Medical Language:

Medical English in its broadest sense includes not only the official nomenclatures of the basic medical sciences (such as anatomy, biochemistry, pathology, and immunology) and the clinical specialties (such as pediatrics, dermatology, thoracic surgery, and psychiatry) but also a large body of less formal expressions, a sort of trade jargon used by physicians and their professional associates in speech, correspondence, and record-keeping.

Since pronunciation, spelling, and even meaning depend on usage rather than etymology, it has often been said that the least important thing about a word is its history. And yet, to trace the history of medical terminology is to trace the history of medicine itself, for every stage of that history has left its mark on the working vocabulary of the modern physician. Each new discovery in anatomy, physiology, pathology, and pharmacology has called forth a new name, and a great many of these names, no matter how haphazardly and irregularly coined, no matter how unsuitable in the light of later discoveries, have remained in use. An etymological survey of this rich lexical medley we call medical English, where terms used by Hippocrates jostle others made up yesterday, where we find words from classical languages adapted, often ingeniously and sometimes violently, to modern concepts, and where the names of celebrated persons, mythic figures, and remote places lend human interest and a spice of the exotic, should claim the attention of anyone having a professional or avocational concern with medicine or one of its allied fields.

For convenience, medical terms currently used by speakers of English may be grouped in eight classes: 1) terms borrowed from everyday English; 2) Greek and Latin terms preserved from ancient and medieval medicine; 3) modern coinages, chiefly from classical language elements; 4) terms based on proper names; 5) borrowings from modern foreign languages; 6) trade names; 7) argot and figurative formations; and 8) abbreviations.

Since maintaining health is ultimately each person’s own responsibility, professional practitioners of medicine have never held an exclusive right to treat diseases, much less to name and discuss them. Physicians have been borrowing “medical” words from lay English as long as the language has existed.

The history of English falls naturally into three stages. During the Old English or Anglo-Saxon period (A.D. 450–1150), a group of Germanic dialects carried into Britain from northwestern Europe by invading continental tribes including Saxons, Angles, and Jutes gradually diffused and coalesced, receiving important additions from the Old Norse of Scandinavian pirates and marauders and the Latin of Christian missionaries and lesser ones from the languages of foreign traders and the conquered Celts. As Middle English (1150–1500) evolved, most of the inflectional endings of its nouns, adjectives, and verbs weakened and were gradually lost, and it assimilated a vast number of French words brought into Britain after the Norman Conquest (1066). Modern English differs from later Middle English in many of its vowel sounds, in the stabilization of its spelling after the invention of printing, and in its increasing richness in loan words and new formations.

Many modern terms used by both physicians and laity for parts or regions of the body (arm, back, breast, hand, head, neck ), internal organs and tissues (heart, liver, lung, blood, bone, fat ), and common symptoms and diseases (ache, itch, measles, sore, wart, wound ) derive from Anglo-Saxon origins. Leg, scalp, skin, and skull, also dating from the earliest period of English, can be traced to Old Norse. We find most of these words in the works of Geoffrey Chaucer (ca 1342–1400), the first important figure in English literary history, and in addition others that entered Middle English via Norman French from medical Latin (canker, jaundice ) and Greek (cholera, melancholy ). Migraine, plague , and pleurisy , also adapted by French from classical words, appear in other Middle English authors.

Though all of these structures, symptoms, and ailments have formal names in the technical language of medicine, physicians generally prefer to use the common English words. They do not, however, always use them in the same way as the laity. For example, medicine has found it expedient to narrow and fix the meanings of some words taken over from lay speech. The anatomist limits the sense of arm to the part of the upper extremity between the shoulder and the elbow, and of leg to the part of the lower extremity between the knee and the ankle. To the microbiologist and the specialist in infectious diseases, plague means a specific communicable disease, not just any epidemic. To the cardiologist, heart failure denotes a group of sharply defined clinical syndromes, not just any breakdown of heart function. Similarly, chill, depression, joint, migraine, shock, stillborn, strain, and tenderness all have more restricted meanings in medical English than in lay speech.

In discussing human anatomy, physicians use some words, such as flank and loin, that the general populace applies only to animals, and others, such as belly and gut, that many of the laity regard as impolite. On the other hand, physicians find it best to avoid certain common words of shifting or dubious meaning and to substitute others (usually borrowed from classical languages or fabricated from classical material) whose meaning can be arbitrarily limited. For example, hip may be undesirably vague when the context fails to indicate whether the reference is to the thigh, the pelvis, the joint between them, the entire bodily region around this joint, or, euphemistically, the buttock. A patient may complain of dizziness, but the physician cannot be content with a term whose range of meanings includes such disparate symptoms as vertigo, disequilibrium, sleepiness, and nausea.

Physicians have been accused of adopting and clinging to an abstruse terminology based on dead languages in order to keep their patients in ignorance or even to conceal their own ignorance. But apart from cases of ambiguity as with dizziness and hip, or of brand-new concepts for which the common speech can supply no suitable names, the medical profession is only too ready to borrow or modify plain English expressions. Medical English includes a great many lively and even poetic compounds and phrases built of native material, some of them involving metaphor or hyperbole: bamboo spine, the bends, clubfoot, frozen shoulder, hammertoe, harelip, knock-knee, mallet finger, saddle block, strawberry mark, and wandering pacemaker.

The enormous stock of Greek words and word elements in the medical vocabulary, a source of difficulties for physicians and laity alike, owes its origin to the fact that Western medicine, insofar as we have written records of it, began with Hippocrates in the Periclean Age of Greece. It can be said with equal truth that Western civilization itself took shape in the same era, when the world and everything in it, from the phenomena of nature to human relations and institutions, first came under the scrutiny of that soaring analytic spirit, tempered by profound wisdom, that found its most perfect expression in Socrates. The presence in modern English of such words borrowed or derived from Greek as astronomy, character, criticism, democracy, dialogue, emphasis, idea, paragraph, problem, system, theme, theory, and thesis attests to the enduring influence of ancient Greek thought on modern culture. The philosophers Plato and Aristotle, the dramatists Sophocles and Euripides, and the historians Herodotus and Thucydides were all roughly contemporary with Hippocrates.

