On the history of disease concepts: the case of pleurisy

INTRODUCTION

It is, I believe, uncontentious to suggest that concepts of disease — both in general and with respect to particular ailments — have changed and developed historically in the long history of the Western medical tradition. And it is obvious, too, that diseases (taking that term in its widest sense, to embrace illnesses at large) were-and-are precisely the distinctive concern of medicine. On principle, therefore, we might expect that the history of disease-concepts plays a central part in the historiography of medicine, just as the histories of celestial, physical and vital concepts do in the historiographies of the respective natural sciences; yet paradoxically, this is far indeed from being the case. That strand of medical history which focuses on medicine’s cognitive content has devoted far more attention to anatomical and physiological knowledge than to pathology; the history of medical practice is often written without reference to the disease-categories by which past practitioners apprehended the illnesses of their patients; and as we shall see, histories of actual diseases have tended to treat their objects as timeless entities, thereby blocking off the very possibility of considering disease-concepts historically. This paper proposes that the history of disease-concepts deserves far more attention than it has traditionally been accorded, not least because this theme is relevant to the full range of medical history’s existing concerns, from anatomy to medical practice. I shall proceed in three stages. Part 1 sketches the historiographic state of play with regard to disease-concepts. Part 2, which makes up the bulk of the paper, seeks to illustrate the possibility of treating such concepts historically by means of an example, namely the disease of “pleuritis” or “pleurisy”; I shall trace the shifting meanings of this term first amongst the ancients and then, on a very selective basis, in the early-modern period. Finally Part 3 will meditate briefly on the results of this case-study, returning to the general historiographic theme and suggesting some points of wider application.