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Communicating Medicine

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Elisabetta Lonati

3. Framing medical discourse in eighteenth-century handbooks

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3.1 General introduction: explanatory prefaces and contents

1The handbooks and practica analysed in the present study belong to the second half of the eighteenth century. It is a period characterised by dramatic changes in the medical field, by a growing and expanding social interest in medical events, as well as by the impact of medical research and practice on British society as a whole. The writing of medical books and their circulation among the lay people was also favoured by the expansion of printing – as a general trade – and the expansion of the book market. According to Sims, in the preface to his Observations on epidemical disorders (1776), the art of printing

with a noble profuseness has scattered knowledge and liberal sentiments to the most distant regions, publications have become so frequent that an author thinks it proper at present to apologize to the public in a preface for daring to step forth in print; […] the medical list having of late increased so enormously by new writings. (Sims 1776: iii-A2)

2For the present research, many texts were consulted and scrutinised, but just a selection was actually used to exemplify medical writing. This selection is mainly based on their relevance as reference works in both professional and lay settings at the time, on the repute of their authors, and on the medical events included, particularly widespread epidemic and inflammatory diseases. In this latter case, the tables of contents were fundamental for the choice.

3The dissemination of medical knowledge, or «diffusing medical knowledge among the people» (Buchan 21772: xxiii), became one of the principal aims of medical authors, either physicians (university-educated M.D.), or practitioners (trained surgeons and apothecaries). Writing was a means to sharing medical experience, to instructing, informing and explaining medical contents, and making them generally useful. Buchan (21772) and Fisher (1785) are particularly effective on this point when they highlight that «people at large […] are entitled to reap the benefit of the Practice of Physic» (Fisher 1785: vii), and that «Diffusing medical knowledge among the people would […] render Medicine more universally useful» (Buchan 21772: xxvii).

4The explanatory prefaces and general introductions to some of the reference works examined were valuable starting points to highlight the key topics to be included in this study, and to suggest the approach for their presentation and discussion. Considerations on medical writing and its socio-cultural function, the reading public, the growing importance of public health issues, the role of experience and experimentation in medicine (practical approach), medicine as a new and consolidating profession (and professional trade), medicine as expanding specialised knowledge (science), and medicine as shared knowledge – and the values they carry with them – frame the context in which medical men were establishing themselves as professionals (and expert writers). These basic principles define the new social role and social function of medical practitioners, and also define the conditions in which medical writing is produced, making these transformations emerge in everyday practice.

5Among the most representative works, the following ones were chosen as source materials to exemplify medical discourse. As it may be evinced from their titles, some of them focus their attention on specific affections (such as fevers), others include infectious and epidemical disorders, a third group instead considers multifarious diseases:

  • Millar’s Observations on the prevailing diseases in Great Britain (1770)
  • Grant’s An Inquiry into the nature, rise, and progress of the fevers most common in London (1771)
  • Buchan’s Domestic medicine: or, a treatise on the prevention and cure of diseases by regimen and simple medicines (21772)
  • Grant’s An essay on the pestilential fever of Sydenham, commonly called the gaol, hospital, ship, and camp-fever (1775)
  • Sims’s Observations on epidemical disorders, with remarks on nervous and malignant fevers (1776)
  • Clark’s Observations on fevers, especially those of the continued type; and the scarlet fever (1780)
  • Borthwick’s The method of preventing and removing the causes of infectious diseases (1784)
  • Fisher’s The practice of medicine made easy (1785)
  • Black’s A comparative view of the mortality of the human species (1788)
  • Wallis’s The art of preventing diseases, and restoring health, founded on rational principles, and adapted to persons of every capacity (1793)

6The socio-cultural function of medical writing is treated in detail by Buchan in his work (21772), and introduced in more general terms by Fisher (1785) and Wallis (1793). All of them insist on the usefulness and the necessity to spread medical knowledge among mankind in order to avoid diseases by communicating «the Prophylaxis, or that part which treats of preventing diseases» (Buchan 21772: vi), by diffusing «simple and approved forms of medicine, and […] cautions and directions» (Buchan 21772: xi), by promoting practical and affordable «relief for the sick and languishing» (Fisher 1785: vii), and by curing «those maladies, by which man is constantly attacked» or by preventing «their origin, or the mischiefs which are apt to succeed» (Wallis 1793: 1). In this perspective, medical writing establishes itself as a groundbreaking, and challenging experience, a kind of ‘scientific experiment’ itself, documenting and communicating the new scientific approach to medical events, and medicine as a whole:

When I [Buchan] first signified my intention of publishing the following sheets […] it would draw on me the resentment of the Faculty. […] I was resolved to make the experiment, which indeed came out pretty much as might have been expected. […] The reception which the book met with from the public was still more flattering, and deserves my most grateful acknowledgments. A persuasion that such a performance might be useful, and was even wished for by the public, encouraged me to print a large impression; […]. (Buchan 21772: v)

Since

Disguising Medicine not only retards its improvement as a science, but exposes the profession to ridicule, and is injurious to the true interests of society. An art founded on observation never can arrive at any high degree of improvement, as long as it is confined to a few who make a trade of it. (Buchan 21772: xx)

7Experience and experimentation, observation and data collection are the founding principles of the ‘new medicine’: «physic is cultivated upon a more rational plan, and faithful observation is allowed to be the sole foundation of medical knowledge» (Millar 1770: 3), before and against traditional scholastic learning, «conjecture» (Sims 1776: iii-A2), «extravagant hypotheses, […] fluctuating, mysterious, and fallacious» (Clark 1780: ix), and «the authority of system» (Clark 1780: x).

8Expressions highlighting practical and accurate observations, data collection, personal experience and useful communication of medical facts, such as

[OBSERVATION AND USEFULNESS]
to endeavour to render practical observations more extensively useful (Millar 1770: 4)
a sagacious, careful and patient observation (Grant 1775: ii)
the descriptions given […] in the writings of those physicians who were the best and most accurate observers, as well as in the journals of my own practice (Grant 1775: iii)

Accurate attentive observation, and collecting useful facts, are the principal means of improving the practice of medicine. (Clark 1780: ix)

[FACTS]
the man who adds one single fact […] does more real service to the art than he who writes a volume (Buchan 21772: xxi)
to establish any one medical fact (Sims 1776: iv)
sensible of the importance of a medical fact (Sims 1776: vi)
supported by obvious facts […] recorded the result of their personal experience […] observation, experiment, and the close inductive reasoning (Clark 1780: x)

[PERSONAL-PROFESSIONAL]
the sagacity and prompt discernment of the physician (Millar 1770: 4)
adding his own experience to that of others (Grant 1771: i)

[DESCRIPTION]
faithful description of the diseases (Grant 1771: i)

[COMMUNICATION]
inexcusable if he does not communicate it to the world (Sims 1776: v)
the laudable purposes of communicating practical instruction (Clark 1780: x)

9are disseminated in the prefaces to emphasise that performing medicine was becoming the core of a revolutionary epistemological change. This change would lead to the transformation from knowledge to science, since

To cure diseases they must first be known; to be known they must be seen, carefully attended to, and considered in their approach, progress, heighth, declension and final termination; in this way alone their nature can be investigated, and each disease critically distinguished, by its characteristic symptoms, from all others.
This science is, indeed most difficult to attain; masters, books, or a knowledge of other sciences will avail little; these, it is true, have their use, and may afford some assistance in the study of physic; but to become an able practitioner in the art of healing, demands a long and unremitting attendance at the beds of the sick; a sagacious, careful and patient observation, and I might add, a turn of mind peculiarly adapted to, and delighting in this particular science. (Grant 1775: i-ii)

10The way of conceiving, thinking, constructing medicine as a science, alongside the need and the effort to diffuse medical knowledge among the people, carried with it a change in writing. Metalinguistic issues expressing – and testifying to – this innovative attitude are included in the prefaces. Special attention is given to the rhetorical strategies, the register and the vocabulary used to encode medical events and to be understood by a non-expert and semi-expert (i.e. students) audience.

