Disease: Medical Terminology in Middle English
George Fort offers a harrowing description of the epidemics that ravaged Europe during the Middle Ages. The complete lack of sanitary precautions during this time occasioned pestilential storms that in some cases threatened the extinction of the human race. A particularly hair-raising account describes a plague that struck England in 1355, and left its partially insane victims howling in the streets (Fort 357-8). Since medicine did not acquire a firm scientific basis until the late nineteenth century, moreover, there was no possibility of legitimate medical intervention during this time. Because of the widespread filth in this epoch, however, even epidemics that originated outside of Europe reached the continent with devastating speed.
Medical terminology in early English texts tended to reflect the cultural context in which it was formulated. Once Christianity was introduced into England in the sixth century, for instance, it imported into the culture a medical terminology that both metaphorically and conceptually connected spiritual enlightenment with physical health, and moral corruption with disease. In the case of the plague of 1355, the infected and deranged victims were believed to be in the grip of demonic possession (Fort 358). The word sick (sik or sek in ME, from OE séoc) offers one example of the way in which language registered these cultural beliefs. Klein observes that the adjective is related to the verb suck (OE súcan); the nature of this connection becomes clear once one considers that Teutonic belief connected disease to the sucking of demons (Klein 1441). Ackerman defines these supernatural conceptions of illness and health in primitive societies as ‘magico-religious or supernaturalistic’ (12).
The Historical and Cultural Background of Medical Texts
In the Anglo-Saxon period, both vernacular writing and Latin texts (which commonly transcribed Greek medical authorities) were the property of monasteries, which continued to act as repositories of medical knowledge until the rise of the universities in the late Middle Ages. For several centuries following the Norman conquest, the language of medical texts was either Latin or Anglo-Norman. Of the two, Latin became the common language of authoritative texts because it was the predominant language of universities. The vernacular, in the meantime, only made a slow return to the language of medical literature in the mid-fourteenth century, during which time a number of medical texts on topics as diverse as bloodletting and the plague were translated into English. The number of medical texts written in English also multiplied significantly with the introduction of printing into England in 1476, though this technological advent surprisingly had no notable impact on the actual content of medical books. English writing in general increased steadily with the reign of Henry V (1413-22). Throughout the fifteenth and sixteenth centuries, physicians and surgeons both owned and produced medical manuscripts in English, though during this time medical texts were commonly written in Latin, Anglo-Norman, or English. English as a written language enjoyed a new popularity in the fifteenth century, as a number of previously unknown Latin and French works were translated into the vernacular. Finally, the sixteenth century saw a renewed emphasis on the study of classical medical texts in their original language, and Greek and Latin consequently became part and parcel of a medical education.
Contemporary theories about human physiology of course also influenced medical terminology. The prevailing theoretical base of the fifteenth and sixteenth centuries was Galen’s doctrine of the Four Humors (AD 130-201), grounded on the Empedoclean principle of the four elements: earth, fire, water, and air. Both good health and good character were thought to depend on the maintenance of a proper balance of blood (air; sanguine), yellow bile (fire; choleric), phlegm (water; phlegmatic), and black bile (earth; melancholy). The positions of the planets, the sun, and the moon were consequently thought to have a direct influence on one’s physical and mental health (Szarmach 505).
The project of preparing a comprehensive overview of Middle English medical terminology is complicated by the kind of variations that one is likely to find not only between different texts during this period, but also within any individual text itself. Juhani Norri observes that spelling differences in medical terminology between different texts can usually be attributed to dialectical differences, because a national written language was not established until 1430. Variations within the individual texts, in the meantime, are often attributed to transcription errors, since the process of transcribing from the original text was inevitably long and difficult. Norri offers the most comprehensive review and analysis of ME medical terminology in Names of Sicknesses in English, 1400-1550, where he observes that medical terminology is also likely to vary depending on the kind of text that one examines. The three basic types of medical texts that Norri identifies are academic treatises, surgical treatises, and remedybooks.
The writing of academic treatises developed the terminology of textbooks and universities. The ME word plage from OF plage (meaning ‘stroke’ or ‘wound’) and late L plaga (meaning ‘plague, pestilence, infection’) belongs in this category, as does the word cardiaca, from the French cardiaque (‘of the heart’) and the Latin cardiacus. Surgical treatises, in the meantime, included the words for the disorders that a medieval surgeon was likely to see in his practice. Some examples in this category are fracture (Fr. fracture, L. fractura, to break), lesion (F. lesion, ad. L. læsion-em, n. of action from l¾dere to hurt) and paine, ME. A. OF. peine, L. pœna penalty, punishment (OED). Terminology in remedybooks often named but did not define the illness. The adjective ill from ON illr (signifying ‘bad’, or ‘of uncertain origin’) belongs in this category, as does the adjective bleche, ‘pale’ or ‘pallid’ from OE blæce (Klein). Though there was semantic overlap across these three categories, each category nevertheless introduced its own native terminology into the lexical field.
Middle English Medical Terminology
One of the most interesting characteristics of Middle English medical terminology is that it was largely descriptive. The distinctions that we make today between disease, symptom, and sign did not exist in Middle English. Thus, rather than identify the nature of the disease, the terminology would simply index the symptoms or signs associated with it. The word disease ( ME disesen, desese from OF desaise), for instance, is itself descriptive, since it literally means ‘lack of ease’ (Klein).
