When I use a word . . . Linguistic barbarisms in medicine

H W Fowler

Henry Watson Fowler (1858–1933) was a schoolmaster who turned to journalism and then became a lexicographer. And it is for lexicography that he is justifiably famous.

Fowler started his lexicographical career in collaboration with one of his younger brothers, Francis George Fowler (1871–1918). Having previously published a translation of the works of Lucian of Samosata (1905), in 1906 they published The King’s English, a volume for which they had originally suggested the title The new solecist for literary tiros.1 This was followed, in 1911, by the Concise Oxford Dictionary of Current English, an abridged version of the Oxford English Dictionary, or as much of it as had been published by then (A–Sc), supplementing it using entries from other dictionaries.

They then began work on a book on English usage, but the first world war intervened, and when Francis died from tuberculosis in 1918, Henry continued the work alone. The first edition of A Dictionary of Modern English Usage, dedicated to Francis (“who shared with me the planning of this book, but did not live to share the writing”), was published in 1926.

Wilson Follett

Roy Wilson Follett (1887–1963) was an American writer, educated at Harvard University. He wrote several books and articles of literary criticism in The Atlantic, including: Joseph Conrad: A Short Study (1915); Henry James (1916), Contemporary Novelists: John Galsworthy (1916), Contemporary Novelists: Joseph Conrad (1917), The Historian of Wessex (1917), and Some Modern Novelists: Appreciations and Estimates (1918), all co-written with his wife Helen Thomas Follett; and The Modern Novel: A Study of the Purpose and the Meaning of Fiction (1918, revised 1923). He edited the first collected edition of the works of Stephen Crane in 12 volumes (1925–7), Crane’s Collected Poems (1930), and the collected stories of Thomas Beer (1947). Follett’s novel No More Sea (1934) was shortlisted for the 1934 Pulitzer Prize.

Fowler had statedly reserved his pronouncements for an English audience. As he wrote in a letter to his publishers, “We have our eyes not on the foreigner, but on the half-educated Englishman of literary proclivities who wants to know Can I say so-&-so? … Is this use English?”1

Follett therefore perceived a gap that he might fill. “It is time,” he wrote in 1958, “we had an American book of usage grounded in the philosophy that the best in language—which is often the simplest—is not too good to be aspired to.” He worked on such a book until his death in 1963, when it was still incomplete. The task of editing and completing it was undertaken by his colleague Jacques Barzun, Seth Low professor of history at Columbia University, in collaboration with six other editors: Carlos Baker, Woodrow Wilson professor of literature at Princeton University; Frederick W Dupee, professor of English at Columbia University; Dudley Fitts, poet, critic, and translator; James D Hart, professor of English at the University of California, Berkeley; Phyllis McGinley, poet; and Lionel Trilling, Woodberry professor of literature and criticism at Columbia University.

The book, published in 1966, was favourably compared with Fowler’s, and a revised version appeared in 1976, edited by Erik Wensberg.

Barbarisms

Both Fowler and Follett included entries on barbarisms in their guides to English usage.

Fowler first distinguished between barbarism, barbarity, and barbarousness: “Barbarism means uncivilized condition, grossly uncultivated taste, or an illiterate expression; barbarity means grossly cruel conduct or treatment, or a grossly cruel act; barbarousness may be substituted for either of the others where the sense quality or degree is to be given unmistakably.”

What exactly Fowler meant by a barbarism is not clear from his entry on the subject: “Barbarisms is a hard word to fling about, apt to wound feelings, though it may break no bones; perhaps it would be better abstained from, but so too would the barbarisms themselves.” The revised text in the second edition (1968), edited by Sir Ernest Gowers, makes things clearer: “[Barbarism] has the meaning the Greeks gave it, of a word formed in an unorthodox way.” And Gowers’s cross reference to hybridsandmalformations sends us back to the first edition, in which Fowler described barbarisms in an entry on hybrid derivatives.

“Hybridderivatives are words formed from a stem or word belonging to one language by applying to it a suffix or prefix belonging to another [and] words … in which all the elements belong indeed to one language, but are so put together as to outrage that language’s principles of formation.” I call these Type 1 and Type 2 barbarisms respectively.

