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Communicating Medicine

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Elisabetta Lonati

4. Case study: fever in dictionaries and handbooks

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1Fever is a term that pervades eighteenth-century medical texts and represents a very common and widespread medical experience in early and late modern times. This is one of the main reasons for fevers to be treated extensively by medical men trying to establish their causes and effects, describe their external manifestations (symptoms), and determine their typical signs (peculiar to each type of fever). The complexity and the variety of febrile experience, the multifarious environmental contexts in which fevers manifested themselves, the influence of climate and, not least, the partial overlapping with contagious and infectious diseases made it difficult to provide a clear-cut set of features and straightforward treatments. Observation and research were in progress, and medical writers documented all this in their effort to define, categorise, classify, predict, and prevent diseases, as well as to inform and instruct their readership. Besides medical handbooks and compendia, medical dictionaries and universal dictionaries of arts and sciences, fever is widely documented in contemporary dictionaries of the English language. Lexicographic evidence, alongside the extensive treatment of the term fever in specialised and general reference works thus testifies to the impact fevers had in civil society and in emerging disciplinary circles. The term carried with it a huge referential load of shared human and medical experience, pointing to scaring mass epidemics or isolated, more confined, episodes. It was difficult to interpret the term, because fever itself was a complex experience to delimit: a distemper (slight disease), a disease, a disorder (cfr. Lonati 2013: 107-109). Martin (1749), Johnson (1755), and Scott-Bailey (1755), the most relevant mid-century dictionaries, provided their definitions:

Martin (1749): Fe’VER (of febris, L. of ferveo to be hot) a distemper accompanied with great heat and thirst. [...]

Johnson (1755): Fe’VER. n.s. [fievre, French; febris, Latin] A disease in which the body is violently heated, and the pulse quickened, N° LIV. or in which heat and cold prevail by turns. It is sometimes continual, sometimes intermittent. […]

Scott-Bailey (1755): Fe’VER [febris, Lat. …] a disorder very differently defined by physicians: as, a strenous endeavour or effort of nature to throw off some morbific matter, that incommodes the body. Sydenham. A velocity of the blood; a fermentation or great motion of it, with heat [and] thirst. Quincy. A disease wherein the body is violently heated, and the pulse quickened, or in which heat and cold prevail by turns.
How much better is that definition which Boerhaave has given?
A swifter contraction of the heart than usual, joined with an encreased resistance at the capillaries, completes the idea of every acute fever. Boerhaave’s Aphorisms, 581. […]

2These definitions reveal the coexistence of traditional and innovative perspectives. On the one hand, fever is considered as a distemper-disease-disorder itself, with its own typical symptoms: violent heat and accelerated pulse. On the other hand, it is an effort (a strategy, a function, an effect) to eliminate «some morbific matter, that incommodes the body» (Scott-Bailey 1755).

3Fever had traditionally been considered as a disease characterised by an excessive bodily heat. However, the perspective changed in the first decades of the seventeenth century, with the publication of Harvey’s De motu cordis (1628). It is in this period that «heat came to be regarded more as an effect than a cause of fever» (Harrison 2010: 29). Sydenham (1624-1689) and his empirical attitude to medicine is another key point in approaching, describing, and curing fevers, since «he insisted that the only sound basis for knowledge was observation […] experiential, practical medicine» (Harrison 2010: 31), besides considering climate and environment two relevant key factors in spreading diseases.

4This interest in climate and environment is particularly widespread and developed in handbooks, and is based on practical experience in performing medicine. While treating fevers, for example, Grant and Clark emphasise both factors:

[…] I have endeavoured to describe the specific differences of fevers at different seasons of the year, and the different treatment required for the cure of diseases nominally the same; with some occasional observations on the fatal effects of the general practice of treating them indiscriminately. (Grant 1771: i-ii)
[…]
I shall then proceed to give an account of each of the common fevers, in a few words as possible, in the same order in which they succeed each other in the course of the year. (Grant 1771: xv)

or

After several years careful attention to the symptoms and nature of fevers, as they have occurred in different climates, I freely confess that I have never been able to follow authors through their numerous divisions and subdivisions. […] fever is essentially the same, or, in other words, consists only of one Genus; […]. (Clark 1780: 6)

5or, again, with the focus on combined environmental causes

To communicate what I know of this matter, I have divided all fevers into two classes: the first I call common fevers; because they happen regularly every year, and seem to be the natural production of this climate, and of the manner in which we have lived for at least twenty years. The second I call uncommon or pestilential fevers; because they are not the constant and natural production of our climate, but are either of foreign importation, or the necessary consequence of some extraordinary combination, and produced in a gaol or hospital, by bad water, bad provisions, or some other cause, co-operating with the climate, and usual manner of life. (Grant 1771: 426-427)

6The study of fevers was also disseminated in the colonies: many reports from surgeons and practitioners working abroad, in faraway countries, constituted a fundamental stimulus to an in-depth investigation of febrile manifestations in the mother country. These contributions led to a more detailed and systematic distinction among them. Causes and effects started to be separated and ascertained, and individual, accidental symptoms to be distinguished from essential symptoms, or signs. Fever itself was sometimes considered as a symptom, or sign, of some other disease.

7As a consequence, the term fever – and fevers as medical events – will be investigated in lexicographic works (universal dictionaries of arts and sciences and medical dictionaries), as well as in handbooks and compendia (practica) as a case study to make the lexicographic (and lexicological), textual and discourse features emerge (cfr. Ch. 0. § 0.2.)

8Fever represents – and carries with it in the imagination of eighteenth-century society – an appalling experience. It was, indeed, a widespread condition whose causes, more often than not, were difficult to discern: sometimes being just mild distempers, sometimes belonging to very dangerous contagious and infectious diseases.

9Fever is treated in each of the four dictionaries under scrutiny, notwithstanding the difference in extension (some are actually inflated entries) and complexity among them: in the MD the entry Pyretos covers forty in-folio pages, followed by RCy’s Fever (fourteen in-folio pages), the EB’s section «Of Fevers» s.v. Medicine (twenty-three in-quarto pages, 60-83), and the NMD’s Febris (two in-folio pages).

10Some extracts of the lexicographic entries are compared and commented on in the following sections to highlight the definitional practice, the encyclopeadic load (inclusion criteria, detailed information, sub-entries, etc.), the rhetorical and discourse strategies used by the compilers in the organisation of their (selected) contents.

11Fever is also treated as a general disease (of fevers in general) and as a specific disease (nervous fever, miliary fever, putrid fevers) in handbooks and compendia. The most interesting reference works on this topic are Millar’s (1770), Grant’s (1771 and 1775), Buchan’s (21772), Sims’s (1776), Clark’s (1780), Black’s (1788), and Wallis’s (1793). The introduction and the discussion on fever in handbooks, and the analysis on a selection of extracts are provided here below.

4.1. Establishing a unit of meaning: glossing, defining, and expanding Fever in the eb, rcy, md, and nmd

12The starting point is the headword and its form: the two general dictionaries of arts and sciences use the anglicised and more familiar version of the term, that is to say fever(s). The NMD chooses the Latin version febris, and the MD the latinised Greek version pyretos. The Latin and Greek forms are both followed by the English equivalent fever. The choice of the classical languages clearly suggests their specialised approach and audience, and the technical lexicalisation of this widespread medical event (variously defined as disease, disorder, affection, etc.).

  • 1   In his Dictionary (1755), Johnson defines affection as «7. State of the body, as acted upon by an (...)

