Raymond Noonan
Brooklyn, New York, United States

 

Author’s note: Original Latin words are written in italics, with macrons (ā) indicating long vowels. Equivalent Latin-derived medical terms are given without italics. Acute accents (á) are sometimes used to indicate stress accent in both English and Latin. Informal phonetic spelling that should be familiar to most readers is also used, usually to demonstrate contrasting pronunciations.

This first-century Roman inscription from Herculaneum demonstrates how the apex was used to mark long vowels, as in AVGVSTÓ. Vowel length is the key to the correct pronunciation and stress of Latin words. Photo by Jebulon on Wikimedia.

As medical students, we often hear that we are learning not just anatomy, physiology, and pharmacology, but a new language. This unique language is a creole that blends together Latin (radius), Greek (acromion), French (bruit), German (Mittelschmerz), and many others. In this way our medical language is similar to English, and any frustrations that English speakers experience while learning it might be considered a taste of what the rest of the world goes through in order to master our native tongue. Like those of English, the medical language’s rules of grammar and pronunciation are complex and sometimes unpredictable. Why is CABG “cabbage” but BUN is never “bun”? To exasperated medical students, these apparently arbitrary distinctions seem to be shibboleths, existing only to separate the novice from the initiate.

A historical perspective, however, suggests that modern medical students get off easy. Our predecessors were expected not only to memorize Latin words, but to read, write, and speak the language fluently. Even the most die-hard double majors in Classics and Biology should agree that forcing trainees to memorize all 75+ inflections of the verb sum, esse is a recipe for burnout. Dropping Latin—or at least leaving it to the enthusiasts—has made medicine more global, accessible, and modern. An unintended consequence, though, is the occasional confusion and debate over how to pronounce the Latin-derived medical terms that make up such a large part of this medical language’s vocabulary. How can a student tackle “thiazolidinedione” when her attendings cannot even agree on how to pronounce “duodenum”? Returning to the grammar books that our profession left in the nineteenth century, we can find a method for definitively settling these questions, allowing students to discuss angina on the wards loudly and with confidence.

Latin medical terms are typically pronounced using what is called the traditional English pronunciation of Latin, which mostly treats Latin words like English ones. Equivalent systems were used worldwide for Latin in all contexts until relatively recently, when the Classical pronunciation rose to prominence in Latin language instruction in the English-speaking world. Based on historical linguists’ reconstruction of educated Latin speech during the time of Caesar and Cicero, the Classical system, described in W. Sidney Allen’s Vox Latina, can be startling to those unaccustomed to it.¹ Most notably, the letter c is always “hard”, like English k, and v is pronounced like English w. Thus Caesar would have called himself something like KY-sarr, and spoken his famous “veni, vidi, vici” as WAY-nee, WEE-dee, WEE-kee.

While no physician has called the vena cava the WAY-na CA-wa in the last two millennia, English pronunciation of Latin words preserves the original syllable stress. The rules for determining stress are as follows:

1. In two-syllable words, stress falls on the penult (second to last syllable): égo, “I”
2. In words of three or more syllables, stress is by default on the antepenult (third to last syllable): cápitis, “head’s, of the head”. Stress shifts to the penult if . . .

a) . . . the penult contains a long vowel: amā́re, “to love”

b) . . . the penult contains a diphthong (a combination of certain vowels, such as a and e): trophǽum, “trophy, memorial”

c) . . . the penult’s vowel is followed by most combinations of two or more consonants: āxílla, “little wing, armpit”

These rules present a guide for determining the stress accent of words borrowed directly from Latin, but they also introduce a major stumbling point, to which most confusion can be attributed: intrinsic vowel length. We talk about long and short vowels in English—short a in “cat,” long a in “day”—but this is a different concept, and merely a way of distinguishing between completely different vowel sounds that are represented orthographically with the same vowel letter. Linguistic vowel length refers to the same vowel sound, held by the speaker for different lengths of time. Contrasting vowel length is found in Finnish, Hawaiian, Xhosa, Japanese, Kannada, Czech, and many other modern languages. Although the concept may be alien to today’s English speakers, Old English vowels came in long and short pairs, too: long o was the only difference between God (god) and good (gōd).

The Romans marked long vowels inconsistently with an apex (MÁRCVS), or occasionally by doubling the vowel (MAARCVS). Modern Latin pedagogical materials often use a macron (Mārcus), as in rules 2a and 2c and the Old English example above. Vowel length distinctions alone can change the meaning of a word, the classic example being anus (old woman) and ānus (ring, anus). This inherent vowel length cannot usually be predicted, so it is invisible if unmarked. Latin medical terms are of course never written with long vowels—you will not find the lātissimus dorsī in Netter’s Atlas of Human Anatomy—which is to be expected, since the distinction in pronunciation has been lost. However, this means that syllable stress, which is the main point of contention in debates over pronunciation, can no longer be deduced from spelling.

