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1) English is unique among modern languages in suffering a disjunction between its concrete vocabulary, which is largely native, and its abstract vocabulary, which is almost entirely borrowed from Latin and Greek.All three features contribute to the difficulties contemporary native speakers of English have with all of their own language's abstract and technical words, but they make Medical Terminology, because of its heavy dependence on Latin and Greek, even more difficult to learn than other specialized vocabularies or jargons.2) The tenuous connection between abstract vocabulary and the concrete words upon which abstract ones are built, though maintained for most of the nine hundred years that the problem has been with us by the universal learning of Latin (at least at the level of education demanded of practitioners of medicine), has been broken in the last one or two generations.
3) To some degree at least, practitioners of medicine, like specialists in any area, are still more or less conscious of the power which comes from the possession of an arcane vocabulary.
The first feature, at once the least widely understood and the most far-reaching in its implications, is perhaps the most difficult to grasp. A set of examples of the problem may help. English speakers are on safe ground if we "grasp" a "point" during a discussion, because both "grasp" and "point" are concrete words used abstractly here but with clear connections of meaning to their concrete denotations. If, on the other hand, we "comprehend" an "idea" or "perceive" the "argument," we are in a realm of abstraction without connection of meaning to tangible reality.
Let us consider only the verbs. When we "grasp" an idea, the metaphorical extension of meaning from the physical act of "grasping" an object is clear and appropriate; its clarity and appropriateness are further helped by the existence of well-known cognate or parallel abstractions such as "grapple with," "seize on," "take hold of" and "come to grips with."
When we "comprehend," on the other hand, we may be dimly aware that our action is related to that expressed by the word "apprehend," but we have no way of knowing, without special training in Latin or etymology, that both words derive from Latin "prehendo," meaning "I grasp" or "I seize," and that we are therefore using the same metaphorical extension of meaning as in the previous example. Similarly, if we "perceive," or "conceive," or understand a "concept," we are again making use of the same metaphor (Latin "capio" means "I seize" or "I take"), but again without being able to connect it, by meaning, to a physical act denoted by a cognate word in the world of concrete objects. The native speaker of Latin, to put this another way, would not suffer the English speaker's disjunction between abstract "comprehend," "apprehend" and "conceive" on the one hand and the concrete act of physically "grasping" or "seizing" on the other, because "prehendo" and "capio" were used of that physical act as well as in their metaphorically extended senses.
Similarly, a contemporary German speaker would find no disjunction between the abstract verb "begreifen" ("to comprehend" or "to understand") and cognate concrete words like "greifen" ("to grab" or "to grasp") and "Griff" ("handle; thing grasped"). Finally, French "comprendre" ("to comprehend") clearly derives, without disjunction, from "prendre" ("to take").
Thus native speakers of English are often handicapped, in a way that speakers of the above-mentioned languages are not, if confronted with an unfamiliar word made from the same root as one we already know ("prehensile" may serve as an example in the present context) or even by a word we do know if it is used in an unfamiliar way ("reprehensible," for example): since our language lacks a cognate concrete word, or a use of the same root to denote something physical and real, we have no image to refer back to in order to guess the meaning of a word or in order to remember its meaning once learned. We must rely upon context alone if we are to guess, and upon memory alone if we are to remember.
My second point, that the disjunction between English abstract and concrete vocabulary has been worsened by the cessation of that almost universal knowledge of Latin that prevailed until very recently among those who claimed to be educated, need not be labored. It does however need to be pointed out. This is because the advantages of knowing Latin in terms of the enhancement of one's understanding of English vocabulary are, for most people who do know Latin, unconscious ones, while for those who do not know Latin those advantages are, by definition, unknowable. Latin has dropped out of the curriculum, almost silently; where a clamor has arisen, the vital problem of disjunction between abstract and concrete vocabulary has not formed a large part of the protest. This is not to suggest that the resuscitation of Latin would in itself solve the problem, as a knowledge of Latin provides only the materials from which connections may be drawn between words in English. In practice, the only solution to this growing problem of communication is going to be specialized study of English etymology.
