Medical Naming Madness

What the heck is “erysipelas?!” While studying for my Step 1 board exam, I’m rediscovering all these medical terms I rarely hear and definitely don’t remember. Many of them, including erysipelas, are vaguely ancient Greek- and Latin-sounding, so I wondered if learning a few more etymological roots would help anchor my memory. This has led to ponderous philosophizing about the history and nature of naming medical terms.

Etymology mnemonics

Well, Google tells me that erysipelas is an old Greek word, possibly derived from eruthros for “red” and pella for “skin.” It’s a type of skin infection, quite similar cellulitis. The word cellulitis, on the other hand, is more easily understandable precisely because it shares the “-itis” suffix is shared by most inflammatory processes. There’s yet another word for a another type of skin infection:  “impetigo,” an old Latin word; and all three terms have been used in various frequencies over the last couple centuries (see ngrams). Medicine made this difficult for us, hasn’t it?

Erysipelas is typically an infection of Streptococcus pyogenes, the bacteria that also causes strep throat, scarlet fever, and flesh-eating bacteria (what a busy bug). I constantly confuse it with its cousin Staphylococcus. Both are “cocci,” for being spherical cells, but I always forget which grows in clumps and and which in chains. Hmmm… perhaps there’s more to unpack under their names? Well, strep comes from streptos means twisted, say like a chain;  staph comes from the Greek root staphule for “bunch of grapes,” which might be the most stereotypically Greek root I have ever learned.

strepto- for chain

This strategy has helped me remember a few other terms, like telangiectasia (Greek: telos end, angeion vessel, ektasis dilatation) for visibly swollen capillaries, or holoprosencephaly (Greek: holos whole, pros before, enkephalos brain) for incomplete brain hemisphere separation, or meningomyelocele (Greek: meninx membrane, muelos marrow, kele hernia) for a type of spinal malformation. It also clarifies terms like schizophrenia (Greek: schizein split, phren mind) and diarrhea (Greek: dia through, rhein flow). Sadly, banking on etymological derivation can fail; like for atelectasis (Greek: ateles imperfect, ektasis dilatation), which actually means collapsing of lung tissue. Still it’s a start! I’m looking for all the mnemonics I can get.

Greek and Latin are dated

Medical lingo is all over the place, and sometimes (especially now, while trying to study a broad overview of medicine) I wish we could update antiquated Greek and Latin terminology to modern recognizable English terms. Like why does nephrology (Greek: nephros kidney) study the renal system (Latin: renes kidney). Oncology (Greek: onkos lump) studies cancer? (more on cancer later) Otorhinolaryngology (Greek: oto- ear rhino- nose laryngo- throat) is such an inconveniently long word that even otorhinolaryngologists say ENT now!

Why say epistaxis when you could say nosebleed? Why diagnose the condition pruritis when a patient tells you they itch? A couple doctors have instructed me that while reporting to healthcare professionals I should never say “bruise” lest I sound uncouth. The term is ecchymosis, obviously. True, it’s cumbersome to switch terminology at all, but seriously?! I think it’s partially because medicine is always run by the pompous old doctors. True, we young doctors will take over someday, but by then we’ll be the old pompous ones.

Then there’s pneumonoultramicroscopicsilicovolcanokoniosis, the longest word in the Oxford English Dictionary at 45 letters. It was made up in 1935 by a puzzle dude just to have a long-ass word.

Freaking drugs

Drugs are difficult to memorize. Not just their strangely derived names, but their effects, mechanisms, indications, and toxicities too. I conflate them constantly.

Thus, I’m relieved when similar drugs have similar names. For instance, I can count on all the -“cillin” drugs being beta-lactam antibacterials, and all “-olol” drugs are beta blockers. Most benzodiazepines are named mercifully similarly like diazepam, lorazepam, triazolam, and midazolam (which I wrote about last week), but did they forget to rename the first benzo, chlordiazepoxide?

