Existential there constructions in early medical texts [1]

Turo Hiltunen & Jukka Tyrkkö
Research Unit for Variation, Contacts and Change in English, University of Helsinki


Despite the extensive literature on the syntax of the existential there construction (ETC), little information is available on how it is used in specific registers in the history of English. This paper explores the use of the ETC in one specific domain, namely vernacular scientific writing in Middle and Early Modern English, and relates the findings to broader developments in the history of medical writing. Using the Middle English Medical Texts (MEMT) and Early Modern English Medical Texts (EMEMT) corpora as primary material, we examine the frequency of use of the ETC and compare four of its phraseological patterns (choice of verb, tense, use of modals, polarity) across different categories of medical writing. The results are compared to data from previous research on the history of the construction.

The main findings of this paper are twofold. Firstly, while the overall frequency of the ETC is relatively stable in medical writing from the 15th to the 17th centuries, considerable variation can be observed between different categories of medical writing and, in particular, between individual texts. Secondly, significant variation is seen in the phraseological patterns of the construction; notably, the relative frequencies of constructions formed with the verb BE and constructions with negative polarity increase from ME to EModE. Comparing these results to contemporary reference data suggests that these developments are to some extent at least specific to the register of medical writing, reflecting developments in both medical discourse and the underlying styles of thought.

1. Introduction

The existential there construction (hereafter ETC) is a common grammatical construction in all registers of Present Day English (Biber et al. 1999). The construction was also productive in different registers in the Middle and Early Modern English periods, as demonstrated by the work of Breivik (1983) and Pérez-Guerra (1999), among others. The main discourse functions of the ETC are to assert the existence of an entity, to present new information, to enact topic shifts and to summarise and reiterate previous points of information (see e.g. Huckin & Pesante 1988). Because ETCs focus discoursive attention on the logical subject, they are useful for increasing clarity in text types with a high information density such as contemporary scientific prose. Indeed, according to Biber et al. (1999: 948-949), in Present-day English postmodification of the displaced subject is particularly prevalent in scientific writing, owing to the need to pack as much information into each sentence as possible.

There is a considerable body of research on the ETC in a historical perspective, addressing a wide range of topics including the early development of the construction and the differences between locative and existential there (see, e.g. Erdmann 1976, Breivik 1981, 1983, 1997, Jenset 2005, 2008, and Nevalainen 2009). However, less work has been done on variation between different registers and within individual registers throughout the history of English, and on the factors responsible for such variation.

In this study, we focus on the frequency and phraseologies of ETCs in medical texts of the Middle English and Early Modern English periods, and compare these with evidence from Present Day medical writing. Our findings will be contrasted with those in Pérez-Guerra (1999) to determine the characteristics of medical writing in relation to other contemporary genres. By examining the socioculturally grounded sub-categories of early medicine, we shall argue that when analysing complex domains of writing, it is useful to pay attention to the discourse practices of specific communities within such domains, rather than collapsing them under a general genre heading as is often done.

2. Methodology

2.1 Existential there construction and retrieval

The existential there construction consists of the unstressed lexical item there, followed by a verb and a typically indefinite noun phrase (Biber et al. 1999: 943). [2] An example from the EMEMT corpus is given below (1).


But now because there are certayne bathes in Ytalye / whiche haue the nature and power to heale certayne diseases / that ether none in England nor Germanye is able to do / or els can in shorter tyme or more surelye helpe / then they of England and of Germanye are able to do. (EMEMT; Turner 1562: f7r)

The word there is a semantically empty function word, which acts as the grammatical subject of the sentence. Typically, the verb be is used in the construction, but other verbs denoting existence, appearance, or occurrence may also be found, although much less commonly (Breivik 1981: 18). The third element of the construction, the indefinite noun phrase, expresses the notional subject, which functions logically as the subject.

It has been suggested that existential there constructions occurred in the Old English period, though the precise details of the grammaticalisation process are subject to debate (see Pérez-Guerra 1999: 88-90, Breivik 1997, Jenset 2008). A topic that has received a great deal of attention is the question of how existential there is distinct from locative there, a form which is its historical origin (see Pérez-Guerra 1999: 64-7). The basic difference between the two forms is that existential there is the semantically empty grammatical subject of a clause functioning as a pro-form for a displaced semantic subject, and locative there is a referential adverb. Various diagnostic tests can be used distinguish between existential and locative there, based on syntactic substitutability (existential there cannot be replaced with here while a locative there can), or prosodic properties of the word (existential there is held to be unstressed while a locative there is not, see Huddleston & Pullum 2002: 1391).

