1230

GRAINS AND SCRUPLESUnder this heading appear week by week the unfettered thoughts of doctors invarious occupations. Each contributor is responsible for the section for a month ; ;

his name can be seen later in the half-yearly index

FROM AN AMATEUR JOURNALISTIV

ACCORDING to the editor of a certain standarddictionary, well-bred persons of education and fairability are able to define or understand 50,000 words,and are accustomed to employ some 20,000 or morein conversation and writing. It cannot be an easymatter, even if it is possible at all, to ascertain theextent of anybody’s vocabulary, excluding of coursethe extreme limit in a little child, a mentally defectiveor an entirely uneducated person. But I should have

thought such figures as those advanced by the editora grotesque overstatement. I have seen it stated,on reasonably good authority, that Shakspere used24,000 words, Milton about 13,000, although bothknew many more. It has also been estimated thatthe average labourer from Dorset-why Dorset —gets along with 300 words and I find it easier tothink in such simple figures than in the tens ofthousands which the editor of that standard dictionaryfiings about so lavishly. "Drugs are of no use"has been remarked on occasion, evoking the retort" not the slightest unless you know how to use them."To some extent the same may be said of words,although the attempt to acquire a large vocabularymust be on the whole the index of a desire to know theproper meaning of the words and, therefore, theircorrect and advantageous employment.

* * *

If one may judge from ordinary conversation, isit likely that the average " well bred person of educa-tion " knows the meaning of more than 8000 wordsand uses more than 6000, excluding of course purelytechnical terms Every advance in knowledge meansan appropriate new vocabulary so that daily accretionsto our language are demanded. Every profession,every trade, every invention has its technicalities,often a language which to the uninformed is com-pletely meaningless. Surely our own professionmust have easily the most extensive of all technicalphraseologies. Dictionaries of medical terms claimto contain something of the order of 80,000 references.What percentage of this stupendous total is utilisedby the majority of our profession Dip into itfor some choice examples: hysterostomatocleisis ;anakinetomeric ; onomatopoiesis ; maieusiophobia ;hyperneurotization ; autarcesiology ; tsutsugamu-shiasis ; synchopexia. One learns with relief thatthe last is " the same as tachycardia." In thepreface to the 18th edition of Dorland’s AmericanIllustrated Medical Dictionary (1938) it is claimed that3000 new words have been added since the previousedition (1935): 3000 in three years; nearly three aday ! No wonder that some of us who would doubtlessbe convicted of an inferiority sense are afraid togo away for a week-end lest during our absencewe shall lose some advance in medicine which weshall be unable to overtake.

* * *

In this connexion it is natural to consider theemployment of proper names in medicine. Whilsta relatively small number are an integral part of ourknowledge and could not possibly be eliminated, itis not remarkable that a protest is raised from time

to time when a fresh sign or syndrome, a new test,a special instrument, a modification of an operationor variation in some form of treatment imposesan additional burden on the memory. Blanchardscathingly described the " syndrome du bapteme "as a neurosis with the absolutely characteristicsymptom that the victim-usually a medical practi-tioner-is seized with an uncontrollable impulse todiscover some extraordinary disease and to bestowhis name upon it. And to this neurosis a not incon-siderable number of our profession display a highdegree of susceptibility and morbidity. To theAnnals of Medical History for January, 1937, SirHumphry Rolleston contributes a fascinating articleon the subject of eponyms, a comprehensive surveywith all the charm and learning we expect from hispen. He quotes the number of eponymous termsin Dorland: if one includes every reference towhich a proper name is attached the number mustrun into thousands. I counted 776 under " sign "alone ! Sir Humphry defends the eponym on certaingrounds. Subsequent research may show that theexact nature and causation as originally denoted areincorrect; so that " Gull’s disease" is preferableto " myxoedema " and " Cushing’s syndrome " to