Revered as the Father of Medicine, Hippocrates (ca 460–ca 370 B.C.) was the guiding spirit, if not the founder, of the world’s first school of scientific medicine on the Greek island of Kos, the site of a famous temple to Aesculapius, god of healing. Tradition assigns to Hippocrates the role of separating medicine from religion by teaching that diseases have organic causes and must be combated by physical measures. He also worked out a primitive system of physiology and pathology based on the physics of Empedocles and the numerology of Pythagoras, and established the ethical directives for physicians embodied in the celebrated Hippocratic oath (which, however, is thought to be by a later hand).

The Corpus Hippocraticum, one of the wonders of ancient learning, is a collection of medical works covering a remarkable range of topics including medical history, geographic medicine, dietetics, prognosis, surgery, and orthopedics. Although no modern scholar believes that all these works are by the same author, a substantial number of them seem to show the same fertile, inquiring, incisive mind at work, and it is through these that Hippocrates has exerted so powerful an influence on all subsequent medical theory and practice. The oldest Greek medical terms in current use appear in the Hippocratic writings themselves, among them anthrax, asthma, bronchus, condyloma, dyspnea, dysthymia, erythema, erysipelas, orthopnea , and tenesmus .

These words were not, of course, invented by Hippocrates (asthma appears in the Iliad ), but only borrowed by him from the common speech and adapted to serve the needs of the fledgling science. The modern physician uses all of these terms, generally with more specific meanings than did Hippocrates, and sometimes with radically different ones. The principal reason for the survival of these words from a classical language is that for centuries after Hippocrates, Greek medicine was virtually the only medicine worthy of the name in the Western world, just as Greek philosophy and science dominated Western thought until long after the beginning of the Christian era. Aristotle (384–322 B.C.), remembered chiefly as a philosopher and the formulator of the system of logic still most widely accepted today, was also a brilliant anatomist and physiologist, and a few of our medical Greek words (alopecia, aorta, epiglottis, nystagmus, pancreas ) made early appearances in his works.

Centuries before Hippocrates, the priests of Egypt learned something about anatomy and pathology through the exercise of their duties as embalmers of the dead. Egyptian medicine, as revealed to us by tantalizingly sparse remnants of ancient writings on papyrus, seems to have been, like Greek medicine before Hippocrates, a branch of religion. There is evidence that early Egyptian science and mathematics influenced the development of these disciplines in Greece, and that, long before Alexander the Great conquered Egypt and annexed it to the Hellenic world, some Egyptian medical lore had reached Greece. A few medical terms that we customarily derive from Greek ultimately had Egyptian origins: ammonia , from an ancient term for ammonium chloride, of which large natural deposits were found near a shrine of the Egyptian deity Ammon (Amen) in Libya; gum ‘vegetable exudation’ from Egyptian qmy.t via Greek kommi; stibium , the chemical name for the element antimony and the basis for its international symbol, Sb, from Egyptian stm by way of Greek stimmi .

Long after Rome, in its turn, conquered Greece and absorbed the best of Hellenic learning and culture, most physicians in Rome and the provinces were Greek slaves or freedmen or Greek-speaking immigrants from the Near East or North Africa. Hence the lore of the craft continued to be passed on in the language of Hippocrates. Aretaeus of Cappadocia, who practised and wrote in the first century after Christ, discussed asphyxia and apparently invented the term diabetes. His contemporary, the medical botanist Dioscorides, used the terms eczema, kerion , and trachoma . Galen (A.D. 129–199), a native of Pergamum in Asia Minor, moved to Rome early in his career, devoted many years to the study and practice of medicine, and became court physician to the emperor Marcus Aurelius. His voluminous writings in Greek on anatomy, physiology, pathology, and therapeutics have earned him second place in medicine’s pantheon. Among words that first appear in his writings may be mentioned allantois, atheroma, coccyx, epididymis , and peritoneum .

In discussing parts of the body or common diseases a medical writer may find lay terms sufficient, but to write about new concepts or discoveries the writer must either invent new words or use old ones in new ways. From the dawn of medical history, writers on anatomy and pathology have yielded to the natural impulse to create metaphors to name new things. Thus, the bone at the lower end of the spine was called coccyx , Greek for ‘cuckoo’, because of its beaklike shape, and the opening from the stomach into the small intestine became the pylorus, ‘gatekeeper’. Loss of hair was termed alopecia, because it suggested the appearance of a fox (alopex ) with mange, and a person with an abnormally ravenous appetite was said to have bulimia, ‘the hunger of an ox’. Perhaps none of these words was the invention of a physician, but they all appear in early Greek medical writings, setting a precedent for subsequent medical word-making in all Western languages down to the present day.

With the collapse of the Byzantine Empire, the Greek language went into eclipse as a medium of scientific and technical communication. Even the masterpieces of Greek drama, philosophy, and history dropped out of sight, to be rediscovered centuries later in the Renaissance. Meanwhile Latin, the language of republican and imperial Rome and its western provinces, flourished as both a widespread vernacular and a literary language. While the popular speech was evolving into regional dialects that would in time become Italian, Spanish, Catalan, Portuguese, French, Provençal, and Rumanian, the classical language, enshrined in the prose of Cicero and the verses of the Augustan poets, survived with changes as the international language of learning, science, jurisprudence, and the Church.

The first Roman writer on medicine, Aulus Cornelius Celsus, who lived in the first century after Christ, was probably not a physician. His eight books De Medicina (On Medicine ), perhaps translated or adapted from a Greek work, review the whole subject of medical theory and practice in lucid, even elegant Latin. The immense historical value of Celsus’s writings lies partly in his nomenclature, for besides recording numerous Greek medical terms for which Latin offered no suitable equivalents (aphthae, ascites, cremaster, lagophthalmos, mydriasis, opisthotonos, staphyloma, tetanus ), he also gives the earliest medical applications of many Latin words still in use today (angina, caries, delirium, fistula, impetigo, mucus, radius, scabies, tabes, tibia, varus, verruca, vertebra, virus ).