13The EB discusses fever(s) in a section included s.v. Medicine, and follows Dr. Cullen’s subdivision of diseases as they appear in his Synopsis nosologia methodica (11769). The headword here functions as a caption. In the other dictionaries the term fever/febris is regularly found in its proper alphabetical order. All the entries open with a lexical definition: fever is said to be «a spasmodic affection» (EB), «a disease, or rather a class of diseases» (RCy), «a very frequent Disorder» (MD). Establishing the relationship fever~affection~disease~disorder means to conceptualise it as an independent entity, having the ‘status of’. Fever is essentially defined by genus-differentia categorisation (‘a kind of’ affection, disease, disorder). The NMD, instead, defines it as an event, a dynamic process, something happening to the body in time, «is when the natural heat of our bodies is converted into a fiery heat» (NMD). The emphasis is placed on time (process) and on space (the body), what can be observed, the external phenomenon (not the nature of it). This difference in defining the topic-headword implies a different conceptualisation of fever(s) and a different medical perspective. RCy and the MD have a more traditional approach, since they identify fever with a disease or disorder of its own: this may partly depend on their issue date, the MD in the 1740s, whereas RCy in the second half of the century, but as a partially updated version of Chambers’s Cyclopaedia (1728). Their definitions seem to reflect their more conventional medical perspective. The attention on fever, and the interpretation of it as an effect, a consequence of some other affection, disease, distemper, disorder, is definitely established only later in the century. This new conceptual focus emerges in the EB – «spasmodic affection»1 highlights a process, not necessarily a disease – and the NMD, which exploits a when-defining strategy. This apparently new perspective is the evidence of existing, but not yet mainstream, ideas. Things become clearer in each dictionary further on in the entries. Lexical definitions moderately expand to better contextualise the topic:

Of Fevers in general.
Hoffman defines a fever to be, «A spasmodic affection of the whole nervous and vascular system, annoying all the functions of the body, arising from any cause which has power to irritate the nervous parts to a more intense contraction; […]». (EB s.v. Medicine)

FEVER, Febris, in Medicine, a disease, or rather class of diseases, whose characteristic is a preternatural heat felt through the whole body, or, at least, the principal parts thereof, attended with other symptoms. (RCy s.v. Fever)

FEBRIS. A Fever. See the Articles Cathartica, Depuratoria, Miliaris, and Pyretos.
[…]
PYRETOS, πυρετός. A Fever.
A Fever is a very frequent Disorder, inseparably attended with an Inflammation, the Cause not only of many Diseases and Death, but, also, frequently of an happy and successful Cure. (MD s.v. Pyretos)
FEBRIS. A fever. A fever is when the natural heat of our bodies is converted into a fiery heat: or it is when the heat in the body is increased, the pulse is quickened beyond its natural speed, and some one or more of the functions are disordered. (NMD s.v. Febris)

14Once again, the EB and the NMD reveal their modernity – both being published in the Seventies – for the details they introduce: in this expansion, the EB considers fever as a consequence of «any cause which has the power to irritate the nervous parts». Studies on nerves and their irritability were lately carried out by Dr. Cullen, whose Synopsis is used as a basis for the classification of diseases in the article Medicine. The NMD just focusses on the characteristic signs of a fever and on functional physiological disorders. RCy, as above said, considers fever as a disease of its own and adds the general symptoms; whereas the MD goes even further, considering it as the cause of many diseases. These are traditional perspectives and, as regards the MD, in open contrast with the EB. These expanded definitions are followed by further expansions. These concise expansions are particularly interesting because, besides their contents, they highlight textual and discursive strategies, which can be found in the rest of their respective entries.

15The EB focusses on the physiological process, the observable phenomena stimulated by a fever, of any kind. The process is expressed in the present tense and framed within the structure «when […] and afterwards, when […] with rapidity […] till». Most of the verbs used are in the passive voice, except for «it operates, it drives […] vanishes», typical of not involved, more objective and focus-on-the-topic rhetorical strategies: «are increased […] are drove back […] constricted […] being relaxed […] are performed». Adverbial expressions concerning manner are reduced to a minimum and bound to the process explained: «with rapidity». What follows concludes the opening definition, which is a quotation attributed to Hoffman:

and when it [fever-spasmodic affection] operates, it drives the vital fluids from the outward parts to the heart and great vessels; and afterwards, when the systole of the heart and arteries are increased, they are drove back with rapidity and heat, through the constricted vessels, to the outward parts again, till the spasms being relaxed, the secretions are performed, and the fever vanishes. (EB s.v. Medicine)

16RCy has a completely different focus: Rees continues the entry providing alternative definitions, ascribed to Sydenham, Quincy, and ‘others’. The outline of the various kinds of fevers and their categorisation follows, according to their causes, duration, and symptoms. Different proposals for classification are attributed to different physicians. Verbs are mostly in the present tense and active voice. They simply ‘tell’-inform the reader of alternative approaches, strictly dependent to and identified with the physicians cited and their thoughts. The focus, thus, shifts from the topic fever to the physician-scholar, a kind of story-exposition of the disease by ensuing defining steps:

Sydenham defines a fever, a strenuous endeavour or effort of nature to throw off some morbific matter that greatly incommodes the body. Quincy defines it, an augmented velocity of the blood; others, a fermentation of the blood, accompanied with a quick pulse and excessive heat.
Fevers are of various kinds, denominated and distinguished from the particular causes that produce them; the time they continue; their accesses and returns; and their different symptoms.
Riverius reckons above thirty different kinds of fevers; and Sydenham has increased them to double that number; but certainly physicians have observed something common to all these diseases, which made them denominate fevers. […] (RCy s.v. Fever)

17Alternative definitions and perspectives are also introduced in Motherby’s NMD but, in this case, attribution is not included and the focus remains on fever. Expressions such as «It hath generally been said […] and this is said to be [….] but, this does not appear to be the case» help depersonalise the whole paragraph, emphasising conceptual abstraction and rhetorical-stylistic elaboration. The prose is neat and the verbs used are, more often than not, linking verbs plus complement, «is an effort […] is no other than […] is the surest and most rational», non-finite verbs, «to remove or expel […] to restore […] abating […] removing», or in the passive voice, «to be proved […] it was caused». The NMD also reiterates the idea that fever is just a symptom of another disease:

It hath generally been said that a fever is an effort of nature to remove or expel some morbific matter from the blood, and so to restore health, and this is said to be proved by eruptive fevers abating when eruptions appear on the skin; but this does not appear to be the case, for the fever is no other than a symptom, which increases and protracts the disease; and an immediate extinction of the fever, if possible, is the surest and most rational method of removing the disorder by which it was caused. (NMD s.v. Febris)

18The MD places instead its attention on the tricky nature of fevers and introduces a more evaluative and involved section, reflecting a complex flow of thoughts and complex situations to interpret and solve. Morpho-syntactic features reflect this complexity since they are characterised by many turns, prepositional phrases (particularly post-modifying units embedded one into the other), subordinate clauses, sometimes in initial position, such as «As the Nature of […] That such Errors may be avoided», and hypotactic and paratactic units, as well as digressions, within the same sentence. This syntactic structure slows reading down and makes it more difficult, since the text – and the message it carries – results in being less consistent, though ‘dense’ in ideational load. The appeal to cohesive and coherent elements is intermittent because of the changing focus of attention and the many secondary elements ‘scattered’ in it. Another interesting feature is the great amount of adverbial expressions of manner, emphasising the evaluative attitude and the more involved perspective in comparison with the preceding compilers. Thus, for example, expressions such as «an highly latent […] the more carefully to guard […] Errors are easily fallen into […] is generally attended […] duly discovered […] maturely weighed», are common:

As the Nature of this Disorder is of an highly latent and concealed Kind, so we ought the more carefully to guard against Mistakes and Errors in investigating it.
But, in a Research of this kind, Errors are easily fallen into, in consequence of the large Train of Symptoms, with which this Disorder is generally attended, and without which, however, there may still be a Fever.
That such Errors may be avoided, it is necessary, from among numberless Symptoms, to select those Phenomena alone, which always accompany every Fever; from the Presence of which Physicians know, that a Fever is present; and from the Absence of which they conclude, that a Person is free from a Fever.
Then, from the Symptoms and Phenomena, duly discovered, are maturely weighed, the particular Nature of the Fever is to be found out. (MD s.v. Pyretos)

19The text also reveals an argumentative nature, typical of debate: reasoning is disclosed, and logical passages are marked by junctions (coordination and subordination) and adverbials. These are as … so, but, in consequence of, and, however, then: from the general assumption, «as […] so», to the general consequence, «then».

20The in-depth encyclopaedic treatment, and the more technical and detailed exposition of fever(s), their classification, their signs and symptoms, their causes, their possible remedies, and their progress in time, are developed further on in the lexicographic entries (or monographic article for the EB). The next section will discuss (some of) these aspects as systematised in the four dictionaries.

