Miami, Florida, United States (Winter 2015)
|Photography by Celeste RC|
Language is the cornerstone of our ability to communicate as humans and underlies the prose of our medical discourse. The words we select can be indicative of our background, training, and intentions. It should come as no surprise that a robust knowledge of one’s own language is essential to good communication between patient, physician, and colleague. As a vehicle towards this end, I chose to begin studying Latin during my third year of medical school and you will find this work to be a prolonged love letter to its use, though its elder, Greek, should never be discounted.
At the convocation of my medical school, a brilliant physician heading a prominent national medical organization shared his thoughts on how to succeed as a physician. He emphasized that the early process of learning medicine was akin to learning a foreign language, in that we would have to become acquainted over the next four years with over 16,000 medical terms. But he neglected to tell us that a knowledge of the classic languages would greatly facilitate the mastery, memorization, and internalization of these terms.
“Entias non sunt multiplicandum praeter necessitatem,” entities should not be multiplied beyond what is necessary. This phrase, often invoked in medicine as Ocam’s Razor, is emblematic of the economy and depth of the Latin language. Beyond the typical explanation of ‘the simple answer is normally the right one,’ Ocam made the observation that explanations can and will be complex, but should not be more complex than required. This subtle point is often lost in translation. It was once understood that studying the works of magnificent orators, educated emperors, and preeminent philosophers in their original tongues could give students of any pursuit a deeper appreciation for prose, syntax, word choice, and nuance (from the Latin nubes, related to clouds, referring to their subtle changes) in their own primary language. Being a Latin derived language, this holds especially true for English. Entering medical school, I became impressed with innocuous appearing faculty who could eviscerate students for poor performance without raising their voices or using unseemly language, but by being fierce, direct, and laconic. This gift of nuance was commented on by Winston Churchill as “the ability to tell someone to go to hell in such a way that they look forward to the trip.” This acquisition of linguistic cunning can be useful when confronting a colleague over a mistake, making an impassioned plea to a superior on behalf of a patient, or motivating a patient towards an optimal course of action. The importance of studying classic language then lies not in yelling at patients in Latin or Greek, but in gaining a deeper understanding of the importance of words and their arrangements as they affect outcomes.
In Eastern medicine, the original written records date back to Hippocratic documents.1 Strolling through the wards you are likely to still hear about “facies Hippocratica,”the facial manifestations of disease so prominent that they were taught from Hippocrates time to ours. Greek physicians made many early contributions to medicine, including Galen who appropriately described tendon suturing techniques and Hippocrates of white coat ceremony infamy.2 Latin began to gain a foothold during the first century AD when a Roman aristocrat wrote a broad overview of medicine based on Greek sources, De Medicinae.3 This novel task involved preserving many Greek words with Latinizing suffixes and neologizing Latin equivalents.4
Latin eventually rose to prominence as the unofficial international medical language with the decline of Greek fluency and with scholars translating Arab and Greek works into Latin.5 For centuries this medical lexicon presented in De Medicinae was preserved and perpetuated, its momentum only halted by the rise of national languages (i.e. French, German, English, Spanish) in recent times.6 Still, these languages naturalized and retained much of the terminology birthed from Latin.
Latin has not survived without contenders for its throne throughout the years. Germany has a history of clinicians who wished to remove from medicine what they saw as an onerous burden, including professors who refused to teach in Latin and those who attempted to change the language of an internationally recognized corpus of medical anatomy terminology shortly before World War II.7 The change was considered and summarily rejected by an international committee on medical anatomical nomenclature, with a return to the preceding version’s Latinate fidelity.8 In recent years, the modern iteration of this international committee has commented that Latin’s unique status as a dead language frees it from nationalistic ties and allows it to exist as a globally neutral vehicle of medical terminology.9
Latin was once considered a prerequisite for many undergraduate and medical schools, leading to at least one doctor to be accused of incompetence for an incomplete grasp of the language. Many reasons exist for this requirement, including its former prominence as the international language of science, but also relatively immutable terms of anatomy and physiology that have persisted for thousands of years to end up in modern textbooks (i.e. flexor carpi brevis). It is difficult to argue that one can successfully learn anatomy, physiology, and many aspects of medicine without a basic working knowledge of Latin. In fact, Smith et al. (from the Latin et allia, “and others”) tackled this issue in a 2007 study that involved teaching first year medical students Greek and Latin etymologies during gross anatomy.10 The authors found that students reported enhanced learning, a more enjoyable experience, and decreased perceived difficulty with the course.
