They're only words, butthey really do matter…

November 9, 2009

I was never very good at the classics at school.

I was never very good at the classics at school. I guess I never really fancied the Latin teacher in the same way I did the French assistante. The languages appeared so dry and so dead at the time, and although we learned “amo, amas, amat…,” there was not the same potential to apply this newfound knowledge. Foreign exchange trips did not take in ancient Rome or Athens, so there was no opportunity to impress a local “puella” with your extensive understanding of Caesar’s Gallic Wars.

Perhaps medical school witnessed a slight enhancement of my enthusiasm for Latin and Greek derivation; anatomy viva-voce examinations made that almost a necessity. But it is only lately that I have become concerned, some would say obsessed, with the proper use of language. The use of Latin and Greek, and occasionally German, words for the description of anatomy and pathology allows the language to be almost universal among medics and therefore affords an understanding between practitioners from all over the world. Why, then, have we become so lazy?

I have become used to the way in which the English language has been modified to accommodate American tastes: foetus becomes fetus, for example, although I remain unable to accept etiology rather than the correct form of aetiology.

I can understand the difficulty that some may have with the use of English, especially when it is not the mother tongue. I can also understand their confusion over certain words incorporated into medical use because of an association with an individual. For example, it is difficult to determine whether and when to capitalize the word Doppler. Should it be capitalized when it’s used in recognition of the scientist who first appreciated a frequency change with motion? What about when it’s used to describe a technique such as “color Doppler”? Capitalization questions aside, however, use of the word as a verb offends my sensibilities.

Perhaps I am being unreasonable if I lay the blame for much of the etymological and grammatical abuse at the door of Americans, but it is they who suggested the description “endovaginal,” notwithstanding that they cannot pronounce the word. Mixing Greek and Latin derivations within the same word cannot be acceptable to any lover of language. Transvaginal is preferable, but I still believe that pervaginal or intravaginal represent more accurate terms.

Sadly, however, it is my own residents and younger colleagues who have awakened the lexicographic Kraken in me. What is so difficult about the filamentous membrane that divides two locules of a cyst? This is a septum. Only if there are two membranes do they become septa, and in no situation are there such things as septae. The same applies to the outpouchings of the colonic wall. These are known as diverticula if there are several but as a diverticulum when there is only one. Diverticulae or diverticuli do not exist.

Some words are, of course, difficult. Adnexus relates to an accessory or adjoining part, such as the ovary or fallopian tube. Even the lexicographers have become confused when determining how to employ the plural, namely “adnexus,” and have employed the neuter plural adjectival form, “adnexa.” Somehow, however, the “e” enthusiasts have had a field day. Not content with creating a plural neologism in the form of adnexae, I have seen an increasing use of a completely new word: the adenexa.

Why do the generative organs create so much confusion? I completely fail to understand the confusion with respect to the male gonad, but it remains the case that a single testis is frequently labeled as the left or right testes!

Perhaps it doesn’t matter. Perhaps I should have another glass of wine and accept that language changes- adapts for current use-and bow to classical derivations being consigned to history.

“Do the terms proximal and distal cause confusion amongst radiologists and other clinicians?,” an article from the April issue of Clinical Radiology (2009;64[4]:397-402) demonstrates how the unqualified use of terms can cause confusion. The words proximal and distal demand a reference point if they are not to be misinterpreted. When using these terms to describe certain anatomical structures, the author found significant conformity in the descriptions when applied to the common bile duct but discordance when they were used to describe the ends of the superior vena cava or jugular vein. Such discordance may lead to significant medical error. One is reminded here of the female medical student asked to describe a lesion on the tip of a penis. Challenged when she described the lesion as being on the proximal end of the penis, she retorted that it may be distal to you, sir, but it is proximal to me! The terms are clearly not absolute.

Most depressing of all, however, are suggestions that certain anatomical structures be completely renamed to avoid confusion. Apparently, the superficial femoral vein is ill understood by many young doctors who do not recognize that it is part of the deep venous system of the leg. Thus, if I report that there is an occlusive thrombus extending from the popliteal vein into the superficial femoral vein but not into the common femoral vein, there is either confusion as to how the thrombus can flit so easily between superficial and deep venous systems or total lack of concern on the part of the clinician, having been reassured that there is no deep vein thrombosis.

So should these vessels really be renamed the proximal and distal femoral veins? Does anyone else begin to feel uneasy? Proximal or distal to what, we should be asking.

Whatever happened to detailed anatomical knowledge as part of the medical curriculum?

I think I will have that other glass of wine… But do I pour from the proximal or distal end of the bottle?