While it is straightforward in principle to apply such tests to identify occurrences of existential there in corpus data, actual instances of there are often ambiguous between the two possible readings. Given that one of the objectives of the present study is to compare our results to Pérez-Guerra’s (1999) results, we have adopted the same broad operationalisation of ETC by including “all the examples with there which are either unambiguously existential or potentially interpretable as existential in a natural way” (Pérez-Guerra 1999: 91).

Apart from the verb be, a number of other verbs can be used in clauses with a dummy there as subject. [3] Views differ on whether constructions with verbs other than be verbs ought to be classified as existential, and some writers do treat these as two distinct constructions. For instance, Huddleston and Pullum (2002: 1402) refer to there-constructions with non-be predicators as presentational constructions. Most non-be verbs in ETCs are intransitive, but some transitive verbs may also occur in the construction in the passive voice (Pérez-Guerra 1999: 74). [4] Our analysis covers both existential and presentational constructions, and the co-occurrence between there-constructions and verbs acting as predicators is one of the points of interest in this study, addressed in section 4.1 below.

Our method consists of an exhaustive retrieval of the occurrences of ETCs in the corpora, followed by descriptive statistical analysis of their frequency and phraseological characteristics. The derivation of ETCs from untagged corpora makes it necessary to start with the word there. Each ambiguous instance of there functioning as the grammatical subject was double-checked by both of the writers before it was included in the analysis. Modal auxiliaries were analysed by the appearance of word form without further regard to their semantics. Polarity was analysed syntactically as either positive or negative, identified by the presence of a negative marker or a negative lexical item. [5] Finally, tense of the main verb was encoded in the database.

To compare the rates of occurrence of ETCs in different subcorpora to the results obtained in other studies, raw frequencies were normalised to 1,000 words. While it is clear that this is not the ideal way to assess the frequency of grammatical constructions, the approach has the merits of being both efficient to carry out and not bound to any particular grammatical theory (see Smitterberg 2005: 40-42). The common base of normalization should be comparable to the sample size (McEnery et al. 2006: 53), which means that our chosen base of 1,000 words is appropriate for the majority of texts in MEMT and EMEMT (samples of ca. 10,000 words are extracted from longer texts). As some samples are considerably shorter, notably the texts in the category Philosophical Transactions (see Taavitsainen et al. 2011), the comparability of results needs to be assessed separately.

We also counted the normalised frequencies of ETCs for individual texts and used these figures to count the mean frequency in each subcorpus. This enables us to test whether the observed differences in the central tendencies are statistically significant, using the Kruskal-Wallis non-parametric ANOVA test.

There are several examples in the corpus where the occurrences of there are not evenly distributed but clumped together in a small segment of text, as the following example demonstrates:

further you shall understand, that wheresoever there is found a vein, there is an Artery under him, if it be a great vein, there is a great Artery; and contrariwise, a little vein a little Artery, for wheresoever there goeth a vein to carry nutrimentall bloud, there also goeth an Artery, conveying the spirit of life. (EMEMT; Turner 1654: 17)

By considering frequencies in individual texts instead of counting the occurrences of ETCs in the subcorpora without regard to their internal divisions, it is possible to assess both the overall frequency and the dispersion of the construction.

2.2 Corpora used in this study

The primary sources for this study were the Middle English Medical Texts (2005) and Early Modern English Medical Texts (2011) corpora compiled by members of the Scientific thought-styles project at the Research Unit for Variation, Contacts, and Change in English (VARIENG) at the University of Helsinki. [6] Both corpora exclusively represent the domain of medical writing and consist of extracts of manuscripts (MEMT) and printed texts (EMEMT) written by a wide array of medical authors ranging from those at the top of the profession to others with little or no formal training. MEMT contains roughly 500,000 words and EMEMT slightly over 2,000,000. The corpora are stratified on the basis of extralinguistic criteria. MEMT is divided into three major traditions of manuscript transmission: Specialized texts, Surgical texts and Remedies and materia medica (see Voigts 1984). By contrast, texts in EMEMT are placed in six categories: General treatises and textbooks (category 1), Treatises on specific topics (category 2), Recipe collections and materia medica (category 3), Regimens and health guides (category 4), Surgical and anatomical treatises (category 5), and Philosophical Transactions (category 6) (see Taavitsainen et al 2011). Although the stratifications of the two corpora differ somewhat, they can be considered to fall into a continuous timeline along which developmental trends can be observed (Figure 1). A number of the texts in both corpora are translations, mainly from Latin. However, it is beyond the scope of this study to take into account the possible influence of translation strategies on how existentials are used.