My final point, that Medical Terminology to a greater extent than other jargons confers a kind of mystical power upon its initiates, will perhaps be disputed. But words do have power, and always have had. Some, in contemporary English, have so much power that few of us can bring ourselves even to utter them, in "polite" company at least. Again, the idea in primitive magic that learning the name of something gives one power over it persists, I believe, in contemporary conventions regarding last and first names and particularly in our almost universal reluctance to acknowledge our middle, or secret, names, except to intimates. Likewise, practitioners of medicine, knowing the special names of things, have, at least in the eyes of most of the rest of us, a kind of power over the things themselves; in addition, in order for the special names to be efficacious they must remain secret or arcane. This kind of "word magic" may or may not have positive psychological value, and I hasten to add that in making this point I am not attempting to pass judgement.
The first lesson the serious student of language must learn, in fact, is the difference between describing linguistic phenomena and passing judgement upon them. If one writes a grammar (and this book is in a modest way a grammar of Medical Terminology) one must decide whether it is a descriptive grammar or a prescriptive one. This book is, I hope, mainly descriptive, and in that spirit I offer the theory of the mystical power of arcane vocabulary merely as a possible explanation of the observable fact that Medical Terminology (considered as a language and thus subject to strict internal rules of usage and equally strictly ruled patterns of change), exhibits few of those tendencies to self-simplification or assimilation to "plain English" which we find when the main intention of users of a jargon is to communicate effectively with the largest possible number of people.
More specifically, books and courses written or designed by classicists concentrate too much on the meanings anciently borne by Latin and Greek roots; by tending to ignore the meanings these roots have acquired during two millennia of medical compounding, they fail to adequately explain (or even to acknowledge) contemporary usage.
Those created by medical specialists, on the other hand, tend to suffer from the opposite problem: by concentrating exclusively on contemporary usage, they pay too little attention to etymological features of compounding which simplify the learning of Medical Terminology. This is because medical authors base their books upon the definitions of words found in standard medical dictionaries, but fail to look beyond those definitions. The editors of Dorland's Illustrated Medical Dictionary (26th Edition, Philadelphia, W.B. Saunders, 1981), for example, while acknowledging the role which roots play in compounding and even presenting a fairly comprehensive and accurate list of them, quite properly make no attempt to reflect consistent meanings for those roots in the definitions given in the body of the work. Unfortunately, they are followed in this inconsistency by the authors of textbooks in Medical Terminology, who frequently use in their definitions words just as arcane as the roots and words which they are "defining."
Neither approach, in other words, attempts to combine the pedagogical value of knowing the concrete meanings of the Latin and Greek roots with the goal of learning contemporary usage: the classicists do not address the developments of meaning through which all words pass over time, while the medical specialists do not explicate the original concrete, physical, tactile meanings of the roots of contemporary Medical Terminology.
Another difficulty is that books and courses designed by classicists are often prescriptive, rather than descriptive. They may contain, for example, injunctions against "hybrid" compounds (in which one element is Latin and another is Greek), in direct contradiction to usage, and they may give "preferred" meanings and forms on the basis of the rules of Latin and Greek grammar, thereby overlooking, or even denying the existence of, the grammar of contemporary Medical Terminology.
Disjunction between Greek and Latin roots two thousand years old, on the one hand, and contemporary English, on the other, leads to a further problem. No textbook which I have seen attempts seriously to point out relationships between the vocabulary to be learned and cognates and derivatives already familiar to the student. This oversight results in the loss not only of a potent aid to learning but also of an opportunity to stimulate that intellectual curiosity which should underlie and be part of any academic pursuit.
Finally, most currently available textbooks fail to give an adequate number of exercises designed to reinforce the material presented in each chapter or unit. Many also lack answer keys, while those which do have them are not consistent in their translations of repeated combining forms.
1) Although my own training is in Classics, the book is mainly descriptive, not prescriptive. Every definition given is therefore based not upon my own prejudices, but upon usage. "Usage," for this purpose, has been determined by examination of the actual meanings borne by Greco-Roman roots in the compounds formed from them which are given in Dorland's.