11Since the aim is to «instruct and inform Persons of ordinary abilities in things which materially concern themselves» (Fisher 1785: iv), Buchan and Fisher insist on the necessity to avoid «a useless parade of learning by using technical terms» (Fisher 1785: iv), or «an useless parade of quotations from different authors» (Buchan 21772: xii). According to them, technical terminology and different perspectives – especially «quotations» and «observations» (Buchan 21772: xii) – may be sometimes introduced in the description of diseases, or discussion of medical events. In these cases, either «every word which is difficult to understand» should be «always explained the meaning in words immediately following» (Fisher 1785: iv), or just those terms «such as most people understand» (Buchan 21772: xv) should be included. A partially different viewpoint on the «simplicity of stile» is expressed by Wallis (1793: iii) in his Explanatory Preface, since ‘simplicity’ does not mean systematic omission, or deletion, of «the terms of the schools» (1793: ix). If duly explained, «the terms themselves, once understood, are infinitely more expressive, and involve more ideas than any other which might be thought more familiar» (1793: x).

12This attention to the public awareness and understanding of medical facts mirrors a strong commitment to public health in civil society: the growing number of hospitals and public institutions in which people were cured and medical men performed medicine expanded professional experience. Alongside ordinary and widespread common diseases, and epidemics, practitioners also dealt with occupational diseases. In hospitals and infirmaries, they had the «opportunities of observing the injuries which […] useful people sustain from their particular employments» (Buchan 21772: vii), to cure, inform, and instruct them «in order that people may be upon their guard against them [diseases]» (Buchan 21772: viii). It is the representation of an emerging pre-industrial country and its social issues, such as the «cure of diseases» and, more important, «the preservation of health», for which «Medical knowledge […] only teaches men how to make the most of themselves» (Buchan 21772: xxvii) both in public and in private life. The ‘physician’s attention’ is thus social, besides being medical: the profession requires both ‘scientific knowledge’ and ‘social awareness’, with a view

To assist […] in relieving distress; to eradicate dangerous and hurtful prejudices; to guard the ignorant and credulous against the frauds and impositions of quacks and impostors; and to show men what is in their own power, both with regard to the prevention and cure of diseases, […]. (Buchan 21772: xxxi)

13As regards the term disease, it is worth noting that both Black (1788) and Wallis (1793) introduce the notion and try to represent its semantic load. In the introduction to the present study, the term disease is treated in association with such other terms as affection, disorder and distemper, as defined by Samuel Johnson in his Dictionary of the English language (1755). In Black’s and Wallis’s, the definition and the interpretation of disease and its meaning(s) precede its contextual use in medical handbooks, and help clarify its pragmatic potential in this kind of reference works. It is a relevant metalinguistic issue, since medical writers include the explanation of the key term they will use in their writing, to avoid ambiguity and vagueness. They also pragmatically exemplify the ideas they express, by adding a series of details to make the average reader understand their point. Black (1788: 70-71), in a comprehensive and extended definition, maintains that

A disease, in the pathological language, is when one or more of the various corporeal or mental functions, cannot be performed as in usual health. The symptoms of all diseases are indicated by few or many derangements of the corporeal functions, of the excretions, and of the sensible qualities: such are pain, disagreeable sensation, anxiety, irritation internal or external; the exercise of some of the external or internal senses impeded; of sleep and waking; of the muscular or moving fibres; of the digestive and intestinal functions: of the lacteal, lymphatic, or absorbent system; of the respiration, sanguiferous circulation, and arterial pulsation; of the different excretions and secretions, the feces, urine, perspiration, bile, pancreatic fluid, saliva, milk, menses, semen, mucus, oil, lymph, and extravasated blood: by the countenance, actions, gestures, debility, strength, heat, colour, smell, taste, magnitude, hardness, softness, the nature and appearance of the excretions, &c. (Black 1788: 70-71)

14The definition is followed by a long list of generic symptoms, or meta-symptoms, as when a specific disease is usually described: a helpful strategy to make ideas concrete. Wallis (1793: 313-314), in a more abstract and neat definition, affirms that

By Disease is meant a general or local affection, by which the system is disturbed, or the action of a part impeded, perverted, or destroyed—or, an appearance deviating from health, from some general, partial, or local affection, by which the system in general, or in a part, is oppressed or disfigured—and this is discovered and distinguished by an enumeration of certain symptoms or appearances with which it is always associated.—But diseases differ; hence it is necessary to distinguish them from each other, with which they may seem to have a near affinity—this is done by the causes and peculiarities that are connected to them; and from whence the deviation arises. (Wallis 1793: 313-314)

15Hence, a disease can include a great amount of symptoms or «appearances», some of them are present in many different diseases and cannot be of use for their distinction. However, diseases must be distinguished, identified – and then categorised and described – according to their peculiarities (their characteristic signs), and their causes.

16The effort to classify diseases clearly emerges from the table of contents of reference works: writers group diseases and organise materials in order to describe similarities and differences, as regards their nature, their causes, their manifestations, their effects. For example, Buchan (21772) distinguishes individual diseases in separate chapters in his «PART II. Of Diseases», each chapter including similar diseases according to their nature and external manifestations. Millar (1770) identifies macro sections such as «PART I. Of Inflammatory Diseases», «PART II. Of Putrid Fevers», and «PART III. Of Diseases which partake both of a Putrid and Inflammatory Nature», each of them including more specific chapters on «Inflammatory Fevers», «Pleurisy and Peripneumony», «Inflammations of the Abdominal Viscera», «Inflammation of the Liver», «Inflammation of the Intestines», «Remitting Fevers», etc. Black (1788) uses a mixed-type organisation: some diseases are grouped according to their similarities, such as «Of fevers», «Diseases of the lungs and organs of respiration», «Diseases of the external senses», «Diseases of the Stomach and intestines, and organs of digestion» etc.; others are treated individually «Headach, Night mare, Apoplexy, Lethargy, coma, and carus, Vertigo, Palsy, Epilepsy, Tetanus», etc. Wallis (1793) organises his materials into specific sections devoted to «Febrile Affections», including continued fevers, inflammatory fevers, mixed fevers, remittent fevers, bilious fevers, intermittent fevers, eruptive fevers, etc.; «Inflammation» of the brain, of the eye, of the ear, of the breast, of the pleura-pleurisy, of the lungs-peripneumony, etc.; «Diseases where Pain is the characteristic Symptoms» [sic], such as head-ach, or cephalalgia, cephalæa, hæmicrania, tooth-ache, pains of the stomach, of the liver, in the kidneys, etc.; «Morbid Evacuations», «Nervous Affections», «Diseases of the Skin», etc.

