head-ach, in Medicine. Physicians commonly distinguish the head-ach into two kinds, according to its degree and continuance. The gentlest kind, and which commonly affects a particular part of the head only, they call cephalalgia, and the more violent and obstinate cephalæa; when the pain is on one side only, it is called hemicrania, and when it is a fixed pain in the forehead, which may be covered with the end of the thumb, it is called the clavus hystericus.

Cephalalgia is defined to be a pain in the head, proceeding from a copious congestion of the blood and humours in that part, which do not find any exit or passage from thence. They generally distinguish it also into two kinds, the idiopathic and the symptomatic.

[…]

Head-ach, causes of the. Among the natural and internal causes, the principal are too great a quantity of blood, […] The external or accidental means that may bring on this pain are very numerous: […].

[…]

Prognostics from it. The head-ach is a pain rather troublesome than dangerous in itself, but it too easily degenerates into worse complaints, and not unfrequently presages defects of the sight or hearing, or the gout; […].

[…]

Method of cure. The congestions of humours are to be derived from the superior to the inferior parts, and, above all things, the bowels are too loosened by clysters and purges, for they are usually bound up in this disorder.

[…]

Cephalæa is a violent and continual pain in the head, occasioned by a rheumatic congestion of humours in the head. […] Signs of it. […] Causes of it. […] Method of cure. […]

Junker’s Consp. Med. P. 96. 100. 104. 116. and Buchan’s Dom. Med. p. 283 edit. 1776.

HEMICRANIA, ’Hμιϰρανια, in Medicine, a species of cephalalgia, or head-ach; wherein only one hemisphere, or half, or one side of the head, is affected; and owing to a congestion of blood in the vessels of that half.

Physicians divide the hemicrania into four kinds. 1. The idiopathic, when it is properly a disease of itself. 2. The symptomatic, where it is properly only the symptom of some other disease. 3. The continual or fixed, where it admits of no absolute intermissions. And, 4. The periodic, where the patient is regularly free from it at certain stated periods.

Signs of it. Among these are vibrative and very acute pains: the pain occupies only one part of the head, while the other part is wholly free and at ease. The left side of the head is usually the part in pain.

[…]

Prognostics. This species of head-ach not unfrequently brings on suffusions, and other disorders of the eyes, and often is a fore-runner of the gout, especially if it be imprudently treated during the fit; […].

[…]

Method of cure. As the primæ viæ are almost always obstructed in this complaint, the regular beginning of a cure is by emptying them; and a gentle vomit, and purging medicines are to be given.

[…]

Junker, Consp. Med. p. 118.

HEMIPLEGIA, or Hemiplexia, compounded of ημισυς, half; and πλεσσω, I strike, or seize, in Medicine, a palsy of one whole side of the body. See Palsy and Medical Electricity.

HEMITRITÆUS, ҆Hμιτριταιος, compounded of ημισυς, half, and τριταιος, third; or, as modern Latin authors express it, semitertian, in Medicine, an irregular intermitting fever, which returns twice every day; by which it is distinguished from the quotidian, which only returns once in the day.

PALSY, paralysis, in Medicine, a disease wherein the body, or some of its parts, lose their motion, and sometimes their sensation, or feeling.

The causes of the palsy are, an impeded influx of the nervous spirits into the villi of the muscles, or of the arterious blood into their vessels: this may happen from some fault, either in the brain, the nerves, the muscles, or their vessels.

The occasional or predisposing causes are various; as drunkenness, wounds of the brain or spinal marrow, pressure upon the brain or nerves, very cold or damp air, the suppression of customary evacuations, sudden fear, want of exercise, and whatever relaxes the system, as drinking much tea, coffee, &c. The palsy may likewise proceed from wounds of the nerves themselves, from the poisonous fumes of metals or minerals, as mercury, lead, arsenic, &c.

The palsy is said to be perfect, or complete, when there is a privation of motion and sensation at the same time. Imperfect, when one of the two is destroyed, the other remaining.