Figure 1

Figure 1. Rough correspondence of stratification in MEMT and EMEMT [7].

The linguistic significance of the stratification derives from the makeup of the contemporary discourse communities. In the early centuries of vernacular medical writing, texts were not produced by a single, homogenous community of licensed physicians, but by members of various schools of thought and professional trades. [8] Recent scholarship has demonstrated that the diverse traditions of writing exhibit distinct lexical and discoursive styles (see, e.g., Tyrkkö & Hiltunen 2009).

The data from the two medical corpora is contrasted with results from previous studies on the ETC. [9] Contemporaneous reference data for the study is presented in Pérez-Guerra (1999), which made use of the Helsinki Corpus for ME and EModE data. The Helsinki Corpus consists of 1.5 million words from a wide variety of genres, covering the timespan of 730-1710. [10] Reference data on Present Day medical English comes from Hiltunen (2010), based on a corpus of 64 research articles in surgery and orthopaedics published between 2001 and 2005 (c. 250 000 words). The corpus aims to be a representative sample of the top-end research articles in these specialisms, and thereby corresponds to the highest strata of medical writing from the ME and EModE periods. [11]

3. Results

3.1 Frequency of existential there

Before considering the individual characteristics of how ETCs are used in the register of medical writing, it is useful first to think about how the overall frequency of the ETC has changed in the history of English, when all registers are taken into account. Pérez-Guerra (1999: 92) shows that the frequency of the existential there construction has increased from Middle English to present-day English. His data, based on the Helsinki Corpus and the LOB corpus, shows an increase from 1.3 to 2.1 occurrences per 1,000 words, with the first EModE period in the HC exhibiting a surprisingly high frequency of 2.5.

When findings from the medical corpora are contrasted with those reported by Pérez-Guerra, the first point of departure must be the differences in the representativeness of the primary data. The Helsinki Corpus is a multi-purpose corpus primarily intended for the diagnostic analysis of early periods of the English language, and as such is not claimed to be representative at the level of individual genres (see, e.g., Sinclair 2005). To investigate the use of a construction in a specific genre such as medical writing, it is therefore necessary to use a specialised corpus, as a general corpus may not provide enough data on the individual categories within genres (cf. Aston 2001). The issue of variation in the use of ETCs across genres and prototypical text categories was addressed in Pérez-Guerra (1999), but owing to the large variance and the relatively small number of texts, his data only allowed tentative conclusions. [12]

Unlike the Helsinki Corpus, MEMT and EMEMT are genre-specific corpora designed for the detailed analysis of medical writing. The texts included in these corpora range from recipes and health guides written for literate householders to complex and learned treatises circulated among the highest strata of medical professionals. Before the Late Modern period, medical texts were commonly produced by writers from diverse backgrounds for a variety of different readerships. [13] Given what we know of the importance of sociolinguistic variables on language variation and change (see, e.g., Nevalainen & Raumolin-Brunberg 2003), it seems likely that quoting a single frequency of ETCs for each subcorpus may not fully explain how the construction was used during the periods in question. However, EMEMT for example contains more than 250 medical texts for the period 1500–1700, as opposed to HC, which has six samples classified as scientific, two of which are medical.

Taking all this into account, evidence from the medical corpora shows that the overall frequencies of ETCs in medical writing are similar to those reported by Pérez-Guerra (1999). Figure 2 shows the frequencies normalized to 1,000 words in time periods corresponding with Pérez-Guerra’s study.

Figure 2

Figure 2. Average frequencies in medical texts and in the reference corpus. [14]

Figure 2 suggests that the frequency of ETCs in medical writing is close to contemporary generic norm. However, by looking at the data from individual corpus categories, it can be shown that sociocultural factors and variation between discourse communities clearly play a role in how frequently ETCs are used.

The average frequency of ETCs in MEMT is 1.7/1,000 words, which is close to the 1.3/1,000 reported by Pérez-Guerra. However, as Figure 3 shows, considerable differences can be found between the traditions of medical writing. This finding is a good example of how an analysis based on the average frequency alone can be misleading, particularly if it ignores the historical principles behind the composition of the corpus.

