The Most Beautiful Words In Medicine
Whether deadly, grisly, or therapeutic, some things in my profession certainly have beautiful names.
PUT A BUNCH OF MEDICS around a dinner table and they will gleefully discuss the most disgusting and graphic aspects of their job while happily knocking back a glass of wine and helping themselves to an extra portion of lasagne.
Medicine has a uncanny penchant for describing pathology in culinary terms, as if we’re constantly compiling some grisly companion volume to Larousse Gastronomique. (Do not read further if you have a sensitive stomach.)
Thus we have the anchovy paste cysts of amoebic liver disease, strawberry cervicitis, the cranberry jelly of blood decorating bowel intussusception (where a portion of the gut herniates into itself), the peau d’orange (orange peel) appearance of skin surrounding breast cancer, and the pizza pie layer that develops on the retina when it is infected by cytomegalovirus. Sputum from patients infected with the Pseudomonas bacterium is recognised by its characteristic “fruity” odour, while the appearance of endometriosis—a painful abnormal profileration of tissue derived from the lining of the womb—is described in terms of… wait for it… chocolate.
The descriptions are accurate, if mildly horrifying. I wonder if the pioneering physicians who first described these nasties were using black humour to subconsciously project their revulsion onto language, in order to deal with the mess and squelch of disease.
The flip side is that the human body, as well as the arts and sciences that revolve around it, is also a source of great beauty and wonder. Once they get over their squeamishness, students encountering practical anatomy for the first time frequently describe a sense of awe as they discover how magnificently nature has cobbled together the machinery of Homo sapiens. While some may scoff at the notion of intelligent design, I cannot fault people for wanting to believe some higher intelligence is at work when considering the structure of the eye, the Fibonacci spirals of snail shells, and the whorling arms of galaxies.
A subtler beauty lurks in the very language of medicine, in the terminology used to describe physical structures, diseases, physiology and pharmacology. I’ve come to appreciate that, sometimes, language needs to be appreciated simply for the way it rolls off the tongue regardless of meaning, the quality known as euphony (the opposite of “cacophony”). Words and phrases such as serendipity, cellar door, lugubrious, hypaethral and sussuration invoke warm fuzzies in many language nerds. (The poets T.S. Eliot and Louis Zukofsky are well known for inserting of seemingly random words purely for their sonic effects). Some words sound beautiful even if they refer to ugly or horrifying things (think miasma, purulence, effluent) while one of the words for beauty, pulchritude, sounds to me like some kind of malignant growth.
I have long appreciated the intrinsic music present in many of the terms and labels I’ve come across in my studies and practice. Some are obscure, some describe truly horrible diseases or unpleasant procedures, while others refer blandly to chemicals or parts of the body. Many—predictably—come to us from the Latin.
I have curated a small glossary of terms and phrases below which you will hopefully enjoy. Who knows, maybe you can casually insert one of them into a sentence next time to sound cute:
VAGUS: the tenth cranial nerve and the longest projection of the autonomic nervous system, sprouting from the brain and innervating structures as distant and diverse as the heart, the lungs, and the gut. It means “wanderer” and shares the same root as the words vagrant, vague, and vagabond.
QUININE: the original malarial cure, first isolated nearly 200 years ago from the bark of the cinchona tree. (The word for quinine toxicity, cinchonism, takes its name from the plant directly and is rather pretty in its own right.) Many medical words starting with “q” share quinine’s elegance: quetiapine (an antipsychotic), quinsy (an abscess of the tonsils that can kill), and quorum sensing (the creepy way a colony of microbes can transfer information across individuals if enough are present despite an obvious nervous system).
VALLECULA: Though it sounds like the name of a seaside resort in Spain, the vallecula (Latin for “small valley”) is actually cul-de-sac between the pharynx and the epiglottis… a vitally important structure for anaesthetists, for it is in here where we insert the tip of a laryngoscope blade to reveal the vocal cords… perhaps the most important vista in all of anaesthesiology… for the safe passage of an endotracheal tube to secure and control breathing while the patient is “under”.
PELLAGRA: Not a Mediterranean dish, but a potentially lethal deficiency of the B-vitamin niacin, classically described as presenting with its own apocalyptic four horsemen, the four “d”s of Diarrhoea, Dermatitis, Dementia, and then Death. I’ve never seen a case of pellagra, nor do I ever hope to.
SYNCOPE: The fancy word for fainting, frequently mediated by the Vagus nerve (vasovagal syncope) described above, when an excess of parasympathetic nervous activity results in relaxation of major blood vessels and slowing of the heart rate, thereby depriving the brain temporarily of sufficient oxygen and hence causing loss of consciousness. In medical urban legend, it is a rite of passage for medical students encountering gore for the first time. Syncope may also be a sign of more sinister, often cardiac pathology.
VENTRICLE: A muscular chamber of the heart, responsible for ejecting blood into either the aorta to supply oxygen to the rest of the body (left ventricle), or to the pulmonary artery towards the lungs to take up oxygen (right ventricle). Mammals have four chambers in their hearts, two atria and two ventricles, an arrangement shared with birds. Reptiles have only one ventricle, but two atria; yet they are still more complex than fish, who have a single atrium and ventricle. Notwithstanding, of course, that all vertebrates are, actually, fish. You read that right. The air-breathing tetrapods (mammals, reptiles, birds, and amphibians) fall under the two main groups of bony fish: the “lobe-finned fish”, which includes air-breathing lungfish and the living fossil, the coelecanth, once thought to be extinct. The lobe-fins are distinct group from the ray-finned fish, which includes the bulk of the bony fish. Further up the family tree, sharks and rays form yet another group. The implications of this are startling: (1) a goldfish is, taxonomically speaking, more closely related to you than it is to a shark, and (2) the coelacanth and lungfish are more closely related to you and your cat than they are to said goldfish.