This disease is more or less dangerous, according to the importance of the part affected. A palsy of the heart, lungs, or any part necessary for life, is mortal. When it affects the stomach, the intestines, or the bladder, it is highly dangerous. If the face be affected, the case is bad, as it shews that the disease proceeds from the brain. When the part affected feels cold, is insensible, or wastes away, or when the judgment and memory begin to fail, there is little hope of a cure. Buchan.

Hoffman distinguishes palsies into serous and sanguineous. […]

The palsy, again, is either universal, lateral, or partial.

Palsy, universal, called also paraplegia, or paraplexia, is a general immobility of all the muscles that receive nerves from the cerebrum, or cerebellum, except those of the head. […]

Palsy, lateral, called also hemiplegia, is the same disease with the paraplegia, only that it affects but one side of the body. […]

Palsy, partial, is that where some particular part, or member, alone is affected; e.gr. where the motion is destroyed. […]

Palsy, electary for the […].

Palsy drops […].

Palsy, infusion for the […].

PARACYNANCHE, in Medicine. See Angina.

***

ANGINA, in Medicine, an inflammation about the muscles of the larynx, or pharynx, attended with an acute fever, difficulty of swallowing, and danger of suffocation.

The word is derived immediately from the Latin ango, formed of […] suffoco, strangulo.

The angina is the same with what we popularly call quinzy, or squinancy. It is an inflammation in the parts of the throat subservient to respiration, speech, and deglutition. When the disorder is epidemic, it is usually between spring and summer, after a long continuance of cold and rainy weather. The true quinzy is an acute inflammatory disorder; and the fever that accompanies it is not acute, but rather chronical.

Angina gangrena, or aquosa, the ulcerated, malignant, putrid, sore throat; on which there are various treatises by Fothergill, Huxham, Northcote, &c.

[…]

Angina pectoris, in Medicine, a name given to a disease, dangerous, and not extremely rare, first described by Dr. W. Heberden, and so called from the seat of the disorder, and the sense of strangling and anxiety with which it is attended. The doctor’s account of it is in the second volume of the London Medic. Trans. p. 59, &c. See also Medic. and Phil. Comment. vol. ii. p. 95. […]

This disease has been since accurately described, and suitable preventives or remedies proposed, by Dr. Fothergill. Med. Obs. and Inq. vol. v. p. 233. 252.

PARALYSIS, in Botany, […].

Paralysis, παραλυσις, formed from παραλυω, I unbind; this disease being supposed to unbind the nerves and muscles, in Medicine, a disease popularly called palsy. The paralysis only differs from the paresis, as the greater from the less.

Authors distinguish the paralysis into a paraplegia or paraplexia, and a hemiplegia, and a partial paralysis.

The second, of one side of the body. See Hemiplegia.

The third of some particular member; which is the proper palsy. See Palsy.

30The frame of symptomatological defining is used to introduce, list, and cluster the causes of some diseases as s.v. Abortion, «very various. The most usual are, distempers […] immoderate evacuations […] passions, violent exercices, frights, lifting of weights, weakness […] fullness of blood, stimulating medicines, offensive smells»; and s.v. Palsy, «causes are various; as drunkenness, wounds of the brain or spinal marrow, pressure upon the brain or nerves, very cold or damp air, the suppression of customary evacuations, sudden fear, want of exercise, and whatever relaxes the system, as drinking much tea, coffee, &c. […] from wounds of the nerves themselves, from the poisonous fumes of metals or minerals, as mercury, lead, arsenic, &c.». In both cases, ‘symptomatological defining’ is characterised by accumulation.

31Rees’s entries are also characterised by categorisation, which is carried out through hyponymic relations: the entry is organised according to different degrees of detail introduced by new, more specific terms or attributes. This linguistic, hierarchical frame, is thus used to structure discourse within the entry, embedding sections and sub-sections through words. This is the case with Absorbents «of divers kind; simple, compound, saline, cinnabarine, marine, fixed, earthy, acid, alkaline»; with Head-ach, distinguished «into two kinds, according to its degree […] cephalalgia, and […] cephalæa», and also into «Hemicrania, and clavus histericus». Cephalalgia is further subdivided into «the idiopathic and the symptomatic» or, again, Hemicrania «into four kinds […] idiopathic […] symptomatic […] continual or fixed […] periodic». Paralysis is distinguished «into a paraplegia or paraplexia, and hemiplegia». Sometimes, as s.v. Palsy («Palsy universal», «Palsy lateral», etc.), Head (Head-ach), a series of sub-headwords are included, thus introducing semi-independent sections.