Celsus’s contemporary, Pliny the Elder (A.D. ca 23–79), an indefatigable if somewhat incautious student of the natural sciences (he died while observing at close range an eruption of Vesuvius), was also a prolific writer. He devoted several books of his monumental Naturalis Historia (Natural History) to medical topics, and recorded for the first time the medical uses of such Latin terms as acetabulum, pruritus , and tinea . Whereas Celsus’s rigorously scientific work remained virtually lost from about the fifth century to the fifteenth, when its rediscovery stirred the medical world to its foundations, Pliny’s compendium of myth and misinformation became one of the non-fiction best-sellers of antiquity, and by the Middle Ages it was firmly established as a popular encyclopedia.

During the centuries following the decline of classical culture, the progress of medicine, as of all the arts and sciences, slowed nearly to a halt. Scientific investigation languished; education consisted largely in the uncritical memorization of ancient lore. In medicine the teachings of Galen, known through Latin translations and commentaries, maintained an unchallenged supremacy for more than a thousand years. But gradual though it was, the development of medical knowledge during the Dark Ages led to a slow accretion of technical Latin terms representing modifications of and additions to the lexical legacy of the ancients.

In the ninth century, when European letters and science were at their lowest ebb, Islamic scholars began a revival of Western learning, translating Aristotle, Galen, and other Greek authors into Syriac and Arabic and subjecting their teachings to searching analysis and impartial verification. The Persian physicians Rhazes, Haly Abbas, and Avicenna, the Arabians Averroes and Albucasis, and the Jew Maimonides performed important original research and made valuable contributions to medical literature. Traces of their influence linger in many terms of Arabic and Persian origin referring to anatomy, chemistry, and pharmacy that made their way into medical English by way of medieval Latin: alcohol, alkali, benzoin, bezoar, camphor, nuchal, retina, safranin, saphenous, soda , and sugar . With the resurgence of intellectual activity in the Renaissance, vigorous and original thinkers arose all over Europe to overthrow the hallowed errors of ancient authorities. In medicine, the earliest revolution came in anatomy with the painstaking dissections and detailed drawings of Leonardo and Vesalius, who dared to show where Galen had gone wrong. Fallopius, Servetus, Sylvius, and many others followed their lead. Increasingly minute descriptions of the human body called for an ever more elaborate nomenclature. The printing, in 1502, of the Onomasticon (Word-book ) of Julius Pollux (second century A.D.), a sort of dictionary that happened to include a section on anatomic terms, enabled anatomists to drop most of the Arabic names for parts of the body then commonly found in textbooks and reintroduce such classical Greek terms as amnion, atlas, axis, canthus, gastrocnemius, tragus , and trochanter .

But the system of anatomic nomenclature that had been largely codified by the end of the sixteenth century, while including a substantial body of Greek terms, was chiefly Latin. Once again metaphor played an extensive role in the choice of terms. Anatomists named body parts after plants (glans, ‘acorn’, uvula, ‘little grape’), animals (cochlea, ‘snail’, vermis, ‘worm’), architectural elements (tectum, ‘roof’, vestibulum, ‘entrance hall’), household implements (clavicula, ‘little key’, malleus, ‘hammer’), articles of clothing (tunica, ‘tunic’, zona ‘belt’), topographic features (fossa, ‘ditch’, fovea, ‘pit’), and even other body parts (capitellum, ‘little head’, ventriculus, ‘little belly’). By contrast, scores of other Latin anatomic terms, including many that we still use, seem almost painfully literal (extensor pollicis longus, ‘long extender of the thumb’, foramen magnum, ‘big hole’). The investigation of the fine structure of the body and of disease-causing microorganisms, made possible by the invention of the simple and compound microscopes, demanded a new stock of terms, and again many of those adopted were descriptive figures (bacillusm, ‘little stick’, glomerulus, ‘little ball of yarn’, nucleus, ‘kernel’).

Medicine, in the modern sense, came into being only with the commencement of the scientific era. Physiology, pathology, pharmacology, and surgery, formulated on an increasingly rational basis, required increasingly rigorous and systematized language. As long as Latin was understood by all educated persons, medical textbooks and monographs continued to be written in that language and lectures to be delivered in it. New medical terms were Latin in form, if not always in lexical origin. The modern vocabulary of medicine contains, besides many words known to Celsus, other terms borrowed from Latin at a much later date, such as angina pectoris, cor bovinum, fetor hepaticus, molluscum contagiosum, placenta previa, rubeola, torticollis , and vaccinia .

In the days when a doctor’s prescription was a kind of recipe calling for several ingredients, prescriptions were written in an elaborate, ritualized, grammatically debased form of Latin. This pharmaceutical Latin flourished until about the middle of the twentieth century, and many abbreviations based on it are still in use today (b.i.d., bis in die, ‘twice a day’; p.c., post cibos, ‘after meals’; p.r.n., pro re nata, ‘as the occasion arises’).

Although not directly connected with medicine, the system of classificatory naming of all living things devised by the Swedish naturalist, Linnaeus (1707–1778) plays an important role in medical communication. Linnaean nomenclature, fundamentally Latin with a substantial admixture of Greek stems and proper nouns, includes terms for disease-causing bacteria and fungi as well as more complex organisms of medical importance.

It is one thing for medicine to borrow a classical Greek or Latin word such as typhus or scabies and assign it a specific technical meaning, and another to combine classical stems and affixes to make entirely new words like hypercholesterolemia and proprioception . Most new medical terms formed from classical elements during the past hundred years have been of the latter kind, which we may call coinages for want of a more distinctive label.