4.2. Expanding medical contents s.v. Fever in the EB, RCY, MD, and NMD

21This section is devoted to the analysis of a selection of encyclopaedic contents included in the four dictionaries s.v. Fever(s), Febris, Pyretos. Particularly relevant – and always present – are the symptomatology (the symptom complex of fevers) and the categorisation of fevers. Both aspects, symptomatology and categorisation, are treated and displayed in the dictionary entries in various ways. As regards symptoms, sometimes they are treated in general terms, sometimes divisions and subdivisions are included according to the many kinds of fevers. The sections devoted to symptoms and categorisation provide an overview of the lexicographic techniques (and practice), and of the textual strategies – rhetorical and stylistic – used by the compilers.

4.2.1. Symptomography: listing, clustering, and recording symptoms

22The section on symptoms may be considered as an extension of definitional practices: actually, symptoms – also variously called signs or phenomena – help delimit the clinical manifestations of fevers and make them easily recognisable to the medical practitioners. This is the reason why most of these symptomatological sections follow the general definitions and concise expansions, which usually create the background for further information.

23Before introducing the symptoms (symptomography, or symptomatological defining), the EB cohesively repeats, with some variation, the initial definition as a general cause: the «formal or fundamental cause of a fever consists in the spasmodic affection of the whole nervous and fibrous genus», immediately followed by the «usual phænomena» (to be read, the usual symptoms) attending it. Most of the symptoms listed point out a physiological state, «a pain […] a coldness […] a livid colour […] a subsidence […] a livid countenance […] a sensation of» etc.; a more limited group, instead, highlights a physiological process going on, «a shivering, shaking, trembling […] a yawning; a stretching; […] a trembling and palpitating motion», all of them observable manifestations (phænomena and symptoms) of the fever, «spasmodic affection». These nominal groups, whose heads are nouns or nominalised verbs, may include further details: these are adverb phrases such as «more particularly about the loins» (pain), «especially of the extreme parts» (coldness) following the noun phrase, separated by a comma; whereas post-modifying prepositional phrases follow the head and are embedded within the noun phrase, such as «in the back», «of the nails», «of the vessels of the hands and feet», «of the heart», «of the præcordia», «of the blood about the heart», etc. This collection of symptoms, along with the accumulation and inflation of details by the use of adverb(ial) and prepositional phrases, makes the sequence conceptually dense, within a simple sentence structure: the only verb is «appears» in the main (and only) clause.

Of Fevers in general.
Hoffman defines a fever to be, […]
The formal or fundamental cause of a fever consists in the spasmodic affection of the whole nervous and fibrous genus. This plainly appears from the usual phænomena of a fever, viz. a pain in the back, more particularly about the loins; a coldness, especially of the extreme parts; a shivering, shaking, trembling; a livid colour of the nails; a subsidence of the vessels of the hands and feet; a shrunk, dry skin; a yawning; a stretching; a pale, livid countenance; a trembling and palpitating motion of the heart; an anxiety of the præcordia, difficult breathing, inquietude, restlessness; a sensation of an ebullition of the blood about the heart; a contracted, weak, small pulse; a nausea, and an inclination to vomit; a suppression of perspiration; costiveness, with thin watery urine. (EB s.v. Medicine: 60)

24This symptomatological definition – overlapping with the whole sentence-paragraph – is immediately followed by another section dealing with possible general causes of fevers: «Hence […] whatever has the power to irritate and solicit the nervous and vascular system to spasms» (cfr. below), can generate fevers. Once again, in this introductory sentence, cohesion is established lexically, by repeating (with variation) the key terms or multiword expressions already used: «the nervous and vascular system to spasms» (cfr. «spasmodic affection of the whole nervous and vascular system», opening definition; «spasmodic affection of the whole nervous and fibrous genus», first definitional repetition, above, previous paragraph). A detailed list of possible causes is provided with the same strategies used for listing symptoms: noun phrases, pre- or post-modified, such as «violent passions of the mind», «a poisonous, subtle, caustic matter», «a stoppage of perspiration», «a suppression of critical sweats; eruptions», etc. follow each other, as before. Some nominal groups are more complex than others, this happens when noun phrases embed non-finite clauses (or, reduced relative clauses, here in italics) to post-modify the head: «caustic matter, either bred within the body, or received by infection», «an abundance of purulent ulcerous matter adhering to various parts», and «corrupt and bilious crudities lodged in the primæ viæ». The overall effect is one of conceptual density reflecting a complex and ever changing physiological condition:

Hence it naturally follows, that whatever has a power to irritate and solicit the nervous and vascular system to spasms, is most likely to generate a fever. To this class belong violent passions of the mind, especially terror and anger; a poisonous, subtle, caustic matter, either bred within the body, or received by infection; a stoppage of perspiration; a suppression of critical sweats; eruptions driven back; an abundance of purulent ulcerous matter adhering to various parts; aliments too acrid and sharp; corrupt and bilious crudities lodged in the primæ viæ; excessive watching; a violent pain and tension of the nervous parts by sharp instruments; acrid and corrosive drugs; cold baths, and, on the contrary, those that are too hot or astringent. (EB s.v. Medicine: 60)

25RCy, similarly to the EB, repeats with variation one of the aspects already introduced in the expansion to the definition proper. The expansion includes some considerations on the denomination and distinction of fevers, based on «the particular causes that produce them» (RCy, s.v. Fever, cfr. § 4.1. above). Here, the focus shifts «on every fever from an internal cause» whose characteristic – and always present – three general symptoms are «trembling, […] heat and quick pulse». These «three chief observables» are framed into a temporal sequence, «first […] and then», and thus presented as a process. Further explanation of the process follows, expanding the key features of fevers and their manifestation, «cold or shivering […] pulse […] quicker». What happens – the narrative process – is highlighted by dynamic verbs in the present tense, «begins […] affords», or in the present participle, «growing». This section ends with an evaluative statement on the presumed function of fevers, «The health […] seems to be the primary aim of»:

FEVER, Febris, in Medicine, a disease, or rather class of diseases […].
In every fever from an internal cause, the three chief observables are these: first, an universal trembling, and then an increased heat and quick pulse: a fever almost always begins with a cold or shivering; and soon after, the pulse growing quicker, affords the primary diagnostic of a fever. The health of the patient seems to be the primary aim of nature in fevers, though they often terminate in death. […] (RCy s.v. Fever)

26The detailed symptomatological section comes further on in the entry and is titled as «Fevers, signs of»: this section may be further divided into sub-sections according to its contents and the way they are communicated to the reader (descriptive vs. narrative). It opens with a presentation and description of the most common signs, «accelerated progressive motion of the blood», «quickness of the pulse», «an increased heat in the body»: each of them is pre- and post-modified by prepositional phrases, mostly introduced by «of the», «by the», «in the», or reduced relative clauses, «of the blood, distinguished by», to create complex and dense units of meaning. The progression from one sign to the other is guaranteed by the use of anaphoric demonstratives, linking together in a sequence the different steps «signs of. These are […] quickness of the pulse; this is […] increased heat […] immediately after this the tonic motion of the parts […]. This is seen», and is definitely summarised by the expression «these symptoms are succeded by», introducing the long and more detailed list of symptoms, or symptomography:

Fevers, signs of. These are an accelerated progressive motion of the blood, distinguished by the quickness of the pulse; this is succeeded by an increased heat in the body, and immediately after this the tonic motion of the parts is either constringed or relaxed. This is seen in the face: in the first case, it becomes red and bloated; in the latter, thin and pale: these symptoms are succeeded by an immoderate thirst, and a loathing of food of all kinds; an absence of sleep; and a peevishness or uneasiness in the temper, with an extreme sensibility of every thing, and a neglect of the common business of life: after this there is a great loss of strength, and an inaptitude to any motion; a sensation of pain in some part; a very uneasy and difficult respiration; a sweating more than usual; and finally, there is a change in the urine, its colour being usually very high, and its consistence thicker than that of persons in health. (RCy s.v. Fever)