32Discourse within the entry is also organised by the use of titled paragraphs, mainly focussing on the causes, the consequences, and the possible cures or remedies for the disease: «Head-ach, causes of the. […] Prognostics from it. […] Method of cure. […]»; «HEMICRANIA […] Signs of it. […] Prognostics. […]». Further information within the dictionary is guaranteed by a number of cross-references, whereas more specialised, in-depth and up-to-date materials are signalled through detailed external reference s.v. Absorbents, «Monro, in Med. Ess. Edinb. vol. V art. 24. […] See Phil. Trans. N°. 459. sect. 2. Van Swieten, in his comment to Boerhaave’s Aphorisms, observes […] M. Homberg has a discourse on the quantity of acids absorbed by […] M. de la Hire gives an experiment for ascertaining the quantity of water absorbed by plants. Mem. Acad. R. Scien. an. 1700, p. 81»; s.v. Head-ach, «Junker’s Consp. Med. P. 96. 100. 104. 116. and Buchan’s Dom. Med. p. 283 edit. 1776»; and s.v. Hemicrania, «Junker, Consp. Med. p. 118.»

33Rees also includes historical sections in some of his medical entries, as s.v. Abortion: «causes of abortion […] which are more particularly pointed out by Hippocrates. The ancient Greek legislators […] the Romans […]». This choice highlights the importance of tradition, and may reveal a scholarly attitude which considers the authority of the past as necessary to background, understand and interpret the present (similar to the introductory function of etymology). However, it is also widespread lexicographic practice in dictionaries of arts and sciences as repositories of general knowledge.

1.1.3. EB and RCy: textual organisation

34The two universal dictionaries of arts and sciences display and unfold their contents in a different manner, according to their own epistemological perspective. The entries analysed are of uneven length and complexity, and this aspect is reflected in their textual organisation.

35Definitions are very neat and concise in the EB, often cross-referring to Medicine, Surgery, Midwifery. In-depth technical exposition is carried out within these comprehensive treatises, which also include specific titled sub-sections such as «Of Abortions», «Of Inflammations and Abscesses», «Of the Head-Ach», «Of the Semitertian Fever», «Of the Palsy», «Of the Quinsey» (cfr. Table 1). These sub-sections may cover a few paragraphs («Of Abortions»), others expand from a single in-quarto column («Of the Semitertian Fever», «Of the Palsy») to as many as nine («Of the Quinsey»), the average length being about four («Of Inflammations and Abscesses», «Of the Head-Ach»). Descriptions and explanations of the disease are essential, they are systematically focussed on the topic (or on a specific aspect of the topic), and usually on contemporary approaches and perspectives. Digressions and historical passages are generally reduced to a minimum, if not completely omitted. As regards the linguistic features and their relevance in the construction of coherent and cohesive texts, topicalisation («A Miscarriage», «As almost all abscesses», «The head-ach», «A Palsy»), the repetition of key terms (inflammation s.v. Abscess), hyponymic and synonymic sense relations (abortions~miscarriage~efflux~expulsion), the frequent use of linking verbs and passive voice («was formerly called […] are not yet formed […] is discharged […] was known […] she was said […] was delivered» s.v. Abortion) are the most relevant.