Coinage entails two kindred processes, derivation (or affixation) and compounding. Derivation here refers to the attachment of one or more prefixes or suffixes to a word or stem, as when the prefix endo-, ‘within’ and the suffix -itis ‘inflammation of’ are added to the base word metra, ‘uterus’ to form endometritis, ‘inflammation of the uterine lining’. Compounding is the joining of two or more adjective, noun, or verb stems, as when the English stems derived from Greek megas, ‘large’, karyon, ‘nut, nucleus’, and kytos, ‘vessel, cell’ are combined to form megakaryocyte, ‘a bone marrow cell with a large, irregular nucleus’. Derivation is exemplified by English outlandish and unfriendly, compounding by headache and windpipe .

The combining form of a classical word consists of its stem plus, if needed, a linking vowel, usually o but sometimes i with Latin words. Thus brady- , as in bradycardia, is from Greek bradys, ‘slow’; cortico- , as in corticothalamic , from Latin cortex, cortices, ‘bark’; hemat- or hemato- , as in hematopoiesis, from Greek haima, haimatos, ‘blood’; femoro- , as in femoropopliteal, from Latin femur, femoris, ‘thigh’; gastr- or gastro- , as in gastroesophageal, from Greek gaster, gastros, ‘stomach’; my- or myo- , as in myoneural, from Greek mys, myos, ‘mouse, muscle’; ov- or ovi- or ovo-, as in oviduct, from Latin ovum,ovi, ‘egg’. The linking vowel is generally omitted before a following vowel: gastritis, hematemesis, hematuria . The final element of a classical coinage may be anglicized (colostomy, dermatome with silent final e, fibroblast, herniorrhaphy) or not (hemochromatosis, keratoconus, polyhydramnios, asystole with e pronounced).

Although in earlier times makers of new terms followed classical precedents more diligently and accurately than now, medical coinages have never adhered strictly to any rule, not even that of self-consistency. Medical language has not hesitated to shorten stems, drop awkward syllables, or use unorthodox forms of juncture. The meanings of some stems have wavered between two extremes (carcinogenic, ‘causing cancer’, but nephrogenic, ‘arising in the kidney’) or even gone in entirely new directions under the influence of analogy. The suffix -itis , in classical Greek merely a means of turning a noun into an adjective (as with English -en in golden ), took on its special meaning ‘inflammation of’ because it often appeared in Greek phrases, such as nephritis nosos, ‘kidney disease’. Even as early as the time of Hippocrates, it was customary to shorten a phrase of this kind by omitting the noun. Similarly, the Greek suffix -ma that was a means of forming a noun from a verb stem (as in drama and diploma) fused with the linking vowel -o- appeared in English as the combining form -oma with the medical sense of ‘tumor, neoplasm’, because it figured in a number of ancient terms, such as sarcoma and condyloma denoting abnormal growths.

For centuries, classical scholars thought it unscholarly to join Greek and Latin material in the same word. Since most of the living medical prefixes and suffixes, including the ubiquitous and indispensable -itis and -oma, were of Greek pedigree, matching Greek stems were dredged up from the depths of oblivion for combination with them, even when synonyms of Latin derivation were already in general use. Thus, although the common adjectives oral, mammary , and renal embody the Latin words for ‘mouth’, ‘breast’, and ‘kidney’ respectively, the corresponding Greek stems appear in stomatitis, mastectomy , and nephrosis . Now that objections to Greek-Latin hybrids have largely died out, many such words (appendicitis, hypertension, radiology ) thrive without the stigma of scholarly reproach. Indeed, compounds of Greek with French (culdoscopy, goitrogenic ), English (antibody, hemiblock ), German (antiscorbutic, kernicterus ), and Arabic (alcoholism, alkalosis ) now find universal acceptance. Meanwhile the medical lexicon remains rich beyond its needs in Greek stems and in Greek-Latin synonym pairs such as hypodermic/subcutaneous, scaphoid/navicular , and xiphoid/ensiform .

The hundreds of classical stems and affixes in daily use virtually invite further coinages, and in fact physicians produce nonce words and ad hoc formations from this material at a rate that defies the lexicographer to keep pace. Each new word may become the basis of a whole dynasty of derivative or analogical formations. Nouns, equipped with appropriate suffixes, readily change into verbs and adjectives, and vice versa. Many terms arise by back-formation, the process of creating an imaginary precursor or a shortened unconventional word from an existing form, such as to diagnose from diagnosis, to perfuse from perfusion , and precordium from precordial .

At all periods of history, proper nouns denoting persons and places have been incorporated into adjectives, verbs, other nouns, and phrases, as in Jeffersonian, Americanize, Marxism , and Halley’s comet . Eponymy, the derivation of words from personal names, has added to the medical vocabulary such diverse expressions as Addison’s disease, chagoma, cushingoid, descemetocele, facies Hippocratica, galenical , and parkinsonism . Besides terms like these honoring distinguished physicians, others stand as monuments to important patients: bacitracin , an antibiotic named for Margaret Tracy, from whose tissues it was first isolated; Carriуn’s disease (bartonellosis), named for Daniel A. Carriуn, a Peruvian student who inoculated himself experimentally with the disease and died of it; Hartnup disease , a heredofamilial metabolic disorder named for an English family of which several members were so affected; HeLa cells , a line of cultured human malignant cells named for Henrietta Lacks, from whose cervical carcinoma they are all descended; Legionnaires’ disease , pneumonitis due to a bacterium of the genus Legionella , the disease and the genus both named for the American Legion, at whose convention in 1976 the first recognized outbreak occurred.

Names of prominent figures in myth, legend, and popular fiction have also found their way into the physician’s lexicon. Atropine, a drug extracted from belladonna and various related plants of the genus Atropa and used as an antispasmodic for smooth muscle, is named, in allusion to its lethal properties, for Atropos, one of the three Fates, who was reputed to cut off each person’s thread of life at the moment appointed for death. Morphine , a narcotic extracted from the juice of the poppy, is named for Morpheus, the god of sleep. Satyriasis , abnormal sexual excitability in the male, refers to the Satyrs, mythic sylvan deities with a leaning toward lechery. Pickwickian syndrome , extreme obesity with hypoventilation, refers to Joe the fat boy in Dickens’s Pickwick Papers.

