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Communicating Medicine

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Elisabetta Lonati

2. Framing medical discourse in specialised dictionaries

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  • 1   Two other relevant dictionaries were Barrow’s Dictionarium medicum universale: or, A new medicina (...)

1James’s A medicinal dictionary (1743-1745; hereafter MD) and Motherby’s A new medical dictionary (1775; hereafter NMD) are the two major specialised reference works of the period1. They represent the effort to illustrate and delimit the medical field by an extensive inclusion and thorough exposition of its terminology. These works, organised in alphabetical order, declare to be of general interest, in particular, James argues that medicine is a common experience and everyone should be correctly informed about medical events and remedies. However, they are specially addressed to medical students or practitioners, that is to say to people who, at different levels, are involved in the profession. This specificity is particularly true for Motherby’s work.

2.1. James’s A medicinal dictionary (1743-1745) and Motherby’s A new medical dictionary (1775): an introduction

2The starting point to introduce the two medical dictionaries is the entry Medicina (not the English version medicine), which is not treated in detail as in the EB and in RCy, and which does not frame medical contents or the history of medicine. In both these works, the two entries are very concise, including equivalents, cross-references (MD and NMD) or lexical definitions followed by encyclopaedic expansions (NMD):

MEDICINA. Medicine. See the Preface. (MD s.v. Medicina)

MEDICINA. Medicine. It is the art of preserving present health, and of restoring it when lost, more properly the last. It is usually divided into Physiology, Hygieine, Pathology, Semejotice, and Therapeutice, which see. (NMD s.v. Medicina)

  • 2   According to O.M. Brack Jr. and Thomas Kaminski (1984: 398), Samuel Johnson may have helped James (...)

3James’s work is a huge, bulky body of medical scholarship. Extensive inclusion, detailed exposition, and exhaustive discussion are its outstanding features. Robert James (1703-1776), a university-educated physician, studied medicine at Oxford and Cambridge, practised in various cities across the country and arrived in London in the 1740s. Here, he decided to publish some medical works to make his name known among colleagues and patients (Brack-Kaminski 1984: 378). In his Proposals for printing a medicinal dictionary (1741)2, he states that «this Useful and Laborious Performance being undertaken by the Society of Booksellers for promoting Learning» (MD, Proposals, Conditions, 1741: 3). Alongside evidence of medical specialisation as a disciplinary field, the epistemological perspective is still one in which medicine is perceived as widespread, shared knowledge: «Physic is an Art which every Man practices» and «almost every Family is furnished with general Axioms of Physic» (MD, Proposals, General Account, 1741: 5 Select). The distinction between professional medical men – their prerogatives as experts, and their role in contemporary society – and the laymen status is still to come. The boundary between these two emerging communities will be defined (and delimited) towards the end of the century. Thus, the general aim of James’s performance is

To establish juster Notions in the Bulk of Mankind, and introduce more useful Medicines into Families, […] to supply all the Defects of those that have gone before us, and at once to familiarize the Knowledge, and reform the Practice, of Physic, by publishing A Medicinal Dictionary.
Many Medicinal Dictionaries have been already written […]. They endeavour to explain the Terms only; we, together with the Terms, the Science of Physic. They enable their Readers to name Distempers, which we instruct them to cure. Their Attempts were indeed useful, and are therefore to be mentioned with Gratitude: The Knowledge of Words must necessarily precede the Study of Science; this Knowledge they undertook to facilitate, and have succeeded so well, that often nothing can be added to the Accuracy of their Explications; and such Passages we have carefully translated without the weak Ambition of concealing the Benefit of unnecessary Variations.
The Diligence with which we have consulted and compared them, will probably make them less necessary to future Students, as we have not only transfused all their Collections into our Work, but added many Terms hitherto omitted; so that what is not to be found in this Dictionary, it will be generally in vain to seek in any other; but what is wanting in others, may be more successfully inquired for in this. (MD, Proposals, General Account, 1741: 5 Select)

  • 3   For essential reference to Harris’s Lexicon Technicum (1704) and Chambers’s Cyclopaedia (1728), s (...)

4The work is thus structured as a kind of ‘scholarly collection’, in which modern innovations and contemporary perspectives (science of physic), «to explain […] together with the Terms, the Science of Physic», are treated alongside what «has been transmitted by the Antients» (Ibidem), that is to say the history of medicine and the exposition of the various doctrines. The benefit to mankind in spreading knowledge, the need and the effort to go beyond the lexical definition of the terms included in the lemmata and distinguish the nature and aims of an encyclopaedic work from ‘a dictionary of words’, the importance of language and accuracy of expressions to explain contents, the legacy of previous works alongside further developments and innovations are received assumptions in encyclopedic prefaces and lexicographic works in general (cfr. Harris 1704, Chambers 1728, eighteenth-century dictionaries of the English language, etc.)3. The target audience is ‘mankind’ and ‘families’ in general, but also ‘future students’, that is to say a far more restricted discourse community. This double perspective is one of the reasons why Brack and Kaminski (1984: 381) maintain that

The Medicinal dictionary, typical of large-scale eighteenth-century compilations, is primarily an assemblage of existing scholarship, relying heavily on the translation of various works for much of its material. James appears to have been little more than an editor, selecting and ordering his materials, perhaps translating much of them himself, perhaps relying on others for such assistance.

5Hence, on the one hand, MD is still rooted in a well-established lexicographic and encyclopaedic tradition; on the other hand, the plan also announces a selection of case studies to be treated and exemplified, along with accurate descriptions of diseases, the method of cure according to different, sometimes contrasting, past and present approaches. These aspects will be analysed further on in a selection of entries.

6The MD includes the five branches of medicine in alphabetical order. In this case, as later with Motherby (1775), the definitions are essentially lexical (providing the meaning of the term). Etymology is an important aspect in both works, and the etymological principle – included in general lexicography since the very start of the century – is highlighted as a central strategy when introducing and defining specialised terminology:

PATHOLOGIA, παθολογια, from παθος, a Disorder; and λέγω, to speak, or commemorate. That Part of Medicine, which explains the Nature of Diseases, their Causes and Symptoms. (MD s.v. Pathologia)

PATHOLOGIA, from πάθ[ος], a disease, and λέγω, to speak or commemorate. That part of medicine which explains the nature of diseases, their causes, and symptoms. In order to understand a disease, we should consider the morbific causes, parts affected, symptoms, crisis, diagnosis, and prognosis: hence pathology is divided into all three parts. (NMD s.v. Pathologia)

PHYSIOLOGIA, φυσιολογία, from φύσις, Nature, and λέγω, to treat of Physiology. That Branch of Medicine, which considers Nature, with respect to the Cure of Diseases, particularly the Human Body, its Parts, Structures, health, Life, Functions, and Œconomy. (MD s.v. Physiologia)

PHYSIOLOGIA, from φύσις, nature, and λεγω, to treat of. That branch of medicine which considers nature with respect to the cure of diseases, particularly the human body, its parts, structure, health, life, functions and œconomy. Physiology depends much on the knowledge of anatomy. See Sauvage, Pemberton, or Haller on this subject. (NMD s.v. Physiologia)

SEMEIOTICE. That Part of Medicine which treats of the Signs of Health and Diseases. (MD s.v. Semeiotice)

SEMEIOTICE. That part of medicine which treats of health and diseases. See Dr. Wynter’s Translation of Lommius’s Obs. (NMD s.v. Semeiotice)

HYGIEINE, υγιεινή, from υγιής, sound, healthy, is the first Part of methodical Medicine, being that which prescribes Rules for the Preservation of Health. Castellus. (MD s.v. Hygieine)

HYGIEINE, υγιής, sound or healthy. It is the first part of methodical medicine, being that which prescribes rules for the preservation of health. (NMD s.v. Hygieine).