Figure 3

Figure 3. Average frequencies of ETCs in the three manuscript traditions in MEMT. (n = 764)

The difference between Remedies and materia medica and specialised treatises, on the one hand, and surgical treatises, on the other, appears dramatic, and is statistically significant. [15] The high frequency of the ETC in surgical texts seems to be due to the number of anatomical descriptions in early surgical writing, where ETCs are a common presentational strategy, as exemplified in the following quote from Guy de Chauliac’s Anatomy (2): [16]


So þat þer ben vij bones of þe braine panne, and so þei be noumberde in dede mennes heuedes, þe whiche ben soþen & diuidid wiþ boilinge water. (MEMT; Chauliac, Anatomy, Interpolated: 20)

The anatomical texts included in MEMT contain descriptions of various parts of the body, and new referents are commonly introduced by using the ETC. Apart from asserting the existence of an entity, it is common that ETCs also present information as to the anatomical locus of the referent, encoded in a place adverbial. Example 3, quoted from John Arderne’s Clysters, contains an adverbial expansion (prepositional phrase vpon it) placed at the end of the clause.


And witte þou þat when þe sideȝ of þe wounde come to þe place of þe bone cauteriȝide of þe arsenic, which was blakke, þai miȝt no more grewe, for þe mortified bone miȝt noȝt receyue nutriment, þat þer miȝt no flesch grew vpon it, ne be regendred. (MEMT; Arderne, Clysters: 84)

By the time we get to the Early Modern period, the frequency of ETCs in surgical writing no longer stands out from other categories so dramatically, although Surgical texts still remains the category with the highest frequency. The data shows that with the exception of Recipe collections and materia medica, the usage of ETCs had become more uniform (Figure 4), [17] mainly as a result of existential there having become significantly more common in the other learned categories (Figure 4). [18]

Figure 4

Figure 4. Frequency of ETCs in different categories of EMEMT.

Moreover, the frequencies appear to have stabilised by the early sixteenth century. When the sixteenth century is compared with the seventeenth, no significant developments can be observed within any specific category. Figure 5 shows the mean frequencies of the categories in the 16th and the 17th centuries, including the Philosophical Transactions (category 6) in the latter period. Interestingly, although the texts in this category are generally much shorter than those in other categories, this is not reflected in the frequency of ETCs in comparison to the other categories.

Figure 5

Figure 5. Mean frequencies in individual categories of EMEMT.

Overall, then, the figures would suggest three lines of development from the ME to EModE period (Figure 6). The frequency of ETCs increases in learned medical writing, decreases in surgical writing, and remains more or less stable in less learned texts. [19]

Figure 6

Figure 6. Changes in ETC frequency from MEMT to EMEMT.

Although we have already seen that the individual categories within the domain of medical writing exhibit frequency differences, arguably even more dramatic differences can also be seen between individual writers.

Figure 7

Figure 7. ETCs in individual extracts of over 5000 words.

A scatter plot reveals the extreme variation within each category of writing (Figure 7). In each of the four categories some texts exhibit extremely low frequencies and others extremely high (see Table 1):

Table 1. Frequency (per 1,000 words) of ETCs in different categories (med = median, min = lowest frequency, max = highest frequency, SD = standard deviation).






Specialized treatises





Recipe collections and materia medica





Regimens and health guides





Surgical treatises





The length of the text extracts also plays a minor role in the results. If extracts shorter than 5,000 words are excluded, both extremely low and high frequencies are moderated somewhat, but the overall trends remain and, if anything, are magnified, as the difference between treatises and recipes, and health guides and recipes are also shown to be significant. [20]

To take the category Specialized treatises as an example, the highest frequency (5.35/1000) is found in Daniel Sennert’s Sixth Book of Practical Physick (1662), the lowest in (0.19/1000) in George Simotta’s Theater of Planetary Hours (1631). The texts are contemporaneous, neither extract is exceptionally short – 9,864 and 5,327 words, respectively – yet there is nothing that immediately explains this variation. Some occurrences of the ETC in the former are clearly related to an enumerative text strategy, as exemplified below, but on the whole ETCs are rather evenly distributed in the sample taken from Sennert’s book:


IN contagious diseases. 1. There is the disease which is called Contagious, because it infects another with the same disease. 2. There is the Medium by which the like disease is produced in another. 3. There is the action by which the like disease is produced in another. (EMEMT; Sennert 1662: 24)

In sum, it seems clear that the normalized frequency of the ETC in the entire corpus or any subcorpus provides only an inadequate picture of the use of the construction in early medical writing. Our analysis of the data in MEMT and EMEMT has shown that variation between individual texts is considerable and should be taken into account when interpreting the central tendencies in the data.