Then there’s the case of the therapeutic monoclonal antibodies. When the the first few were developed from mouse antibodies, or mAbs, in the 70s and 80s, the scientists started a very logical naming convention by using the suffix “-omab.” They were probably just as fed up as I am about keeping track of disparate drug names. Fortunately for humankind, the nature of antibodies makes antibody-derived drugs delightfully versatile, and our armamentarium grew steadily. Unfortunately for us med students, the naming convention grew out of control, and now the chimeric ones are “-ximab,” the human ones are “-zumab,” and they treat a broad spectrum of diseases. Denosumab treats osteoporosis, natalizumab treats multiple sclerosis and Crohn’s disease, and trastuzumab treats breast cancer subtypes, to name a few. I have no idea how I’m going to memorize them in the next month…

They all sound funny though. Say bevacizumab three times fast. Teehee.

However, this scheme is not without consequence. Similar drug names is a BIG PROBLEM and a notorious generator of medical errors. Hospitals and medical record systems have tried numerous safeguards (e.g. cross-checking indications, capitalizing unique syllables, limiting formularies) in an effort to tackle the systemic problem. Hmm.

You’d figure one of the most used drugs ever, acetaminophen (Tylenol), would be a freebie, but nope. It’s actually called paracetamol almost everywhere in the world! Dang it, ‘Murica.

Oh, by the way, “etoh,” capitalized as such, is the worst. Yes, reading EtOH instead of ethanol or alcohol would please my inner orgo geek, but come on! While you’re at it, write booze, or draynk, or “the good stuff” or somethin’.

EtOH, q.d. p.r.n. = alcohol every day as needed
Drug brand names

My classmates and I are learning these drug names in an academic vacuum at the moment, but very soon we’ll have to map scientific names to brand names that our future patients will recognize. The onus to translate is on us. This prospect makes me sad, because drugs are hard enough to memorize once, let alone twice!

I like studying aspirin because everyone calls it aspirin. Bayer’s chemists named it Aspirin after meadowsweet, Spiraea ulmaria, the plant from which it’s derived. When Bayer started marketing it in the 1910s as a breakthrough painkiller, other chemical manufacturers started selling theirs using the same name, and Bayer didn’t complain fast enough about trademark infringement. Now it’s the official AND marketed name. In conclusion, please don’t write “ASA” (acetylsalicylic acid) for aspirin, please.

Nonetheless, I understand that pharmaceutical companies must trademark their own brand names to market their own formulations to the public. Whenever “methylphenidate” appears as a choice in my practice questions, I have to pause and translate. I know it’s a very important compound… but which? I’d have a much easier time recognizing Novartis’s trade name for it: Ritalin.

It’s a great drug for ADHD, and it’s also a notorious drug name that every neurotic American high school student recognizes. They’d know Ritalin and its distant relative: Adderall (amphetamine). Oh, if Adderall’s scientific name sounds suspiciously like methamphetamine a.k.a. crystal meth, that’s because Adderall works exactly the same way meth that does. That explains why the ADHD drugs are controlled substances, huh?

You’d recognize these drugs: azithromycin, omeprazole, bismuth subsalicylate, or sertraline. Z-Pak for infections! When you have heartburn, reach straight for the purple pill Prilosec. Nausea heartburn indigestion upset stomach diarrhea!!!! Pepto Bismol has the best drug jingle ever. When you’re feeling down and out, liken yourself to a melancholy black and white blob and get some Zoloft so you can return to bouncing off the walls. Big pharma is phenomenal at marketing.

Memorizing eponyms

Now, we come to things — diseases, cells, concepts, diagnostic signs — named after the doctors who described them. Charcot-Marie-Tooth disease, Reed-Sternberg cells, Trendelenburg sign, Brown-Sequard syndrome… the list is extensive and, in my opinion, confusing! For instance, Lambert-Eaton syndrome would be way easier to remember if it were renamed myasthenia gravis Type II (Greek: myas muscle, asthenes weak, gravis heavy). Then the name would actually describe the disease.

Blotting techniques are the only memorable exception . The Southern blot was actually named after the guy (Edwin Southern, English molecular biologist, 1975), but the Northern blot and the Western blot and the Southwestern blot just spoofed his name. I could never remember which was which until I literally drew a compass.

Sadly, most of the time, there’s no association. Just gotta memorize them all. Why oh why do we have to memorize all these eponymous terms? To make every utterance a homage?

Actually, renaming happens! von Recklinghausen syndrome became neurofibromatosis Type 1, or NF-1, which makes it way easier to remember. The mutated gene is the NF1 tumor suppressor, so it’s logically named now.