THERAPEUTICE, θεραπεύτικη, is that Part of Medicine, which is particularly concerned in the Cure of Diseases. (MD s.v. Therapeutice)

THERAPEUTICE, from θεραπεύω, to heal or cure. It is that part of medicine which particularly respects the cure of diseases. (NMD s.v. Therapeutice)

7The definitions are identical: in this case, the tradition repeats itself across dictionaries – typical of the lexicographic practice – with some variations and up-to-date expansions, particularly external references, in the NMD. This fact also signals well-established basic taxonomic principles, a kind of medical ‘scaffold’, on which medical men definitely agree. However, the two physicians live and compile their works in different periods and different contexts; their disciplinary perspectives and their aims are different and their experience in performing medicine is different. Their works reflect such diversity, though starting from and dealing with a common disciplinary, medical basis.

8The previous definitions introduce George Motherby’s NMD (1775). It opens the last quarter of the century, a period in which British medical reform was starting to operate: the spreading of hospitals and infirmaries, the clinical approach and observation, the collective experience for medical men, the multiplication of case studies, the possibility to discuss them and experimenting new remedies are the main innovations. All this brought to the institutionalisation of practical training and experimentation not only for surgeons and apothecaries, but also for physicians. This also implied the redefinition of the relationship between the medical men and their patients in contemporary civil society: each of them now with a definite and – self-defining – role. The medical men – either physicians or trained practitioners – were becoming medical professionals. Along with traditional university education, new courses were established at different levels of specificity to encompass a larger cohort of future medical practitioners. This would help reduce, if not eradicate, quackery and the fringe of lay practitioners so typical of and widespread in late eighteenth-century British society.

  • 4   On Motherby’s A new medical dictionary (1775), cfr. McConchie (2009).

9This is the innovative and changing climate in which Motherby (1732-1793) compiles his dictionary4. His preface, while stating the «utility of propagating what the ancients taught, and the modern improved» (NMD, Preface 1775: iii), also highlights how this «additional publication […] in affording general instructions, enables the reader to select, rather than increase his volumes» (Ibidem). Improvement does not necessarily mean expanding or inflating contents, since «[s]ystematic productions are doubtless adapted for a student’s regular pursuit; but speedily to assist the memory in practical researches, alphabetical digest justly claim the preference» (Ibidem). This is the reason why «each respective article will terminate with a reference to some of the most eminent writers on the subject» (Ibidem). This process of selection is a process of distinction, delimitation and identification of medicine as a professional domain, and as science.

10The preface thus reveals how different the perspective and the method applied are in Motherby’s work, if compared to James’s MD. A selection of topic-headwords, instead of a large-scale collection, and a selected readership of students and practitioners are the key points: the dictionary would enable «those for whom it is designed to expand their knowledge in the art they profess» (Ibidem). His readership and his customers have a job, and their profession implying technical skills, contents and expertise, is not based on shared knowledge. Their role and function in society are changing, and their interlocutors are specialists. Two separate discourse communities are then envisaged. Motherby is mainly dealing with experts, and his work may assist them in their profession:

One principal use of a Medical Dictionary is, to discover in haste what the present urgency requires; therefore, in the prosecution of what follows, peculiar care has been taken that the busy practitioner may refresh his memory, or derive a hint, without the tedious labour of searching over many leaves. […] (NMD, Preface 1775: vi)

  • 5   Micro-structure refers to the internal organisation of the entry, its lexicographic constituents (...)

11The approach is practical, strictly connected to the needs of a busy professional looking for clear tips and answers to cope with real cases: haste, urgency, performance (busy practitioner) and hint are the key words. This paragraph also highlights the new attitude and the innovative usage of medical dictionaries in general, «[o]ne principal use of a Medical Dictionary», thus marking a turning point in medical lexicography. To discover, refresh, derive useful information «in haste» are the essential, characterising features. This approach is further highlighted by the detailed description of the meta-lexicographic principles at the basis of his work and its macro-structure, as well as the meta-linguistic thought emerging from such a detailed plan. Moreover, this is the only work of the four analysed which provides the ideal micro-structure of the entry5, according to Motherby. He also adds meta-lexicological considerations. The following extract displays some relevant key points:

I. Technical terms, proper names, &c. have their etymology given; and where a farther explanation is required, it is added with conciseness and perspicuity.
II. That wanton variety to which some authors have yielded, in giving different names to the same subject, and the same names to different ones, serves but to perplex the inquirer; care hath therefore been taken to obviate this error, and each article is discussed under that name which is most in use; […].
[…]
IV. Anatomical subjects have,
1. Their various names immediately succeeding that by which they are most commonly known.
2. A concise description, as far as may be of service to the medical practitioner.
3. Where an account of their use can contribute any advantage, as far as art hath enabled us, this is also regarded.
V. Diseases according to their importance, either as to inconvenience to the patient, tediousness in the cure, or danger of life, are considered with respect to some or all the following particulars.
1. Their various names, or at least the most generally known.
2. – general rank.
3. – different species.
4. – seat.
5. Who, and when they are more subject to them.
6. Their causes.
7. – signs } Diagnostic and prognostic.
8. What diseases they resemble.
9. Their occasional symptoms.
10. Preventives.
11. Indications of cure.
12. The proper regimen.
13. The method of cure, both manual and medical.
14. Their usual modes of terminating.
(NMD, Preface 1775: vi)

12As previously said, etymology is referred to as an important – or, rather, fundamental – strategy in medical lexicography. Also widespread in general dictionaries of the English language, it serves as a starting point for further definitional and encyclopaedic development. To know the origin of a word was considered as an essential step towards the definition, explanation and representation of things, here medical things.

13Conciseness and perspicuity refer to the contemporary linguistic and metalinguistic debate on the standardisation of English and on what should characterise it, particularly when used to write about disciplinary contents requiring precision (avoid redundancy, obscurity, ornament, figurative language, pompous words and overload of information) and clarity (avoid lexical and morpho-syntactical ambiguity). The need to establish an educated, formal, prestigious, and appropriate standard is the focus of prescriptive attitudes and the publications of grammars of English (Priestly and Lowth, for example). The general linguistic and discursive principles are thus borrowed, exploited, moulded and popularised by disciplinary discourse communities, medicine being one.

14Clarity, precision and accuracy also imply the reduction of what Motherby calls «wanton variety». This expression refers to the many denominations used to deal with the same medical event. This phenomenon would cause confusion and obscurity in communicating science. A clear, univocal, one-to-one connection between a term and its specific referent is the aim. Lexical variation and graphic variants are to be eliminated in technical and scientific vocabulary. Use and frequency would determine the choice, «the most generally known» (NMD, Preface 1775: vi).

15Motherby is particularly detailed in providing meta-lexicographic information, and in explaining how entries are built. An interesting section is the one on diseases: the use of their most known and recurrent denominations is again highlighted; their classification according to their distinctive characteristics, such as rank, species, seat, and causes, reveals the state of the art in medical approach at that time (many works were issued by authoritative and competent medical men), and helps organise the entry itself.

16Rank and species refer to a hierarchical connections among diseases – their similarities and differences – and medical events in general, and to their external and multifarious outcomes. Seat highlights the relevance of location of diseases, the possibility of discovering the place in which they originate(d), the original causes within the body. This gives also prominence to anatomy (and pathological dissection) and changes the relationship between what can be seen (symptoms and external signs) and what is usually hidden away from the human gaze (internal causes and conditions).

17The interest in causes, whether internal (degeneration of organs, diseases, hidden changes) or external (environmental causes, viral, etc.), even violent, sudden, unexpected causes (violent deaths) represent another focus of contemporary medical research. Two other key words in Motherby’s plan – signs and symptoms – tell a lot about the state of the art in medical thought of the time: the disease is perceived as an entity, independent of the body hosting it. Signs are typical of and depend on a specific disease and distinguish such disease from others, they are not the same as symptoms. Symptoms, or «occasional symptoms», can manifest themselves in different bodies and in different manners (ex. intensity) according to the individual patient reaction to the same disease. This is an important key point in the evolution of medical approach and medical epistemology, since it allows physicians and practitioners (medical men in general) to identify a disease or a group of disease according to shared features-signs and study them as such, «What diseases they resemble». This also promotes the recording of case studies to be shared with other medical men, becoming a collective experience in observing and reading about patients.