It could be mentioned that comprehensive medical treatises (EMEMT category 1) only truly began to emerge in the vernacular in the seventeenth century, [21] and consequently the category is represented by only three texts from the sixteenth century. Two of these are by the same author, the Cambridge educated physician Christopher Langton. Both of Langton’s texts, A Uery Brefe Tretise (1547) and Introduction into Physicke (1550), show a high frequency of ETCs at 5.3/1,000 words, while the third text in the category, Prognostications by an anonymous author, only reaches 0.8/1,000. Langton’s use of ETCs features several characteristics common to ME data, such as the use of the formulaic there + present indicative be and a wide variety of lexical verbs (see sections 4.1 and 4.2 below), particularly in Introduction to Physicke (5) and (6). Langton’s writings, like early medical textbooks in general, contain a notably high number of introductory definitions of various terms and topics. [22] This may in part account for the high frequency of ETC use.


There be .iii. faculties, or powers, diuers ech to other, which gouerneth the bodye, and be called Animall, vitall, and naturall. (EMEMT; Langton, A uery brefe treatise 1547: D5)


After all thys yet there remayneth a certayne watrye substance wyth the blood, to the entent, that parte of it may be co~cocte, and tourned in to bloode, afterwarde, and parte of it may make the blood thinner, … (EMEMT; Langton, Introduction to Physicke 1547: 38)

4. Phraseology of existential there constructions

In this section, we concentrate on some of the more remarkable phraseological variables that co-occur with the ETC in MEMT and EMEMT. These are then contrasted with corresponding phraseologies in PDE, with a view to explaining the differences on the basis of their discoursive functions.

4.1 Verbs in ET constructions

Our data contains a number of occurrences of the existential clauses with a verb other than be. However, the frequency of non-be verbs is generally low compared to be in the medical texts, and appears to decline over time. While findings from both the ME and EModE periods attest to some use (27% and 16% of all instances, respectively), non-be existentials are extremely rare in PDE medical writing, at least as far as research articles are concerned: the dataset of 340 ET-sentences examined in Hiltunen (2010) yielded a single instance of remain). [23] These results are in line with Pérez-Guerra’s (1999: 106) observations of the changes in the ratio of be vs. non-be constructions from late ME onwards, whereby the former has progressively increased and the latter decreased.

Figure 8

Figure 8. Verbs in ETCs over the timeline.

In total, 78 different lexical verbs were found in ETCs in MEMT and 81 in EMEMT. Although most of the verbs only occur once in the corpus, the repertoire clearly attests to greater productivity in the earlier periods than in PDE.

It is not surprising that the frequency of ETCs with verbs other than be is low in PDE medical research articles; according to Biber et al. (1999: 945-946), the verb exist is sometimes used as an alternative to the verb be in PDE academic prose, but is it is only in the register of fiction that a wide range of verbs is used in existential clauses. However, the fact that a wide variety of non-be verbs are used in both MEMT and EMEMT suggests that the register of medical writing at least has changed in such a way that it no longer contains contexts that would give rise to non-be existential constructions.

To find out why the frequency of non-be ETCs has dwindled in medical prose, it is useful to look at the contexts in which these constructions are used in earlier periods. In both MEMT and EMEMT, the most common lexical verbs are those of appearance and movement (cf. Pérez-Guerra 1999: 106, Breivik 1983: 229-235); a list of most frequent verbs is these corpora is provided in Table 2 below.

Table 2. Non-be verbs in ETC (raw frequencies) (* = passive).












































































































In MEMT, the non-be ETC is characteristically realised with verbs of appearance in contexts where physiological processes are described or where advice is given to the reader regarding a certain procedure (Examples (7) and (8)). Example (8) tells the reader how to separate fire from earth.


namely, if þat þer come out of þe wounde a sotil quytture reed (MEMT; Lanfranc, Chirurgia Magna: 57)


And put hit vij dayes þat hit may be wel incorporate in þe hoote watre. And after þat put hit ouer a strong flammyng fire and þere shal ascende a reede watre. And whenne þere distilleth noo more, þenne has þou a blacke watre in þe bottume of the vaisshel þe whiche is pure erthe. (MEMT, Rupescissa: 133)

Occurrences of the ETC with verbs of appearance in EMEMT are very similar to those found in MEMT, as demonstrated by examples (9) and (10). The first example describes a wound in the diaphragm, and the second the way in which the human body consists of the four elements (fire, air, water and earth):


VVhen the middle reefe or Diaphragma is vvou~ded, the~ are the syde of the patie~t dravvne, & shruncke vpvvardes: they have exceedinge greate & violent payne, internallye in the backe bone: they have verye retardate breathe, and there issueth out of the vvounde frothye bloode. (EMEMT; Guillemeau: 4r)