17It can be argued that the complexity of the structure changes according to the principle of inclusion vs. selection, the principle of grouping and clustering vs. listing individual diseases (sometimes just in alphabetical order as in Fisher, 1785), and the principle of abstraction to identify macro-similarities, such as the inflammatory nature, to organise contents. However, it is almost clear that certain diseases frequently recur in every work (some of them are even devoted to specific diseases, or specific class of diseases such as fevers, cfr. Ch. 4.), and this testifies to the endemic or epidemic affections which characterise the period.

18The following sections present and discuss a series of extracts treating the most frequent affections as they emerge from the works. The aim is to highlight the rhetorical strategies, the language and the textual features which frame medical contents for a large audience.

3.2. Medical experience and medical practice in eighteenth-century handbooks

19The examples discussed in this section are subdivided into two main groups: Group A (cfr. § 3.2.1.) introduces some lexicographic practices (lexical definition, etymology, glossing, equivalence, basic and concise descriptions; in other words, what constitutes an extended definition, cfr. § 0.2.1.), alongside their discursive function (categorisation, vernacularisation, expansion, etc.); whereas Group B (cfr. § 3.2.2.) discusses longer and more elaborate descriptions of disease, that is to say symptomatological definitions, alongside their systematisation in a descriptive-discursive framework (particularly stative or dynamic verbs featuring respectively the context or process under scrutiny, and discursive makers organising the text). Moreover, there are at least two main criteria to organise materials in handbooks, or practica: the alphabetical order, in the case of Fisher (1785), and the thematic one, the most frequently used by medical authors. However, in both cases, some rhetorical, textual, and linguistic strategies recur, since medical writers select and combine them according to their specific communicative and discursive aims.

3.2.1. Denominating, defining and categorising diseases: basic patterns and discursive issues (Group A: glossing, equivalence, etymology)

20The first goal for medical writers in their works is to denominate individual diseases or groups of diseases to make them known to – and recognisable by – their diverse readership. Denomination is a key feature in all the handbooks under scrutiny here, and is the first basic issue to organise and introduce medical events of any kind (diseases as entities and their development in time). Usually, denominations are single- or multi-word expressions, and are often more than one for the same disease: such as pleurisy~inflammation of the pleura, peripneumony~inflammation of the lungs, hepatitis~inflammation of the liver, hydrophobia~bite of a mad dog, phthisis~pulmonary consumption, convulsions~epilepsy, cyranche inflammatoria and maligna~throat sore, etc. Some are in English (convulsions, blood-spitting, head-ach, inflammations of the breast, etc.), some are anglicised versions of Latin names (pleurisy, dysentery, catalepsy, dropsy, etc.), others are Latinised denominations derived from Greek (pleura, peripneumonia, hydrophobia, cephalalgia, cardialgia, etc.).

  • 1   According to Adamska-Sałaciak (2010: 393), there is a distinction to be made between translationa (...)

21In reference works, the practice of using variant denominations, including lexical variation, graphic variation, or morpho-syntactic variation, was meant to connect lexical variants and different registers (specialised and formal vs. general and core vocabulary) to the same medical reality. This facilitated the non-expert, or the semi-expert, readership to associate background knowledge and experience, represented by shared vocabulary in everyday communicative situations, with more formal, technical – and, for this reason, more complex – expressions. If technical terminology had to be used, the association with well-known and widespread expressions was necessary to clarify the concept(s). This procedure – known as glossing, especially through equivalence – was systematically exploited in handbooks to gather and organise medical terminology, in order to introduce medical contents and notions to the ‘average’ readership1.

22Generally speaking, variant denominations for the same disease – or for the same notion(s) or event(s) – precede any definition, description, or explanation. Hence, denominations – and their equivalent expression(s) – serve as headings and headwords at the same time, they are the starting point for any in-depth analysis.

23This is the main technique used by Fisher (1785) to structure his work and introduce his contents. Fisher organises his materials in alphabetical order, not always consistently, as in a dictionary, for quick reference, and exploits denominations and glossing essentially as a vernacularisation strategy before further descriptions or explanations.

24The table below lists a series of topic-headwords which are immediately followed by their respective English or Anglicised equivalents, either translation or explanatory. Some of them are transparent and easy to understand (bite of a mad dog, blood-spitting), others are opaque and more complex for the average reader to grasp (fever intermittent, epilepsy, lethargy). This aspect depends on register, as well as on the level of technicality expressed by the equivalent itself:

Equivalence and Vernacularisation Fisher (1785: 12 ff.)

Ague, (See Fever Intermittent.)

Albugo, or Speck on the Eye.

Angina. (See Throat sore.)

[…]

Apoplexy.

Arthritis. (See Gout.)

Asthma.

Bite of a Mad Dog.

[…]

Cardialgia. (See Heart-burn.)

Carus. (See Lethargy.)

Catalepsy. (See Epilepsy.)

[…]

Caphalalgia. (See Head-ach.)

[…]

Chorea sanctiviti. (See St. Vitus’s Dance.)

[…]

Coma (See Lethargy.)

[…]

Convulsions. (See Epilepsy.)

Crooked Spine. (See Spine Crooked.)

Cyranche Inflammatoria and maligna. (See Throat Sore.)

[…]

Deliquia. (See Faintings.)

Diabetes. (See Urine excessive.)

Diarrhœa. (See Loseness.)

[…]

Dysentery. (See Bloody Flux.)

Dysury. (See Urinary Passages, Diseases of)

Dyspepsia. (See Stomach Complaints)

[…]

Herpes. (See Leprosy.)

Hæmorrhois. (See Bleeding Piles.)

Hæmoptoe. (See Blood-spitting.)

Hepatitis. (See Inflammation of the Liver.)

[…]

Hydrophobia. (See Bite of a Mad Dog.)

Hydrops (See Dropsy.)

[…]

Inoculation. (See Small Pox.)

Incubus. (See Night Mare.)

Ischuria. (See Urinary Passages Diseases of)

[…]

Nephritis. (See Inflammation of the Kidnies.)

[…]

Opisthotonos. (See Cramp.)

Ophthalmia. (See Inflammation of the Eye.)

[…]

Paraphrenitis. (See Inflammation of the Pleura or Pleurisy.)

Peripneumony. (See Inflammation of the Pleura.)

Phrenitis. (See Inflammation of the Brain.)

Phthisis. (See Consumption.)

Pleurisy. (See Inflammation of the Pleura.)

[…]

Psora. (See Itch.)

Quinsey. (See Throat sore.)

[…]

25The single-word or multi-word equivalents are used both to get to the core meaning of the source expression and to cross-refer to those sections where the topic is thoroughly described and/or discussed. Frequently, the topic-headwords are Latinised expressions ultimately coming from Greek, whereas equivalents are familiar expressions appropriate for both laypeople and semi-experts (for example students or apprentices), or trained practitioners.