Norri provides a helpful analysis of medical terminology by dividing its formulation into the following semantic patterns: metaphor, metonymy, specialization of meaning, suffixation, prefixation* (rare), imports, compounds and phrases, or semantic integration of elements.
Metaphorical classifications would use a common word to describe a morbid phenomenon. Words that fall into this category include corn (a round swelling), cloud (ML nebula - film covering the eye), fire (L ignis - inflammatory condition of skin).
Metonymy would take the name of an action as the result, as in the case of bruise (a breaking, a breach), or use one part to represent the whole, as in pock(e)s (plural of pocke, a pustule, pimple or spot).
Specialization of Meaning
In specialization of meaning, common words would acquire medical meaning. Examples include fit, which signified hardship but was used for attacks of illness, and mole, from OE mal, a spot or blemish.
Suffixation usually involved the adding of a suffix to a word adopted either from French or Latin. In this category, the common suffixes were as follows:
Indicating process/action1 or the result of process/action.2
1Examples: picchinge (f. picchen ‘pierce’), trembling, burning, bocchinge (f. bocchen ‘swell up, fester’)
2Examples: swelling, poisoning, breaking, bruising.
Mainly forms deadjectival nouns expressing condition referred to by adjective,1 or as denominal suffix.2
1Examples: baldnes, deafnes, si(c)knes, windines.
2Examples: lousenes (infestation with lice), rot(e)nes (putrefaction)
Indicating a morbid state.
Examples: bellen (swell up), rothed (putrefaction), blereship (of the eyes)
-of foreign origin
Example: OF suffix Ðet for hicket (hick ‘hiccup’)
Prefixation (mis-, dis-, un-) appears rarely. The only widely used prefix is un-. Examples include distemperature, an upset state of bodily humours, and unhelthe, ill health.
Compounds and Phrases
Examples in this category include blood/letting, brain/washing, up/braiding, up/spewing/ nose/bleding.
In medical terminology formed through semantic integration, there is no structural fusion. In other words, two or more words collectively constitute a medical term, but do not fuse to form a new word. Some examples here include depe slepe (unconsciousness), Goddis wrathe (epilepsy), and drunken mannes coughe (hiccups).
In general, the largest group of medical terminology for the classification of disease in ME consists of simplex terms (those words that have no affix and are not part of a compound) and derivatives of foreign origin. In the adoption of foreign words into ME terminology, Old French [OF] and OF + Middle Latin [(M)L] words were more commonly adopted than (M)L words alone, while the (M)L words that were adopted were often highly technical in nature.
The chronological development of the lexical field could be traced from OE, which had many words of Germanic origin designating common illnesses, to the medical terminology of the thirteenth century in which OF words were most influential, to the fourteenth century which saw an influx of both (M)L and OF words, to the fifteenth and sixteenth centuries, in which the adoption of foreign words continued to increase exponentially (Norri).
For Further Reading:
History of the English Language
Bauer, Laurie. English Word-formation. Cambridge: Cambridge UP, 1984.
Klein, Ernest. A Comprehensive Etymological Dictionary of the English Language: Dealing with the Origin of Words and Their Sense Development Thus Illustrating the History of Civilization and Culture. A-K. New York: Elsevier, 1966.
---, A Comprehensive Etymological Dictionary of the English Language: Dealing with the Origin of Words and Their Sense Development Thus Illustrating the History of Civilization and Culture. L-Z. New York: Elsevier, 1967.
Wardale, Elizabeth. An Introduction to Middle English. London: K. Paul, Trench, Trubner & Co., 1937.
History of Medicine
Bonser, Wilfrid. ‘Anglo-Saxon Medical Nomenclature.’ English and Germanic Studies 4 (1952): 13-19.
Dirckx, John H. The Language of Medicine. Its Evolution, Structure, and Dynamics. 2nd ed. New York: Praeger, 1983.
Fort, George. Medical Economy During the Middle Ages; A Contribution to the History of European Morals from the Time of the Roman Empire to the Close of the Fourteenth Century. New York: A.M. Kelley, 1970.
Kealey, Edward. Medieval Medicus: A Social History of Anglo-Norman Medicine. Baltimore: Johns Hopkins UP, 1981.
Norri, Juhani. Names of Sicknesses in English, 1400-1550: An Exploration of the Lexical Field. Helsinki: Suomalainen Tiedeakatemia, 1992.
Szarmach, Paul E., M. Teresa Tavormina, and Joel T. Rosenthal eds. Medieval England: An Encyclopedia. New York: Garland Pub., 1998.
Siraisi, Nancy. Medieval and Early Renaissance Medicine: An Introduction to Knowledge and Practice. Chicago: U of Chicago P, 1990.
Rawcliffe, Carole. Medicine and Society in Later Medieval England. Stroud: Sutton, 1995.
Walsh, James J. Medieval Medicine. London: A . & C. Black, 1920.
 Some helpful sources on the history of medical writing include Juhani Norri, Edward Kealey, Nancy Siraisi, and Carole Rawcliffe.
 For additional information about the linguistic importation of foreign words into English, see Elizabeth WardaleÕs An Introduction to Middle English. London: K. Paul, Trench, Trubner & Co., 1937. 27-40.