And therefore wee oughte not to thinke that pure fire or water, aire or earth, should be conteined in mannes bodie, if that he bee made thereof, because the elementes are not vnmixed in any liuyng creature, but like as in medicine made of waxe, pitche rosyn and tallowe, when the are melted together, there appeareth neither waxe, nor pitche, nor rosin, nor yet tallowe, but a thyng compounded of their substaunce whiche retaineth their qualities, and yet is like none of them. (EMEMT; Moore: 5)

Unlike ME and EModE texts, medical RAs in present-day English do not contain extensive descriptions of actual physiological processes as observed by the authors of the study. For instance, Dahl (2004: 1819) has observed that the medical RA is less a ‘text’ than an account of an experiment, and the presentation of data is kept apart from interpretation. This being the case, if non-BE existentials are mainly used precisely in such contexts, this may be the reason why presentational ETCs are hardly used in these texts at all.

4.1.1 Tense and polarity

A striking difference is also seen when it comes to (the) tense and polarity of the verb in ETCs. ME and EModE writers overwhelmingly favour the present tense, as can be observed in Figure 9. [24]

Figure 9

Figure 9. Distribution of tenses of ETCs across the timeline. [25]

However, medical authors of our own time are much more likely to use ETCs in the past tense in research articles, as observed in Hiltunen (2010): 20% (67/340) of ETCs in his data were in the present tense while 73% (247/340) were in the preterite.

This striking difference in usage has a clear explanation. The tense of the verb in ETCs generally conforms to the tense of the other verbs in the same passage. For instance, in (11), all the verb forms are in the present tense (underlined), including the two instances of the ETC.


There is another kind of Cough that troubleth much old folke, and that is of a Catarrhous humour. The third kind of Cough written of by us, is that which cometh to those that have the Fever Hectick. Also there is another kind which is caused of the French Pox. And these are the foure kindes of Coughes that do commonly happen vnto men and women. (EMEMT; Phioravante, Secrets: 12)

The high frequency of ETCs in the preterite in PDE research articles has to do with the fact that their main discourse function in this genre is to state individual findings of the current study. This is highlighted by the fact that ETCs are particularly frequent in two of the sections in the canonical structure of the research article, namely results and discussion, which generally favour the use of verbs in the preterite tense.These sections take a retrospective view of the analysis, which leads to the use of verb forms that have past time reference, as demonstrated in (12).


Assessment of islet cell viability by the means of membrane exclusion dyes and of mitochondrial membrane potential showed no differences between CGP and RGP islets within the same islet preparation, suggesting that the additional purification step had no impact on this parameter. Furthermore, endocrine function was evaluated by measuring the potency of isolated islets during in vitro stimulation in both static incubation and dynamic perifusion. These tests indicated that there was no significant difference between CGP and RGP islets. (PDE: Ichii et al., “Rescue purification maximizes the use of human islet preparations for transplantation”, 2005)

A contrast between the historical data and Hiltunen (2010) also emerges when it comes to polarity. ETCs may be realized with either negative or positive polarity. [26] Polarity was operationalised as the presence or absence of either a clause negator or a negative lexical item, whether formally negative (e.g., none) or not (e.g., seldom) (see Quirk et al. 1985: 776-782).

The ratio of positive and negative polarity is similar in the ME and EModE corpora, where ETCs showing positive polarity are considerably more frequent. A significant difference is found between these two subcorpora. [27]

Figure 10

Figure 10. Polarity of ETCs.

In contrast to the data from MEMT and EMEMT, the portion of negative existential constructions is considerably higher in PDE medical journals: Hiltunen (2010) showed that the proportion of negative ETCs is 42% (143/340) of all ETCs. This finding is explained by the prominence of statistical testing of hypotheses in contemporary medical research, giving rise to statements of the type “there was no association between variables X and Y”; illustrated in (13).


Body weight decreased from pretreatment (screening) to end of follow-up, but there was no significant difference between treatment groups (PDE: Byrne et al., “Growth Hormone, Glutamine, and an Optimal Diet Reduces Parenteral Nutrition in Patients With Short Bowel Syndrome”, 2005).

The application of statistical methodology became common in medicine in the twentieth century, and it seems likely that the introduction of this paradigm has also led to the emergence of a new discourse function for the negative ETC.

4.2 Modal auxiliaries

The final phraseological variable investigated in this study is the presence of modal verbs in the ETC. The relative frequency of ETCs with modal auxiliaries is relatively low in our data. Modal auxiliaries are found in roughly 10% of existential there clauses in the ME and EModE (Figure 11); the difference is not statistically significant. [28] In PDE, the use of modals in ETCs is even less common. [29] Only 5 out of 340 ETCs in Hiltunen (2010) contained a modal.

Figure 11

Figure 11. Modal auxiliaries in ETCs.