26Occasionally, the equivalence, or the cross-reference, starts from the more familiar expression or denomination to the more technical and prestigious one, such as «Convulsions. (See Epilepsy)»; more rarely, cross-referring is just a matter of internal alphabetical organisation, with the inversion modifier → head «Crooked Spine. (See Spine Crooked.)». Each of these heading + equivalent or cross-reference patterns are usually and immediately followed by more elaborate descriptive sections, known as symptomography. Definitions after glossing are sporadic in Fisher, since equivalence already introduces the meaning expressed by the technical terms. When definitions are included, they are very simple and essential, usually categorising the topic-headword as a disease, distemper, disorder, complaint, or means of curing, such as

BITE OF A MAD DOG. […]
HYDROPHOBIA. This disease is too often the consequence from a bite of a mad dog. Symptoms. […]
BLACK DISEASE. This is a distemper which does not happen very frequently […] owing I believe, to an effusion of blood […]. Symptoms […]
BLEEDING AT THE NOSE. This is often a means of curing some disorders, such as head-ach […]
CATARACT. This is a disease of the crystalline humour of the eye by which the sight is impaired […].
FEVER BILIOUS. This disease is only a continual remitting or intermitting fever, accompanied with a great discharge of bile upwards or downwards. […]
HEAD-ACH. This is a disease the symptoms of which need no description. Regimen […].
HICCUP or HICCOUGH. This complaint is so well-known, that I need give no account of the symptoms. (Fisher 1785: 21 ff.)

27Denominations and definitions are followed by detailed ‘entries’ (or sections, or articles) including descriptions, symptoms, and cures (regimen and medicine), which is the primary interest and purpose of the author, and of his work.

28Denominations and glossing, particularly equivalence, are a widespread practice in dictionaries and encyclopaedias, and this versatile strategy is also extensively applied and adapted to handbooks. Actually, glossing becomes a well-established and basic method to introduce specialised lexical items, and the contents they represent. Moreover, glossing is also a key feature which structures this kind of reference works, independent of the register used to discuss the medical events included, and of the length and complexity of subsequent paragraphs, sections, and chapters.

29In the following examples, taken from Buchan (21772), Wallis (1793), and Black (1788), single- or multi-word denominations are glossed by their respective translation or explanatory equivalents. Sometimes definitions are introduced immediately after a topic-headword without any equivalence; only later, further linguistic, lexicological, and etymological information is given. The examples 1-3 deal with what is generally called inflammation(s) of the breast, especially pleurisy; whereas the examples 4-6 deal with aches, especially head-ach.

30The first example is taken from Buchan, the concept is introduced by the topic-headword pleurisy and immediately narrowed by a more specific denomination, i.e. «true pleurisy» (modifier-head). This is followed by an explanatory equivalent, which functions as a first phrase-like definition, very short and essential: «inflammation of that membrane». Further on, the more prestigious and technical term in Latin, i.e. «called the pleura», is introduced. Other modifier-head denominations follow, introduced by «called the», and help categorise, «distinguished into», the species of pleurisy, «moist and dry», «spurious or bastard», to be treated later on by Buchan:

Example 1

OF THE PLEURISY.
The true pleurisy is an inflammation of that membrane, called the pleura, which lines the inside of the breast. It is distinguished into the moist and dry. In the former, the patient spits freely; but in the latter, little or none at all. There is likewise a species of this disease, which is called the spurious or bastard pleurisy, in which the pain is more external, and chiefly affects the muscles between the ribs.
[…]
Of the BASTARD PLEURISY. That species of pleurisy which is called the bastard or spurious, generally goes off by keeping warm for a few days, drinking plenty of diluting liquors, and observing a proper regimen.
[…]
Of the PARAPHRENITIS. The paraphrenitis, or inflammation of the diaphragm, is so nearly connected with the pleurisy, and resembles it so much in the manner of treatment, that it is scarce necessary to consider it as a separate disease. (Buchan 21772: 202, 211)

31Two sub-topics, or sub-headwords, are here included, i.e. bastard pleurisy and paraphrenitis: both are defined by the genus-differentia pattern, «BASTARD […] species of pleurisy», «paraphrenitis […] is so nearly connected with the pleurisy, and resembles», which is typically used in the attempt to categorise contents. In the case of paraphrenitis, the definition is preceded by the equivalent expression «inflammation of the diaphragm». Here, the notions of translational and explanatory equivalence overlap. What emerges from this linguistic and conceptual organising principle is that pleurisy (genus expression) is a disease (itself a genus expression, the most general notion) which can be subdivided into different species, such as moist, dry, spurious/bastard, and paraphrenitis (differentia).

  • 2   Here, as in other contexts, the notion of translational and explanatory equivalence is fuzzy, sin (...)

32The second example, taken from Wallis (1793), traces back to the same strategies used in the preceding extract: equivalence for introducing and vernacularising the topic, and its variant denominations; genus-differentia pattern for defining and categorising. However, the textual organisation is neater and more lexicographic in approach. The ‘entry-article’ is detailed, opening with a general and all-inclusive heading, «INFLAMMATIONS OF THE BREAST», and going on with more specific sub-headings or sub-headwords. First, it provides the anglicised denominations, followed by its respective explanatory equivalent, «Pleurisy, or inflammation of the Pleura», «Peripneumony […] Inflammation of the Lungs»2; or its translation equivalent «Pulmonary Consumption […] Phthisis pulmonalis». In this latter case, the more scholarly denomination follows. An interesting feature, which is almost always present in Wallis (1793), is etymology. The inclusion of the etymological principle in lexicographic reference works (dictionaries and encyclopaedias) dates back from the beginning of the eighteenth century to help readers understand the core meaning of the headwords, particularly as regards specialised or technical terminology. The same strategy is often adopted in non-lexicographic reference works with the same interpretative issue, and Wallis is extremely careful and systematic in including the original etymological meaning when introducing diseases (particularly from Greek and Latin). Wallis’s ‘entry-article’ is well structured, the morpho-syntactic sequences well-organised, marking the different textual paragraphs, for example definitions vs. further expansions, «This is an affection of» vs. «It is divided into», «This disease is» vs. «Authors have divided them», and discourse units (introduction, detailed information, or treatment, cfr. example 2 below).