Most of the medical terms that incorporate geographic allusions are names of infectious diseases or their causative agents and refer to sites where these diseases are specially prevalent or endemic or where they were first identified or studied. In some of these terms, the names preserve their original form, as in Lyme disease , a tick-borne spirochetal infection named for a town in Connecticut, and Norwalk virus , which causes outbreaks of diarrhea in school children and is named after a city in Ohio. For other terms the geographic origins are not so evident: coxsackievirus , any of a group of human viruses causing various acute febrile syndromes, named for Coxsackie, New York; maduromycosis, a fungal skin disease, named after the city of Madura, India; tularemia , an infection of rodents sometimes transmitted to humans, first identified in Tulare County, California.

These terms based on proper nouns impart an element of novelty as well as a liberal dimension to what might otherwise be a depressingly prosaic assemblage of dry lexical bones gathered from the graveyard of dead languages. In a similar way, terms borrowed from modern foreign languages lend a cosmopolitan flavor to medical speech and writing. There are logical reasons why speakers of English customarily use foreign words for certain diseases, symptoms, or drugs. During the nineteenth century, the teachings and writings of Continental medical authorities played an essential part in the education of British and American physicians. Up until World War I, Americans flocked to Paris and Vienna for specialty training, and brought back French and German words and phrases for which no English equivalents seemed quite right. Numerous French words continue in use today in clinical medicine (ballottement, ‘shaking’, bruit, ‘noise’, grand mal, ‘big disease’, petit mal, ‘little disease’), surgery (bougie ‘dilator’, curette, ‘scraper’, dйbridement, ‘unbridling, cutting loose’, rongeur, ‘gnawer’), and obstetrics (cerclage ‘encirclement’, cul de sac ‘bottom of the bag’, fourchette ‘little fork’, souffle ‘blowing’). The suffix -ase , used to form the names of enzymes, first appeared in diastase, a French respelling of Greek diastasis, ‘separation’. The sugar suffix -ose dates from French glucose, based on Greek gleukos, ‘sweet wine’. The phrase milieu intйrieur, applied in French by Claude Bernard in the 1850s to his concept of internal physical and chemical equilibrium, is used in English today to designate the same concept.

German words also abound in medical English. Mittelschmerz, ‘middle pain’ (that is, pain midway between menses) is a well-established term for the pain of ovulation. Spinnbarkeit, ‘stretchability’ refers to the consistency of cervical mucus under the influence of estrogen. Magenstrasse, ‘stomach street’ picturesquely designates a portion of the stomach whose longitudinal folds seem designed to channel food toward the intestine. A number of German terms have been retained in English for findings first reported by German or Austrian scientists: mast, ‘stuffed’ cell in histology, gestalt, ‘shape’ in psychiatry, anlage, ‘foundation’ in embryology, quelling, ‘swelling’ in microbiology. The term eyeground for the retina and associated structures as examined with the ophthalmoscope probably owes its origin to German Augenhintergrund. Antibody is a translation, or at least a partial translation, of Antikцrper , and sitz bath bears the same relation to Sitzbad . The adjective German in German measles , a synonym for rubella , probably came into use in the sense of ‘false’ or ‘illusory’, but may allude to the German term Rцtheln, by which the disease was widely known in the nineteenth and early twentieth centuries.

Most of the Spanish and Portuguese loans in medical use denote diseases endemic in tropical colonies established by Spain and Portugal in the Old and New Worlds, or drugs derived from plants first found in those regions. Spanish espundia (apparently an alteration of esponja, ‘sponge’) and pinta, ‘splotch of paint’ are names for tropical infections based on their appearance, and Portuguese albino, ‘little white one’ was first applied to the occasional African slave without skin pigment. Spanish curare and Portuguese ipecacuanha are derived from South American Indian words, Portuguese ainhum from an African word. Other medical terms of African origin are kwashiorkor and tsetse .

Among Italian words in modern medical English, pellagra and malaria denote diseases once endemic in Italy. Influenza and petechia are also Italian in origin. Kala-azar is Hindi for ‘black disease’, and beriberi means ‘extreme weakness’ in Sinhalese. Tsutsugamushi, ‘dangerous bug’ disease and sodoku, ‘rat venom’ are from Japanese.

Trade names inevitably figure in workaday medical parlance, as they do in the speech of the general public. Nearly all drugs in common use and many dressing materials, instruments, and appliances bear trade names that are simpler, more euphonious, and more distinctive than their generic names. The trade name of an especially successful product may become a generic term for all similar products despite the efforts of the manufacturer to assert its legal rights in the name. Aspirin, lanolin , and milk of magnesia were once trade names; Band-Aid, Vaseline , and (in Canada) Aspirin still are.

When Jokichi Takamine isolated the hormone of the adrenal medulla in 1901 he called it Adrenalin and patented both name and product. This created difficulties for the compilers of the United States Pharmacopeia , since regulations forbade the inclusion of trade names. The term epinephrine , the Greek equivalent of Adrenalin , which had been suggested in 1897 by John Jacob Abel, was therefore substituted in the U.S. Pharmacopeia , but meanwhile adrenaline (with final e ) had slipped into the British Pharmacopoeia . Nowadays epinephrine and adrenaline are generally used interchangeably for both the natural hormone and the drug, although Parke-Davis holds the rights to Adrenalin as a trademark for a preparation of epinephrine used as a drug.