The way in which modal auxiliaries are used in MEMT and EMEMT ETCs is largely predictable, given the prototypical meanings of individual auxiliaries. The most common modals occurring in the EMEMT data are will (typically indicating future time reference), must and may (examples (14) and (15)).


For blood leting and strong purging there must bee particular directions had from the Doctors deputed according to the constitution of the parties (EMEMT: Certain necessary directions 1636) .


Dioscorides affirmeth that one root helps a quotidian ague, three a tertian, and four a quartan, which though our late Writers hold to be fabulous, yet there may be a greater truth in it than they are aware of… (EMEMT: London Dispensatory 1649: 15)

As for PDE medical research articles, Vihla (1999: 46) has demonstrated that modal auxiliaries are in general less frequent in research articles than in other genres of medical writing, and this tendency is reflected in their their low rates of occurrence in ETCs observed in Hiltunen (2010).

5. Conclusions

The findings indicate that while the existential there construction is productive in all categories of medical writing both in ME and EModE periods, some categories of medical writing exhibit unique practices and stylistic features. During the ME period the construction is unusually frequent in surgical writing, while in the EModE period its frequency is broadly similar in all categories except recipe collections, where it is less frequently used. The anomalies can be at least tentatively explained by the topical make-up of these categories.

Overall then, it seems that apart from the aforementioned category-specific differences, ETC phraseologies remained more or less unchanged in medical prose throughout the ME and EModE periods. However, when the two periods are compared with Present Day medical research articles, considerable differences can be observed. The most dramatic changes to have taken place after the 17th century have been the disappearance of non-be ETCs, the almost complete switch to past tense, and the increase of negative polarity. The study does not provide direct evidence of developments that took place between 18th and 20th centuries, but the contrast between the historical and PDE data suggests that changes in the use of the existential there construction may be linked to the well-attested developments that took place in the broader paradigm of medicine and natural sciences during those centuries.

Earlier studies investigating stylistic changes in scientific prose have suggested that the style of writing has become increasingly informative and nominal, less author-centred and more object centred, less narrative and less personal from the 17th century to the present day (Atkinson 1999, Halliday 2004 and Banks 2003); other studies comparing the stylistic development of different genres have pointed to the increasing specialization of scientific prose from other registers (see e.g. Biber & Finegan 1997). The present study provides evidence of quantitative changes in the use of ETCs in the history of medical writing. If we subscribe to the idea that the dominant styles of scientific thinking are reflected in language use, our data can be interpreted as one concrete example of how the frequency of a grammatical structure is indicative of more fundamental changes in the objectives of discourse.


[1] Jukka Tyrkkö’s research for this paper was funded by the Academy of Finland Research Unit for Variation, Contacts, and Change in English (VARIENG) at the University of Helsinki. Turo Hiltunen was funded by the Finnish Cultural Foundation. We are grateful to colleagues at ICAME30 in Lancaster for their comments and questions, and in particular to Prof. Terttu Nevalainen for informative discussions.

[2] Note that while some scholars (e.g., Breivik 1997) do not regard the word there as the defining characteristic of existential sentences, this study focuses solely on constructions with the word there as the dummy subject. Breivik’s definition of the existential sentence is inclusive of sentences like “On the table is a book” and “A book is on the table” (1997: 33), but these are not considered in this study.

[3] Levin (1993: 89-90) provides a list of over two hundred verbs in different semantic classes that are possible in the construction in PDE. Jenset (2005: 60) has observed 90 different non-be verb lemmas in ETCs in Chaucer’s works.

[4] Breivik (1997: 33) refers to these as “passive there1 sentences”, and does not regard them as existential sentences.

[5] Our operationalisation of polarity is thus purely syntactic. It goes without saying that clauses of negative polarity can be employed to assert a positive statement, e.g. “for so long as he doth bring it up again there is danger of him: but if he once brook it, there is no doubt of his recovery by the Grace of God” (EMEMT: Queen’s Closet, 1679)

[6] See http://www.helsinki.fi/varieng/CoRD/corpora/CEEM/index.html. A pre-publication version of the EMEMT corpus was used for this study; figures obtained may differ slightly from those in the published version. All examples from MEMT and EMEMT are cited with the name of the corpus, name of the author, a short title and a page number. For full references, see the manuals of MEMT and EMEMT, respectively, or get in touch with the authors.

[7] Category numbers in brackets are those used in the EMEMT corpus.

