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Communicating Medicine

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Elisabetta Lonati

5. Conclusions

Texte intégral

1The analysis of vernacular medical writing in reference works, such as universal dictionaries of arts and sciences, medical dictionaries, and handbooks testifies to the fact that medicine was a relevant topic both in genteel society, and within an emerging disciplinary community. On the one hand, medicine was general knowledge and shared experience; on the other hand, it was on the way to specialisation and professionalisation. The advancements in medicine, in the second half of the eighteenth century, favoured a gradual epistemological change, from medicine as scholarship and erudition to medicine as scientific, technical, and experimental knowledge. This implies a progressive shift from learning to science. This also stimulates a substantial expansion of medical writing at different levels, and for different users.

2Universal dictionaries of arts and sciences were mainly addressed to a lay educated readership: they included medicine as part of a more general, comprehensive idea of knowledge. Medical terminology – and medical entries – in alphabetical order was a practical way to store, organise, and display medical information. Two works of this kind were examined and discussed: the Encyclopaedia Britannica (EB 1768-1771) and Abraham Rees’s Cyclopaedia (RCy 1778-1788).

3The EB includes three main treatises of medical content: Medicine, Surgery, and Midwifery. The most relevant and complex is the first, with many sections and sub-sections. The choice of collecting medical knowledge under specific treatises mirrors the general plan of the work, which aims at avoiding dispersion of information. Symptomatological defining is one of the strategies used by the compilers, it is embedded within the progress of the disease and signalled by time markers. Hypothesising is another discourse strategy meant to introduce different situations and individual cases (signalled by if and when). The single entries in alphabetical order are as short, essential, and concise as may be found in dictionaries of the English language published in the same period. Entries generally consist of lexical definitions, usually followed by cross-references to the main treatises. Etymology is never included, whereas spelling variants and lexical variants are hardly ever listed. Almost always, one single form is provided. This method is typical of the EB, and distinguishes it from other contemporary universal dictionaries of arts and sciences, as RCy.

4RCy organises its contents in alphabetical order, and no monographic treatises are included: if compared to the EB, RCy displays a different epistemological approach and lexicographic practice. Entries are usually long and complex, including such linguistic information as etymology, equivalents, spelling variants, and lexical definitions. In the description of diseases, symptomography is one of the key features in listing and clustering symptoms and signs of the diseases, and sometimes also their possible causes. The practice of identifying single topics as headwords (and vice versa) helps readers to focus on them as conceptual units (cross-references are reduced to a minimum to avoid dispersion).

5In both the EB and RCy, medicine and medical headwords represent a major subject of interest and show extended treatment, though with different discourse strategies. The relevant presence of medical contents and terminology in both of them also testifies to their pervasiveness in society and everyday shared experience.

6As regards more specialised reference works, two major medical dictionaries were analysed and discussed. James’s A medicinal dictionary (MD 1743-45), and Motherby’s A new medical dictionary (NMD 1775). They are organised in alphabetical order, and represent the effort to include, illustrate, and delimit the medical field through its terminology.

7James’s MD is a huge work which aims at extensive inclusion and detailed exposition: a scholarly collection of what is known about medicine, from past tradition to contemporary practice. Not unlike seventeenth-century works for educated readers, MD declares that its target audience is mankind in general. However, the length and complexity of its entries actually address a more restricted and specialised readership, of experts and semi-experts, such as physicians, practitioners, apprentices, students, surgical and apothecary trainees. The internal organisation of the entries, their sub-topics, their digressions, the description of diseases, and the inclusion of detailed case studies for practical reasons make this perspective quite evident. Actually, MD entries are monographic articles, in which the historical dimension is a key feature that is meant to background – and sometimes compare – contemporary medical issues. The density of details makes reading a demanding activity, which requires an expert perspective. Some sections are highly informative and expositive, others more argumentative (different perspectives are provided); sometimes, personal involvement emerges, particularly in reports of real medical events, highlighting practical and situation-dependent approaches, in time and place. MD may be considered as a kind of summa of medical knowledge, especially as learning.

