MG I 2011-2012, 1st semester

Module I: Medical Terminology, part 1

Quick Introduction to Medical Terminology

About 75% of medical English today is made of words originally from Latin/Greek. Also, the possibilities of forming new words using Greek/Latin prefixes, roots and suffixes are practically endless. This explains why much of a medical dictionary looks so strange and complicated. It also explains why even the thickest dictionary to date may not tell you what you want to know. This is why its better to figure out how medical language works rather than try to memorize it by heart. First, a little bit of history Many find the language of medicine to be fascinating. Knowing, understanding and appreciating the history behind the words can offer doctors valuable insight into their professional language. Henrik Wulff is one such doctor and, in his recent paper The Language of Medicine (Journal of the Royal Society of Medicine, 97/2004, p.187-188), he provides a clear and concise overview which I will present here. Western medicine has its roots in the Hippocratic writings dating back to the 5th and 4th centuries BC, and the same applies to the language of western medicine. Ancient medical Greek was full of vivid imagery, using words naming musical instruments, armour, tools, plants, animals etc. to refer to various anatomical structures. The Greek era lasted even after the Roman conquest, as Romans imported Greek medicine (as most doctors practising in the Roman Empire were Greek). At the beginning of the 1st century AD, Aulus Cornelius Celsus (frequently referred to a the Cicero of doctors due to his eloquent and elegant use of Latin) wrote De Medicina, an encyclopaedic overview of medical knowledge based on Greek sources. He had a problem though most Greek medical terms had no Latin equivalents! To this, he found three solutions which had a great impact on medical Latin later on. He imported some Greek terms as they were (e.g. pylorus), he latinized others (e.g. stomachus), and - most importantly - he translated many of those imaginative words from Greek to Latin (e.g. from the Greek kynodontes meaning dog teeth to the Latin dentes canini). During the Middle Ages, many classical Greek medical texts were translated into Arabic, as Arab scholars became interested in medicine and then made their own contributions to medical literature. This is when words such as nucha (meaning nape, the back of the neck) made their way into medical language. However, by Renaissance, all these Greek and Arabic texts were translated to Latin, which was the lingua franca of science at that time. The Latin medical vocabulary expanded, but its essential features remained the same. The last notable medical text to be written in Latin appeared in 1802 and some doctors continued to write their notes in Latin until 1853. After this, Latin gave way to the national medical languages (mixes of ordinary words and medical terms) medical English, medical French, medical German, medical Italian etc. They all had a common legacy from the Latin era, which they used differently: - Germanic languages kept Latin words as such (e.g. nervus musculocutaneus). - Romance languages "naturalized" them (e.g. le nerf musculo-cutane in French or nervo musculocutaneo in Italian). - Because English is a Germanic language with half of its vocabulary of Romance origin, medical English tends to apply its grammar rules to "naturalized" words (e.g. musculocutaneous nerve). The examples above illustrate a general pattern which has, of course, many exceptions: - English, too, accepts direct loans from Latin (e.g. diabetes mellitus) - German, too, naturalizes Latin words (e.g. Coronararterien).