Latin dictionaries, such as the venerable A New Latin Dictionary by Lewis and Short (L&S), do report vowel length, offering tantalizing hope of settling arguments such as dew-AH-de-nuhm versus dew-oh-DEE-nuhm (duodenum) once and for all.² For proof of principle, consider “equina,” meaning equine or relating to horses, as in the spinal cord’s cauda equina. Stress is invariably heard on the second syllable (penult), but according to our rules, it should fall on the first by default (antepenult). The only explanation is a hidden long vowel attracting stress to the penult, and L&S indeed gives us equīnus, of which equīna is the feminine form. Confident in our model, let us move on to address some of the big questions.

 

ÁNGINA vs. ANGÍNA

Many a first-year medical student has hesitated before trying this one out loud. The source of confusion is certainly vagina, which in Latin originally meant sheath or scabbard. As with equina above, the accent of angina, meaning quinsy or suffocation in Latin, hinges on whether there is a long vowel in the penult. We find angĭna in L&S, with the breve mark (˘) emphasizing a short vowel. With a short penult, stress remains on the antepenult, giving us ANN-jin-uh. By contrast, flipping to the V’s reveals vāgīna, with the long vowel on the penult accounting for the difference in stress.

Winner: ÁNGINA

 

DUÓDENUM vs. DUODÉNUM

The proximal part of the small intestine is named for its length of approximately twelve fingers. The exact form duodenum is quite rare in classical Latin, occurring only four times in texts from the classical period. One of these uses, however, was by Caesar himself in his Commentarii de Bello Gallico, one of the most widely read of all Latin works. A derived form of the word for “twelve each,” which L&S gives as duodēnī, duodēnum is a contraction of the possessive plural duodēnōrum. As in angina, the long vowel in the second to last syllable attracts the stress accent, giving the victory to dew-oh-DEE-nuhm.

Winner: DUODÉNUM

 

UMBILÍCUS vs. UMBÍLICUS

The supremacy of um-bil-EYE-kis among gross anatomy faculty can be confusing to medical students who have heard um-BIL-ih-kuhl cord their entire lives. Such consensus strongly suggests a long vowel hiding in the penultimate syllable, and L&S unsurprisingly delivers umbilīcus.

Winner: UMBILÍCUS

 

ALVEÓLI vs. ALVÉOLI

Alveoli is the plural of alveolus, which is itself a diminutive form of alveus, meaning hollow or cavity. Adding the “diminishing” suffix –olus accordingly yields the word for a small hollow or cavity. The most popular pronunciation seems to be al-vee-OH-lie, with al-VEE-oh-lie giving off a slight whiff of pedantry. Nevertheless (or perhaps fittingly), the Latin supports the latter, with L&S reporting alvĕŏlus. Since both e and o are short, the stress remains on the antepenultimate e. Note that the same rule applies to “malleolus.”

Winner: ALVÉOLI

 

DIFFICÍLE vs. DIFFÍCILE

Those who think that the species name of this tenacious member of the Clostridium genus is French can be forgiven—some professional actors think the same thing about Caesar’s dying words, “et tu, Brute?” in Shakespeare’s Julius Caesar. Alas, both are Latin. The fault lies not in our stars or in ourselves, but rather in Latin’s declining position in the modern world. Difficile is the neuter gender form of the Latin adjective difficilis, inflected to match Clostridium’s neuter gender –um ending. Since the penult of difficile has a short vowel and ends in a single consonant, the stress remains on the antepenult. In the traditional English pronunciation used in medicine, we get something like dih-FISS-ih-lee.

Winner: DIFFÍCILE

 

The intention of this article is not to present a prescriptive guide that divides the many English interpretations of the Latin words we use in medicine into right and wrong. After all, our anglicized Latin, regardless of stress accent, would be incomprehensible and barbarous to the Romans. Instead, it merely offers a historically informed method that can be consulted in the event of an intractable debate or argument, or a presentation assignment from a particularly mischievous attending. The modern study of Latin has deservedly acquired an elitist and classist reputation, but Latin itself is a language like any other. Using it to erase, rather than reinforce, power discrepancies like those encountered by medical trainees grappling with our medical language could be a kind of poetic—or linguistic—justice.

 

REFERENCES

1. Allen, Sidney W. Vox Latina: A Guide to the Pronunciation of Classical Latin. Cambridge: Cambridge University Press, 1978.
2. Lewis, Charlton T. and Charles Short. A Latin Dictionary. Oxford: Clarendon Press, 1879.

 

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RAYMOND NOONAN is a medical student at SUNY Downstate College of Medicine in Brooklyn, NY, and was previously a research assistant at The Rockefeller University. He is also a musician and is interested in literature, languages, and linguistics.

 

Summer 2020  |  Sections  |  Literary Essays