33Two kinds of definitions are used in the following extract. On the one hand, the disease is defined according to its salient features, as an entity, «This is an affection», «This disease is»; on the other hand, the disease is defined as a process, according to what actually happens in context. In this case, Wallis uses what is known as when-definition (or, when-defining), a strategy aimed at popularising concepts otherwise difficult to be figured out by a non-expert readership. The general concept corresponds to the genus, whereas the when-definition introduces the differentia: «when the membrane itself», «when the intercostal muscles», etc. The differentia is also highlighted by the introductory expression «into different species», followed by a list of run-on modifiers, «dry […] moist […] catarrhal […] sanguinary», s.v. Pulmonary Consumption):

Example 2

CHAP. II.
INFLAMMATIONS OF THE BREAST.
§ I. Pleurisy, or inflammation of the Pleura.
This is an affection of the membrane called pleura, from the Greek word pleos, plenus, full, which lines the inside of the chest, covering the ribs internally, and intercostal muscles (27.) and lungs, (19.) and forming the mediastinum and pericardium, (19.) attended with an acute fever, great pain, and difficulty of breathing.
It is divided into the true pleurisy, when the membrane itself is affected—into the spurious, when the intercostal muscles; —and also into moist, when expectoration is an associate; and dry, when there is no such appearance—indeed, at the onset it puts on generally the appearance of the latter, and of the former in its progress, if not conquered by resolution; for then most commonly expectoration takes place. (Wallis 1793: 512-513)
[…]
§ 2. Peripneumony, so called from the Greek words peri, circum, about, and pneuma, pulmo, the lungs.
Inflammation of the Lungs. (Wallis, 1793: 517)
[…]
§ 3. Pulmonary Consumption, called Phthisis pulmonalis, from the Greek word pthino or pthuo, corrumpo, to corrupt.
This disease is a wasting away of the whole body, attended with a hectic fever, cough, and spitting up of matter, from an ulcer on the lungs.
Authors have divided them into different species: the dry, or tuberculous consumption;—the moist, or catarrhal—and the sanguinary, from their attendant symptoms and causes; […]. (Wallis, 1793: 524)

34The third example, on the same topic, i.e. inflammations of the breast in general, is drawn from Black (1788). His approach is different from the preceding ones, more descriptive and situation-bound, and less structured from a lexicographic perspective. The heading cannot, in this case, be completely overlapped with a headword, even though it is directly followed by a general definition, «is a frequent inflammation», or the most inclusive genus expression, and further on by «pleurisy and peripneumony», the more technical and prestigious anglicised denominations. These are diversified by a long list of modifiers, «bilious, erysipelatous, catarrhal» etc., the differentia, introducing kind of run-ons, without any further information or definition:

Example 3

CHAP. XVI.

Inflammation of the Lungs and Organs of Respiration, is a frequent inflammation in northern climates […]. Nosologists have enumerated several extraneous symptoms as complicated species of pleurisy and peripneumony; such as bilious, erysipelatous, catarrhal, rheumatic, intercostal, arthritick, verminous, flatulent, scorbutick, putrid, and malignant: […] The primary seat of pulmonick inflammation […] is not clearly established in medical diagnosticks; and therefore we comprehend pleurisy and peripneumony under one genus: […]. (Black 1788: 142-143)

35The examples 4-6 concern aches, and again are drawn from Buchan (21772) and Wallis (1793): head-ach and otitis. In «OF THE HEAD-ACH», Buchan introduces the general topic aches (genus), to focus on «those only which occur most frequently» (differentia). He systematically defines the different kinds of headache in a when-definition pattern (as Wallis in the preceding example 2 on pleurisy). Only after each single definition, the specialised denominations are given in Latin: from «when the head-ach», «when the whole head», «when on one side» (when-definition), to «it is called cephalalgia […] cephalæa […] hemicranias […] is called clavis hystericus» (prestigious denomination). This strategy is used to popularise ideas and concepts before giving them formal – or technical – status, which would otherwise be incomprehensible to the readership. The approach is onomasiological. Buchan – as Wallis in the previous and following examples – starts from the concepts, in order to identify and include the terms expressing them only later on:

Example 4

CHAP. XXXIII.
OF THE HEAD-ACH.
Aches and pains proceed from very different causes, and may affect any part of the body; but we shall point out those only which occur most frequently, and are attended with the greatest danger.
When the head-ach is slight, and affects a particular part of the head only, it is called cephalalgia; when the whole head is affected cephalæa; and when on one side only, hemicrania. A fixed pain in the forehead, which may be covered with the end of the thumb, is called clavis hystericus. There are also other distinctions. Sometimes the pain is internal, sometimes external; sometimes it is an original disease, and at other times only symptomatic. When the head-ach proceeds from […]. When from a cold phlegmatic habit, […]. (Buchan 21772: 448)

36In extract 5, Wallis defines and categorises head-ach as a «complaint» (both words representing the genus). Then, a series of more specific definitions (differentia) introduced by if- or should conditional patterns follow: «if there is a heaviness […] if the whole head […] should the pain attack». These patterns have the same function of when-definitions, that is to say they make the reader imagine a single empirical situation – possibly a well-known one – to grasp the concept expressed. The technical denominations cephalalgia, cephalæa, hemicrania, introduced by explicit linking formulae, such as «it is denominated […] by way of distinction […] it is called», come later. Convinced of the importance of using and explaining scholarly terminology, to be perspicuous and appropriate at a disciplinary level, Wallis includes etymology. In his preface, Wallis highlighted that the inclusion of the derivation of every term was absolutely necessary since «the terms themselves, once understood, are infinitely more expressive, and involve more ideas than any other which might be thought more familiar» (1793: x). The inclusion of etymology is not systematic in medical writings (unlike many lexicographic works, either universal or specialised dictionaries); however, it serves as a starting point to approach both lexical meaning and extra-linguistic events.

37The focus shifts from the definition, to the scholarly denomination, and finally to the unfolding of the original meaning (etymology proper) and its morphological constituents (derivation). The passage underlines the movement from the medical situation or concept to the not-always-necessary linguistic detail. However, it is through precise language that medical notions can be communicated:

Example 5

CHAP. I.
§ I. Head-ach.
In this complaint, […].
If there is a heaviness and uneasy dull sensation, occasioning a pain in the head, as it was too full, internally distended, and overloaded, it is denominated cephalalgia, from kephalos, caput, the head, and algos, dolor, pain;—and, by way of distinction, cephalæa, if the whole head should not only be affected, but the pain be acute and violent, having severe exacerbations, or increase of severity on slight occasions, with spasmodic tension, and soreness of the integuments.
And should the pain attack either side of the head, chiefly at the temples, forehead near the eyes, and that should be violent, and often periodical, it is called hemicrania, from emisus, dimidium, half, and kranon, caput the head. (Wallis 1793: 549)

38The function of etymology in Wallis (1793) is, once again, well represented in the extract «Otitis, or Otalgia» below:

Example 6

§ 2. Otitis, or Otalgia—from the Greek words, ous, auris, the ear; and algos, dolor, pain;—Inflammation of the Ear. By this is meant an inflammatory state of the internal parts of the ear, whose membranes, from their being well stored with nerves, are extremely sensible; and from being attached to bones, feel pain very acutely. (Wallis 1793: 493)

39In this case, the Latinised denomination otitis, or otalgia is directly followed by its Greek and Latin equivalents (derivation) «ous, auris […] and algos, dolor», then translated by their English equivalents «ear […] pain». Etymology is followed by the self-explanatory – and highly explanatory – translation equivalent «Inflammation of the ear», defined as «an inflammatory state of the internal parts of the ear». The approach is semasiological, from the topic-headword, that is from the denomination of the concept (disease), to the notion expressed by it. Denomination and definition are linked by etymological information, both origin and derivation. Wallis’s definition is further expanded by a concise description of anatomical details, and later repeated in the subsequent section including symptomatological defining patterns (cfr. § 3.2.1).