18A more precise diagnosis based on clinical observation also means a more definite prognosis and cure, this may be medical or regulated by the six non-naturals of Hippocratic origin, that is regimen. The «method of cure» is actually performed by apothecaries and surgeons, since medicine is essentially practical, particularly in case of manual, or surgical operations.

19Another relevant feature in the NMD is systematic external reference: this practice is not innovative in itself, since reference to external sources was common in other dictionaries as well, if not systematic. The innovative feature is Motherby’s commitment to professional needs in including intertextual information:

VII. At the conclusion of each subject, there is a reference to the most approved authors who have written upon it: the reader will hereby be enabled to proceed to an acquaintance with all that hath been said (or at least that merits his attention) respecting his enquiry; and thus, as inclination favours, he may proceed to obtain a competent skill in those branches to which his avocations more directly lead, or extend his pursuits to every part that compleats the character he professes.
VIII. This dictionary closes with an English Index, as well to facilitate the general enquiry, as to trace many articles that are not arranged in the particular order of the preceding Work. (NMD, Preface 1775: vi)

20Motherby’s disciplinary commitment emerges in the following expressions: «as inclination favours», «to obtain a competent skill», «his avocations more directly lead», «extend his pursuits», «compleats the character he professes». They emphasise the dynamic function of the NMD and the unceasing, regular training process of professional experience. As for previous dictionaries, a selection of entries will be analysed to make Motherby’s plan emerge in his lexicographic practice.

21As regards the history of medicine, in a very concise section Motherby summarises the major issues. He recognises that «in some instances the improvements of the moderns are little more than recurring to the instructions laid down by the great father of the healing art [Hippocrates]» (NMD, Preface 1775: iv) and, in this case, he traces back to traditional approaches. However, he continues, «it must be justly asserted, that the moderns claim the honour of having advanced medicine to its present state: for, with regard to the former, their physiology was extremely defective, their skill in anatomy very imperfect, and their knowledge of chemistry proportionably confined» (Ibidem).

22These particular considerations refer to the many advances in anatomical dissection, which was going to be regularised, and came to be socially accepted as a necessary medical practice. In this perspective, surgery was acquiring higher status than decades before, and surgeons were becoming trained professionals, operating in the navy, in the army, in hospitals and infirmaries. Under the same circumstances, pharmacy and chemical improvements for the production of medicines and cures were acquiring prestige and independent status.

2.2. Introducing, organising, and defining medical contents

23The following sections present the works which have been introduced so far in further detail: a selection of entries on specific topics is discussed and compared in the two dictionaries to highlight some of the lexicographic techniques applied by the compilers: the headwords are Abortus, Abscessus, Absorbentia, Abstergentia, Cephalæa, Cephalalgia, Paralysis.

24The entries represent a variety of interesting micro-structures which – according to their length, contents, amount of information, complexity of definitions and encyclopaedic expansions – are helpful to exemplify and establish both the compilers’ lexicographic practice and their epistemological perspective in compiling the work(s) as a whole. The analysis is carried out on a qualitative basis to make the general features of each dictionary emerge, but it cannot be considered as an exhaustive one, though relevant. This sample analysis aims at giving an overview of the frequent and most typical organisational patterns used by the authors-compilers, according to their specific plans.

25The entries exemplified for the two specialised dictionaries are the same which have already been analysed in the EB and RCy (cfr. Ch. 1, Table 1 and Table 2), but their treatment undergoes at least three processes in comparison with the EB and RCy: expansion (particularly in the MD, all-embracing and comprehensive), specialisation (MD and NMD), and selection (particularly in the NMD, entries are neat and essential in their contents).

2.1.1. James’s A medicinal dictionary

26Expansion is a recurring feature of the MD: it includes very long, detailed and complex entries, such as Abortus (twenty-two in-folio pages), Abscessus (seventeen in-folio pages), Cephalagia and Paralysis (five and seven in-folio pages). Actually, these are monographic articles framed into a lexicographic structure: after the introductory section defining the headwords, or providing equivalents (Abortus~aborsus~miscarriage, Cephalæa/Cephalalgia~head-ach, Paralysis~palsy), different sections dealing with and describing every possible detail on the topic follow each other. The historical dimension is a key feature and serves as a background for contemporary and future medical developments: among the ancients Galen and Hippocrates are the cornerstones, almost always cited for their fundamental contributions. The choice among the moderns varies according to the topic: La Motte and Mauriceau s.v. Abortion, Wiseman s.v. Abscess, Dr. Harris s.v. Absorbentia. The entries are characterised by sections and sub-sections which may be variously organised. Some of these sections are titled observation(s): these are case studies recording real medical events in the practice of medicine (s.v. Abortus they are one hundred fifteen; s.v. Cephalalgia, twelve) and providing concrete examples. Other paragraphs are titled according to the ‘kind of’ circumstance they describe: «Abscesses in the Urethra», «An Abscess of the Lungs», «An Abscess of the Liver», etc., and have the function of sub-headwords.

27Etymology is another feature exploited by the MD, not always but frequently present, as in similar contemporary reference works: it is used to introduce the subject and support definitions. Sometimes the etymology becomes itself a starting point for the discussion, particularly on the variability of present usage: «Hence the word Abscess, generally used by modern authors to signify […] though sometimes it signifies […]. These words seem originally, by their derivation […] signifying to recede […]. Accordingly they are generally used by Hippocrates to express», s.v. Abscessus.

28In general, James’s entries are extremely dense in details, with many digressions, making reading a slow and demanding activity. However, the MD’s complex and composite textual pattern also highlights a growing degree of specialisation, requiring an expert or a semi-expert approach to the matter: «for the sake of those who shall make the disorders of women their peculiar study», s.v. Abortus.

29James’s style varies according to the contents and to the needs of the different communicative aims. Some sections are highly informative and expositive, particularly those concerning the description of the phenomenon under scrutiny. Causes, consequences, and possible remedies are relevant topics: «The signs of a future Miscarriage are», s.v. Abortus; «Inflammation from all causes have three ways of terminating», s.v. Abscessus; «The Cephalæa frequently proceeds from», s.v. Cephalalgia. Some other sections are more argumentative, in this case the compiler presents alternative or complementary perspectives, quoting the ancients or contemporary colleagues: «as was observed by Hippocrates», «La Motte also observes», «Galen in his Commentary», s.v. Abortus; «Castellus seems to think these the same as», s.v. Abstergentia; «Physicians are much divided in their Opinions […] Some extol them as […] whilst there are others, who affirm», s.v. Absorbentia.

30On the contrary, further sections are characterised by a more involved (cfr. § 0.2.2.) and personal approach: this happens with observations, or case studies, included in the micro-structure of the entry but not integrated within or adapted to the new text. They usually are reports of real medical events exemplifying the main topic: their style reveals their origin, which is practical and situation-dependent (vs. generalisation, abstraction, elaboration). The perspective is narrative and personal, witnessing and reporting a process of decision making in time and place (use of first person pronoun, dynamic verbs, present and past tenses, usually active voice, use of time and manner adverbs, etc.):

When I dissected her, I found […]
I had cut through it
I was immediately called […]
nor could I discover […]
I ordered her
(MD s.v. Abortus)
I was sent to him […]
I found the outside […]
I laid it open […]
I dressed the Escar
(MD s.v. Abscessus)

31Personal involvement also emerges when James himself enters the debate and comments on it, announcing what will happen further on in the entry («which I shall give particular examples», and «I have omitted Longing, which frequently occurs, though taken no notice of by the ancients», s.v. Abortus), evaluating («I must not omit remarking singular excellence of the last mentioned author. He seems to have observed nature with great diligence […] accuracy», s.v. Abortus), or generalising («From this case we may learn that the exclusion of», s.v. Abortus; «Women are more subject to this Disorder than Men, because they are so much employ’d about the Care of their Hair», s.v. Cephalagia). The following table exemplifies the entries just commented above:

Table 3

James’s A medicinal dictionary

ABORTUS, or Aborsus. A Miscarriage.

Some authors tell us that Aborsus signifies a Miscarriage during the first months of pregnancy; and Abortus one that happens near the full time of gestation. But there is no foundation for such a distinction, both signifying exactly the same thing.

