Word oddities in medicine

This column was originally published in AMA eVoice on August 30, 2007. Dr. Davis is president of the American Medical Association.

The last two president's columns did not contain my usual addendum on "the lighter side." So this column will give you a double dose of distraction from weighty issues in medicine as we wrap up our summer.

I've had a long-standing interest in language, probably from having taken one-year courses in both English grammar and Latin in junior high school. I enjoy playing Scrabble. I read William Safire's weekly column on language in the New York Times Magazine. And writing and editing have been an important part of my career.

In one of my most enjoyable editorial roles, I served as North American editor for the BMJ in the late 1990s. As I mentioned in a previous column, the BMJ publishes a Christmas issue each year, which is full of humor, satire, and lighthearted science. One of my favorite articles from those issues was entitled "Alliteration in medicine: a puzzling profusion of p's."

That article was written by a professor of pediatrics, who reported on a particular prominence of the letter p in the medical literature. He mentioned familiar two-word sequences, such as pink puffer, pleuritic pain, poor prognosis, prone position, and prophylactic penicillin.

The author found several three-word sequences in the dermatologic literature, including pinpoint, pruritic pustules; persistent, painful plantar masses; and progressive, pigmentary purpura. He also cited sequences involving four or more words, as well as the mnemonics of seven p's to describe the complications of a Meckel's diverticulum and nine p's to describe features of the nephrotic syndrome.

Do you have favorite alliterations in medicine that involve letters besides p? If so, please e-mail them to me. Perhaps we'll identify other letters that might rival p.

Several years ago, I found a wonderful Web site devoted to word oddities and trivia. Medical terms are featured there quite often. For example, biopsy is one of the longer words in the English language whose letters are in alphabetical order.

The longest words containing the six vowels in alphabetical order are pancreaticoduodenostomy and pancreaticoduodenectomy.

Arteriosum (as in ligamentum arteriosum) and arteriosus (as in ductus arteriosus) are among the few words in which the five vowels (excluding y) occur once each and in alphabetical order. Subpopliteal contains the five vowels in reverse alphabetical order.

Pseudopseudohypoparathyroidism contains each vowel at least twice.

Asthma is one of the few words (with six or more letters) that begin and end with a vowel, but have no vowels in between.

There are seven consecutive consonants in Hirschsprung's disease. Postphrenic, postsplenic, and postsphenoid contain five consonants in a row.

Cytomegaloviruses, hypovitaminoses, paramyxoviruses, parasitological, tenosynovitides, and heterozygosity are among the longest words consisting entirely of alternating vowels and consonants.

Vesiculography (radiological examination of the seminal vesicles) is one of the longest isograms (words or phrases without a repeating letter).

Among the longest words that do not contain an e (the most frequently occurring letter in English) are uvulopalatopharyngoplasty, supradiaphragmatically, and macracanthorhynchiasis.

Only three words have as many as six c's, and two of them are medical terms—cholangiocholecystocholedochectomy and pneumonoultramicroscopicsilicovolcanoconiosis, a 45-letter word coined to be the longest English word, meaning lung disease caused by inhaling very fine silica dust found in volcanoes.

Other medical terms that win or tie for having the most occurrences of a particular letter are ophthalmophthisis (four h's), jejunojejunostomy (four j's), transureteroureterostomy (five r's), and vulvovaginitis (three v's).

A list of words containing double, triple, or quadruple letters had very few entries for triple-o, but the most impressive is laparohysterosalpingooophorectomy (15 syllables and 33 letters).

A triple-i is found in Wiiitis, which has been suggested as a term for shoulder pain caused by excessive playing of the new Nintendo video game Wii. (Wiiitis was described as a more specific variant of Nintendinitis, a condition first reported in 1990.)

One of the longest words consisting of only short letters is unconsciousness.

Hydroxyzine (the antihistamine branded as Atarax and Vistaril) is the only word in the Oxford English Dictionary (second edition) containing XYZ.

ZOONOSIS—a word heard more commonly in medical circles in this era of avian influenza—may be the longest word in which each letter is rotationally symmetrical (in upper case).

In beriberi and intestines, each letter appears twice.

The Web site presented a plethora of palindromes, but only a few were medical terms—rotator, Xanax, and a few other pharmaceutical names.

What are the most unique word oddities you've seen in medicine?

Please send comments, questions, and replies to amaprez@ama-assn.org.