40The examples 1 to 6 have highlighted recursive elements used to organise medical contents in handbooks: denomination, definition, equivalence (translational and explanatory), and etymology. Some of them are frequently found in medical texts, even though they may be used differently: definitions in Buchan, Wallis and Black, or the order of constituents within similar paragraphs (denomination-equivalent-definition vs. definition-denomination-equivalent), or the amount of information included. Others are systematically used only by Wallis: this may obviously depend on the general aims of the reference works under scrutiny as declared in their prefaces, or by the target readership. The ideal reader is the average educated one for all of them, either expert or non-expert. However, among the members of this ‘average audience’ there may be some differences, which emerge from the different linguistic and stylistic strategies the individual writers choose: register, occurrence and frequency of familiar vocabulary and construction vs. technical terminology and morphological information.

3.2.2. Defining terms and expanding knowledge: symptomography and elaborate descriptions (Group B)

41Symptomography: listing, clustering, and recording symptoms. Symptomography, or symptomatological defining, is another relevant feature in structuring and communicating medical contents in handbooks and practica, as it is in dictionaries. It is mostly used to define and describe in detail the many diseases, distempers, disorders, affections, and complaints which medical practitioners, at any level, experimented in their professional life and tried to cure. Actually, listing, connecting symptoms, and recording them, is considered one of the major and useful resources to identify diseases. Professional recording of symptoms and their manifestation in time is then used to share individual experience within the emerging medical community. This procedure allows medical men to categorise – or, try to categorise – individual diseases, and group of diseases, according to symptomatological similarities and differences. These are the reasons why descriptions are extremely detailed, even overflown by major and minor symptoms, as they can be observed – and perceived as relevant manifestations – by an expert eye. Symptomatological defining is thus extensively and systematically adopted by medical writers. They also adapt symptomography to their textual and discursive perspectives: symptoms may be simply listed (often used in dictionaries, or in very practical and quick reference works), or included in more complex structures describing and interpreting them according to their progression in time (disease process) and space (site of their manifestation and parts of the body). In this case, symptomatological defining merges with textual and discursive analysis, since symptoms are embedded within rhetorical and linguistic features which frame contents and determine their communicative issues. The following excerpts highlight how symptomography is used by medical writers in their handbooks, and how differently (as regards their quality and their quantity) symptoms may be included, introduced and discussed in practical texts, for essentially practical reasons.

42The first text to be analysed (example 7) is the continuation of Black’s excerpt (1788) exemplified in the section on glossing and concerning «pulmonick inflammation» (cfr. § 3.2.1., example 3). Following the opening sentences on the prevailing characteristics of the disease, the subsequent paragraphs focus on a myriad symptoms introduced by a general statement, «The symptoms of pulmonick inflammation are», which frames the whole section:

Example 7

Inflammation of the Lungs and Organs of Respiration, is a frequent inflammation in northern climates […]. The symptoms of pulmonick inflammation are fever, darting pungent pain fixed like a dagger in some part of the chest, the side, breast, or back; and sometimes shooting to the scapula and clavicle: sometimes the pain is more dull and obtuse; and its situation oftenest in the side, about the middle of the ribs, between the sternum and spine; and commonly confined to one lobe. At the invasion there is shivering, restleness, anxiety, succeeded by heat: hot accelerated laborious respiration; load and oppression at the breast; urgent, short, and painful cough; and very early in the disease more or less expectoration, streaked with blood; the pain is exasperated by inspiration and coughing, and mostly fixed, but sometimes veering or shifting: the pulse quick, full, hard, and tense, like a stretched chord; the blood drawn forms a buffy tenacious crust on the coagulum; the urine is of a florid colour: from the violence of pain, patients are often unable to lay on either side, but compelled to recline half-erect on their backs: when the inflammation is violent, or both pulmonick lobes assailed, there is inexpressible anxiety and struggle in respiration, florid countenance, prominent eyes; with other symptoms of obstructed circulation, and return of blood from the head, and menacing suffocation. In the advanced or dangerous stage of the disease, the pulse is weak, soft, and irregular. Sometimes there is nausea of the stomach; and sometimes delirium.
The termination of pulmonick inflammation is by resolution, by suppuration, by gangrene, by fatal effusion of blood, or exudation of coagulable lymph into the cellular texture. (Black 1788: 142, 144-145)

43The above excerpt includes major symptoms, such as fever, pain, shivering, restlessness, anxiety, heat, respiration, load, oppression, cough, expectoration, pulse, nausea, and delirium. However, they are neither simply listed, nor only presented to the reader in a broad, vague, or ambiguous manner. Most of them are pre- and/or post-modified by adjectives and participles specifying their nature: «darting pungent pain […] fixed […] shooting», «pain […] dull and obtuse», «hot accelerated laborious respiration», «urgent, short, and painful cough», «more or less expectoration, streaked with», «pain […] exasperated […] fixed […] veering and shifting», «pulse […] quick, full, hard, and tense», «inexpressible anxiety», «obstructed circulation […] return of blood […] menacing suffocation», «pulse […] weak, soft, and irregular». These phenomena emerge in time, and expressions such as «At the invasion there is» (starting point), «succeeded by» (second stage), «and very early in the disease» (third stage), «In the advanced or dangerous stage» (fourth stage), «The termination of pulmonick inflammation» (final stage) mark the process going on until a final stage, characterised by «resolution […] suppuration […] gangrene […] effusion of blood» etc., takes place. These textual and discourse markers also frame and announce bodily transformations, «the blood drawn forms a buffy tenacious crust on the coagulum», «the urine is of a florid colour», «florid countenance», «prominent eyes», necessarily modifying the patient’s habits and behaviour, «patients are often unable to lay on either side, but compelled to recline half-erect on their backs», «struggle in respiration», etc.

44The process is ultimately dramatised, the body becomes a stage where symptoms play their role: symptoms and bodily changes highlight the relevance of space, they emphasise the fact that the disease is located in the body, it moves from one site to another and eventually transforms the body as a whole, alongside its parts: «pain […] in some part of the chest, the side, breast, or back […] to the scapula and clavicle», «pain […] in the side, about the middle of the ribs, between the sternum and spine; and commonly confined to one lobe», «load and oppression at the breast», «both pulmonick lobes assailed», «blood from the head», «nausea of the stomach», etc. Symptoms become relevant according to the time when and the site(s) in which they emerge: in this context, symptomatological changes should help the reader recognise the disease itself, and draw a map of what, where, and when something happens. Symptomatological defining is here definitely embedded in a complex and multilayered frame, except for the last paragraph of the passage on favourable symptoms:

Favourable symptoms are, as in anginous excreation, facility in expectoration, without much exertion or coughing, copious, of due consistence, a little yellow, white, thick, slightly streaked with blood; the sooner this is concocted and excreted, the sooner is the crisis; less urgent and painful cough; freer breathing; abatement in the heat of the body and velocity of the pulse; general perspiration; deposition of sediment in the urine; nasal hemorrhage; dispersion of the pain, hitherto fixed in the thorax, about the shoulders, back, or arms; erysipelas in some external part; pustular eruption about the breast, neck, and scapulæ; abscesses in different parts. […]. (Black 1788: 145-146)

45In this case, symptomography is mainly characterised by a sequence of nominal groups: a more simple and direct structure. However, here as before in the text, clustering of sub-units of meaning is used to detail information. At a morpho-syntactic level, this is achieved by the embedding of prepositional phrases: «without much exertion or coughing», «of due consistence», «in the heat of the body», «of the pulse», «of sediment in the urine», «of the pain […] in the thorax», «about the shoulders», «in some external part», «about the breast», etc.