Miscarriages happen at any time, and from various causes; but most frequently about the end of the third month, as was observed by Hippocrates. The Grecians courtesans […].

La Motte also observes, that […].

Galen in his Commentary on the Third Book of Epidemics, says, […]. But there are many other causes of Abortion, of which I shall give particular examples.

A continued and obstinate looseness in a woman with child, endangers her fruit. If milk flows out of her Breasts, it is a sign of the weak condition of her child; but plump and hard Breasts, are evidence of a sound and healthy Fœtus.

[…]

The signs of a future Miscarriage are an evacuation first of an acqueous, and then a sanious [sic] and bloody matter. […]

For this reason, and for the sake of those who shall make the disorders of women their peculiar study, I shall end this article with a considerable number of cases, which will instruct much more than any general rules that can be laid down, and will in some degree supply the place of practice.

These cases are principally extracted from some new authors of our own country, Mauriceau, and La Motte.

I must not omit remarking singular excellence of the last mentioned author. He seems to have observed nature with great diligence, and to have given the history of her operations with great accuracy; insomuch that many of his cases seem almost made with a view to confirm some important maxims of Hippocrates, whom, I dare say, La Motte never read; otherwise he would not have failed to mention him, with a degree of ostentation peculiar to his countrymen.

Observation I.

A Miscarriage from a Stone in the Kidneys.

A woman of quality was many years afflicted with tormenting pains in the Kidneys, especially on the Left-side, where she was first seized; and though she was no less than fourteen times with child, she constantly came before her time in the eighth, or beginning of the ninth, month.

When I dissected her, I found the left Kidney quite wasted, but the Right swelled to a prodigious bigness, in which, after I had cut through it, appeared a large Stone. Bonetus.

[…]

Observation XXV.

July 19. 1693, a labourer’s wife of the parish of Gourbeville had such a violent fall from her horse, that she remained a considerable time insensible. At this time she had been with child six months. I was immediately called, and found her come a little to herself; but upon examination could not find her Head had received any injury, nor could I discover any signs of approaching Labour, except that the child moved in an extraordinary manner, which was no wonder, considering the concussion she had received from the fall.

I ordered her to be laid on a sort of litter, and carried home; and then directed that she should take some good nourishment, and keep her bed for seven or eight days. From this time she never felt the child move, but it seemed like a weight which fell spontaneously to the side she lay on, which incommoded her much, but especially when she stood up, when pressing on the Bladder, it caused frequent inclinations to make water. In this situation she remained till her full reckoning was completed, her fall having neither advanced nor retarded the Birth. At this time I was called to deliver her, but the child was born long before I arrived, but was so weak that it died a few hours after, and the mother did very well. La Motte.

Remark.

From this case we may learn that the exclusion of the Fœtus should never be precipitated, unless some dangerous accident renders it necessary for the preservation of the mother. Because all the symptoms usually attending the gestation of a dead Fœtus may occur, and yet the child may be born alive at the full period.

[…]

Observation LXXIII.

March 7. 1682, I attended a woman gone with child no more than two months and a half, who miscarried in my presence of a living child, that plainly moved its Legs and Arms, and even opened its Mouth for the space of half an hour. It came into the world without assistance, with a great Flooding. But as it was very small, and the Womb had only dilated itself in proportion to it, the After-birth remained behind, there being no room to bring it away; because the thickness and hardness of the Internal orifice, which was very close shut, could not bear to the stretched without too great violence, which might have brought on a very dangerous Inflammation in that part. But the Flux of Blood was so increased by this retention of the After-birth, that the poor woman had several bad Fainting fits the first day; after that it stopped a little, but only for a day or two, and then returned in a dismal manner, which it did, at several intervals, for the space of three weeks, the Womb all the while not sufficiently dilating so as to be able, of itself, to throw off its burden, nor to admit assistance to get rid of it without violence. And as it stuck all that time to the bottom of the Womb, so its sticking there was the cause that it did not at first resolve by Suppuration, as it usually does, when, being intirely loose from the Womb, it has no longer communication

with it. So that the true Suppuration of the After-birth not beginning till at the end of three weeks, the patient was afterwards more than eight days in voiding it piecemeal, and consequently was a full month in getting rid of the Appendage to this diminutive Fœtus, though most women are no longer about it than three or four days, and seldom above eight. But what contributed very much to lengthen out the time was, that the living roots of this foreign mass hindered its separation from the Womb, where it stuck close, and could not be expelled without Pain, which was not little aggravated by the straitness of the Internal orifice. In these eight days of the Suppuration, the woman, as it usually happens under such circumstances, had a Fever, with several Exacerbations, accompanied with a great Pain in the Head, and Hysteric fits. The part being afterwards purified from the infection of the Suppuration, the woman recovered her health, having run the less risk by committing the work of Expulsion to Nature, which if I had tried by Hand, as I must have used violence, the remedy might have proved worse than the disease. It is remarkable that this little Abort, which I saw living half an hour, had strength enough to move its Arms and Legs, but had not the power to put forth a cry, though I plainly saw it open its Mouth several times. For Aborts have commonly no voice till the end of the third month, their Lungs not having strength enough till then to push the air with an impetuosity sufficient to form a cry. Mauriceau.

[…]

In the general account of the causes of Miscarriages, I [James] have omitted Longing, which frequently occurs, though taken no notice of by the ancients, that I remember, and by little by any modern author of credit; though I have seen a few treatises wrote with a view to prove or disprove the reality of many effects attributed to it. […]

32This entry is extremely long: contents are detailed, and often refer back to medical men of the past, such as Hippocrates and Galen, and of the present, such as La Motte and Mauriceau. Ideas, interpretations, and works are compared. The history of medical thought is still relevant in this work. This entry may be considered as a long monothematic treatise in line with other contemporary non-lexicographic works of reference moulded within – but not adapeted to – dictionary structure. The innumerable case studies are included after a long debate on remedies.

33The many observations included constitute most of the lexicographic entry: the case studies are essentially taken from Mauriceau and La Motte, and the majority belongs to the last quarter of the seventeenth century. The frequent usage of the first person pronoun ‘I’ does not refer to James, but to the original physicians, practitioners, surgeons, or apothecaries dealing with the specific medical circumstances reported. Sometimes observations are followed by remarks, which evaluate the case study, its progress, cure and remedies applied. Some observations are very concise, others long and complex.

34The following entry (Table 4) concerns Abscessus: this, as the preceding one, is a long and comprehensive lexicographic article.

Table 4

James’s A medicinal dictionary

ABSCESSUS, ’Aπόςημα. […] translated by Celsus Abscessus, and sometimes Vomica. Hence the word Abscess, generally used by modern authors to signify a Suppurated Phlegmon, or Inflammatory Tumor, though sometimes it signifies a Tumor of another kind, which would not admit of discussion, as all Encysted Tumours. These words, seem originally, by their derivation, to import any sort of exclusion of morbific matter […] signifying to recede and retire. Accordingly they are generally used by Hippocrates to express any critical removal of offending humours from the vital parts […].

Abscesses in the Urethra. […]

An Abscess of the Lungs. […]

An Abscess of the Liver. […]

An Abscess of the Spleen. […]

Abscesses of the Kidneys and Baldder. […]

For Abscesses in the Reins and Baldder. […]

For Ulcers in the Bladder, attended with an Inflammation. […]

For an Hæmorrhage from the Bladder. […]

An Abscess of the Uterus. […]

An approved Suppuratory for Abscesses, is this, viz. […]

To break 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 to make some inquiry into their disposition. Inflammations from all causes have three ways of terminating, either by Dispersion, Suppuration, or Gangrene; […].