" pituitary basophilism." Again, the pathologicaldescription may be inconveniently cumbrous. Com-pare " Raynaud’s disease " with " local asphyxiaand symmetrical gangrene of the extremities."Drawbacks are in many instances obvious. Mostly

the reference is, to say the least of it, meaningless.Priority of description is not ensured with anycertainty. Sir Humphry points out that the Stokes-Adams form of heart-block was reported by threeprevious observers and it is not surprising that thesame condition is claimed by many different countriesand identified by a corresponding name. Everybodyin the profession in the British Isles is familiar with" Graves’s disease " although there may be somedoubt whether it should be Grave or Graves. Alesser number recognise " Parry’s disease " and areaware that on the Continent toxic goitre is invariablyidentified with K. A. von Basedow. I wonder howmany know that in Italy they describe it as " Flajani’sdisease" and I judge that only the most erudite

(to whom such a study almost smacks of an obsession)would be familiar with the claims of Stokes, Demours,Marsh, Parsons and Begbie in the same connexion.Argyll Robertson, Cheyne-Stokes, Austin Flint,Brown-Séquard, Stokes-Adams are hallowed names,although an impish examiner can generally score

off a student by inquiring whether one observer ortwo are intended. I have myself encountered thebelief that a possible occupation-disease was designatedby " Baker’s cyst " and that " Parrot’s nodes "derived recognition from resemblance to the beakof a bird. ("Writer’s cramp" is’ perhaps too

thoroughly established to justify the attempt tofasten upon an unsuspecting victim the acceptanceof a possible eponym in " Scrivener’s palsy.") Iconfess to a resentment in encouraging a flippancywhen accepting " Jones’s cock-up splint" and" Cock’s peculiar tumour " ; but too much of ourscientific nomenclature has received the cachet ofantiquity to assume as the avoidance of an invidiousdistinction the well-known recommendation of thelate Lord Fisher.

1231

The out-and-out pedant is admittedly a nuisance.If he desires to talk like a book he will begin by beingdistrusted and end by being thoroughly detested.The man who uses the expression " our mutualfriend," which was good enough for Dickens, is likelyto be annoyed rather than grateful or even interestedif he is informed that the construction is nonsense.To speak and write fairly good English is a not over-laborious occupation : to speak and to write whatthe pundits would accept as correct English seemsto demand a nightmare of study. There are bookson the subject ; one which is at my elbow has 21 pagesoccupied with rules for the correct use of " shall "and " will." Twenty-one pages of complicatedinstruction and examples for an even chance ! Youare as likely to be correct by guessing. Did anybodyever write perfect English ? 1 It is not difficult to

pick holes in Carlyle and Macaulay, to say nothing ofScott and Meredith.Apart from the condemnation of preciosity, a

word is pertinent in regard to the abuse of slang.I say abuse, not use, because an occasional indulgenceis a not too generous concession to gregariousnessand to have no slang at all is as bad as to haveno redeeming vice. Recruits to our language hailfrom every section of society and the smart expres-sions of one class are the slang contributions ofanother. Some are transferred from such exaltedquarters that we average beings are dazzled intoadmiration and forget the unworthiness of their

origin. But abuse introduces the dangers of slovenli-ness and inexactitude-dangers only too prevalentin our profession, in which the habitual slang addictwill never lack for company, in which indeed thestylist or purist is likely to gain more ridicule thanrespect. I was a dresser to a famous surgeon of his

day and early in the course of my duties I informedhim in the affable manner of one brother of the lancetto another that such and such a specimen had beensent to the " path. lab." " The path-o-log-i-callab-or-a-tory," he corrected, with unctuous and

punctilious demarcation and would-be devastatingreproach. The lesson was not forgotten. Two

years later, when his house-surgeon, I thoroughlydrilled my dressers so that when the great manasked one of them colloquially " Anything in thechest, anything in the lungs " he was staggeredinto inarticulate fury by the quiet rejoinder " Theusual thoracic viscera, sir, and air in the lungs."The cultured layman learned in the classics is

contemptuous of the whole of our phraseology,many terms in which are a mixture of Latin andGreek with elements which long ago parted companyfrom their original meaning. Even if we have tooffend him we have no remedy ; we have to acceptour current language. But much of our slang is