46The excerpts analysed in the following section will instead focus on the progression of the disease and the discourse markers structuring the changing situation and process. If some features of that have already been put forward in the previous example (especially time and space expressions), the ensuing excerpts will be essentially dealing with the network in which symptoms are embedded.

47*

48Symptomography: the progression of symptoms in medical records. This section focusses on symptomography as part of more complex medical expositions and commentaries. Symptomatological defining – the listing and clustering of individual symptoms – plays here a central role in the construction and in the communication of medical experience: symptoms are not simply used to identify and define single diseases. They are organised and discussed alongside their manifestation in real-life circumstances: their step-by-step progression, their changing nature, their impact on everyday life, on human feelings and sensations, on patients’ expectations and practitioners’ views. They are (re)contextualised within the frame of medical discourse – and as medical discourse – as a whole.

49For reasons of coherence, the extracts below treat some ‘diseases of the organs of respiration’, as previous examples do. This will help easier comparison among them, and make elaborate textual structures and discourse strategies emerge more directly.

50The first extract (example 8, -bis, -ter) is drawn from Millar’s Observations on the prevailing diseases in Great Britain (1770). The section devoted to «Pleurisy and Peripneumony» opens with an evaluative comment on previous records and discussions of the disease: the point is their excessive details, «affected precision […] minute divisions […] particular symptoms […] distinctions […] so minute or equivocal […] subdivisions», which seem to «perplex» the reader rather than «elucidate the subject» (Millar 1770: 15). Detailed lists – and clusters – of simultaneous and minute symptoms are typical of symptomatological defining or symptomography.

51On the contrary, Millar prefers an alternative approach. He highlights a different level of disciplinary – if not only personal – awareness in treating diseases, and in identifying their salient features, «the obvious, essential, and characteristic signs, […] common to all of them». According to him, more consistent methods of inclusion vs. exclusion in symptomatological defining would stimulate «a more accurate knowledge» and «a more successful method of cure»:

Example 8

CHAP. III.
Of the Pleurisy and Peripneumony.
sect.i.
Description of the Disease.
The love of novelty, or an affected precision, hath given rise to many minute divisions in treating of the pleurisy, which tend rather to perplex than elucidate the subject. Distinctions have been made according to the different parts affected; particular symptoms have been attributed to an inflammation of the pleura, the lungs, their membranes, the mediastinum, and the intercostal muscles: but if such distinctions really exist, the signs of them are either so minute or equivocal, as to elude the investigation of attentive observers; and it will, perhaps, lead to a more accurate knowledge of the disease, as well as a more successful method of cure, to lay aside these subdivisions, and to view carefully the obvious, essential, and characteristic signs, which are common to all of them. (Millar 1770: 15)

52This clearly represents a more specialised attitude in clinical observation and in the record of symptoms (as signs): reliability does not depend on long lists or clusters of indistinct – and decontextualised – items, but on their structuring function in the progression and development of the disease itself. Selection and contextualisation are the principles on which his approach is strictly based. Not all the perceived (patient) and observable (practitioner) symptoms are responsible for disease identification, control, and cure: not all of them may be considered as signs. Symptomography is integrated into an elaborate descriptive and informative record of the disease (example 8-bis). Symptoms are often preceded by explicit comments on their status, «constant attendant is a violent pain […] essential to the disease», and on their possible – but still essential – variants, «sometimes accompanied with a hard cough», «generally introduced with coldness and shuddering», «sometimes attended with more deceitful appearances». Moreover, before foregrounding the consistent symptoms of pleurisy, Millar establishes the real life circumstances – and shared experience – in which the disease may emerge:

Example 8-bis

When a person, after breathing in a close room, where the air has been much heated, or drinking warm liquors, imprudently exposes himself to the violence of a keen, cold air, he is sometimes seized suddenly with a pleurisy, or peripneumony. The constant attendant of this complaint is a violent pain in the back, sides, or breast, darting through the chest, or toward one or both shoulders. This symptom, which is essential to the disease, is sometimes accompanied with a hard cough, which the patient endeavours to suppress, because it increases the pain. It is generally introduced with coldness and shuddering, but sometimes the pain continues for some hours before the rigor is felt. The breathing is affected from the beginning, but becomes gradually more difficult in the progress of the disease. The pulse is quick, hard, and full; the face much flushed, the patient’s rest disturbed, and being unable to shift to either side, he is obliged to lie on his back, or to sit erect.
Unless proper remedies are speedily applied, these symptoms gradually increase. […]
But the disease is sometimes attended with more deceitful appearances; the violence of the symptoms is mitigated; and an inexperienced practitioner will be apt to pronounce his patient out of danger, when a very different termination is quickly to take place. (Millar 1770: 16-17)

53Major symptoms, «violent pain in the back, sides, or breast, darting through the chest, or toward one or both shoulders», «hard cough, which […] increases the pain», «coldness and shuddering», «breathing is affected […] difficult», «pulse is quick, hard, and full», «the face much flushed», «the patient’s rest disturbed», are structural to the disease and always present, «constant […] essential», but they may vary according to the ‘time when’ they unfold, «from the beginning […] becomes gradually […] gradually increase […] termination». The same symptoms are also defined according to the ‘place where’ they typically manifest themselves: the disease is mapped within the patient’s body, «back, sides, or breast […] chest […] shoulders […] pulse […] face», and the progression is defined according to a complex network of elements (symptoms-signs, time, space) which combine and interact at textual and discourse levels.

54Millar’s presentation and discussion of pleurisy and peripneumony concludes with a study case section, the experimental, empiric side of medical discourse. This section provides a concrete situation and offers the author the possibility to exemplify his professional experience («I» as professional eye-witness, professional gaze) as a practitioner:

Example 8-ter

CASE II.

In my early practice I was desired to visit a man of 60, who had laboured under a pleuritic fever for seven days, without being blooded, or taking any medicine. His pulse was hard, full, and quick; his breathing laborious, his breast violently pained, and he coughed almost incessantly. As the disease was too far advanced to be removed by the common methods, after bleeding and applying a blister, a tea-spoonful of the antimonial wine was prescribed every four hours. The first dose excited a gentle diaphoresis, which greatly alleviated the severity of the symptoms, and gave the patient so good an opinion of the medicine, that he greatly exceeded the quantity prescribed, and took no less than an ounce of the wine in twelve hours. It sweated, vomited, and purged. In the morning his pulse was soft and regular, he breathed easily, the pain vanished, and no complaint but weakness remained. (Millar 1770: 34)

55The same essential symptoms, «pulse […] hard, full, and quick», «breathing laborious», «breast violently pained», «coughed […] incessantly», introduced at the beginning are thus (re)contextualised in a narrative frame: symptomography/symptomatological defining adapts to new contexts of use and to different text types. It actually becomes a fundamental component in Millar’s medical discourse.