27Symptomatological defining (McConchie-Curzan 2011: 85-86) is here characterised by a series of noun phrases starting with «immoderate thirst» and closing with «in health», and is articulated into three phases: «these symptoms are succeeded», «after this there is», and «finally, there is», the temporal frame, delimiting the nominalised process is almost always present. Sometimes, these nominal groups are pre-modified, «immoderate thirst», «uneasy and difficult respiration», but, more often than not, they are post-modified by prepositional phrases, «loathing of food of all kinds, «absence of sleep», «uneasiness in the temper, with an extreme sensibility of every thing», «a neglect of the common business of life», or by non-finite clauses, «the urine, its colour being usually very high, and its consistence [ellipsis of the verb] thicker than». This section, as a whole, from «FEVERS» to «in health», is a descriptive one, characterised by the presence of linking verbs, «these are», «being», existential expressions, «there is», and the passive voice, «this is succeeded», «this is seen», «is constringed or relaxed». Its complexity, thus, is due to its ideational load and distributed in the many nominal groups syntactically embedded one into the other. The immediately following sub-section, instead, introduces a change in perspective, since the focus is now placed on what fever does and how the patient may react to it. The shift is from description to narration, from a general – and more abstract – listing of symptoms to an apparently more contextualised experience. The fever and the patient interact, «the fever comes […] the patient generally complains», the fever manifests itself gradually in different manners listed in a new sequence of symptoms from the patient’s perspective, «the patient generally complains […] languor, listlessness, soreness […] heaviness, loss of appetite, sickness». Here, as in previous sections and sub-sections, the text is organised by means of time expressions delimiting the process: from «When […] gradually», to «after some time», to close with «the fever attacks suddenly». The difference is one of emotional involvement in the action. It is first a gradual challenge for the patient, then a sudden attack to face, a kind of military combat against worse symptoms:

When the fever comes on gradually, the patient generally complains first of languor, listlessness, soreness of the flesh, or of the bones, as it is vulgarly expressed; heaviness of the head, loss of appetite, sickness, with clamminess of the mouth; after some time there succeed excessive heat, violent thirst, inability to sleep, &c. When the fever attacks suddenly, it always begins with an uneasy sensation of excessive cold, accompanied with debility and loss of appetite; the cold is frequently attended with shivering, oppression about the heart, and sickness of stomach, or vomiting. Buchan. (RCy s.v. Fever)

28Most of the verbs used are dynamic ones, and in the present tense to highlight immediacy and action «comes […] complains […] there succeed […] attacks […] begins». A similar approach is exploited further on in the entry, in the section titled «Fevers, method of cure in». Once again, the patient’s perspective seems to be the organising principle of this narrative-descriptive paragraph. However, instead of just listing symptoms and possible remedies, both of them are displayed with further, contextualising explanations. This is the case with heaviness, «this symptom evinces the propriety of keeping him [the patient] easy, […] in bed»; in bed, «lying in bed relaxes the spasms, abates the violence of […] gives nature an opportunity […]. The bed alone has often removed»; food, «should be light, and easy of digestion […] given in small quantities […] of the vegetable kind, as panada, roasted apples, gruel, and such like». These explanatory sequences also make an evaluative attitude emerge, modulating meaning in various ways (asides, lexical choice, adverbs, modal verbs): «if possible», «gives nature an opportunity», «the bed alone has often removed», «should be light», «ought chiefly to be». The record of the individual patient’s experience, essentially expressed in the present tense – «complains […] evinces […] relaxes […] abates […] gives», though not situation-dependent – helps the general reader to perceive it as a shared experience, close to everyday life:

Fevers, method of cure in. At the beginning of a fever, the patient generally complains of great lassitude or heaviness; and this symptom evinces the propriety of keeping him easy, and, if possible, in bed: lying in bed relaxes the spasms, abates the violence of the circulation, and gives nature an opportunity of exerting all her force to overcome the disease. The bed alone has often removed an incipient fever. The food of the patient in a fever should be light, and easy of digestion, and given in small quantities: it ought chiefly to be of the vegetable kind, as panada, roasted apples, gruel, and such like. […] Buchan’s Med. chap. 13. (RCy s.v. Fever)

29Small portions of texts thus reveal a great discourse complexity and a multilayered textual organisation, both of them reflecting the complexity – and the difficulty – of treating fevers in the real world. Furthermore, ascription to a well-known author and work of the period (Buchan’s Domestic medicine, 21772, Ch. XIII, titled Of Fevers in general) adds (declared) intertextuality to intra-textual (sometimes cross-referred) medical discourse.

30This is the state-of-the-art for the entry fever in the two universal dictionaries of arts and sciences (EB and RCy), whereas the two medical dictionaries organise their contents differently, according to their target readership and general aims.

31James’s MD, as previously said, includes a very long entry and symptomography covers more than just one section. Symptoms are disseminated throughout the entry when describing different kinds of fevers, their development, and their cures or remedies. However, there are many sections completely devoted to the systematic treatment of symptoms. They first appear organised in a list and labelled as «usual» in «an acute Fever»:

FEBRIS. A Fever. See the Articles Cathartica, Depuratoria, Miliaris, and Pyretos.
[…]
PYRETOS, πυρετός. A Fever.
[…]
The usual Symptoms, accompanying an acute Fever, are, Cold, Tremors, Anxiety, Thirst, Nausea, Eructations, Vomiting, Weakness, Heat, Exestuation, Dryness, Delirium, Coma, Watchings, Convulsions, Sweats, Diarrhœas, and inflammatory Pustules. (MD s.v. Pyretos)

32This general list is followed by an explanatory section and some evaluative comments, «it must be remarked», «always having due Regard to» on their meaning and treatment. Here, as at the very start of the entry, «a Fever is a very frequent Disorder, […] the Cause not only of many Diseases», fever is considered the cause of (all) these symptoms «arising from, and caused by the Fever». This denotes a traditional outlook on the phenomenon if compared to the EB and the NMD (both issued in the 1770s, and considering fevers as a manifestation, an effect, symptoms themselves among others, of many diseases). However, some hints of a changing perspective may be recognised in the expression «Regard to the Cause and State of the original Distemper», closing the paragraph. This seems to suggest other possible causes than the fever itself. In any case, the discourse is rich in alternative hypotheses, even in a few lines. The complexity of reasoning is unfolded by post-modification, symptoms «arising from, and caused by», remedies «adapted to»; and subordination, «when that is removed», «provided they», «remarked that these», «which can», «if any of these»:

All these Symptoms arising from, and caused by the Fever, cease spontaneously, when that is removed: For this Reason, they require no particular Method of Cure, provided they can be supported without endangering Life, till the Termination of the Fever.
But it must be remarked, that these Symptoms frequently arise from an Attempt of the vital Powers to form a Crisis, and expel the critical Matter; and then they precede, accompany, and follow the Crisis; in which Cases, nothing must be done to moderate them, which can in any Degree interfere with the salutary Work carrying on.
But if any of these Symptoms are unseasonable, or too severe to be supported without the Hazard of Life; if so troublesome, as to render the Patient insupportably uneasy; or if there is Danger of their producing some more formidable Disorder; in such Cases they must be mitigated by Remedies adapted to them; always having due Regard to the Cause and State of the original Distemper. (MD s.v. Pyretos)

33At the end of this general introduction, the MD has specific sections on each of the symptoms previously listed. These sections are titled and subdivided into clustered sub-sections concerning remedies, prognostics in acute diseases, or in the parts of the body, etc. Each of them includes detailed contents, ascriptions, and quotations to highlight the complexity of medical reality and medical issues, according to alternative perspectives and approaches. Once again, the discourse tends to be exhaustive and scholarly, carrying a dense informational load, framed in a complex morpho-syntactic and textual structure. What follows are the opening paragraphs of the first symptom:

Febrile Symptoms; and first of
Febrile Cold
Cold, in the Beginning of Acute Fevers, arises from a decreased Attrition of the Liquids with each other, and with their respective Vessels; a Diminution of the circulatory Motion; a Stagnation of the Liquids at the Extremities of the Vessels; a diminished Contraction of the Heart, and only a partial Evacuation of its Ventricles; and a less copious Influx of the Spirits conveyed from the Cerebellum.
This Cold, if of long Duration, causes polypose Concretions in the larger Vessels near the Heart; and in the small Vessels an Evacuation of the Fluids […]; and in both these Cases many and severe Disorders are excited. (MD s.v. Pyretos)

34The strategy is always the same: accumulation of causes of the symptom itself, «Attrition […] Diminution […] Stagnation […] Contraction […] Evacuation […] Influx», all of them pre- and post-modified; and circumstances, «in the beginning», «if of long duration», «in both these cases».