Physicians would not be human if they never playfully made up unconventional expressions or indulged in humorous distortions of technical terminology. What motives lie behind the creation of medical argot—the natural relish for a secret group language, the poetic impulse gone astray, a spirit of rebellion against regimentation of language and thought, or a craving for comic relief—need not concern us here. As mentioned earlier, no sharp distinction can be drawn between formal terminology and medical argot. Clearly retinitis pigmentosa and antihemophilic factor belong to formal language; just as clearly red-hot belly in the sense of ‘an abdomen showing signs of acute inflammation’ and electric lights and watermelons as a jocular variation on electrolyte and water balance do not. Between these extremes lie a large number of expressions that, without being perfectly orthodox in formation or altogether serious in tone, hover on the verge of respectability, and occasionally achieve it. Since this dictionary is based on a bank of citations from printed sources, it includes only such examples of medical slang as find their way at least occasionally into published literature.

Many terms now ratified by long use began as figures of speech, euphemisms, or experiments in onomatopoeia. An unconscious anthropomorphism has influenced the physician’s way of talking about disease-causing microorganisms, which are described as fastidious, resistant , or sensitive , and about neoplasms, which may be benign, invasive , or malignant . Many expressions in daily use seem based on the notion that medical practice is a warfare waged against disease. The physician plans an aggressive clinical strategy, choosing weapons from his arsenal (or armamentarium ) to augment the patient’s defenses against attacking organisms or foreign substances.

Despite the nature of their calling, physicians are not much less squeamish than others about naming and discussing certain body parts and functions, nor less ready to substitute euphemisms for cruder and more explicit terms. Some expressions still in use, such as stool for feces and void for urinate, were already well established in lay speech by the end of the Middle English period. During the Victorian era, medical language copied the extreme prudishness of demotic English: childbirth was disguised as confinement and a leg masqueraded as a limb. Modern medicine continues to sugarcoat its less palatable pills, calling one kind of abortion a menstrual extraction and substituting chemical dependency for drug addiction. Even disease, infirmity, and invalid are somewhat euphemistic in tone, hinting at illness by denying wellness.

Onomatopoeia is the creation of a word whose very pronunciation seems to echo the thing named, as in the case of screech, squawk, and whisper . Any discussion of medical onomatopoeia must ignore the lines dividing languages and epochs, for the process has undoubtedly been at work since the origin of speech. In fact, at one time linguists were ready to trace all words to this source. Although that theory is no longer held, onomatopoeia still provides the most reasonable explanation for certain recurring associations between sound and sense, such as the relations between [sn] and the nose (sneeze, sniffle, snore ) and between [gl] and swallowing (deglutition, gullet, singultus ). Greek borborygmus, bruxism , and rhonchus , Latin crepitus, murmur, and stertor , and English croup, hiccup , and wheeze are also plainly onomatopoetic in origin. Less evidently so, because of phonetic refinements, are eructation, rale, and sternutation.

The more frequently a medical word or phrase is used, the more likely it is to undergo some kind of shortening in both speech and writing. Spoken shortenings on the order of “CA” for cancer and “scope” for bronchoscope do not often achieve formal status, but the list of written abbreviations that have become standard grows steadily longer. The most common type of written abbreviation is the initialism, consisting of the initials of the words in a phrase or of the key elements in a compound term: BUN, blood urea nitrogen; ECG, electrocardiogram; HMO, health maintenance organization .

When, instead of saying the letters separately, one customarily pronounces such an abbreviation as a word (AIDS, acquired immune deficiency syndrome; CABG, pronounced “cabbage,” coronary artery bypass graft ) it is often called an acronym. An acronym may be treated as an ordinary word and combined with stems or affixes, as in vipoma ‘a neoplasm that secretes VIP (vasoactive intestinal polypeptide)’. Other kinds of shortening to which medical terms are subject include telescoping of phrases (arbovirus, arthropod-borne virus ) and omission of one or more words from a phrase (steroid for adrenal cortical steroid).

Not all shorthand expressions are abbreviations in the strict sense; sometimes letters or numbers are chosen arbitrarily to designate the members of a group or series. Thus the letters A, B, C, and so on, as used to designate the vitamins, are not abbreviations of more elaborate names (though, as an exception, vitamin K refers to Danish koagulation ). Nor are the letters P, Q, R, S, and T , as applied to the electrocardiogram (as in P wave, QRS complex , and Q-T interval ), abbreviations for words beginning with those letters. Greek letters as well as Arabic and Roman numerals figure in many medical terms: alpha-fetoprotein, beta-hemolysis, gamma-aminobutyric acid, factor V, HLA-B27 antigen .

These, then, are the ways in which nearly all of the words, phrases, and expressions in this dictionary have come into being. We often forget that words are first of all combinations of sounds, and only later marks on paper. The pronunciation of a word is that word, no matter what it means, how it is used, or how we choose to spell it. The pronunciation of medical terms by speakers of English tends to parallel the somewhat unruly practice of the general language. Classical precedents are largely ignored in the pronunciation of Greek and Latin words, particularly as to vowel sounds and syllable stress. Words and proper names borrowed from foreign languages fare little better, and the reproduction of French phonology is usually essayed with more zeal than accuracy. Moreover, an attempt at French pronunciation is often forced on words (chalazion, raphe, tamponade, troche ) not actually borrowed from that language.

Although medical English may give a superficial impression of order and system, it does not possess these qualities in much higher degree than the common speech. In fact, the ceaseless proliferation and endless semantic fusion and differentiation of medical terms have created a variety of problems. The presence in the medical lexicon of four or more names for many anatomic structures, many diseases, and many diagnostic and therepeutic procedures makes it awkward to maintain consistency in medical record-keeping, gathering statistics, billing for medical services, and assigning health insurance benefits, not to mention difficulties in medical and paramedical education and publishing.

Several official and quasi-official groups have sought, with varying degrees of success, to establish and even enforce standard nomenclatures for their spheres of interest and influence. Many of these groups have international memberships, hold periodic congresses at which experts agree (or disagree) on changes in terminology, and publish official lists, indexes, atlases, or keys of approved terms. The editors of this dictionary continuously monitor such attempts to write prescriptions for the use of medical language, but entries are made in the vocabulary section only when there is proof of compliance as evidenced by citations for actual use in the general and medical literature.