Weirdly, Huntington’s disease regressed from being Huntington’s chorea, where chorea (Greek, khoreia, dancing in unison, like a chorus) is the term for the involuntary movements they have. It’s caused by a mutation in the Huntingtin gene that codes for the huntingtin protein, so the name is pretty thorough.

Eponymous names can undergo all sorts of changes. Asperger’s syndrome was first described in 1944 by Hans Asperger, an Austrian pediatrician. People didn’t really use his diagnosis until it became popularized in the 1980s and then made an official diagnosis in the 1990s in the DSM-IV. Then Asperger’s was made non-official when it was collapsed into autism spectrum disorder (ASD) in 2013 by the DSM-V. The word “autism” was coined in the 1900s and is derived from autos for self, as it was regarded as a symptom of schizophrenia where fantasy dominated over reality. Accurate or not, autism is a term that will last.

Renaming stuff

The thing about renaming things in medicine is that the terms exist in the collective vocabularies of both the medical and general societal sectors. There’s so much inertia and resistance to change anything, especially in the medical realm. There would be people to reteach, books to rewrite, and and sufferers of diseases to relabel. Nonetheless, names are not set in stone, and stumbling over linguistic detritus is–ahem–lame. Can we change some?

History has precedents. In 1909, German anatomist Korbinian Brodmann published a map of the human brain cortex divided into 52 numbered regions based on histological differences in neuronal architecture he observe in microscopic brain slides. He postulated each area would be responsible for a different brain function, and by golly he was right! As technology and techniques advanced, neuroanatomists filled in his map with appropriate descriptive labels. For instance, Brodmann’s areas 1-3 were named the primary motor cortex, while Brodmann area 17 became the primary visual cortex. Everyone still honors Brodmann’s incredible work, but we all use the descriptive names and retrospectively memorize Brodmann numbers. Descriptive names are just so much more useful!

still called Brodmann areas, sometimes

In 2015, Clara cells officially became club cells, much to the chagrin of the current generation of pulmonologists (Latin: pulmon lung) who were accustomed to the name. I like the new name because they’re shaped like clubs. People dislike the old name because Max Clara got his samples from Nazi prisoners. This continues the trend of stripping Nazis of their naming honors: Reiter syndrome became reactive arthritis; Wegener’s granulomatosis became granulomatosis with polyangiitis. It reminds me of the current controversy of college students demanding universities to rechristen buildings named after slave owners. Surely it’s different with buildings than with diseases, but I’m not sure how.

Oh, here’s another renaming story. ALS, or amyotrophic lateral sclerosis, was given another name in 1939: “Lou Gehrig’s disease,” when in stole the life one of America’s favorite athletes. Yet, because it’s so rare, for decades ALS remained an “orphan disease” one which has too few lobbyists and political sway to garner further support for research. ALS rose to the surface of public conscience once again in 2014 thanks to the ice bucket challenge on YouTube, which ended up being a successful (albeit controversial) fundraising campaign. Nonetheless, ALS has another contemporary figurehead: Stephen Hawking. Thankfully he doesn’t conform to the average prognosis of 3-5 years (poor Lou Gehrig), but Hawking is the image we all have of the disease: a mentally intact (read: genius theoretical physicist) but disfigured man in a wheelchair who’s almost completely paralyzed and thus communicates through his trademark bionic voice.  So, uh, will ALS become the Stephen Hawking disease when he passes?

Phthisis (pronounced “TIE-sis“) sounds like a horrible and very antiquated disease that’s not possibly still around today. The “white plague” ravaged Europe in the 17th century. When a disease is called “consumption,” you know people feared it arriving to consume both their body and their soul. Well… all of those are older names for tuberculosis (Latin: tuberculum lump, -osis). Presently, we sometimes reduce its name to the diminutive TB, as in “aww I’ve gotta get my annual TB skin test!” Phthisis isn’t even it Google Chrome’s dictionary anymore. Quite the change, huh? I’m not sure if it’s for the better.

 What’s in a name?

The medical term myocardial infarction (Latin: muos muscle, kardia heart, infarcire stuff into) accurately describes its physiology, but the public just knows it as a “heart attack.” It’s an intuitive name. Everyone can tell what it means, and everyone knows it means trouble. Sure, the other name is scientific, but never are you going to hear anyone say “quick, call 911! He’s having an MI!”

Names are vital, for diseases just as much as for people or ideas. A disease’s name can outlive the many lives it ends.