By understanding the classical languages that make up a large sum of medical terminology, the language becomes poetry. Every ancient neologism contains a history that resonates to the days of Hippocrates. Often dismissed as a dead language, one of the most prominent Latin teachers of the last century remarked “Inexorably accurate translation from Latin provides a training in observation, analysis, judgment, evaluation, and a sense of linguistic form, clarity, and beauty which is excellent training in the shaping of one’s own English expression.”11 Indeed, gaining this deeper appreciation for the beauty of language can make practice more satisfying, new terms more memorable and also more interesting dinner party conversation (who wouldn’t like to know the origins of the word trivial?).
The art, beauty, and satisfaction of medicine revolve around identifying a constellation of information and objectifying it by considering pathological origins, likely prognoses, and treatment. The language of medicine is no different. A medical student with a strong background in the classics can easily grasp the meaning of dystocia, crus cerebri, or caput medusae. With a little more insight, one can learn about the vermis, remembering classic Latin pronounced ‘v’s as ‘w’s and correctly identify its similarity to a worm. Better yet, the astute student of Latin will feel comfortable taking terms and applying them to novel situations. It allows students of Latin to use and interpret abbreviations with confidence rather than as some outdated relics.
Although patient notes were written exclusively in Latin as recently as the mid-19th century, today Latin or Latin abbreviations are still found throughout a patient’s note.12 It is hard to find a note that does not have a mention of PRN (Pro re nata, as required, or quite literally, for the thing born), TID(Ter in die, thrice a day, commonly mistaken for twice a day due to the numeral adverb ter which is cognate with words such as tertiary), or QD (quaque die, every day). Such knowledge can allow an existentially challenged attending make a medical student sweat with seemingly simple questions, and also is practical knowledge that can be easily mistaken without familiarity with the underlying vocabulary. Studies have shown abysmal understanding of the terms written on prescription pads among medical students and house officers.13 Literature is rife with examples of Latin abbreviations causing prescribing errors.14 There have been suggestions to Anglicize prescription abbreviations, but the Latin ones are unlikely to disappear overnight. Clearly then, at least remedial training in Latin etiologies of commonly used medical abbreviations would be helpful.
English is thought to be winning the war of national languages to rule modern medical terminology.15 Most major international conferences and journals are in English. With English having such a prominent place in the medical and scientific world, it would behoove medical professions to acquire a deeper understanding of its parent language and an easier grasp of the medical terminology thereby derived. It is the contention of some experts that English will not utterly eclipse Latin, but that its origin as a Latin derived language serves the role of promulgating Latin into the next era.16
Latin is a beckoning call from our heritage of Western medicine. While the study of the language is instructive itself, learning the language that great Renaissance anatomists used to describe newly identified segments of the body preserves an intellectual continuity unbroken for many hundreds of years. Medical conferences and round reports should not be taking place in unaltered Latin, but it would be instructive to learn the basics and be able to educate students on what “QHS” actually means. Finally, wherever our focus on medical linguistics may land we should never forget to whom our efforts are beholden: “The old doctor spoke Latin, the new doctor speaks English, the good doctor speaks to the patient.”17
Editor’s note: The trend against using Latin in medical practice and particularly in writing orders and prescriptions is not likely to be reversed. But Dr. DeLone’s “love letter to its use” is to be commended. Latin has been the language of great authors and poets. For centuries it was the lingua franca of Europe. Educated men learned Latin, spoke Latin, wrote Latin. Isaac Disraeli, in his Curiosities from Literature, tells the story of the distinguished French scholar Arnauld, who when asked what were the best means of forming a good writing style, advised the daily study of Cicero. But when it was observed that the object was to form a good style in French, not in Latin, he replied: “In that case, you must still read Cicero.”
- Wulff, H.R. “The language of medicine.” Journal of the Royal society of Medicine 97(2004):187-188
- Cerveny, L., Mareckova, E., Simon, F. “Latin as the language of medical terminology: some remarks on its role and prospects.” Swiss Med Wkly 132(2002):581-587
- Carmichael S.W., Pawlina, W., Smith, S.B., Spinner, R.J. “Latin and Greek in Gross Anatomy.” Clinical Anatomy 20(2007):332-337
- LaFleur, R., Wheelock, F. Wheelock’s Latin (New York: HarperCollins, 2005). P.X
- Drury, N.E., McKeever, J.A., Powell-Smith, E.”Medical practitioners’ knowledge of Latin.” Medication Education 36(2002):1175
, BS, MS, is a fourth year medical student and member of the inaugural class at Florida International University College of Medicine in Miami, currently applying for residencies in Emergency Medicine, with research interests that include biomedical engineering, neurophysiology, and adaptive neural prosthetics. His other academic interests include Latin, Stoic philosophy, and economics.