35Of the four dictionaries, the NMD is the most concise one. The section introducing symptoms is very short and focusses on the most general ones, always present: «heat and a disordered pulse». Interestingly, Motherby uses the term sign(s), that is what is actually an objective signal of a fever and belongs to it, and not the term symptom(s), which mainly represents many possible manifestations according to the patient(s) and changing circumstances. The linguistic choice thus lexicalises – and institutionalises – a conceptual difference: that is to say, what belongs to the personal and environmental perception («symptomatical»), and what, instead, strictly belongs to the nature of an affection, a disorder, distemper, disease («pathognomonic signs»). This is the kind of selection – and selective attitude – discussed by Motherby in his preface: a selection of contents and a selection concerning the way these contents are included, presented, and treated.

FEBRIS. A fever. A fever is when the natural heat of our bodies […].
All fevers are symptomatical. And perhaps it is but the truth to assert, that all fevers are but every fever differently circumstanced; or, that fever is one and the same disorder; but appearing differently, according to the various circumstances that it meets with in different constitutions. [...]
As to the diagnostics of fevers, they vary for the most part of them, in different patients, and in the same patient at different times; [...]. However, it is sufficient to know that the pathognomonic signs of a fever, that is, those signs that are present in every fever, and without which a fever cannot subsist, are heat, and a disordered pulse; these attend every fever, every degree, and every stage of it; and from these marks alone do we judge of the presence or absence of this disorder.
[...]
Every fever is a symptom of some disease, either manifest or latent; and as the secretions are diluted more as this symptom increases, the immediate suppression of it will at once appear the necessary aim. […] (NMD s.v. Febris)

36The section on symptoms, as compared with the preceding dictionaries, concludes by repeating that a fever is just a symptom of some other disease, and not a disease itself. This statement emphasises, once again, the innovative perspective of Motherby’s dictionary. It reflects the claims and achievements of contemporary medical thought. Some other details on febrile symptoms are included later on in the entry, when Motherby introduces some remedies and cures to specific manifestations of fevers. Hence, for example, «Longings. […] should be moderately gratified», «Hæmorrhage at the nose» should never be stopped, «Delirium» may need bleeding or cataplasms, «Hiccup» is a danger and should be cured by «julep, large doses of milk, and gentle cordial opiates», «Night sweats» are easily relieved by «a light but nourishing diet, moderate exercise in the air, […] infusion of the bark», etc. Each symptom has thus its specific remedy.

4.2.2. Systematising fever(s)

37The four dictionaries also include taxonomic sections on the different kinds of fevers, according to different degrees of detail and/or conciseness. The EB adopts and introduces Dr. Cullen’s classification, and continues with Hoffman’s explanation:

The doctor [Cullen] divides diseases into the four following classes, viz.
Class. I. Pyrexiæ, or Feverish Disorders.
[…]

The first class (Pyrexiæ) is subdivided into two sections. viz. I. Intermittent; and, 2. Continued fevers.—The first section contains three genera, viz. I. The Tertian fever; 2. The Quartan; 3. The Quotidian: —The second section likewise contains three genera, viz. I. The Synocha; 2. The Typhus; 3. The Synochus.
[…]
Of Fevers in general.
Hoffman defines a fever to be […]
According to the different nature of these causes, and the various manner [sic] of affecting the nerves, arise fevers of divers kinds. Some are benign, other malignant; some are intermitting, others continual; some are simple, others compound; others regular or anomalous; eruptive, spotted, putrid, hectic, or slow. Some admit of an easy cure, others difficult; some soon terminate, others are protracted a long time; and many hurry the patient suddenly out of the world.
[…] (EB s.v. Medicine)

38Fevers are an effect of a nervous internal cause whose external signs determine its clinical severity: a sense of urgency emerges from the accumulation of contrasting situations, «intermitting […] continual», «easy cure […] difficult», «soon terminate […] are protracted a long time», and typologies, «benign […] malignant», «simple […] compound», «regular […] anomalous», «eruptive, spotted, putrid, hectic […] slow». This sense of urgency and dramatic development of certain dangerous fevers is definitely conceptualised and lexicalised as «hurry […] suddenly out of the world», in the passage closing the paragraph. The move involves a shift from an informational sequence of linguistically neutral elements to an emotionally involved metaphorical passage. Here, the reader identifies with «the patient suddenly [hurried] out of the world». This introductory paragraph is systematically followed by titled sub-sections on the diversity of fevers which cover much of the treatise (pp. 60-83): «Intermitting Fevers, or Agues […] Catarrhal Fever […] Semitertian Fever […] Nervous Fever […] Epidemic, Catarrhal, Eruptive Fevers […] Malignant, Goal, and Spotted Fevers […] Pestilential Fever […] Miliary Fever […] Scarlet Fever […] Measles […] Small-Pox […] Erysipelas, or St Anthony’s Fire […] Synochus, or Continual Fever […] Bilious Fever […] Causus, or Burning Fever […] Burning Bilious Fever, or Yellow Fever of the West Indies […] Senegal Fever».

39RCy distinguishes fevers into two main categories – «essential and symptomatic» – according to their possible causes. This background section is extremely concise, starting from two moderately expanded definitions and closing with a list of ‘symptomatic fevers’:

FEVER, Febris, in Medicine, a disease, or rather class of diseases
[…]
The most general and genuine division of fevers is into essential and symptomatic.
Fever, essential, is that whose primary cause is in the blood itself, and which does not arise as an effect or symptom from any other disease in the solids or other parts.
This is what we absolutely and properly call a fever.
Fever, symptomatic, is that which arises as an accident or symptom of some other antecedent disorder; as an inflammation, phlegmon, erysipelas, imposthume, small-pox, pleurisy, &c.
Whence it is peculiarly denominated inflammatory, erysipelatous, purulent, variolous, or pleuritic fever. (RCy s.v. Fever)

40Essential and symptomatic fevers are treated separately under specific sub-headwords such as «Fever, essential […] symptomatic […] continual […] non putrid, continual […] continual putrid […] ardent or inflammatory […] bilious […] benign catarrhal […] malignant catarrhal […] choleric […] colliquative […] epidemic […] eruptive […] goal […] hectic […] inflammatory […] intermitting» etc. Some of these sub-hedwords just cross-refer to other headwords, others are structured as any other entries, starting from a general definition and expanding contents with further explanations.

41As regards the MD, the section – or, sub-sections – concerning the categorisation of fevers and their individual treatment is (significantly) concise for James’s standards of expansion and detail of inclusion. Apparently, only three (macro) typologies are identified, titled and discussed: «Continual Fever […] Causus, or Ardent Fever […] Intermittent Fevers». However, each of them includes sub-categories – or, sub-species – as run-ons:

PYRETOS, πυρετός. A Fever.
A Fever is […].
A Continual Fever. The most simple of continual Fevers, is an Ephemera, or Diary Fever, which goes through the different Stages, as the Beginning, Increase, State, and Declension, in the space of twenty-four Hours. It arises from […]. If this species of Fever continues many Days, it is called A continual but not putrid Fever. The Causes, Signs, and Cures […].
That species of Fever, which is called a putrid Synochus, arises from […]. This Fever is distinguished by the Name Homotonos, when it preserves […]: When it perpetually increases, it is called Epacmastica, or Anabatica: But when it continues to decline […] Paracmastica.
A causus, or Ardent Fever. Among these Fevers, we may just reckon the Causus, or burning Fever, on account of its Frequency, Danger, and Difficulty to Cure. The primary Symptoms […].
Intermittent Fevers. We have already given the Definition of an intermittent Fever, the Diagnostics of which are obvious, and its Distinction in various Classes easy, since these depend only on the Difference of Time. But ’tis to be observed, that intermittent Fevers, in general, are either vernal, […]; or autumnal […]; which Distinction is necessary on account of the various Conditions, Symptoms, Terminations, Durations, and Cures of different Intermittents: Besides, one intermittent Fever sometimes removes another. […] (MD s.v. Pyretos)

42The sub-section on intermittent fevers is the longest and most articulated one; however, all of them share a common structure (definition and expansions: emerging symptoms, progress, cure). The organisation of discourse reflects James’s all-inclusive attitude in order to be as exhaustive as possible: that is to say, to add information in his texts, to disseminate and cluster details, and to hypothesise different situations.