Some diseases have retained old intimidating names: sepsis (Greek: sepein make rotten); plague (Greek: plaga strike); malaria (Italian, mala aria bad air). Some are so feared that they have stigmatized the names given to them, such as pox (English: plural of pock mark), leprosy (Latin: lepra scale), ebola (Ebola River), and even cancer (Greek: karkinos crab).

The history behind cancer’s name is an interesting one (listen to this NPR story). First termed by Hippocrates and reinforced through the ages, karkinos is literally crab in Greek and cancer is literally crab in Latin, but the disease’s reputation grew so much that we developed an independent repugnance to the word. When cancer’s prevalence rose with longevity and smoking but before our advances in understanding and treatment, cancer was growing into a death sentence. The “C-word” was a condemnation. People spoke of it in hushed tones. Thankfully, the stigma has lifted, and now people are more open to discussing their illnesses, thinking about it, and helping promote further research and understanding. Cancer’s name now serves as its own invaluable symbol.

Diabetes is the new kid on the block, having a meteoric rise to prominence in the past half-century. It’s mostly Type 2 diabetes mellitus (Greek: diabetes syphon, mel- sweet, as in sweet urine), named so for the voluminous sweet urination that Type 1 diabetes mellitus classically presents with, and to be differentiated from the entirely separate diabetes insipidus.  The word “diabetic” as a term for people with diabetes is less politically correct these days, but Americans still throw around the word “diabetes” haphazardly, commonly mispronouncing it as “die-BEE-dus.” It’s an understated name considering that diabetes (9.3% of Americans, 26% of >65) is now the leading cause of blindness, kidney failure/transplant, and limb amputation in the country.

And yet, we joke about diabetes, taunting our friends about getting it as punishment eating cake and drinking milkshakes (which we do anyway). Diabetes hasn’t earned the same notoriety as cancer because diabetes grows insidiously, manifests invisibly, and kills indirectly. The treatment is preventive through education about diet and exercise, but still we don’t budge. Perhaps diabetes should be assigned a new, more threatening name? Would people then fear it more and do more to prevent it?

Then there’s the grandest eponymous disease of them all: Alzheimer’s disease. Alois Alzheimer, a German psychiatrist, was studying senile dementia and described his landmark pathophysiological findings in 1906. By 1910, his colleagues took to calling senile dementia by the name Alzheimer’s disease instead, and it persists to this day. The word “Alzheimer’s” strikes fear in all of us because it is exceedingly common (1.6% of Americans, 11% >65, 32% >85) and unravels our memory and very identity. Yet, it’s a surname! Isn’t that bizarre? How does people still named Alzheimer feel about that?

Senile dementia (Latin: senex, old man, de out of, mens mind) seems like a suitable name for the disease. The word dementia bears coincidental similarity to demon, as in to be mentally plundered by a demon, and I think that image helps. Then again, “having Alzheimer’s” sounds and feels better than the indictment “is demented,” so perhaps the argument for giving diseases ominous names is completely backwards because the stigma it’d generate would hurt the people suffering from it.

AIDS, the acquired immunodeficiency syndrome, is a terrifying disease with a relatively short but storied history. It’s name when first described in 1981 was GRID, for “gay-related immune deficiency.” I wasn’t around then, but I’ve heard stories about the prejudice suffered by the original cohort of gay men. Society at large treated them as if they deserved the illness, believing that it was God’s punishment for their godless practices. The name GRID seemed like the medical community’s endorsement of the stigmata, a misstep. Thankfully, it was rechristened AIDS in 1982 when other people — the intravenous drug users, the blameless Haitians, the already vulnerable hemophiliacs — began getting it too. When the causative virus was described in 1986, it was named the human immunodeficiency virus (HIV), an appropriately universal and sympathetic name.

the name HIV/AIDS is just as much a symbol for solidarity

Medical lingo is an evolving component of natural language. It’s antiquated and confusing, but that doesn’t diminish it’s importance. I joke about and conjure hypotheticals about these disease names as a procrastinating (Latin: pro- forward, cras tomorrow, crastinus belonging to tomorrow) medical student, but all while learning about them the best I can.





Disclaimer: I’m neither an etymologist nor a linguist; in fact, I kinda suck at languages. Most of the etymological information was ascertained from casual googling.