2) The book is thus "formulaic," in the sense that the translation given for each combining form represents the simplest and most consistent meaning that can be elucidated by examination of that combining form's function in many compound words with diverse definitions. One example should suffice. The cognate suffixes "-gram," "-graph" and "-graphy" appear in very many, very diversely defined words in Dorland's. A small selection of these follows, with definitions based upon those found in that dictionary (highlighted words in the definitions translate the suffixes in question).
dactyl/o/gram a fingerprint taken for purposes of identification hyster/o/gram a roentgenogram of the uterus angi/o/graphy 1. the roentgenographic visualization of blood vessels 2. a treatise on the vessels hem/o/gram the blood picture; a written record or a graphic representation of the differential blood count kinemat/o/graph an instrument for exhibiting pictures of objects in motion stere/o/gram a stereoscopic drawing my/o/gram the record or tracing obtained by a myograph my/o/graphy the use of the myographThe suffixes, which derive ultimately from Greek grapho ("I scratch;" hence "I inscribe" and later "I write"), are translated in this book as follows ("x" stands for a combining form and denotes "any organ or part"):
x-o-gram a record of x x-o-graph an instrument for recording x x-o-graphy the recording ofThese translations reflect the simplest consistent meanings which can be discerned from usage and which the student may therefore safely apply when meeting these suffixes in new words. Inconsistency of translation can almost always be avoided, if necessary by the addition of words. The following examples are to be compared to the last two dictionary definitions given above (added words are highlighted; "my/o" means "muscle").
my/o/gram a record of something involving muscles my/o/graphy the recording of something involving musclesIt is in the pursuit of consistency that I have occasionally, and reluctantly, been more prescriptive than descriptive. In so doing I have also sometimes quietly "corrected" inconsistencies of definition found in Dorland's, inconsistencies which I believe to have arisen from misapprehension of subtle distinctions in meaning. Again, one example should illustrate the problem and my solution to it. A number of words in Dorland's consist of the combining form "hem(at)/o" ("blood"), another combining form designating an organ or part, and a nominative ending ("-us," "-a," "-um" or "-on," for example). By all rules of grammar, such words must denote concrete physical objects, rather than abstract processes. Here, however, is a partial list of such words, with definitions based upon those in the dictionary:
hem/o/thorax a collection of blood in the thorax hemat/o/colp/os an accumulation of blood in the vagina hemat/o/cyst an effusion of blood into the bladder hemat/encephal/on the effusion of blood into the brain hemat/o/colp/o/metr/a accumulation of blood in the vagina and uterus hemat/oste/on hemorrhage into a bone cavityThus only the first three definitions are correct, for the last three imply (wrongly) a process rather than the concrete result of that process. Suitable medical words for the last three definitions would replace the nominative, concrete, endings by "-ia," which denotes a process. In this book, the words above (and many others) are subsumed under a formula:
Where a word consists of a combining form denoting a substance, a combining form denoting an organ or part, and a nominative ending, it will always mean "a collection of the substance, in the part." (See Note i.b. in Chapter 5 for a symbolic formulation of this rule.)3) Preference, in form or meaning, follows that indicated by frequency of occurrence in Dorland's and is therefore based on usage. Many combining forms used in Medical Terminology occur in pairs, of which one reflects a Greek word and the other its Latin equivalent. This means that, in theory, many medical compounds have doublets constructed by means of synonymous roots. In practice, however, for a given object or concept one word will be used more frequently than its synonym. The latter is entered in Dorland's only as a cross-reference to the more frequently used word. In this book, all words used in the examples and exercises are found as "main entries" in Dorland's (with one class of occasional exceptions, discussed at premise 8] below) and are thus "preferred forms" according to usage rather than according to prejudice or theory.
4) So far as is consistent with usage, definitions are made as concrete as possible in order to facilitate memory and recognition. This occasionally results in apparent over-simplification, as, for example, when the combining form "malle/o" is defined as "hammer" rather than as "malleus." The advantage in such concretization is that the student has the readily available mental image of a mallet to help in learning and remembering the word as well as the ensuing ability to define the same root in a totally different context (in the words "malleable" and "malleolus," for example). Similarly, given that in practice many students of Medical Terminology are not yet students of Medicine, defining "clavicul/o" as "collar bone" rather than as "clavicle" offers the student a way of remembering what a clavicle actually is.