A decayed old gentleman walking in the streets one evening, was crushed up to a wall by a cart; the wheel passing too near him, bruised the outside of his Left-leg, but did not break the Skin: it was suddenly swelled, and very painful. His friends chafed it with Brandy, and dipping a cloth in the same, bound it about the part. By this way of dressing, that side of his Leg swelled and inflamed very much. Others advised him Lucatellus’s Balsam; by which improper application the Fluxion was increased, and the patient confined to his bed. […] I was sent to him. I found the outside of his Leg swelled and apostemated from the Gartering to the Small. I laid it open by Caustic an inch or two, according to the length of the Member. In dividing the Escar, there was discharged a large quantity of Matter, with clotted Blood in it. I dressed the Escar with Lenients, and embrocated the parts affected with Oil of Roses and red Wine, and applied an Emplaister of Armenian Bole over the Tumour, with Compress and Bandage. […] Wiseman.

[…]

Abscesses in the Heel. […]

35The entry is very long, with sub-headed sections. As in the case of Abortus, the lexicographic structure actually embeds a short treatise on the topic-headword Abscessus. It includes internal cross-references and references to external contemporary sources, relevant for the compilation of the entry itself. The attention for the historical dimension is substantial in James’s scholarly approach: what happened in the past constantly backgrounds the present, and is essential, as Hippocrates and Celsus are. Once again, James’s work is rich in details, situations, and perspectives which make it a kind of summa of medical knowledge up to the 1740s, not a reference work to be consulted in haste.

  • 6   Richard Wiseman (1621-1676) was a royalist surgeon (serjeant-chirurgeon) who is considered one of (...)

36A long list on the different typologies of abscess is introduced, as well as a long series of ancient and modern remedies to cure abscesses. In the sub-sections, case studies are included alongside the description of the disease and its multifarious manifestations. The lexicographic article also includes some references to external sources for further reading (ex. Richard Wiseman)6. James’s style is multifaceted: from an expository, informative, argumentative dimension (describing medical events, processes, perspectives), to an evaluative and conversational tone (genteel conversation), less formal and more involved attitude when ‘summing up’, or concluding the entry or single sub-sections (particularly case-studies). Case studies, strictly situation-dependent, may be followed by paragraphs which usually abstract from individual circumstances more general issues for further similar use.

37Table 5 below includes more than one headword: these are shorter entries than Abortus and Abscessus, and replicate some of the features already discussed for them.

Table 5

James’s A medicinal dictionary

ABSORBENTIA. Absorbents.

Thus all medicines are called, which have the Power to drying up redundant Humours, whether applied externally to Ulcers, or taken into the Stomach.

The Testaceous Powders of all Sorts are Absorbents, and are much recommended by Dr. Harris, in Disorders of Children especially.

Physicians are much divided in their Opinions concerning the Efficacy of this Sort of Medicines. Some extol them as the most Sovereign Remedies in almost all Distempers, whether Acute or Chronical; whilst there are others, who affirm they are very pernicious, because, if taken in considerable Quantities, as they must be to have any Effect, they mix with the Mucus of the Stomach and Intestines, and, concreting therewith, line the Instestinal Tube, or some Part of it, with a crustaceous Coat, and thereby stop up the Orifices of the Lacteals, and of the Excretory Vessels of the Intestines, by this Means both preventing a fresh Supply of Chyle from being carried into the Blood, and a Discharge of Redundancies by the usual and most proper Way, that of the Intestinal Glands. […]

ABSTERGENTIA. Abstergents.

Castellus seems to think these the same as Abluents, from which they appear to me to differ very much, Abluents being Fluids which can only dissolve and wash away Salts, which are dissolvable in Water; whereas Abstergents are of a Saponaceous Nature, and capable of dissolving Concretions formed of Earth and Oil[s] of the Nature of a Resin, which cannot be dissolved by simple Abluents, or a watery Menstruum.

CEPHALÆA, κεφαλαία. A sort of Head-ach. See Cephalalgia.

CEPHALALGIA, κεφαλαλγία, from κεφαλη, the Head, and άλγος, Pain, A Head-ach.

Cephalæa […] and Cephalalgia, are Affections of the Head, which differ in Degree; for a Cephalæa is an inveterate and obstinate Cephalalgia, according to Aretæus […].

[…]

Observation XII.

A certain Lady of Distinction, who had long labour’d under a pungent Head-ach, which resembled the Pricking of Needles or Darts in the Part affected, and which was sometimes more, and sometimes less violent, at last fell a Sacrifice to her Disorder.

Upon opening her Cranium there was found, under the Dura Mater, near the torcular Harophili, a certain indurated stony Matter, resembling a small rocky Protuberance, unequal, rough, with many Points, variegated, as it were, with Appearances like Cats Claws, the Images of Shell-fishes, and several other Figures, and adhering strongly to the Dura Mater. Between the Inequalities of this Protuberance small Veins were distributed, which moisten’d this Substance. Above the Pia Mater there was a certain mucous Humour found. Cattierus, Observ. Medic. 15.

The Cephalæa frequently proceeds from Refrigeration, or Cold, or, on the contrary, from the Heat of the Sun’s Rays, or from long want of Sleep; and Women are more subject to this Disorder than Men, because they are so much employ’d about the Care of their Hair. […]

Curatory Indications. […]

Cautions and Clinical Observations. […]

PARALYSIS, παραλύω, to dissolve or weaken. A palsy.

Among the Diseases arising from the Want of a due Tone of the Viscera, and solid Parts, none are more considerable than such as affect the Head, and Parts situated therein: And, of these, the most important are, those Resolutions of the Nerves, commonly, by Physicians, called an Apoplexy, an Hemiplexy, and a Palsy; which three Disorders are so nearly connected, that we shall consider them in one joint View.

That all these Disorders affect Sensation and Motion, the primary Organs of which are, the Nerves, and the nervous and membranous Parts formed of them, is universally allowed.

Now a Nerve is […].

[…]

Hence we are to account for a spasmodic Apoplexy, and a sanguineous Hemiplegy, which happen to hypochondriac and hysteric Patients; a memorable Instance of which is found in Fred. Hoffman. Consult. Med. For this Reason ’tis, also, often observed in Practice, that the Menses, and hæmorrhoidal Discharge, when not duly carried on, contribute much to the Production of Palsies.

[…]

If, when the Physician is called immediately after the Invasion of the Disorder, he finds the Pulse quick, and the Face red, there is no more present and efficacious Method of removing the Cause of the Disorder […]

If the Disorder is inveterate, besides the above-mentioned Remedies, proper Evacuants are to be called in

[…]

Those who, by paralytic Disorders, have their Heads greatly weaken’d, and their internal Senses, especially, their Memories, injur’d, ought to abstain from an incautious internal Use both of the hot and cold mineral Waters ; […]

[…]

A Palsy in the Iris. […]

A Palsy of the upper Eye-lid. […]

38Absorbentia is a single in-folio column in length, whereas Abstergentia is a very concise entry, just a few lines including an equivalent and a short lexical definition of the term, «are of a Saponaceous Nature, and capable of dissolving», in opposition to Abluents. S.v. Cephalæa (eleven in-folio columns), as elsewhere in James’s MD, a series of observations and situation-dependent case studies, adapted and translated from external sources, alternate with more descriptive, informative, and expository sections, along with more general and elaborated considerations for further medical use. Paralysis (thirteen in-folio columns) includes a detailed description and further explanation on the function of nerves, on the different clinical severity of paralysis, on its multifarious typologies. To support and exemplify the general treatment of paralysis, some observations and case studies are included. However, the observations-case studies are here completely integrated within the text: «Hence we are to account», «If, when the Physician», «If the Disorder is», «Those who».

2.2.2. Motherby’s A new medical dictionary

39The NMD is mainly characterised by processes of selection and specialisation. Both concern the informational load to include in the entries and the degree of detail to be focussed on in view of their utility for an expert or a semi-expert readership. Indeed, Motherby is particularly selective, since his aim is to be useful to the practitioner ‘in haste’, as well to the student, and not to be exhaustive and all-inclusive in his entries. In his opinion, in-depth disciplinary knowledge may easily and more appropriately be found in monographic works other than his dictionary. External sources, essentially contemporary and up-to-date texts, are systematically referred to in general terms (the expert’s name) or in detail (author, title, volume and page number):

Dr. Monro, senr. of Edinburgh, says that […]
And, as Dr. Hunter hath observed […]
Further satisfaction […] by Dr. Wilkinson, in the Medical Museum, vol. ii. p. 117, &c. […]
Dr. Hunter’s Medical Commentaries; also observations theron by Dr. Garner, in the Med. Mus. vol. ii. p. 229, &c.
(NMD s.v. Absorbere)
Hippocrates, in the 13th section of his book De Flatibus
(NMD s.v. Cephalalgia).