Fowler thought that most hybrids were unobjectionable, referring to Greek or Latin words to which a simple English suffix had been added (e.g. plainness and sympathizer) and those in which an English word has had a foreign prefix or suffix added (e.g. disbelieve, readable, and breakage). I call these Type 0 barbarisms. Fowler described them as “hybrids technically, but not for practical purposes.”

The first definition of barbarism in the Oxford English Dictionary (OED) accords with Fowler’s descriptions: “The use of words or expressions not in accordance with the classical standard of a language, especially such as are of foreign origin; originally the mixing of foreign words or phrases in Latin or Greek.”2

Although Follett clearly took his cue from Fowler in including the term “barbarism” in his guide, he offered a different definition: “A barbarism is an expression in the mouth of an educated speaker which is so at variance with good sense and good usage that it startles the hearer.” He suggested that barbarisms arise though “a total blindness to logic and to what the Germans call Sprachgefühl, the sense of language.” Among the examples he gave, he included the sort of hybrids to which Fowler referred, such as “obliviate,” but he also included what we might better call malapropisms, such as confusion between “mitigate” and “militate,” as well as mispronunciations, and a variety of malformations, such as the non-words “irregardless,” “beneficient,” “portentious,” “somewheres,” “anywheres,” and “everywheres,” misuse of “aegis,” as in “through the aegis of the Foundation,” and neologistic phrases such as “guidance counselor,” “fun activities,” and “leisure-time preoccupations.” In short, anything that is linguistically wrong, otiose, or self-contradictory. “All these,” he wrote, “are in different degrees barbarisms.” I call these Type 3 barbarisms.

Type 0 medical barbarisms

I suspect that under this heading Fowler would have included many medical terms, such as “aspirin,” originally a brand name. It has three components: , short for “acetyl,” itself a combination of Latin and Greek, , which is short for Spiraea ulmaria, the meadow-sweet, and a meaningless suffix, akin to -ine, often used in the names of drugs (heroin, insulin, penicillin, warfarin), plant extracts (alizarin, aloin, coumarin, curcumin, dextrin, inulin, lignin, palmitin, pectin, salicin, vanillin), proteins and their derivatives (albumin, casein, chondrin, fibrin, gelatin, globulin, myosin, pepsin, plasmin), and other substances (allantoin, chitin, chromatin, lecithin, prostaglandin, purpurin).3

Type 1 medical barbarisms

“Bureaucrat” is a good example of a Type 1 barbarism, the formation of a word by combination of two words from different languages. It comes from the French word bureau, an office, and the Greek word κράτησις, power.

Many words of this type are well formed, each part of the word coming from a Greek root. Examples include aristocrat, autocrat, democrat, gerontocrat, kleptocrat, ochlocrat, phallocrat, plutocrat, pornocrat, technocrat, thalassocrat, and theocrat. Barbarisms of this form include educrat, mediacrat, meritocrat, mobocrat, all from Latin+Greek, and quangocrat. Mobocrat is not obviously Latin, but “mob” is short for the Latin word “mobile” (pronounce the final ), itself a shortening of the original phrase “mobile vulgus,” a common crowd. “Quangocrat” is a particularly barbaric coinage; it’s an acronym from Quasi-Non-Governmental Organisation. NHS England has been described as “the world’s biggest quango.”4

Fowler cites “cablegram” as a barbarism, cable coming from a Teutonic root and -gram from the Greek word for something written, such as a letter, γράμμα. Today we also have strippergrams, kissograms, gorillagrams, and even Rambograms, the last being delivered by Sylvester Stallone look-alikes. Medicine has many -grams, some of which are barbarisms. Take electrocardiogram; it comes from the Latin word for amber, electrum, and a Greek word for the heart, καρδία. Other Latin+Greek examples include interferogram, mammogram, milligram, radiogram, and spectrogram; and roentgenogram is from the name of the German discoverer of x-rays.