43The NMD is very concise in the categorisation of fevers, summarising what previous «writers» – as Motherby calls them – «have enumerated». Fevers are then reduced to three main groups, ardent, nervous, and putrid. The principal differences among them regard either their nature and signs, «blood is redundant […] the heat […] increased […] the lymph is disordered […] defect of the natural heat», or their progress, «symptoms proceed with rapidity […] symptoms proceed more slowly»:

FEBRIS. A fever. A fever is […].
[…]
Various are the divisions and subdivisions of fevers which different writers have enumerated, but they may be included in those of the ardent, nervous, and putrid; at least every acute fever is best managed by the methods required in one or other of the just named three kinds.
In ardent fevers the red blood is redundant, and the heat of the body increased beyond the medium of health. In the nervous kind, the lymph is disordered; and in the putrid sort, there is such a defect of the natural heat, as admits of a putrid quality taking place, and increasing in the blood.
An acute fever is when the pathognomonic symptoms proceed with rapidity, and danger to the patient. When these symptoms proceed more slowly, and with less danger, the fever is said to be chronical. (NMD s.v. Febris)

44Nothing else is said in the entry about the classification of fevers. However, Motherby includes different fevers under specific headwords, to facilitate the finding of the term and the consultation of the entry ‘in haste’: that is to say, to facilitate distinction and selection, and to be to the point according to the practitioner’s immediate need(s). All erudition is avoided.

4.3. Framing Fever in eighteenth-century handbooks: basic patterns, elaborate descriptions, and discursive issues

45The objective of this section is the analysis and discussion of fever as treated and represented in medical handbooks. The topic is a relevant one in this kind of reference works. Some of them are completely devoted to it, such as Grant’s An enquiry into the nature, rise, and progress of the fevers most common in London (1771), and Clark’s Observations on fevers, especially those of the continued type; and the scarlet fever (1780). Some others include fever as one of the main affections of the period and, as such, one of the main topics of interest and description for the professionals and the lay readers. This is the case with Millar’s Observations on the prevailing diseases in Great Britain (1770), Buchan’s Domestic medicine: or, a treatise on the prevention and cure of diseases by regimen and simple medicines (21772), Sims’s Observations on epidemical disorders, with remarks on nervous and malignant fevers (1776), Black’s Comparative view of the mortality of the human species (1788), and Wallis’s The art of preventing diseases, and restoring health, founded on rational principles, and adapted to persons of every capacity (1793). All of them introduce fever in general terms and distinguish between manifestations common to every kind of fever, and specific symptoms belonging to specific fevers. The classification of fevers according to the genus-differentia pattern is a recurrent feature, and also reflects the structure of their works. Usually, the introductory sections provide general issues on any fevers, whereas sub-sections are devoted to particular fevers, their causes and manifestations. The similarities among fevers are organised in a symptomatological defining pattern. Symptomography is thus the main strategy to collect symptoms under the general denomination fever. The following extracts, taken from Clark (1780) and Black (1788), exemplify the approach:

PART I. OBSERVATIONS ON FEVERS, &c. SECT. I. Character of Fevers. FEVERS are known by beginning with chilness or shivering, succeeded by frequency of pulse, preternatural heat, and weakness of voluntary motion, without deriving their origin from Local Inflammation, Specific Eruptions, or other primary diseases which produce symptomatic fever.
[…]
When fevers are once confirmed, a very numerous train of symptoms arise: the nervous system is in general disordered, and all the functions of the body perverted: The mind is often affected with delirium: Want of appetite, thirst and inquietude generally prevail; and the salutary secretions and excretions cease to be regular. (Clark 1780: 3, 5)

and

We shall first trace the prominent features of the general febrile Class, descending progressively through the different Orders and Genera. In most fevers, of whatsoever genus, one or more of the following symptoms occur: shivering, chilliness, and heat of the skin alternating: the circulation of the blood, and consequently of the pulse, as felt at the wrist, accelerated more than in the natural state; […] also general languor, lassitude and debility of the nerves and muscles; dryness of the mouth and tongue, thirst; little or no sleep, or disturbed and not refreshing, and generally headach: in most of the continued and remittent fevers, there is total suspension of appetite, sickness at the stomach, nausea and vomiting; increased heat of the skin, at least burning sensation; aversion to motion; the sick are mostly confined to bed, unable to walk, or frequently even to sit erect; and this is commonly the case, even in the intermittent genera during the febrile paroxysm: the remittent and continued have usually an evening or nocturnal febrile exacerbation: the voice and countenance frequently express condolence: and in the genera of topical inflammations, there is fixed pain in the different parts affected. (Black 1788: 77-78)

46In the first example, Clark frames symptoms within a process developing in time, «by beginning with […] succeeded by», and highlights similarities by the use of adjectives and adverbs, «When fevers are once confirmed […] in general disordered […] often affected […] generally prevail […] cease to be regular». The number of symptoms is limited to the most relevant ones, and the most widespread. In the second extract, Black takes a partially different approach to «trace the prominent features of the general febrile Class». The context and the structure is still one of symptomatological defining, but the number of symptoms increases, and they are mainly provided as a list, «shivering, chilliness, and heat of the skin alternating», «the circulation of the blood […] accelerated», «general languor, lassitude and debility of the nerves and muscles», «dryness of the mouth and tongue, thirst»; generalisation is provided by the use of adjectives and adverbs, «whatsoever […] general […] total» and «progressively […] consequently […] generally […] at least […] mostly […] frequently […] commonly […] usually»; elaboration of ideas and a more abstract perspective, that is to say detachment from situation-dependent events placed in time and space, are signalled by the abundant use of nominalisations, «circulation of […] debility of […] dryness of […] suspension of […] sickness at […] aversion to»; and non-finite verbs, «descending […] alternating […] accelerated […] disturbed and not refreshing […] increased».

47Notions concerning the general issues on fevers may also be found in concluding sections, such as in Grant (1771). In his Recapitulation, the author sums up the general features discussed in previous chapters, thus providing the reader with further hints on the topic:

All fevers are, for some days, preceded by several little complaints, […]. These are succeeded by a degree of rigour, which is the beginning of the stated fever, and marks the first day of it in the journal. The quick pulse, dry mouth, hot skin, and other febrile symptoms follow: these increase gradually for some days, and at length get into a regular train; so that something of the same sort happens every day nearly at the same hour, for some days, without any sensible alteration.
[…]
Every fever may be divided into the following periods: the harbingers, the beginning, the increase, the state, the decline, and the consequence; and each of these may have different degrees, both of violence and duration, according to the nature of the fever; for each species of fever has a nature peculiar to itself, in consequence of which, it goes through its periods with greater or less velocity than others: it is therefore necessary to acquire a particular knowledge of each species, so as to distinguish the fever in question from all others, and to determine the duration of its periods. (Grant 1771: 425-426)

48Grant reduces the main symptoms of «All fevers» and «Every fever» to a concise list: «quick pulse, dry mouth, hot skin, and other febrile symptoms». His attention is instead focussed on the evolution and the manifestations of these symptoms: the process is emphasised by the use of verbs, «preceded by […] succeeded by», and adverbial expressions «for some days […] the first day […] gradually […] at length […] every day nearly at the same hour […] for some days» etc. The passing of time thus becomes the criterion to identify different states shared by every fever, independent of its nature and cause, «the harbingers, the beginning, the increase, the state, the decline, and the consequence»: symptoms are only relevant if considered in this context.

49Another interesting, and worth quoting, introduction to fevers belongs to Wallis (1793). Under the heading «Febrile Affections in general», the main symptoms recur, «pulse […] heat […] chillness […] languor […] lassitude […] weakness», in a very concise pattern:

CHAP. I. Febrile Affections in general. All those are so considered where there is an alteration respecting the pulse and the heat; for the most part, an increased quickness of the former, and the latter augmented in some degree;—many of the functions of the machine injured—particularly the strength of the limbs diminished; attended with chillness, languor, lassitude, and other marks of weakness, without any local primary disease.
Under this head is comprehended all the fevers, of whatever nature, by which the human frame is afflicted; but, as they put on different appearances, they are divided under distinct heads, according to these appearances, as

  • Continued, or continent.