40This methodological perspective clearly emerges at first glance, if NMD is compared, for the same headwords, with the MD. The extension of NMD’s entries is generally more limited than the corresponding MD’s entries: from very concise ones (headword only followed by equivalents or cross references, or by lexical definitions, Abstergentia, Cephalæa, Cephalagia), to medium length (Absorbentia, half in-folio column; Cephalalgia, two in-folio columns; Paralysis, three in-folio columns), to more expanded ones (Abortus, five in-folio columns; Abscessus, thirteen in-folio columns). They usually include a very neat lexical definition, which may be preceded or followed by a gloss (usually a translation equivalent or a lexical variant), and by etymology and derivation. Greek transcriptions, instead, are not systematic. Sometimes definitions are moderately expanded to make the meaning – and the topic – clearer (s.v. Abscessus, Absorbentia, Abstergentia):

ABORTUS, a miscarriage. The birth of a child before its due time; or, the destroying a child in the womb.

ABSCESSUS, an Abscess; from abscedo, to depart. A cavity containing pus, or a gathering of matter in a part. So called, because hereby the parts which were joined are now separated; one part recedes from another to make way for the collected matter.

ABSORBENTIA, Absorbents: from absorbeo, to swallow or drink up into themselves. All medicines which have the power of drying up redundant humours, either internally or externally, are thus denominated. These consist of sea shells, coral, burnt hartshorn, crabs-eyes, chalk, boles, &c.

ABSTERGENTIA, abstergents or cleansing medicines. They are of the saponaceous nature, capable of dissolving concretions formed of earth and oil, &c. which water, simply as an abluent, cannot effect.

CEPHALALGIA, from κεφαλη, the head, and άλγος, pain. The head-ach. It is also named cephalæa, cephalagia, and cephaloponia

PARALYSIS, παραλύω, to dissolve or weaken. A palsy.

(NMD s.v. Abortus, Abscessus, Absorbentia, Abstergentia, Cephalalgia, Paralysis)

41Definitions are regularly followed by sections developing – describing, exposing, and explaining – the topic-headword: the amount and the kind of information encompassed in the entries is usually to the point and strictly focussed on the subject for practical usage. This means that the historical perspective, as well as digressions, are reduced and what actually emerges is the state of the art of Motherby’s times in performing medicine, in everyday practice. Expressions such as

If the fœtus is dead […]
If pains come on […]
If an hæmorrhage attends […]
If a cough attends, etc.
(NMD s.v. Abortus)

Abscesses are opened by either incision or the caustic, but in general the first is to be preferred
(NMD s.v. Abscessus)

42reveal the operational goal of the work, providing practical issues to real situations. In this perspective, these sections are sort of instructive texts, as may be found in handbooks. Other sections categorise contents starting from hyponymic relations: this is the case with Cephalalgia, further subdivided into cephalalgia and cephalæa (co-hyponyms), and hemicranias, distinguished in critaphos and clavus istericus (co-hyponyms); and Paralysis, subdivided into apoplexy, hemiplexy, and palsy.

43As in the preceding works, sections dealing with causes, effects, signs and symptoms are included. Informative and expository paragraphs come in succession, and usually omit personal involvement and evaluation. Topicalisation is instead a structural feature:

Miscarriages happen at any period […]
The causes are various […]
An approaching miscarriage is to be apprehended by […]
(NMD s.v. Abortus)
The matter in abscesses is formed by […]
The progress of an abscess […] is generally as follows […]
Abscesses are opened by […]
(NMD s.v. Abscessus)
In the beginning, the palsy, which is caused by […] is acute
A palsy is when […] When the muscles of the face
(NMD s.v. Paralysis)

44What emerges is that NMD’s entries are more homogeneous in their lexicographic structure, and more consistent as regards textual organisation and contents, than the corresponding entries in the MD. In other words, they seem to be more coherent and cohesive as a whole. The Tables 6, 7, and 8 below partially reproduce some of the preceding entries to exemplify and clarify Motherby’s textual arrangement and discourse strategies.

Table 6

Motherby’s A new medical dictionary

ABORTUS, a miscarriage. The birth of a child before its due time; or, the destroying a child in the womb.

Miscarriages happen at any period of pregnancy, and from innumerable causes; most frequently in the third and beginning of the fourth month; but those which happen in the sixth or in later months, are more difficult and more dangerous.

Women who are very thin, or very fat; women who have miscarried before, and who easily or without any particular inconvenience, during the time of miscarriage, or soon after, part with their burden, are more subject to this accident.

The causes are various: violent motions, frights, poisons, violent purges, too much blood, great loss of blood, an obstinate diarrhœa, the small-pox, and other acute diseases. Habitual miscarriages happening at stated periods, without manifest cause, are very common among women of fashion, from these general causes of weakness, viz. indolence, laying long in the morning, and sitting up late at night; fear, grief, or indeed whatever debilitates, may be a cause; longings not indulged, &c. In general, the causes may be reduced to what immediately affects the child, the placenta, the membranes, or the mother.

Whatever causes the death of a child, causes abortion sooner or later.

If the membranes are too weak, they may easily break, and so prove a cause, against which no help can be proposed.

The funis may be too short, or the placenta separated or diseased, in which cases no care can prevent the ill effects.

As to the mother, beside the causes above enumerated, the two following are very common ones. The first is too great a stricture of the uterus; in which case it is not capable of a dilatation sufficient to make room for the fœtus as it increases in bulk: this is known by a great tension and hardness of the belly, and violent pain therein. Bleeding, and whatever relaxes, are indicated in this case. The second is a relaxation of the uterus, which renders it unable to support the inosculations of the vessels of the placenta into itself, after the fœtus and the placenta, &c. are grown to a certain weight: and, of all others, this is the most frequent. In these two cases, the miscarriage always happens about a stated time of the woman’s pregnancy.

An approaching miscarriage is to be apprehended by the following signs: The breast growing flabby on a sudden; the loins have a painful weight, which reaches to the thighs; pains about the navel, head, and eyes; a gnawing at the stomach; coldness in the extremities; when violent means have been used to expel the fœtus, convulsion [sic] sometimes come on; pains in the belly, like a cholic, and sometimes more like labour pains; shiverings; fainting; and, if it is past the time of quickening, the motion of the fœtus is more languid, and less frequent than usual: as the miscarriage draws nearer being effected, the pains in the loins increase, extending to the hips; the orifice of the womb begins to be dilated; a watery discharge from the womb is perceived, which becomes bloody, at length pure blood or clotted comes away.

[…]

If the fœtus is dead, […]. If pains come on, […]. If an hæmorrhage attends, […]. If a cough attends, […].

If acute diseases are the cause, […]. If a tenesmus produces the danger, […]. If the child is supposed to be dead, […].

Convulsions and Floodings […].

Convulsions […].

Floodings […].

45The entry is five in-folio columns in length, an expanded one if compared to Motherby’s average length, but much shorter than James’s Abortus. It includes ‘integrated observations’, exemplifying different circumstances which are introduced by ‘if’ or ‘when’; besides the general – but detailed – treatment of the topic, three titled sub-sections follow, in this case the focus is on some specific and recurrent effects accompanying miscarriage.

46The next entry (Table 7) is Abscessus:

Table 7

Motherby’s A new medical dictionary

ABSCESSUS, an Abscess; from abscedo, to depart. A cavity containing pus, or a gathering of matter in a part. So called, because hereby the parts which were joined are now separated; one part recedes from another to make way for the collected matter.