Television is an example of a barbarism that combines a Greek word with a Latin one—Greek τῆλε, afar, and Latin videre, to see (supine visum). One of several Greek words meaning to see, σκοπειν, had already been taken for words such as “telescope” when “television” was first named. Many medical words prefixed with tele- are well formed, such as telecardiography, telegony, telekinesis, telemetry, teleology, and telepathy. Barbarisms include teleceptors, teleconference, and telemedicine. Of two hybrids that involve people’s names, teleroentgenography is still alive and well,5 but the OED’s most recent reference to telecurietherapy is from 1996.6

Type 2 medical barbarisms

The specific Type 2 barbarisms to which Fowler took exception included Pleistocene, Pliocene, and Miocene (respectively from the Greek words πλεῖστος, most or fullest, πλείων, more, and μείων, lesser, plus καινός, new or recent) because he thought that they were not formed by proper methods of word formation—even though the two elements in each word are Greek, the Greeks would not have combined two adjectives in this way.

When I previously wrote about utopian literature,7 I mentioned that Sir Thomas More’s choice of the word he had invented, “utopia” (no place), was a deliberate pun, coming as it might from Greek words for either “no place” (οὔ τόπος) or “a goodly place” (εὐ τόπος). Later, the term “dystopia” was coined as an antonym, in etymological contrast to “eutopia” rather than “outopia.” Later, others suggested that “cacotopia,” a bad place, might be a better antonym, and other terms have included “agathotopia” and “kalotopia,” respectively a good place and a beautiful place.

In an essay on dystopia, Philip Howard wrote that “Eu-topia is, if not a barbarism, at any rate odd, because it uses the adverb Eu (well) to qualify a noun ‘topos’ (place).”8 And later in the piece he wrote that “Eu was a jack-of-all-trades prefix in Greek. It could mean plain good (eueides: good-looking), noble (eugenes: of noble race or high descent), brave (euenor: abounding in brave men), auspicious (euphemia: the use of words of good omen), easy (euphoros: easy to bear or patient), or quite (euthumos: in quite good spirits).”

However, there is a paradox here. According to Liddell and Scott’s Greek-English Lexicon, εὐ was always used adverbially. On the other hand, Howard was right—the word, as the Greek-English Lexicon specifically confirms, was often used to prefix not only verbs and adjectives or adjectival forms of verbs, where an adverb might be expected, but also nouns, where it would not. To resolve this, I turn to the word “goodly,” which in English can serve as both an adjective and an adverb. Perhaps εὐ actually served a similar dual purpose in classical Greek.

In that case, we should not regard all the medical terms that are formed from eu+a Greek noun—eubacteria, eucapnia, eudipsia, euthanasia, euxanthon, and all the many others—as barbarisms after all.

Type 3 medical barbarisms

Of the other examples I have cited above, one stands out: the frequent misuse of the word “mitigate,” when people talk about mitigating against something, confusing it with militate. To mitigate is to alleviate or lessen something; you just mitigate it, not against it. You can, however, militate against something, and when you hear “mitigate against” you don’t know which of the two meanings was intended. Fowler mentions this, but he classifies it as a malapropism, whereas Follett calls it a barbarism.

Medical publications are full of this, and not only from authors whose first language is not English. In a Pubmed search for “mitigate against” in titles and abstracts I found over 2000 examples. Here is the most recent example: “Given that brain changes have been observed in athletes following repetitive head impact exposure, it is important to understand better and mitigate against this phenomenon.”9 Mitigate? Militate against?

A final thought

These days we don’t agonise over linguistic medical barbarisms, and probably most of those who use them don’t even realise that the phenomenon exists nor that the words they are using could be described as such. In many cases there is little alternative when a new term is being created but to create a barbarism. But occasionally it would be satisfying if attention were paid to the linguistic origins of the words we use.

For example, in 1937 Nymphus Frederick Hicken wrote that “The procedure utilizes contrast fluids which are injected directly into the milk ducts, thus giving an accurate roentgenographic pattern of the ductal and secretory system of the mammary gland. The terms ‘mammography’ and ‘mammograms’ have been coined to describe these examinations.”10 Hicken’s use of the passive mood conceals the identity of the individual who first suggested these terms, although he was probably the one. But “mammography” for example, could easily have been “mastography” (from the Greek word for a breast, μαστός), as in mastalgia and mastitis, and would have gained the admiration of those who are sensitive to linguistic origins.

So, when next you decide to coin a new biomedical term, do try to match its several components using the same language, Greek+Greek, Latin+Latin, Hittite+Hittite. Whatever.