  • Remittent,

  • Intermittent,

  • Hectic, and

  • Eruptive.

(Wallis 1793: 315-316)

50However, since these general symptoms assume «many different appearances», Wallis distinguishes five sub-categories of fevers, according to their external manifestations, and their degree of severity. The same organising and categorising principles, based on the relationship genus~differentia, or general~particular, or superordinate~hyponym, is repeated in subsequent sections, that is to say for the classification of continued, remittent, intermittent, etc. fevers.

51The classification of fevers is also present in other medical writings, but it is not identical across handbooks. The criteria used may overlap, particularly when expressing the need to identify similarities and distinguish differences, but the aspect to be highlighted for distinction may vary: symptoms (external manifestations or appearances), causes (inflammation, infection, contagion, other diseases), process (remittent, intermittent), severity (malignant, putrid, etc.). However, what generally emerges in all of them is the need to be clear and essential, and avoid useless sub-divisions and excessive variety in the denotation and description of febrile affections. Millar (1770) and Clark (1780) are determined in expressing this:

The division of fevers hath been so widely extended, and so many minute differences established, that if the knowledge of these distinctions are really necessary, in order to their being successfully treated, it is in vain to pretend that any physician on earth can ever be duly qualified to undertake the cure of them. The very names by which they have been distinguished afford a subject for laborious study, and the multiplicity of minute circumstances, on which they are founded, is too intricate to be unraveled by the most unwearied and attentive observation. But if they are the offspring of fancy and invention, and not of an accurate attention to the progress of nature, it is highly expedient that they should be for ever discarded from the records of physic. (Millar 1770: 128)

and

SECT. II. Of the Differences of Fevers. Fevers have been divided into many genera, and various appellations have been given to them both by the ancients and moderns, derived from the time of their duration; from some remarkable predominant symptom; from the state of the fluids; and from other circumstances*. But, unfortunately, the many names to be found amongst Authors, not only load the memory, perplex the unexperienced, but answer no real advantage in practice.
After several years careful attention to the symptoms and nature of fevers, as they have occurred in different climates, I freely confess that I have never been able to follow authors through their numerous divisions and subdivisions. […] fever is essentially the same, or, in other words, consists only of one Genus; and that the only species which can be well ascertained, are the following, viz. Intermittent, Remittent, and Continued Fevers. (Clark 1780: 5-6)

52If handbooks are meant for practical usage, then useless subdivisions and the multiplication of perplexing names are to be avoided, or deleted: «minute differences […] minute circumstances» (Millar), «many genera […] numerous divisions and subdivisions» (Clark), «the very names» (Millar), «various appellations […] the many names […] load the memory, perplex the unexperienced, […] no real advantage» (Clark).

53In the following sections, some extracts on general and particular fevers are analysed in detail. The main pattern selected by authors to organise contents, and the main linguistic and textual features adopted by them, are highlighted and discussed.

4.3.1. Lexical definition: categorisation and shared knowledge

54The first series of examples drawn from medical handbooks emphasises at least one major definition pattern, that is to say, the definition per genus et differentiam. In examples 1 and 2 the structure and the categorising function of this pattern at both lexical and content levels are highlighted:

Example 1

Chap. Xiii. Of fevers in general.
A fever is the most general disease incident to mankind. It attacks every age, sex, and constitution, and affects every part of the body; nor is the mind itself free from its influence. A fever is known by a quick pulse, an increased heat, a general debility, and a difficulty in performing some of the vital or animal functions, as breathing, walking, &c.
Fevers are divided into continual, remitting, and intermitting. By a continual fever is meant that which never leaves the patient […]. A remitting fever differs from a continual only in degree. […] Intermitting fevers, or agues, are those which, during the time that the patient may be said to be ill, have evident intervals or remissions of the symptoms. (Buchan 21772: 174-175)

Example 2

Nervous Fever.
This is so named, because the nervous system appears to be the part most affected. It differs from the inflammatory fever in the part of the constitution attacked, and occurs in such as are dissimilar. Here the nervous system is defective, attended with little or no intenseness of vascular motion; the fluids are also poor and thin, and the nerves extremely incitable. This is also called the slow fever, because it is slow in its progress compared with other fevers, particularly the foregoing. (Wallis 1793: 335-336)

  • 2   In this quotation and in the following ones, italics highlights the expressions which introduce s (...)

55In example 1, the term fever is firstly defined as a ‘kind of’ disease (genus), that is the sense relation of hyponymy with the term disease is thus established. However, this is not simply a lexical definition, since it points at the real world of experience: stating that fever is a disease means to categorise medical knowledge. The second paragraph opens with the same sense relation of hyponymy, this time between «Fevers» (superordinate) and «continual, remitting, and intermitting» as hyponyms: once more, the usage of lexical definitions as a starting point to categorise extra-linguistic encyclopaedic knowledge operates. At a lexical level the genus-differentia pattern is obviously condensed in pre-modification, the genus being represented by the head fevers, the differentia by the pre-modifiers continual, remitting, and intermitting. However, the difference is not only performed along the vertical axis, that is to say between fever and ‘kind of’ fevers: «Fevers are divided into continual, remitting, and intermitting», but also between co-hyponyms along the horizontal one (‘kind of’ fever 1 vs. ‘kind of’ fever 2). In this case, individual co-hyponym~co-disease features alternate with co-hyponym~co-disease difference(s), as in «a continual fever is meant»2, «intermitting fevers […] are» vs. «a remitting fever differs from a continual only in degree». The same compare-contrast structure is also exploited in example 2, describing and discussing the nervous fever: the focus here is on co-hyponym~co-disease difference(s), introduced by the expressions «It differs from […] and occurs in such as are dissimilar». To identify the characteristic features of a nervous fever, the reader must primarily infer ‘what nervous fever is not’. In both examples, 1 and 2, the ‘kind of’ fevers discussed are also identified by what they do as a ‘real disease’ in the real world of experience: dynamic verbs are emphasised in «it attacks […] and affects» (example 1) and «constitution attacked […] occurs» (example 2). A concise description enumerating the most relevant symptoms (example 1) or delineating the general condition (example 2) – but not overlapping with symptomography (cfr. § 0.2.1.) – follows: «a quick pulse, an increased heat, a general debility, a difficulty in […]» (example 1) and «the nervous system is defective, […] little or no intenseness of vascular motion; the fluids are also poor and thin, and the nerves extremely incitable» (example 2), most of them expressing nominalised (material) processes.

56In example 3, the comparison with a well-known external phenomenon or situation is the main feature.

Example 3

Chap. xxi. Of the miliary fever.
This fever takes its name from the small pustules or bladders which appear on the skin, resembling, in shape and size, the seeds of millet. The pustules are either red or white, and sometimes both are mixed together.
The whole body is sometimes covered with pustules; but they are generally more numerous where the sweat is most abundant, as on the breast, the back, &c. A gentle sweat, or moisture on the skin, greatly promotes the eruption; but, when the skin is dry, the eruption is both more painful and dangerous. (Buchan 21772: 257)

57The definition of miliary fever firstly overlaps with the explanation of its denomination, «This fever takes its name from» (as it happened in ex. 2 above with nervous fever, «This is so named, because the nervous system»), and further on is expanded by the inclusion of shared knowledge. The connection with the real world helps thus the reader understand the use of the term(s): «the small pustules or bladders […] resembling […] the seeds of millet». The definition then expands to a concise description: «The whole body is sometimes covered with pustules […] A gentle sweat […] greatly promotes the eruption […] the eruption is both». The disease is, once more, primarily identified by its most relevant clustering symptoms and their evolution in time.