5) Since one or more of the combining forms given in this book are found in approximately forty-five thousand compound words (or approximately ninety-five percent of the words in Dorland's [according to Dr. Roy Butler, "Sources of the Medical Vocabulary," Journal of Medical Education, vol. 55, Feb. 1980, page 128]), it is obviously to the advantage of the student to learn the combining forms, their definitions, and the rules governing translation of resultant compounds rather than to memorize the definitions of individual compound words. Hence in this book any one compound word, whether in the examples or in the exercises, will regularly occur once only.
6) If the "importance" of a combining form can be measured by the frequency with which it occurs in compound words or phrases, then this book presents the majority of the most important combining forms found in Dorland's. At the other end of this scale, I have (arbitrarily) excluded combining forms which are found in fewer than four of the words or phrases which are listed in that dictionary.
7) A fundamental element of the "grammar" of Medical Terminology is the fact that virtually all its words (like most English compounds) are analyzed from right to left. The endings of words are therefore of primary importance, and this book deviates from most in that the majority of the frequently occurring endings are given in the first chapter. A large number of systematically arranged combining forms denoting body parts follows, while prefixes are relegated to rather late in the book in keeping with this "right to left" principle and in keeping with their relatively greater difficulty.
8) In the 1940's an international effort to standardize at least some aspects of Medical Terminology began. The corpus of anatomical terms thus produced (and approved by several International Congresses of Anatomists; the most recent citation in Dorland's is to the eighth, at Wiesbaden in 1965) is called Nomina Anatomica. These terms are, by and large, straight Latin. As they are virtually all formed by the addition of regular endings to standard Medical combining forms and put together into phrases according to a few simple rules of Latin grammar (augmented by restrictions on word order, specific to the corpus itself), they are presented in this book along with the combining forms from which they are made. In selecting Latin phrases for examples and for exercises, I have followed the usual practice of elementary Latin textbooks in resorting sometimes to simplification and occasionally to outright invention, in the interests of facilitating the learning of endings and the principles of agreement.
9) So far as has been possible, each combining form to be learned has been presented along with an English derivative or cognate chosen, at one level, to facilitate through association the memorization of the combining form itself and of its meaning. But the mere rote-learning of lists of words or parts of words is not an academic pursuit in itself, and therefore at another level the number and diversity of the derivative and cognate relationships thereby exemplified should provide a stimulus to the student's curiosity about etymology, historical linguistics, and the history of the English language. This curiosity often results in an enhanced ability not only to analyze words which fall outside the scope of Medical Terminology but also to think critically about both words themselves and the ways in which words are used for communication.
10) Users of this book who have previous training in medicine will occasionally encounter words which will, when translated by the formulaic principles given here, yield medically nonsensical meanings. It should therefore be kept in mind that, like all languages, Medical Terminology has many exceptions to any "rules" which can be discerned governing its grammar and usage, and that I make no claim here to have taken all such exceptions into account. A further complication is that, since the decline of the study of Latin and Greek referred to above, a number of words, now well accepted, have come into Medical Terminology, and that many of these have been coined by medical practitioners who simply misunderstood the "rules." But comparatively few words fall into these categories and the occasional difficulties created by them are, in my opinion, greatly out-weighed by the efficiency of learning, instead of individual words, combining forms and the principles which almost always govern translation of their combinations.
11) Similarly, readers with experience in classics or linguistics will occasionally be irritated by simplifications and also by grammatical terminology different from that which they have learned. My guiding principles here have been utility and clarity, in terms of the students for whom the book is intended. Thus, for example, my account of word order in the phrases of the Nomina Anatomica is specific to the simplifications which actually exist in that corpus and is not intended to apply to classical Latin. Likewise, from a plethora of grammatical terminology used inconsistently in a variety of disciplines and sub-disciplines, I have chosen to use words which seem to me unambiguous and easily understandable.
Each chapter consists of four parts (A, B, C and D).
Part A) A list of the combining forms which are to be learned. These are given according to certain conventions which can be illustrated by the following examples (taken from Chapter 2).
30. omphal/o (umbilical) navel
31. umbil(ic)/o (umbilical) navel umbilic/us
32. glute/o, glut/o ("rump") buttock
33. gon/o, gony/o (pentagon) knee
The first column gives the number by which, in conjunction with the chapter
number, the combining forms will be referred to throughout the book (as,
2.30, 2.31, 2.32 and 2.33).