Some systems of naming and classification pertain to the basic sciences, and thus have a broader relevance than their connection with medicine. The Linnaean classification of all living things, including disease-causing organisms, has been mentioned already. Linnaeus’s Systema Naturae survives in the official nomenclatures, consistently expanded and revised, of botany, zoology, microbiology, and now virology. The Nomina Anatomica (NA) is an official body of anatomic, histologic, and embryologic nomenclature, entirely in Latin, that is revised every five years by an International Congress of Anatonists. The International Union of Pure and Applied Chemistry (IUPAC) has established rules for the naming of chemical substances, old and new.

In spite of such attempts at standardization, medical language as a whole does not match the regularity of chemical and taxonomic nomenclature but it is no less precise and consistent than, for example, the technical vocabularies of banking, geology, aeronautics, and law, nor less useful and convenient for those who speak and write it daily in their professional work.

There is a recent and growing trend in some official nomenclatures to assign numeric equivalents to certain specialized medical terms. The Nomenclature Committee of the International Union of Biochemistry and Molecular Biology publishes recommendations on the nomenclature and classification of enymes, in which each is assigned a unique number. Thus 1.1.1.27. stands for lactate dehydrogenase. The International System for Human Gene Nomenclature (ISGN) standardizes the notation used to distinguish genes (including oncogenes, which transmit a tendency to develop certain cancers) and their positions (loci) on chromosomes. One form of early-onset breast cancer is induced by the BRCA1 oncogene, located at position 17q21 (band 1 in region 2 on the long arm of human chromosome 17).

The ICD (International Classification of Diseases) is an adaptation, endorsed by the U.S. Department of Health and Human Services, of the World Health Organization’s Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death . ICD provides an elaborate classification of diseases, injuries, and inherited disorders, in which each condition is accompanied by a numeric or alphanumeric code. Simple acute appendicitis is designated as 540.9, Kaposi’s sarcoma as M9140/3, and death by capital punishment as E978. In recent years ICD has been updated annually, and extensively revised at longer intervals.

Closely coordinated with ICD, and partly derived from it, is the Diagnostic and Statistical Manual of Mental Disorders (DSM), first published in 1952 by the American Psychiatric Association. The DSM classifies, names, and supplies diagnostic criteria for each mental disorder. Code numbers are those of ICD .

Although ICD contains a section of diagnostic and therapeutic procedures, a more elaborate classification is published by the Americal Medical Association as the Physician’s Current Procedural Terminology (CPT), with its own set of five-digit numeric codes. The CPT code number for an appendectomy, for example, is 44950.

One might sum up the history of medical English by saying that it has grown and evolved as an integral part of the common language, choosing and even manufacturing its vocabulary to suit the special needs of medical practitioners, investigators, teachers, and writers, but generally clinging to the phonetic, semantic, and syntactic habits of plain English. The individual histories of medical words may be both fascinating and instructive, but they do not necessarily help in determining correct meanings or current spellings. Indeed, the entry of a term into the medical vocabulary is not the end of its history but only the beginning.

The meaning we accept nowadays for a word may be but the latest of many it has borne. In the Greek of Hippocrates, aorta refers to the lower respiratory tract and bronchus means the throat, gullet, or windpipe indifferently, as does stomachos in Homer. In classical Latin, vulva means ‘uterus’ and uterus generally means ‘belly’. We retain the term influenza for a group of specific viral syndromes although we no longer attribute them to the malign influence (for that is the purport of the term) of the heavenly bodies. We preserve terms alluding to Hippocratic pathophysiology, such as cholera, chyme, crisis, dyscrasia, humoral, hypochondria, and melancholia , although the concepts for which these terms stand were rejected as invalid early in the nineteenth century. These words remain in use because over the years they have lost their original meanings and acquired others. Cholera is now a specific bacterial infection, and a blood dyscrasia is a disturbance in the formation of blood cells, both notions that would have baffled Hippocrates.

These hardy survivors illustrate the point, often overlooked and sometimes vigorously contested, that the meaning or definition of a word depends on association and analogy, not necessarily on its history or etymology. The portal vein got its name from the porta or gate of the liver, a cleft on the underside of the organ where this vein enters. For centuries the portal vein was believed to be the only blood vessel in the body that both begins and ends in capillaries. For this reason the term portal lost its earlier associations and came to mean ‘beginning and ending in capillaries’. When a similar arrangement was finally discovered in the pituitary gland, the vessels there were called the pituitary portal system . Because the sense of colic (Greek kolikos ) has shifted from the literal one of ‘pertaining to the colon’ to ‘any intermittent, cramping pain in the lower trunk’, we can speak without incongruity of renal colic ‘the pain caused by a stone in a kidney or ureter’.

The definitions assigned to terms such as abortion, acupuncture, chiropractic, holistic medicine, macrobiotic diet , and wellness by advocates of these disciplines or practices may differ radically from the definitions of their opponents, and these again from those of disinterested observers. Our language both reflects and shapes our ways of perceiving, dividing, and classifying reality. As modern medical thought becomes less empirical and superstitious, more coherent and linear, so does modern medical language. The words may sound the same, look the same on paper, but their connotations shift with the passing years, responding to shifts in theory, doctrine, and point of view.

The quest for the exact meaning of a medical term is more than just an academic exercise. Words are our most effective means of recording and transmitting information, and almost our only way of dealing with complex and abstract subjects. The precision and perspicuity with which words are used determine the efficacy of educational and informational endeavors and the validity of written records. On the meaning of a single word in a hospital chart may hinge thousands of dollars in insurance benefits, millions in litigation settlements, even the life of the patient. In this light the importance of an accurate, up-to-date dictionary of medical English with definitions based on current usage citations can hardly be exaggerated.