58Also glossing strategies may be variously exploited in medical writing, the following extract highlights the flexibility of this textual, stylistic and lexicographic device. In example 4, glossing corresponds to a long list of Latinate and English highly-descriptive denominations:

Example 4

[Nervous and Putrid fevers].
[…] Nervous and putrid fevers have been described under the following different names: slow nervous fevers, febricula, maligna lenta insidiose mitis, nervous and putrid fevers, putrid remittents, typhus castrensis, jail, hospital, infectious, putrid, malignant, continued, putrid, spotted, purple, petechial fevers; yellow fever of the West Indies, or typhus Icterodes. (Black 1788: 92)

59Apart from showing the abundance of medical terminology for analogous – if not identical – ‘disorders’, these denominations cannot be organised: this means that no hierarchical sense relations among them can be definitely established, whether (co-)synonyms, (co-)hyponyms, or superordinate vs. hyponyms, etc. In other words, no categorisation at both lexical and content levels is possible. Moreover, in this highly ambiguous context, the notion of equivalence becomes useless. Here uncertainty – and possibly overlapping – dominates. In this sequence, glossing probably simply corresponds to a series of loosely related expressions; in any case, its function is not clear.

4.3.2. Symptomography: listing and clustering

60This and the following section (§ 4.3.3.) exemplify longer and more elaborate descriptions of symptoms than the concise typologies just outlined in the previous sections. For practical reasons, the first extract has been schematised below (the original version is regularly structured into paragraphs) to highlight the various ‘symptomatological groups’ (italics mine):

Example 5

[Nervous and Putrid fevers]. […]
The symptoms slight alternate

1. chills and fugacious heats,
especially in the evenings;

2. heaviness, giddiness, and headach,
particularly in the posterior and superior part,
and the pain often descending down the spine;

3. great debility and prostration of strength;
and in both nervous and putrid, the functions of the brain, and of muscular motion, considerably weakened, and interrupted;

4. also depression of spirits, sighing, restlessness, very little sleep and not refreshing;

5. accelerated, weak, and small pulse;

6. nausea, total inappetency;

7. inconsiderable heat of the skin or thirst;

8. dry tongue,
a little yellow at the sides;

9. pale urine,
and without sediment;

10. irregular sweats;

11. sometimes pains
resembling rheumatick.

After a few days,

12. the fever, stupor, delirium, and headach increase,
i. with slow muttering delirium,
chiefly during the nocturnal exacerbation,
ii. and with noise in the ears,
iii. and universal debility of the corporeal and mental organs.
The remissions are generally more distinct in the beginning, and, by degrees, more obscure. (Black 1788: 93-94)

61As my synthesis makes clear, the definition is characterised by twelve juxtaposed symptomatological groups in which the individual symptoms are either listed (ex. 1-7, 10) or clustered (ex. 9, 12 i-iii). Some groups also include both details expressing ‘time when’ something usually happens (1, 11 and 12 i) and additional information concerning the course of illness (2-3). Most symptoms are identified by means of nouns without pre-modification, whereas others are pre-modified by adjectives emphasising clinical severity: «great debility» (3), «very little sleep» (4), «accelerated, weak, and small pulse» (5), «total inappetency» (6), «inconsiderable heat» (7), «irregular sweats» (10), «universal debility» (12). The prevailing feature in this extract is the accumulation of symptoms, either listed or clustered, whereas in other cases the framework is structurally more elaborate, as will be shown in the following section.

4.3.3. Symptomography: process and discourse markers

62The paragraph excerpted here below is one in which not only symptomatological groups, but also discourse markers and other details in the course of illness are highlighted (italics and bold mine): that is to say, the network in which symptoms are embedded is more complex and tight than the one in the previous text. For the purpose of the present analysis, in the following excerpt, such structural and discursive complexity is marked in bold, whereas symptoms are in italics:

Example 6

Nervous Fever. […]
Description. This fever makes it attack with dejection of spiritsloss of appetiteoppressiondisturbed sleep, or restlessness—the patient often sighs and groans involuntarilyis frequently terrified, and affected with uncommon lassitude after exercise, though that should be slight, and at the same time has cold and hot fits succeed, and alternate with each other—he is troubled with nausea, and a vomiting of insipid phlegm, which come on in a few days after the attack, with giddiness and pain of the headextreme prostration of strengthno remarkable heatno thirst—the pulse is frequent, weak, and sometimes intermits—the tongue continues moist, white, and is covered over with a viscid mucusthere is an oppression at the pit of the stomach, and the breathing difficultthe urine is pale, watery, and sometimes like milk wheythe face red, and flushes, at the same time that the feet are coldthe mind is slightly disturbed by ridiculous imaginations, which continues, but without any violent deliriumsometimes immoderate sweats break out, or colliquative, dissolving looseness comes onthe senses lose their quickness, and become dull and heavy—with anxiety and fainting attending.
Towards the close, when nature appears almost worn out by the continuance of the disease; the tongue tremblesthe extremities grow coldthe nails livid—they lose the power of sight and hearing—the delirium is converted into stupor, and a lethargic dispositionthe fæces and urine pass away involuntarilytwitching of the tendons come on—and generally convulsions close the scene, in death. (Wallis 1793: 336-337)

63The course of illness is delineated by dynamic verbs marking the subsequent steps in the process: the beginning «makes it attack», the evolution «sighs […] groans […] succeed […] alternate […] come on […] intermits […] flushes […] disturbed […] continues […] break out […] becomes […] trembles […] grow […] pass away», and the conclusion «close». Adverbial expressions (both single-word and multi-word) usually mark time, frequency and manner, either by pre-modifying the verbs themselves, «often sighs», «groans involuntarily», «is frequently terrified», «slightly disturbed», «pass away involuntarily», or by introducing further developments «at the same time», «in a few days after», «sometimes», «towards the close». As regards symptomatological groups, more often than not they are noun phrases, whose head may be pre-modified by adjectives either intensifying the symptom itself, «uncommon lassitude», «cold and hot fits», «insipid phlegm», «extreme prostration», «no remarkable heat», «ridiculous imaginations», «violent delirium», «immoderate sweats», or categorising it, «viscid mucus», «colliquative, dissolving looseness», «lethargic disposition». Post-modification is mostly represented by prepositional phrases, «dejection of spirits, «loss of appetite, «vomiting of insipid phlegm», «pain of the head», «prostration of strength», «oppression at the pit of the stomach», «power of sight and hearing», «twitching of the tendons». In general terms, example 5 is descriptive in nature (accumulation of symptoms, mostly juxtaposed), example 6 is characterised by a more narrative approach which highlights the process underlying symptoms.

4.4. Chapter summary

64This chapter has introduced and discussed fever as a shared medical experience represented in eighteenth-century reference works. The analysis has highlighted both similarities and differences of treatment across genres (universal/medical dictionaries vs. handbooks) and within the same genres (universal/medical dictionaries or handbooks). In general, medical writers organise their materials in order to define, categorise, and unfold the complexity of their topic, and of their experience as practitioners. Their aim is the distinction, selection, classification of fevers, with the practical issue of curing them. However, the variety of febrile manifestations and their denominations are so numerous that the identification of specific fevers, and their diagnosis, is often problematic and uncertain.

65Among the most relevant similarieties across and within dictionaries and handbooks is the extensive use of symptomatological defining: the listing and clustering of symptoms which strictly characterise every fever, or distinguish specific fevers. The expansion of symptomography depend on the general aims of the work under scrutiny. In any case, what is a lexicographic technique is systematically exploited by medical writers in their handbooks: symptomography establishes the background for text structure and discourse organisation.

66As regards dictionaries, differences mainly concern the extension of lexicographic entries, the degree of detail included, internal or external references, and the focus of their discussion: on the one hand, contemporary medicine and case studies; on the other hand, contemporary perspectives alongside traditional approaches.

67Handbooks may be completely devoted to fevers, or include fevers among other diseases: this may determine the extension and the detail in their description and treatment. Among the most relevant features across handbooks is the aim of avoiding excessive sub-divisions of fevers and their respective denominations: medical writers of handbooks have a strictly practical attitude, and theorising cannot be of any help. The omission – or reduction – of redundant details, the necessity to be clear and to the point, the systematisation of topics and sub-topics are reflected, as far as textual organisation is concerned, into titled sections for quick reference. Once again, symptomography plays a key role in the organisation of textual structure and topic development. The focus on contemporary approaches is sometimes supported by the presentation of more traditional cures and remedies.

Notes

1   In his Dictionary (1755), Johnson defines affection as «7. State of the body, as acted upon by any cause».

2   In this quotation and in the following ones, italics highlights the expressions which introduce similarities and differences.

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