’Aπόςημα and απόςασις, used by Hippocrates, are translated by Celsus, abscessus, and sometimes vomica. Paulus Ægineta seems to limit the signification of abscessus to suppuration, […] or a corruption of the fleshy parts, muscles, veins, and arteries. The words […] signifying to recede or retire, are used by Hippocrates with great latitude. He signifies by them any critical removal of offending humours, however discharged; also the change of one disease into another, as a quinsy into a peripneumony, &c. But the present practice seems universally to consider an abscess as that tumor which follows an inflammation, for almost all of them are the consequence thereof.

The proper seat of abscesses is the cellular membrane.

The matter in abscesses is formed by the heat of the part acting on the humour collected there, and dissolving the adjacent fat; these two fluids are also concocted by the same heat.

[…]

The progress of an abscess on the external parts of the body is generally as follows: the tumour encreases, so does the heat, pain, and redness thereof; a pulsation is also perceived therein, a fever sometimes attends, which is increased every night, when the contents are all suppurated, the pricking pain gives way, and an itching, with a growing numbness, is complained of, the hardness of the part at length yields to the touch, and the skin bursting, gives a vent to the contained matter.

An abscess should be carefully distinguished from an hernia, an aneurism, and from a varicous tumour. If during the treatment of an abscess […].

Abscesses are opened by either incision or the caustic, but in general the first is to be preferred, especially if a knife is used, for it is less painful than the caustic, and does not bruise in cutting like the scissors. The opening may be as far as the skin is discoloured, or a circular piece may be taken out if the discolouration spreads. The opening must be, if possible, in a depending part, tho’ where nature points out, the operation must be performed. When the bad quality of an abscess is likely to retard its future incarnation, an opening made by a caustic best prevents the lips of the wound from growing callous. […] For the application, &c. of a caustic, see the article Caustica.

Many advise not to open […]. When the knife is used […].

[…]

An ABSCESS in the Maxillary Sinus […]. An ABSCESS of the Anus […]. An ABSCESS in the Arm-pit […]. An ABSCESS in the Back and Loins […]. An ABSCESS of the Belly […]. An ABSCESS in the Urinary Bladder […]. An ABSCESS of the Bones […]. An ABSCESS in the Brain […]. An ABSCESS of the Breast […]. An ABSCESS of the Diaphragm […]. An ABSCESS in the Ear […]. An ABSCESS in the Eye […]. An ABSCESS in the Eye-lid […]. An ABSCESS in the Feet […]. An ABSCESS in the Gums […]. An ABSCESS of the Heel […]. An ABSCESS of the Fingers and Toes […]. An ABSCESS in the Groin […]. An ABSCESS on the Hands […]. An ABSCESS on the Head […]. An ABSCESS in the Hip […]. An ABSCESS about the Jaws […]. An ABSCESS in the Intestines […]. An ABSCESS in the Kidney […]. An ABSCESS in the lachrymal Glands […]. An ABSCESS of the Liver […]. An ABSCESS of the Loins […]. An ABSCESS of the Lungs […]. An ABSCESS of the Mediastinum […]. An ABSCESS of the Mesentery […]. An ABSCESS of the Neck […]. An ABSCESS of the Nostrils […].

[…]

47The entry is a long one for Motherby’s standards: thirteen in-folio columns, including many sub-headwords. Descriptions, explanations, and particular circumstances are essentially provided from a contemporary perspective: «the present practice seems universally to consider an abscess». Scholarly and useless details, empty learning, are systematically omitted. Etymology introduces the topic and explains the reasons for Hippocrates’s lexical choice: «The words […] signifying to recede or retire, are used by Hippocrates». Immediately after the etymological introduction, Motherby describes the nature of an abscess, «matter in abscesses is formed by», and where it usually seats in the human body «proper seat of abscesses». He then proceeds by describing the «progress of an abscess» and its external manifestations, enumerating its symptoms and their evolution. Subsequent detailed paragraphs are strictly devoted to the medical remedies, and surgical operations to cure abscesses: «opened by either incision or the caustic, but in general the first is to be preferred», «if a knife is used […]. The opening may be as far as», «an opening made by a caustic best prevents». The procedures are described in technical detail, as often happens in manuals and practical compendia.

Table 8

Motherby’s A new medical dictionary

ABSORBENTIA, Absorbents: from absorbeo, to swallow or drink up into themselves. All medicines which have the power of drying up redundant humours, either internally or externally, are thus denominated. These consist of sea shells, coral, burnt hartshorn, crabs-eyes, chalk, boles, &c.

Under this class are included such medicines as are called Edulcorants, for that term can only signify that the animal fluids are by then rendered less sharp; and this is the only effected by breaking off the points of their particles, or by so absorbing them by soft and porous bodies that they cannot be perceived; increase of motion does the first, absorbent medicines do the latter.

[…]

The fixed alcaline salts, besides their absorbent virtue, […].

Iron, coral, bole, chalk, &c. have a degree of astringency. […]

If the intention is to absorb, astringe and strengthen at the same time, give chalk, coral, oyster or egg-shells; if to restrain […] if to loosen the belly […] if to provoke urine […] if to promote perspiration […] if to dissolve […].

The word Absorbentia is also applied to several vessels in the human body, viz. the lacteals which absorb the chyle; the cutaneous vessels, which admit of water from the atmosphere, and from baths, &c. to enter into the body; and other vessels […].

See the next Article.

ABSORBERE, to absorb, drink up, or suck up. The absorbent vessels are called also lacteals and lymphatics, which see.

[…]

Dr. Monro, senr. of Edinburgh, says that […]. And, as Dr. Hunter hath observed, […]. Further satisfaction […] by Dr. Wilkinson, in the Medical Museum, vol. ii. p. 117, &c. […] Dr. Hunter’s Medical Commentaries; also observations theron by Dr. Garner, in the Med. Mus. vol. ii. p. 229, &c.

ABSTERGENTIA, abstergents or cleansing medicines. They are of the saponaceous nature, capable of dissolving concretions formed of earth and oil, &c. which water, simply as an abluent, cannot effect.

CEPHALÆA. See Cephalalgia.

CEPHALAGIA, i.e. Cephalalgia.

CEPHALALGIA, from κεφαλη, the head, and άλγος, pain. The head-ach. It is also named cephalæa, cephalagia, and cephaloponia.

It is sometimes acute, and sometimes chronical.

In some the pain is in the back part of the head, from a contraction of the occipital muscles. When mild it is called cephalalgia, when inveterate it is called cephalæa. When one side of the head only is affected it takes the name of hemicranias. In one of the temples only it is entitled critaphos. And that which is fixed to a point, and that is generally in the crown of the head, is distinguished by the name of clavus hystericus.

The nervous membranes of the head are the general seat of pains there, as the pericranium, the skin, dura mater, the membrane which covers the sinus in the os frontis, &c.

Women, on account of their care about their hair, and children, because of the irregular indulgences that are allowed them by improper foods, are the most subject to this disorder.

The causes are very numerous. Hippocrates, in the 13th section of his book De Flatibus […].

[…]

Among the variety of causes are, suppressed or diminished customary evacuations; the acrid matter of some diseases, by fixing particularly on any part of the head; a caries in the bones of the head; polypuses, &c. obstructing the blood’s passage through the jugular veins and sinuses of the brain; stony concretions in the brain; acrid humours repelled from the external parts of the head; abscess in the brain; a want of sleep; exposure of the head either to heat or coldness; a spasmodic constriction of the nervous membranes in the head; uneasiness in the stomach, and the faulty quality of its contents; cold feet; inanition; repletion; hardness and adhesion of the meninges. The hemicranias is usually from disorders in the stomach; and periodical pains have their cause in the stomach or other viscera, &c.

When the pain is in the back of the head, […]. When a suppressed usual evacuation of blood from the nose is the cause […]. When a catarrh is the cause, […]. When a lues venerea is the cause, […]. When the cause is from a hot bilious habit, […]. When Hysteric affections are the cause, […]. When the cause is within the cranium, and the pain is attended with a considerable degree of fever, there is danger of phrenitis.

[…]

PARALYSIS, παραλύω, to dissolve or weaken. A palsy. Celsus and Cœlius Aurelianus say that the most ancient writers give the name of attonitus morbus to that species which follows an apoplexy.