The second column contains the combining form itself, which usually consists of a base or root ("omphal-") and the combining vowel (usually but not always "-o-") associated with it. Where brackets occur, as in "umbil(ic)/o" (2.31), they indicate that two combining forms, "umbil/o" and "umbilic/o" are used, and that the second is the one more frequently found. If the first were more frequent, the entry would be written "umbil/o, umbilic/o," and the relative frequency would be indicated by the order. Thus "glute/o" and "gon/o" (2.32 and 33) are found more frequently than "glut/o" and "gony/o."
When the combining form given in the second column is a termination, it is preceded by its combining vowel and the letter "x," standing for (unless otherwise indicated) "any organ or part" (for example, "x-o-gram," mentioned above).
The third column gives where possible either a related derivative word ("umbilical" is derived from "umbilic-") or a cognate form (Latin-based "umbilical" is cognate with Greek "omphal-") which should be familiar enough to the student to provide an aid to memory; alternatively, the concrete meaning of the combining form is given, within quotation marks ("glut/o" means "rump"). In those rare cases where the third column is left blank, the meaning of the combining form can be assumed to be identical to the translation found in the fourth column.
The fourth column presents what examination of the combining form's occurrences has proven to be its most consistently useful translation, and therefore the one which will be used throughout the book. Where the translation is itself a cognate or a derivative of the combining form, it is highlighted; thus Greek "gony-" (2.33) is cognate with English "knee."
In the last column is given, where appropriate, the Latin noun as used in the Nomina Anatomica. This will usually consist of the combining form itself plus a nominative ending, as is the case with "umbilic/us" (2.31).
In the case of doublets (two distinct combining forms with the same meaning; 2.30 and 31 above, for example), I have regularly presented the more frequently used one ("omphal/o") first. An unfortunate but true observation may be made: generally speaking, where two distinct combining forms denote the same thing, the more frequently used one will be Greek and less familiar to the English speaker, while the more obvious Latin form will be less frequently used. Thus the meaning of Latin "umbilic/o" (2.31), for example, is immediately apparent, but in practice Greek "omphal/o" (2.30) is much more frequently found (the former occurs in initial position in six words cited in Dorland's, the latter in twenty-four).
Part B) Notes on the combining forms, their usage, and rules governing their translation, as well as on other matters as these seem appropriate to each chapter. The system of rules governing Nomina Anatomica terms, for example, is given in the "Notes" section of various chapters, beginning with Chapter 3. It should be pointed out that Chapter 1 is anomalous in that some notes on formation and usage are also given in Part A.
Part C) Exercises. The value of doing these thoroughly for each chapter cannot be over-stated, as they are designed so that each set gives not only practice with the forms learned in that chapter but also a review of much of what has been learned in previous chapters.
An Optional Exercise is always to translate the definitions generated by doing the regular exercises (once they have been checked) back into Medical Terminology. Because of the large number of doublets, however, care must always be taken to ensure that the generated term is at least a plausible one, if it differs from the one given in the Exercises.
Another Optional Exercise, useful as a "warm-up" before the regular ones are attempted, is to cover the translations in Part A, and practice defining the combining forms. As an advanced exercise on the other hand, any number of words in Section C can be looked up in any large medical dictionary, and their definitions, as created by the formulaic conventions of this book, compared to the ones given in the dictionary. Imaginative students (particularly those with a sense of humor) can also invent words (of varying degrees of plausibility) and challenge their colleagues to translate them; if this is done in pairs or small groups it will obviously further facilitate memorization of the combining forms.
D) An Answer Key, provided for each set of Exercises.
Four appendices follow the last chapter. The first, "Some Basics of Historical Linguistics," will provide some help for those using the book without benefit of a teacher, particularly as it includes those features of "Grimm's Law" necessary for establishing the cognate relationships between words. The second, "A Glossary of Latin Words, Phrases and Abbreviations Found in Prescriptions and/or in Standard English," is partly an expansion of Chapter 20 and partly a reference tool for those whose curiosity about Latin influence on English has been aroused by working through this textbook. A brief Appendix on Roman Numerals is also included for reference. The Synopsis of Information Presented provides a synoptic overview of the material presented in this book.
Finally, there are two indices: an Index of Terminations and an Index of Non-Terminal Combining Forms.