lamentable, although it may survive with the defencethat it saves time and trouble and is generally (notalways) unambiguous. Nobody, for example, oughtto worry about the distinction between an " infre-quent " and a " slow " pulse, for although there isa difference it is only a man intoxicated with themadness of superlative accuracy who would desireto advance it. And to some extent the same may besaid about the familiar pronouncement that thepatient has " no temperature." We always know whatis meant and do not need reminding of the absurditythat his temperature cannot be absolute zero. Still,it is a pleasing little courtesy to the ears of the moreparticular to announce the absence of pyrexia orfever. But much of our medical gibberish isunnecessarily inelegant. Life may be short andart fleeting but neither to such an extent that we

need flu, gynae., primip., abdo., pul. tub., auric.fib., chronic appendix, gastric case, pronouncedbelly, a cardiac, teeth O.K., he was bismuth-mealed,Babinski present, I put her on iron, she had aCsesar., I did a P.R. Odd tenths of seconds saved,but what are you going to do with those tenths ’!As a really good New Year resolution (which could

be adopted in May) we all ought to eliminate the verb" to get " as much as possible. Consider this uglinessfrom a leader in our midst-of course the contextis paraphrased. " In this condition you do not

get perfect expansion, you get irregularities and youare apt to get a tendency to bronchitis which in thecourse of time gets worse." This shows the perpetuityof the early habit in a student’s training, for whenone asks for the description of a lesion, in the hugemajority of cases the construction proceeds upon thelines-" You get." I may resent the imputationwhen he is referring to hobnails in the liver or rejectthe absurdity if he assures me that " you get h2emor-rhage from the vagina." "You get" serves allpurposes-as for " one observes (or finds) " or " thereis present (or occurs or develops)." In fact thereexists a host of appropriate choices from our richvocabulary which like verbal misers we keep hoardedup between the boards of dictionaries, content tosubsist on a battered or counterfeit phraseology.

« * *

And the delight in abbreviations ! Perhaps we areas a nation peculiar in a penchant for multiplyingand utilising the letters which its citizens are permittedto adopt as indicative of the distinctions and honoursthat they have gained or acquired. A high-courtjudge has sardonically pointed out that the paymentof a few guineas appeared to be the only qualificationfor election to the fellowship of certain societies withthe privilege of putting a number of letters after one’sname. In some instances, I suppose, the qualifica-tion is even more slender than that. How manypeople know what an M.B.LP.S. is ? Most are

familiar with I.O.U., but I.O.P. has an entirelydifferent significance. Beware lest your friend withthe last-named distinction is inadvertently addressedas 1. O.O.P. So far as I can see there is nothing toprevent one from starting a society of any kind,say " The Metropolitan Association for EncouragingAmbidexterity in Midwives " and associating withthis, fellowship, membership, associateship, withcorresponding letters to follow the name.What must the layman make of our honourable

professional adornments ? He has to discover that abachelor of surgery may be a B.C., a B.Ch., a B.Chir.,or a B.S. The last he probably confuses with B.Sc.>the second must puzzle him because of its clericalappearance and the first he probably refuses tobelieve. What does he think of us when we callmost of our doctors of medicine M.D.s but a selectfew D.M.s ? ‘? Don’t we know our own mind IM.R.C.S., L.R.C.P. he encounters so frequently thathe masters their significance, and to F.R.C.S. heaccords a respectful recognition of superiority.But what does he make of L.M.S.S.A., of L.R.F.P.S.,of M.M.S.A. I am not at all sure that the majorityof us would be confident in respect to B.A.O., L.A.H.,L.S.Sc. In our jargon we have a kind of recognisednotation : P.R., W.R., H.S., H.P., R.M.O., Tb orT.B., T.A.B., K.L.B., C.O.A., pH, F.H., B.B.A.,L.O.A., R.O.P. and a host of others. Theremay not be much danger of confusion althoughI found that of two consecutive students selectingthe abbreviation P.A. one meant pernicious anaemia

(Continued at foot of next page)