36In RCy, definitions are the starting point for further in-depth treatment within usually extended, complex, articulate entries (cfr. Table 2, the average length for the examples analysed and discussed is about two in-folio columns) in which textual and discourse granularity is higher than in the EB. This means that the focus shifts from the main topic to satellite topics, from the present (usually descriptive, or expository texts, from «The causes of abortion» to «promote the menses», s.v. Abortion; «Absorbents consume the humors without fusing them […] They are of use for […] Absorbents have also their ill effects; […] They are generally prescribed as […] They are sometimes applied» s.v. Absorbents) to the past (digressions on traditional or historical approaches, «But the most frequent causes […] which are more particularly pointed out by Hippocrates. The ancient Greek legislators […]. Hippocrates, in the oath» s.v. Abortion). The macro-text of the entry is thus fragmented into shorter sections with their own focus, making reading and the elaboration of contents more difficult and laborious. Some sections are distinguished by sub-headings dealing with causes, signs, prognostics, method of cure, as in handbooks and compendia. This textual and discourse strategy provides formal and ideational order to the sequence of paragraphs and ideas (s.v. Head-ach, Hemicrania), but it is not a systematic approach. Other entries include many sub-headwords (s.v. Palsy), organising and differentiating specific pathologies. In general, the amount of information included is dense. The linguistic features already discussed in the EB may be found also in RCy. However, due to ideational density and focus shift, they result in being less effective at a textual and discourse level or, rather, their effectiveness is intermittent.

1.2. Chapter summary

37This chapter has introduced the two most relevant universal dictionaries of arts and sciences issued in the second half of the eighteenth century: the Encyclopaedia Britannica (1768-1771) and Rees’s Cyclopaedia (1778-1788). For each of them, the epistemological inspiring principles – and their relevance at lexicographic and encyclopaedic levels – have been thoroughly discussed. Their prefaces are explicit as regards their respective general aims and the methods to achieve them.

38The EB focusses on the unity of contemporary disciplines, providing comprehensive treatises essentially based on the present state of the art. The approach is practical, and the perspective of classifying the arts and sciences is completely avoided. Medicine, Surgery, and Midwifery are not ‘dismembered’ under multifarious entries in alphabetical order, and reconnected in an ideal tree of knowledge. The unity is built within the individual discipline, as science. The definitions of technical terms are concise, and essential, systematically cross-referring to the unifying medical treatises.

39RCy assumes a more traditional perspective in comparison to the EB: it reproduces the tree of knowledge as a unifying principle across disciplines in an ideal universal whole. This approach reflects the organisation of Chambers’s Cyclopaedia (1728), and its attempt to provide detailed and specific contents under individual headwords in alphabetical order. However, RCy also introduces some innovations: some entries are rearranged and expanded under the same headword (ex. Head-ach, Hemicrania, Palsy), in order to establish a sense of unity at disciplinary level, as science. Rees’s entries are longer and more complex than the EB’s entries: they include linguistic information (etymology, synonyms, hyponyms, etc.), historical details (digressions on medical history and traditional approaches), internal cross-references (fewer than in Chambers’s Cyclopaedia, and not to comprehensive treatises as in the EB), and references to contemporary external sources.

Notes

1   This practical attitude is particularly shared by the editors of the EB (1768-71) and by Motherby (NMD 1775) and, as such, mirrored in their works; whereas James (1743-45) and Rees (1778-88) echo a more traditional and scholarly approach in their dictionaries, though they also emphasise the practical benefits of their ‘innovative’ and comprehensive attempts. James and Rees are still rooted in traditional systematisation of knowledge, though stimulating and enhancing new outlooks as well.

2   Dr. William Cullen (1710-1790) was professor of Medicine at the University of Edinburgh.

3   As regards medicine and the treatise Medicine in the EB, see also Kafker (1994a: 164-165) and Lonati (2002: 37-40). For the principles of inclusion and arrangement of medical contents in universal dictionaries of arts and sciences see also Lonati 2007 and 2014.

4   Except for minor differences (ex. cross-references), this section overlaps with Chambers’s 1728. The same branches are included in alphabetical order in Rees’s work: the single entries include etymology and the definition starts from it and is essentially lexical. Such entries, for their characteristics (both structural and linguistic), could be regularly found in contemporary universal – or general – dictionaries of the English language (the etymological principle became systematic since the first decades of the century in language dictionaries and was also exploited by eighteenth-century encyclopedists as a starting point of their entries, when introducing technical terminology or scientific concepts and/or topics).

5 Here, the expression medical writing refers to those reference works investigated in the present study, also including the handbooks analysed in the following chapters.

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