8The NMD is instead the result of a process of selection and specialisation of contents and vocabulary. The general aim of the NMD is to be useful to the practitioner ‘in haste’. This means that Motherby (de)limits the amount of details and internal cross-references: exhaustiveness and comprehensiveness are established by referring to more specific external sources. Motherby provides systematic intertextuality, when necessary. Entries generally consists of lexical definitions, regularly followed by descriptive, expository, or explanatory sections, which develop the topic-headword. They are well structured, and more coherent and cohesive at textual and discourse levels than the corresponding entries in the MD. Etymology is still perceived as an essential element to introduce the topic, whereas the number of lexical and spelling variants gradually decreases. Historical approaches and perspectives, as well as scholarly digressions are reduced to a minimum, since the attention is placed on contemporary medicine, and events strictly medical.

9The third group of reference works analysed and discussed is composed of handbooks and practica. This kind of works highlights the expanding social interest in medical events, since their general aim was diffusing medical knowledge in society: at large, this socio-cultural interest is treated by such writers as Buchan, Fisher, and Wallis. However, besides the strong commitment of these works to public health, another fundamental goal was to share medical practice within the emerging disciplinary community. This is the reason why their readership was, once again, multilayered (as for universal and medical dictionaries). Different levels of education among the non-experts (or lay people) and different degrees of specialisation among the experts (physicians, practitioners, students, trainees) involved different registers and textual issues in medical writing. As a consequence, the works analysed show some similarities but also some differences as regards their structure, contents and their organisation, detail of treatment, language and register, etc. Some of them were focussed on specific affections (fevers, infectious diseases), others on many different diseases, as kinds of general repositories with very practical goals (cfr., for example, Fisher 1785). The tables of contents make the main topics and the internal organisation emerge. Clusters of specific diseases are usually ‘displayed’ under more comprehensive headings: these headings function as headwords and more specific diseases as sub-headwords (sub-topics, for example inflammation of the lungs vs. pleurisy). Diseases are usually introduced by recursive elements, such as etymology, equivalents (variant denominations), and lexical definitions. They are systematically followed by more complex paragraphs on symptoms (symptomatological defining), causes, specific manifestations (accounts based real circumstances), possible cures, and remedies. Sometimes, descriptive or expository sections are interspersed with more personal passages by the physician- or practitioner-writer commenting on some situations: it is a way to provide further information related to personal experience.

10Fever is the last topic-headword analysed and discussed in this study. It is both a term which pervades medical writing, and a widespread scaring experience in eighteenth-century society. Fever, and what is written about it, is here compared across reference works. This means that the analysis is carried out in universal dictionaries of arts and sciences, in medical dictionaries, and in handbooks at the same time. This makes some similarities vs. differences emerge more directly than in previous chapters, which were focussed on individual genres. The results of the comparison highlight that some major strategies and lexicographic techniques are systematically used across reference works, independent of their nature. These include: etymology, to introduce and provide a preliminary understanding of the topic; equivalence (variant denominations of medical events; different registers and degree of specialisation); lexical definition; symptomatological defining (listing and clustering of symptoms); use of hyponymy to categorise and organise contents (topics and sub-topics as headword and sub-headwords). In all the works analysed, medical discourse on fever(s) and its complexity at a conceptual level emerge as a multilayered textual organisation. Reference works, according to their specificity, are rich in details and digressions (particularly James’s MD, and RCy). Explanatory and expository sections alternate with argumentative paragraphs, and some evaluative comments. The NMD, instead, among the four dictionaries is the most concise, essential, and focussed on the main characteristics of fever. This is in line with the original plan, which emphasises Motherby’s practical issues, and systematically refers to external specialised works for thorough reading. As regards the treatment of fever(s) in handbooks, the most recurrent feature is the genus-differentia pattern, used to organise contents, text, and discourse. As said above, symptomatological defining is a major feature: it goes from concise typologies, to elaborate descriptions of symptoms (listing and clustering), to the structuring of the disease as a process, in this case along with time and space markers.

11In the second half of the eighteenth century, the communication of medical knowledge both as science and as practice was a widespread and well-established activity, among expert writers (MD, NMD, and handbooks) and non-expert compilers (EB and RCy). The construction and the dissemination of medicine as an emerging science and shared disciplinary practice take advantage of recurrent discourse strategies and textual features across genres. In particular, the practice of classifying contents under individual topic-headwords – in both dictionaries and handbooks – gradually helped to delimit and to identify specific, technical topics for professionals rather than scholarly erudition and learning for mankind. Medicine was definitely on the way to becoming science.

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