With the progress of medicine, new concepts appeared which had to be given new names by medical scientists still trained in a classical way. Again, Greek provided a rich source of possible combinations (also because it allows composite words more than Latin does) nephrectomy, ophthalmoscopy etc. (which in Latin would have been more complicated - excisio renis, inspectio oculorum). This also explains how many Greek prefixes and suffixes are more frequently used in combinations than their Latin equivalents (e.g. the Greek prefix hyper- is used more often than the Latin super-, although they both mean the same thing). Some of these national medical languages became vehicles for international communication in medicine. Today we are in the era of medical English, which resembles that of medical Latin from a few centuries ago: - Medical English is used by all the influential medical journals and in international conferences - New medical terms are often composed or borrowed from English e.g. bypass, screening, scanning. - Non-English-speaking medical communities can either adopt them as such (e.g. bypass in German, Romanian), naturalize them (e.g. skanne in Dutch for to scan) or translate them (e.g. pontage for bypass in French) One source of difficulty and confusion is caused by the many English acronyms (e.g. AIDS, CT, MRI etc.). While AIDS, for example, is widely accepted, the French use SIDA and Russians SPID as corresponding acronyms. Learning medical terminology It is not difficult to acquire a good working knowledge of medical English terminology. The first step in acquiring medical vocabulary has been to understand a little bit of its history. Next, we will learn how to identify and analyze these words - to break them down and then determine their meanings based on the meaning of the parts they are made of. Thanks to the imaginative ancient Greeks, many of the medical terms we use today (whether or not they were translated to Latin by Celsus and others) have fun and interesting meanings: - musical instruments (e.g. tibia = flute) - armour (e.g. thorax = breastplate) - tools (fibula = needle) - plants (uvea = grape) - animals (helix = snail) and the list goes on. The analysis of medical terms is a systematic breaking up of the words into their component parts ROOTS (STEMS), PREFIXES and SUFFIXES. Word roots/stems are the simple elements which constitute the basis on which words are formed. Those used in medical terminology often indicate an organ or part of the body. For example, in the word "arthritis" the basic term or root is "arthr-", from the Greek "arthron" meaning joint. The roots are modified by combining them with prefixes or suffixes or both. "Arthritis" is modified by adding the suffix "-itis" denoting "inflammation". By placing the prefix "peri-" before the word we get "periarthritis", a term meaning inflammation of the tissues around (peri) the joint. Most prefixes have a final vowel which is dropped if the root which follows begins with a vowel, e.g. "hypo" and "adrenia" combine to form "hypadrenia", meaning adrenal insufficiency. Prefixes are the most frequently used elements in the formation of medical terms and usually consist of one or two syllables placed before a word to modify its meaning. Most prefixes mean something. - The prefix "par-" from the Greek "para" means beyond or apart from, or other than. You can combine it with the root "-enter" from the Greek "enteron", which means intestine. Parenteral,

therefore is an adjective meaning not (or other than) pertaining to the intestine and is commonly used to indicate the route of administration of therapeutic agents - NOT via the intestinal canal as when not taken orally, but by subcutaneous, intramuscular or intravenous injection. Suffixes are added at the end of a word to produce nouns, adjectives or verbs. True suffixes are abstract elements serving a formative or inflectional function only. - For instance in the word parenteral, the end syllable "-al" denoting of or pertaining to, or belonging to. In another example, "ot-" (from "otos" -the ear) plus the suffix "-ic" gives us the adjective "otic". The word "crystal" (from crystallos) plus the suffix "-ize" produces the verb to "crystallize". However, in medical terminology many endings are not abstract suffixes but are in fact nouns or adjectives with meanings of their own, added to the root to form compound words: - "otitis", where "ot-" means ear and "itis" means inflammation ("otitis" = inflammation of the ear) - "adenoma", where "aden" means gland and "oma" means tumour ("adenoma" = glandular tumour). As a general rule, Greek roots are correctly used with Greek prefixes and suffixes, and Latin roots with Latin prefixes and suffixes. - A good example is "hypo-", a Greek word meaning under or below, which can combine with "dermic" (from Greek "derma" -the skin) to form the frequently used term "hypodermic". - Similarly, the Latin derived word "subcutaneous" is formed with the prefix "sub-" (under) and cutaneous (from "cutis" -the skin). It is the equivalent of the Greek term "hypodermic". - Some "hybrids" are in use, however; a well-known example is the noun "appendicitis" which is made up of the Latin "appendix" and the Greek suffix "-itis". Constructing and deconstructing meaning. The most important rule in correctly decoding the meaning of long and complicated medical terms made of Greek/Latin parts is to read the meaning backwards from right to left. Lets illustrate with an example: the word ELECTROCARDIOGRAM is made of ELECTRO + CARDIO + GRAM. An electrocardiogram is a "gram", not a "cardio" and not an "electro". It is a "gram" (record) of the "cardio" (heart)s "electro (electricity)? Do you see how I am constructing the meaning of the word from right to left? The same rule can be applied when you want to form a medical term. With this simple rule and a good medical glossary/dictionary, you can understand, remember and use correctly even the longest and most complicated medical terms. A practical way to start practising this rule is to select a few words which you are already familiar with. With a little bit of practice and after memorizing a relatively small list of roots/stems, prefixes and suffixes, a basic vocabulary of frequently used medical terms is acquired. Building it up can be an interesting and fascinating activity.