[8] It is worth noting that during ME and EModE periods, medical discourse communities were very small; for example, at the end of the sixteenth century the College of Physicians had only thirty fellows (see Pelling & Webster 1979: 171). Not only were medical texts produced by few authors, but the total number of copies in circulation was very low as well. ME manuscripts were generally produced in the dozens, and at least prior to the mid-seventeenth century, EModE printed medical books rarely saw print runs greater than a few hundred.

[9] The results of these studies have not been verified for this study, and the corpora used therein have not been consulted further.

[10] See http://www.helsinki.fi/varieng/CoRD/corpora/HelsinkiCorpus/index.html.

[11] See Vihla (1999: 38-41) for a description of the main genres of contemporary medical writing. Naturally, no direct equivalent to scientific journals existed in the ME period, and the first such journals only began to appear at the very end of the seventeenth century.

[12] Breivik (1983: 10-11) reports a figure of 3.1/1,000 from the written (PDE) part of the Survey of English Usage in 1978.

[13] See, e.g., Furdell (2002) and French (2003).

[14] Kruskal-Wallis nonparametric ANOVA (KW = 19.59), Dunn’s multiple comparisons test shows significance between 1570–1640 and 1640–1700 (p < 0.01). Note that PDE material was not included in this calculation.

[15] Kruskal-Wallis nonparametric ANOVA (KW = 20.49), Dunn’s multiple comparisons test shows significance for remedy and surgery (p < 0.001) and special and surgery (p < 0.01).

[16] It should be noted that because the surgical texts in MEMT are almost exclusively translations of Latin works by continental surgeons, the high frequency of the ETC may also be motivated by some kind of translation principle.

[17] Kruskal-Wallis nonparametric ANOVA (KW = 27.083), Dunn’s multiple comparisons test shows significance between specialized texts and recipes (p < 0.001) and surgery and recipes (p < 0.001).

[18] In a study of knowing-verbs in Early Modern medicine, the frequency of verbs know and understand was also found to be lower in Recipe collections than other kinds of texts (see Tyrkkö & Hiltunen 2011).

[19] The tradition of remedy books and materia medica in MEMT continues in EMEMT as two clearly distinct categories, recipes and health guides. The relative stability in frequency is achieved when the two categories are considered together.

[20] Kruskal-Wallis nonparametric ANOVA (KW = 30.172), Dunn’s multiple comparisons test for specialized texts and recipes (p < 0.05) and surgery and recipes (p < 0.05).

[21] See Taavitsainen et al. (2011).

[22] See McConchie and Curzan (2011).

[23] These figures are very similar to the data on written British English presented by Martínez Insúa (2004: 83), where over 97% of all occurrences of the ETC were made up by constructions with be.

[24] χ2(3) = 31.883, p < 0.0001.

[25] It should be noted that present time reference is commonly expressed with the present indicative form be in Middle English (cf. Barber 1976: 246). The proportion of ETCs with present indicative be decreases dramatically in medical prose from the Middle English period to the end of the 17th century.

[26] On formal aspects of negative ETCs, see e.g. Tottie (1991), Martínez Insúa (2004).

[27] χ2(1) = 11.201, p = 0.0008.

[28] χ2(1) = 0.4405, p = 0.5069.

[29] χ2(1) = 28.076, p < 0.0001.


The Helsinki Corpus of English Texts. 1991. Department of English, University of Helsinki. Compiled by Matti Rissanen (Project leader), Merja Kytö (Project secretary); Leena Kahlas-Tarkka, Matti Kilpiö (Old English); Saara Nevanlinna, Irma Taavitsainen (Middle English); Terttu Nevalainen, Helena Raumolin-Brunberg (Early Modern English).

The London-Oslo-Bergen Corpus, original version. 1970–1978, compiled by Geoffrey Leech, Lancaster University, Stig Johansson, University of Oslo (project leaders), and Knut Hofland, University of Bergen (head of computing).

Middle English Medical Texts (MEMT). 2005. Taavitsainen Irma, Päivi Pahta and Martti Mäkinen (eds.). CD-ROM. Amsterdam: John Benjamins.

Early Modern English Medical Texts (EMEMT). 2010. Taavitsainen, Irma, Päivi Pahta, Turo Hiltunen, Martti Mäkinen, Ville Marttila, Maura Ratia, Carla Suhr and Jukka Tyrkkö (compilers), with the assistance of Alpo Honkapohja, Anu Lehto and Raisa Oinonen. Early Modern English Medical Texts (EMEMT, 1500–1700). DVD-ROM with EMEMT Presenter software by Raymond Hickey. Amsterdam and Philadelphia: John Benjamins.

A corpus of research articles in surgery and orthopaedics. Compiled by Turo Hiltunen.


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