The apoplexy, hemiplexy, and palsy, are so nearly connected, that they may be considered in one view. In the beginning, the palsy, which is caused by an excess of good blood, is acute; but it soon becomes chronical; the other palsies are all, and at all times, chronical.

A palsy is when there is an abolition of voluntary motion, or of feeling, or both. When all the parts below the head are affected, or to the lower half of the body, it is called paraplegia; if one whole side, or one side of the head and face, it is an hemiplegia; and when confined to a particular limb, it is a paralysis, or a particular palsy; when both sides are seized, and reason is lost, it is then an apoplexy.

When the muscles of the face are paralytic, the source of the disorder is in the brain; but if these be free, the nerves only of the spine, or medulla oblongata, are affected.

[…] the same disorder will require different remedies, according to the varieties of its origin. Occasionally the palsy may proceed from an apoplexy, an epilepsy, violent pains, suppression of usual evacuations, a transflation of the morbific matter of acute diseases, whatever distends, distorts, compresses, or contracts the nerves, strong ligatures, luxations, fractures, wounds, gangrenes, inflammatory or other tumours in the coats of the nerves, extreme heat, violent cold, mineral effluvia, a too frequent use of hot water, &c.

[…]

A palsy sometimes attacks suddenly without any previous symptoms by which it might be expected; but sometimes an hemiplexy succeeds an apoplectic fit, and begin with a refrigeration of the side to be affected, and a preceding vertigo, and gradually terminates in an abolition of sensation and motion; the sound side is often racked with spasmodic and convulsive motions; the mouth is frequently distorted like that of a dog, and as the disorder proceeds, the functions of the mind, and especially the memory, begins to be weakened. A particular palsy is sometimes preceded by a sensation of weight in the part about to suffer, a slow motion accompanied with stupor, paleness, and torpor; the part affected id lax, flaccid, soft to the touch, and cold, like as it is affected in an atrophy or an œdematous tumour.

[…]

Blisters are not so well applied on the nape of the neck as on remoter parts, for in some instances they have produced convulsive twitchings when placed on the neck or back. In general palsies, blisters are useful by their stimulus; but they are most so when only particular parts are affected, and then the properest place of application is where the nerves of the respective part have their origin; for example, when a palsy seizes the upper extremities, blisters should be applied to the vertebræ of the neck and obliquely towards the shoulders; if the lower extremities are affected, the region of the sacrum is the properest part of blisters.

[…]

See Archigenes, Ætius, Celsus, Cœlius Aurelianus, […] Hoffman, and Boerhaave, Shebbeare’s Theory and Practice of Physic, Lond. Med. Obs. and Inq. vol. iii. p. 160, &c. p. 237, &c. For many useful elegant forms of medicine, see Brook’s and the London Practice of Physic.

48Absorbentia (half in-folio column) introduces the topic in general terms, but it also describes those chemical substances which possess the quality of absorbing other substances, and which may be used as remedies. The entry closes with a cross-reference to the following entry Absorbere, in which many external and more specialised sources are included. The works and the names of the authors provided are almost contemporary of – or just preceding – Motherby’s work. Cephalæa-Cephalalgia (two in-folio columns), besides including the etymology of the term, along with some graphic variants and lexical equivalents, classifies and defines the different typologies according to their specific nature. In most cases, distinguishing features are introduced by if, when, in one of, and that which is. Paralysis is three in-folio columns in length: the entry opens with the etymology, followed by the English equivalent palsy, the very general clinical conditions characterising the «nearly connected» types known as apoplexy, hemiplegia and palsy, to conclude with its main cause, «an excess of good blood». These general features set the scene for further, more detailed treatment of paralysis. It is at this point that the lexical when-definition «A palsy is when» is provided. This is immediately followed by specific distinctions which broadly categorise different types, introduced by if or when: «when all the parts below the head are affected […] paraplegia», «if one whole side […] hemiplegia», «when confined to a particular limb […] paralysis», «when both sides […] apoplexy». No symptomatological defining, as a list or cluster of symptoms, is provided here. However, Motherby uses a symptomatological defining frame to list and cluster the possible causes, «the varieties of its origin», and to describe the changing states – effects and symptoms – in the narrative progression of the disease, «A palsy sometimes attacks». As in the preceding entries, Motherby is detailed and precise in his exposition and explanations: he also adds sections in which practical instructions are provided for the practitioners, remedies, cures, and external sources at the end of the entry.

2.3. Chapter summary

49This chapter has analysed and discussed two of the most relevant medical dictionaries of the period: James’s A medicinal dictionary (1743-1745) and Motherby’s A new medical dictionary (1775).

50The MD is a huge work of medical scholarship, which aims at extensive and detailed treatment of any medical topic – and topic-headword – included in it. The MD is a comprehensive, complex, articulated reference work, structured as a scholarly collection in which the traditional approaches of the Ancients, their various doctrines, remedies and cures, along with contemporary discoveries and practices, are provided. It is the outcome of medical erudition: this emerges in the macro-structure of the work (many pages long, complex, and clustered entries) in which some entries actually are treatises with titled sections and sub-sections displayed as lexicographic entries. It aims at exhaustiveness, also including the translations of many works. The target audience is ‘mankind’ in general, but also ‘future students’.

51The NMD is a more dynamic work than the MD: the general aim is practical, and professional. This means that practitioners should be able to find rapidly the topic – or topic-headword – they need, and the solution to a ‘present urgency’. This marks a turning point in medical lexicography, more focussed on and restricted to a professional readership of medical men and students. Notwithstanding the inclusion of some historical notions, the attention is on contemporary medicine and present approaches. This up-to-date perspective is reflected in the macro-structure of the work, and in the micro-structure of the entries. Lexical and spelling variations are reduced, conciseness of description and perspicuity of expression are highlighted. Accounts and records are included when their contribution may be of help for the solution of present circumstances, neither as useless additional information, nor as erudition. The result is a visible reduction in the length of the entries, and a correspondent emphasis on the topic described. Further information is provided with references to external sources.

Notes

1   Two other relevant dictionaries were Barrow’s Dictionarium medicum universale: or, A new medicinal dictionary (1749), which aimed to explain ancient and modern medical terms, by emphasising etymology as «the truest method of fixing just and lasting Ideas of them [terms] in the mind» (Preface: A); and Hooper’s A compendious medical dictionary (1798), a portable dictionary which aimed «to deliver, in a concise and perspicuous manner, the explanation, &c. of all the terms used in the whole science of medicine […] acceptable to medical students» (Preface).

2   According to O.M. Brack Jr. and Thomas Kaminski (1984: 398), Samuel Johnson may have helped James by writing sections of Proposals and Conditions (1741) for Robert James’s A medicinal dictionary (1743-1745): «That Johnson “helped” in writing the proposals would seem the most likely explanation. James, a physician of some learning and ability, […] could be expected to know how he planned to compile his own dictionary and must have provided the more technical information. Johnson, who was still in the process of gaining his “knowledge of physic … from Dr. James,” appears to have added some paragraphs and done some revising. The set of “Conditions” which precedes the proposals does not have a distinctive style and may or may not have been written by Johnson. When we turn to the “General Account of the Work,” perhaps the first eight paragraphs, and even less certainly paragraphs 19 and 26, all of which deal with medicine in general, nontechnical way, sound more Johnsonian than not.»

3   For essential reference to Harris’s Lexicon Technicum (1704) and Chambers’s Cyclopaedia (1728), see Bradshaw 1981: 107-121 and 123-140, respectively. For further reference on Chambers’s Cyclopaedia, see Yeo (1996 and 2001).

4   On Motherby’s A new medical dictionary (1775), cfr. McConchie (2009).

5   Micro-structure refers to the internal organisation of the entry, its lexicographic constituents (etymology, equivalent(s), lexical definition(s), cross-reference(s), sub-headwords and sub-entries), and its lexicographic construction of knowledge (encyclopaedic matter).

6   Richard Wiseman (1621-1676) was a royalist surgeon (serjeant-chirurgeon) who is considered one of the father of British surgery. He wrote A treatise of wounds (1672) and Severall chirurgicall treatises (1676).

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