A living language is a dynamic process, not a static product, and no dictionary of it can ever be definitive. The editors of this dictionary have not set out to assign meanings to words arbitrarily, much less to fix them unalterably, but only to record the meanings that the words presently convey in actual use. Drawing on the full lexicographic resources of Merriam-Webster, Incorporated, the editors have produced a current word list that includes new formations and omits terms no longer used, and have supplied current definitions as reflected in recently published material. The result is a uniquely authoritative and up-to-date reference work for professional, student, and layperson.

MEDICAL VOCABULARY

Arthritis: inflammation of joints

Stomatitis: infection of mouth

Homoeopathy: Similars cure similars.

Allopathy: Contrary cure contrary.

Pneumoccocus: virus

Meningoccocus: virus

Bronchitis: inflammation of bronchi

Pneumonia: infection of lungs

Otitis Media: infection of ear

Otosclerosis: ear

Sinusitis: inflammation of sinuses.

Bronchial Asthma: bronchi inflamed with panting

Tonsillitis: inflammation of tonsils.

Pharingitis: inflammation of pharynx

Globus Histericus: hallucination, something on throat

Allergy: any substance has a bad effect

Nasal Allergy: allergy in the nose

Urticaria: skin disease

Menopause: climacteric, after 47 for women

Menorrhagia: violent menses

Menarche: first menstrual period

Vaginitis: inflammation of vagina

Cystitis: urine infection

Osteoporosis: frail bones at menopause

Insomnia: no sleep

Leucorrhoea: white discharge

Amenorrhoea: no monthly period

Ovarian cysts: growths in the ovary

Dysparunea: difficult coition

Polyuria: too much urine

Prostatitis: inflammation of prostate

Hypertrophy of prostate: growth of prostrate

Sterility: no children

Uraemia: uraea in the blood

Gastroenterology: digestive problem

Colitis: inflation of colon

Gastritis: inflammation of stomach

Reflux oesophagitis: inflammation of oesophagus

Haemorrhoids: congestion of veins at anus

Hernia: umbilical and inguinal:

Hepatitis: inflammation of liver (hepar)

Bulimia nervosa: nervous sickness of eating too much

Abulia: no willpower

Cholesterol: too much fat

Cirrhosis of liver: inflammation of liver due to alcohol

Hypochondriasis: sadness

Aphthous stomatitis: mouth ulcers

Dental gingivitis: inflammation of gums

Parotid gland diseases: inflammation of parotids

Stye: sebaceous growth at eye lids

Conjunctivitis: inflammation of conjunctiva of eyes

Iridocyclitis: inflammation of iris

Nyctalopia: night blindness

Biopsy: test for cancer

Cervical spondylosis: spine problem at neck

Gout arthritis: inflammation of joint with uric diathesis

Osteoarthritis: arthritis of bones

Knee arthritis: inflammation of knee

Lumbago: inflmation of back

Coccydynia: pain of cocyx

Coccyxalgia: pain of cocyx

Ganglion: growth at wrist

Frozen shoulder: pain at shoulder

Haemotympanum: blood at ear tympanum

Haemorrhage: bleeding (from Greek haima+rrhagnumi)

Haematemesis: blood vomiting

Parkinsonism: tremors

Lower motor neurone disease: nerve disease

Cardiology: science of heart (Greek kardia, Latin cor, Konkani kalliz-undd)

Encephalitis: inflammation of brain

Encephalogram: X-ray of brain

Angina pectoris: pain of heart muscle

Hypertension: hypertonie, high blood pressure

Hypotension: lower blood pressure

Pseudoangina: false pain of heart

Coronary bypass: heart operation

Congestive heart failure: heart problem

Cardiac neurosis: heart problem

Arrythmias: lack of pulse regularity

Antibiotics: drugs against bacterial infection

Dermatology: medical science of skin

Barber’s itch: skin disease

Dandruff: scalp disease

Alopecia: baldness

Lichen planus: skin disease

Genital warts: warts at the penis

Acne: facial skin disease

Dermatitis: inflammation of skin

Ectopic heart beats: heart problem

Ectopic pregnancy: pregnancy outside the place

Vertigo: giddiness

Vaginitis: inflammation of vagina

Vulvitis: inflammation of vulva

Nephrology: kidney problem

Ophthalmology: science of eye

Psychiatry: science of mind

Gynaecology: science of women’s disease

Obstetrics: science of delivery

Neurology: science of nerves

Hormones: progesterone,

Anaemia: lack of blood

Herpes zoster: skin disease

Obesity: overweight

Impotency: difficulty in coition

Sciatica: pain at leg

Epilepsy: disease of electrical waves at the brain

Bell’s palsy: paralysy of face

Uterine prolapse: falling of uterus

Hallucination: loss of sense of reality

Delusion: deception

Schizophrenia: nervous disease

Diabetes insipidus/mellitus: too much sugar (dia+baino +mell: too much honey runs)

Sperm/semen: seed

Smegma: substance for lubrication

Glans: of penis

Penis: popott

Urethra:

Scrotum:

Platelets: blood

Crohn’s disease:

bipolar disorder

colorectal cancer: cancer of colon

emphysema: lung problem

endometriosis: inflammation of endometrium

thrombosis: blood stroke

eclampsia: at pregnacy

estrogen: hormone

progesterone: hormone

neurone: nerve

lipid profile: test for cholesterol

angioplasty: operation of arteries through balloon

pediatrics: science of children’s diseases

immunology: science of immune system

pharmacology: science of drugs (pharmakon: drug)

epidemiology: science of contagious diseases

cosmetic surgery: surgery for beauty

cardiovascular disease: heart disease

geriatrics: science of old age (

gene therapy: new science of genes

diagnostic tools: tools for examination

hypodermic/subcutaneous injection: injection under the skin

phimosis: the prepuce does notcome out

leukemia: too many white blood corpuscles in the blood
Addison’s disease:
alanine aminotransferase
albumin
alkaline phosphatase
amino acid

amylase
anaphylactic shock
anorexia nervosa
anterograde
anti-inflammatory
antidepressants

antinuclear antibody
anxiety disorders
asthma
autoimmune disease
axillary lymph nodes