LITHIUM: The third element, stabiliser of mood. Also the name of one of Nirvana’s most poignant songs, frequently played on rotation to mirror my apathy when I was studying pharmacology as a medical student. Lithium’s name derives from the Greek lithos, meaning “stone”, as found in another medical term, lithotomy (or “stone cutting”), now used to refer to a surgical position in which a patient lies on their back with their legs in stirrups. (Not the most elegant of positions, but essential for some types of colorectal, obstetric/gynaecologic, and urological procedures.) Lithium is also the gold standard for treating bipolar disorder, and we don’t quite know why. A casual glance at its position on the Periodic Table provides a hint: it is in the same column as sodium, one of the most important atoms involved in transmitting electrical signals in nerves and muscle. It is thought that lithium mimics the action of sodium, dampening down electrical activity in the brain and thus levelling out the extremes of depression and mania. Long thought to be unnecessary for life, it is now becoming evident it may be an important trace element: studies have revealed populations exposed to higher natural lithium levels in drinking water (I’m talking levels orders of magnitude lower than its use as a drug) live several years longer.
MALLEUS, INCUS, and STAPES: The Hammer, Anvil, and Stirrup; the three smallest bones or ossicles of the ear, responsible for conducting sound via the eardrum to the eighth cranial nerve and hence the way we are able hear sound. The development and arrangement of the ear bones is one of the distinguishing features of mammals, along with hair/fur (even whales have rudimentary hair) and mammary glands and (aside from marsupials) placentas.
PHAEOCHROMOCYTOMA: Probably the top prize at a spelling competition, this is, equally impressive to pronounce. It means collection of dark-coloured cells, describing this adrenal gland tumour’s appearance under the microscope. At least they didn’t name it after a foodstuff. Secreting large amounts of noradrenaline (and adrenaline), it can lead to spectacular symptoms such as extremely high blood pressure, excessive sweating and rapid heart rate. It often presents unexpectedly during surgery, due to it being small and hiding at the top of the kidney, and only releasing its toxic load when handled. Attending anaesthetists may develop phaeochromocytoma-like symptoms themselves as they scurry to draw up elephant doses of magnesium to stem the potentially fatal spikes in blood pressure. Most tumours, however, can be safely removed with appropriate planning and careful, pre-surgical antihypertensive therapy.
MORPHINE: Drug of drugs, named after the god of sleep himself. One of the oldest and most trusted medicines known to humanity, it is found in the sticky sap of the opium poppy. It remains the painkiller by which all other painkillers are compared to, and is still a core part of modern anaesthetic practice. It is a potent, loaded word and drug, providing relief from even the most intractable pain, accompanied by euphoria, yet also bringing nausea, suppressing breathing, and the spectre of addiction. Users of heroin (nothing more than a morphine derivative) describe their first hit of the stuff the most exhilirating high of their lives, never to be replicated as they spiral into the horror of addiction. Endorphins, the feel-good painkillers our bodies naturally produce in response to pain, exercise, and orgasm, similarly take their name from the concept of “endogenous morphines”. There are also caseomorphins, peptides found in cheese, that actually stimulate our opioid receptors… explaining the almost spiritual experience of melted mozzarella on pizza, or a perfectly-ripened camembert.
UMBILICUS: More patrician than “navel”, and carrying so much more gravitas than “belly button”: the scar reminding us where we were once connected to the placenta that kept us alive in our mother’s womb. And every mother has her own umbilicus, remnant of her connection to her own mother. So we can trace a continuous connection of cords and placentas and wombs to some mammalian Eve, the last common ancestor of all placental mammals who abjured an external egg and instead gestated her young in a membranous fluid-filled sac. From her came the line of all humans, all mice, all wolves, all leopards, all elephants. But this is not the whole story. It turns out that, in order to attach the placenta to the lining of the uterus, mammals require a protein called syncitin… which is manufactured by none other than viruses whose genetic code somehow entered our own genetic material millions of years ago. Not only that, but different species of mammals adopted the ability from several different viruses. The syncitin-producing provirus (the technical term for a dormant or captured virus that has embedded itself in another organism’s DNA) for carnivores is different to the one needed by primates. It is poetic that the most advanced lifeforms on earth require the simplest ones to reproduce.
(There are, of course, many more lovely curiosities, and I have to name a few runners-up to this list, such as the SARTORIUS muscle (the Tailor, so named because it was noted tailors sat with their legs crossed and in whom this long, ribbon like guardian of the thigh was particularly prominent); VERTIGO, dizziness on steroids and Hitchcock’s crowning achievement; ANAPHYLAXIS, the allergic reaction that can kill, whether induced by penicillin, peanuts or latex; FUGUE, a dissociative psychiatric state where someone loses their identity and undertakes sudden travel (and also, a mathematically elegant musical composition perfected by Bach); and, finally, DELIRIUM, an acute and (usually) fortunately reversible disturbance of consciousness and cognition almost always with an organic cause such as pain, infection, metabolic insults, toxins, and electrolyte misadventures)
I’ll be honest, all this euphony has little practical value. It will not help one in the middle of an airway emergency, catastrophic blood loss or breaking bad news. But that things can still sound beautiful, even if what they refer to is decidedly not, at least provokes a sense of fascination, and even wonder. Language is perhaps the crowning achievement of humanity. It is appropriate that some of this spilled over when we started describing life in both its normal and diseased states, planting words that light up and beguile among seemingly dull and dreary passages of facts.