56The second extract (example 9, -bis) belongs to Fisher’s The practice of medicine made easy (1785), a work for quick reference and immediacy of use for the practitioner. The macro-structure of the work partially reflects the organisation of dictionaries and encyclopaedias: the micro-texts devoted to individual diseases are in alphabetical order and are similar to lexicographic entries or, rather, encyclopaedic entries. Under the headword-disease, a series of titled sub-sections follow, usually treating «Symptoms», «Unfavourable symptoms», «Regimen» (healthy lifestyle habits) and «Medicine» (cure).

57The headword «PLEURISY» – introduced by the equivalent expression inflammation of the pleura – exemplifies this usual and recurrent scheme. The entry opens by introducing the most typical symptoms and their progression in time: personal comments, or methodological hints, framing meta-discourse as in Millar’s (1770: 15 ff.) «The love of novelty, or an affected precision, hath given rise to […] Distinctions have been made according to […] When a person, after breathing in a close room […] In my early practice I was desired to visit», are omitted.

58Fisher goes immediately to the point highlighting the gradual appearance of symptoms and their development: «begins with cold […] succeeds heat […] thirst and restlessness […] after these […] a violent pain […] pain considerably increased by […] quick, hard, and full pulse […] high coloured urine, and a cough». He also highlights the changing nature of symptoms, their movement in space, «sometimes […] in one side […] in the other […] under the […] towards the […] sometimes lower», and time, «sometimes in the beginning […] and often», up to the most dangerous manifestations, appearances, and signs of the disease. It is at this stage that the unfavourable symptoms unfold, rapidly succeeding each other, and definitely leading to a «delirium»:

Example 9

INFLAMMATION OF THE PLEURA, OR PLEURISY.
Symptoms. The disease begins with cold, to which succeeds heat, thirst and restlessness, after these the patient perceives a violent pain in his throat or breast, sometimes in one side, sometimes in the other, sometimes under the sternum or breast-bone, sometimes towards the back or shoulders, but most frequently in the side about the sixth or seventh rib, yet sometimes lower. The pain is considerably increased by drawing in a full breath. There is a quick, hard and full pulse, high coloured urine, and a cough sometimes in the beginning of the disease dry, and without expectoration of matter various in thickness and colour, and often streaked with blood, and the blood when drawn from a vein is covered with a tough crust or buffy coat.
Unfavourable symptoms. The breathing very difficult, the cough very violent, without expectoration, sweats about the head and neck, a flushed face, an irregular pulse, and a delirium.
Regimen. […] (Fisher 1785: 125)

59If in the first section major symptoms are provided and contextualised in a descriptive and well-balanced text, with a few expansions introducing some symptomatological details, «sometimes […] but most frequently», «by drawing in», «dry, and without expectoration», «various in thickness and colour», «often streaked with», «covered with a tough crust», the paragraph on unfavourable symptoms is extremely concise, characterised by a more direct and essential approach which suggests clinical severity, and simulate its degenerating process in a sequence of juxtaposed noun and adjective phrases, separated by commas. Hence, symptomatological defining adapts to the changing needs of medical discourse and its textual organisation. The two sections are strictly related to each other: the first, setting the scene; the second, providing further developments. Later on, both of them converge into the last section, dealing with the method of cure:

Example 9-bis

Medicine. Bleeding largely is the principal remedy in this disease. It should be repeated according to the strength of the patient, and urgency of the symptoms. […] Bleeding is generally more requisite and advantageous during the first three days of the disease, but yet it is necessary at any period or time of the same, if the symptoms of a hard pulse, violent pain, and great difficulty of breathing, require it. When the pain abates, the pulse growth softer, the breathing freer, and the expectoration copious, bleeding should be no more repeated. To prevent the difficulty of passing urine […]. To promote expectoration […]. If the body be bound, a clyster of barely water […]. If the patient’s skin is very hot and dry […]. When the disease is far advanced, and the difficulty of breathing is abated, and yet the cough continues urgent with want of sleep, […]. When the disease is over, and the patient has recovered a little strength, his diet should still continue for some time to be light […]. (Fisher 1785: 126-128)

60This paragraph gives Fisher the opportunity to restate and reorganise major symptoms – and symptomatological defining – in a new textual and discursive frame. The perspective is one of recovery and prevention, in which remedies obviously depend on the «urgency of the symptoms», such as «symptoms of hard pulse, violent pain, and great difficulty of breathing», and their gradual decrease, «When the pain abates, the pulse growth softer, the breathing freer», etc. Symptomatological defining is thus used to re-elaborate and modulate the same symptoms in new circumstances. The same elements are recombined in a positive background.

3.3. Chapter summary

61The publication of medical handbooks and compendia noticeably increases in the second half of the eighteenth century. This fact testifies to a steady growth of interest in medical writing for an audience of experts and non-experts, and an expanding medical awareness both in society as a whole, and in emerging disciplinary communities of professionals. The prefaces to some of these reference works emphasise the expanding role of a practical, ‘experimental’ approach focussed on useful observation of medical facts, on faithful descriptions of diseases, and on the need to communicate medical experience among physicians and practitioners.

62This new interest influences the structure of reference works, the linguistic features, and the construction of medical discourse as a whole. Materials may be arranged in alphabetical order (ex. Fisher 1785) for quick reference, others are usually organised around groups of diseases sharing causes and essential characteristics. Definitions are commonly used to introduce the topic-disease, sometimes etymology is included with the same function. Descriptions and explanations focus on the main topic-disease, and usually include expository sections in which the observations are elaborated and generalised (passive voice, linking verbs, topicalisation, nominalisation, etc.). Situation-dependent circumstances – or, case studies – are also included to provide evidence of previous experience. These situation-bound texts usually display a high degree of personal involvement (ex. personal pronouns), and testify to the process of discovery through eye witnessing and decision-making (dynamic verbs, present or past tense, active voice, narrative text type, time and space markers).

Notes

1   According to Adamska-Sałaciak (2010: 393), there is a distinction to be made between translational-insertable (tr) and explanatory-descriptive (ex) equivalents (eqs). This distinction is not always clear-cut. The relationship between the two types is, instead, extremely complex: in general terms, tr eqs are directly insertable in a text, whereas ex eqs take the form of a short paraphrase, they are phrase-like (not overlapping with definitions, but sometimes similar to them). However, tr eqs themselves may be multi-word expressions and, at a certain extent, phrase-like (if they are not completely lexicalised in the target language): this means that nominal groups such as inflammation of the ear may be interpreted both ways (and, sometimes, also as definitions). The sequence is directly insertable in a text (and so behave as a single, independent lexical unit in the target language) but it is also phrase-like, since all its constituents may be moved independently according to their morpho-syntactic features and semantic load. In other words, the sequence may be also considered as an ex eq and thus modified: inflammation of the X, X of the ear, etc. Here, it has been interpreted as a single unit of meaning at a semantic level (being its extra-linguistic referent a specific entity) and a single lexical item, at a structural, morpho-syntactic level, since it is directly insertable in the text. For a thorough discussion on this topic see Adamska-Sałaciak (2010) and Zgusta (1971 and 1987).

2   Here, as in other contexts, the notion of translational and explanatory equivalence is fuzzy, since the explanatory equivalent (multi-word expression) may be directly insertable into the text, instead of the single-word denomination.

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