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During an annual “well-woman” visit, it is customary to perform a pelvic exam to screen for cancers of the reproductive system. These cancers include uterine cancer, ovarian cancer, and cervical [Origin: Latin, cervix (neck)] cancer. The last one is especially noteworthy, thanks to the development and implementation of the most successful cancer screening test in medical history: the Pap test. This screening test swabs the cervix of the uterus and assesses the morphology of the obtained cells. If the cells are atypical, the gynecologist obtains a cervical biopsy to further assess the situation and take the appropriate measures.

What is the etymology of “Pap” in “Pap test?” Turns out that this is not from an ancient Greek root; rather, it’s from a modern Greek physician! Georgios Papanikalaou (1883-1962) drew inspiration from Walter Hayle Walsh (1812-1892) when the latter reported on the observation of malignant cells under the microscope in certain lung diseases. In 1928, Papanikalaou presented his technique to an audience of physicians:

  1. Gather cellular debris from the vaginal tract
  2. Mount it on a microscope slide
  3. Stain it with the Pap stain (haematoxylin counterstained with OG-6 and eosin azure)

Left: Georgios Papanikalaou, right: Aurel Babeş

Even though Papanikalaou first developed and demonstrated the use of this technique, it turns out that another physician—Aurel Babeş—made similar progress regarding the microscopic analysis of malignant cells. Babeş used a platinum loop to collect cells from the cervix and mounted the sample on a microscope slide. Babeş published before Papanikalaou, but Papanikalaou used the technique in hospitals before Babeş published. For this reason, we give it the name of “Pap test,” but in Romania, it is called the “Babeş-Papanikalaou test” in honour of Babeş’s independently-developed method. In Spanish, the “Pap” is said in full, i.e., it is “la prueba de Papanikalaou”: the test/probing of Papanikalaou!

There is another gynecologic eponym [Origin: Greek, epi- (on/upon) + onoma (name)] that most people don’t readily recognize. Gabrielle Falloppio (1523-1562) was an Italian physician and anatomist who primarily explored the anatomy of the head: he described the inner ear, the middle ear, the mastoid cells, and the circular & oval windows, among many other structures. He also studied the reproductive systems of both males and females—including the structures that connect the ovaries to the uterus. For those that prefer non-eponymous nomenclature, an alternative name for the Fallopian tubes is uterine tubes. Note that Falloppio’s name is spelled with 2 “p”s, but we only use one “p” in Fallopian! (In Spanish, it is cut down by an extra “l,” spelled “Falopio.”) Falloppio also advocated the use of condoms to prevent syphilis and conducted an early clinical trial of sorts; he observed that the approximately 1100 men who used condoms and reported to him did not contract syphilis.

Left: Gabriele Falloppio, right: a 16th century prophylactic device

If the Fallopian tubes and the ovaries are afflicted with cancer and need to be removed, what words do we use to describe the surgery? For the Fallopian tubes, we use salpingectomy, and for the ovaries, we use oophorectomy.

Salpingectomy
Origin: Greek, salpinx (trumpet) + ek- (out of) + temnein (to cut) + -ia (condition of)
A cutting out of the trumpet, i.e., the Fallopian/uterine tube
N.B. (nota bene): in Spanish, they are called “las trompas de Falopio”: tube/horn of Falloppio!

Oophorectomy
Origin: Greek, oion (egg) + pherein (to carry) + -ectomy (a cutting out)
A cutting out of the egg-carrier, i.e., the ovary

And if both entities need to be removed, we call it a salpingo-oophorectomy. This term denotes that only one ovary and one Fallopian tube is excised; if both are excised, we append bilateral [Origin: Latin, bi- (two) + latus (side)] to the procedure for a bilateral salpingo-oophorectomy.

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Who doesn’t love a good cup of joe? Coffee is a much-beloved beverage that we drink for a variety of reasons, chief amongst them taste and stimulatory effects. Coffee was supposedly first cultivated in Ethiopia, and the first credible evidence of its consumption by humans is from the port town of Mocha in Yemen in the mid-15th century. There is a whole host of etymology and history to talk about, but let’s start with the word coffee itself:

Coffee
Origin: Arabic, qahwah, from qaha (to lack hunger)
So named for the age-old observation that coffee, via caffeine, blunts the appetite

As for the phrase, “a cup of joe,” there are a number of possible etymologies, but the one that I prefer is the shortening of “cup of jamoke”:

Jamoke: Java + Mocha
Java is a country that produces a lot of coffee bean
Mocha (Arabic: al-muka) is the port city in Yemen that was a huge coffee marketplace

mocha rev

European factories at the port of Mocha, 17th century

I would like to clear up a number of misconceptions about different styles of coffee. We have cappuccinos, espressos, mochas, lattes, and many more. Their etymologies may help you differentiate them! The first one that we build off of is espresso.

Espresso
Origin: Italian via Latin, ex- (from/out of) + primere (to press)
Coffee produced by forcing (“pressing”) nearly-boiling water through fine coffee grounds

This form of coffee is the base for the others that we commonly see. To produce cappuccinos and lattes, we need a base of espresso. A cappuccino is 1/3 espresso, 1/3 hot milk, and 1/3 foamed milk. Where does the word come from?

Cappucino
Origin: Italian, cappuccino (of the Capuchin friars)
So named because of the resemblance of a cappuccino’s color to the friars’ garments

cappuccino rev

Left, Portrait of a Capuchin Monk by Rubens; right, his namesake

Contrast a cappuccino with a simple café latte, which simply translates to “coffee with milk.” The coffee in question is espresso. Different establishments use different ratios of coffee to milk, but if we want to be rigorous with our etymological descriptions, a cappuccino is thus considered a subset of café latte. Now, a macchiato is something that is greatly misunderstood. It is a drink with hot milk at the bottom and a small amount of espresso at the top. Its etymology:

Macchiato
Origin: Italian, macchiato (marked)
So called because the espresso “marks” the hot milk at the bottom

Again, different people will use different ratios, so a quantitative definition is difficult, but that’s the general idea. Finally, out of our current list there is the mocha. As you might imagine, this is the very same Mocha that I presented earlier, i.e., the port town in Yemen that was a large hub for coffee in Ottoman times. Supposedly, the coffee beans that were exchanged in Mocha often had a chocolate taste to them, which is why we use the term mocha these days to refer to any coffee with a chocolate flavor or coffee with chocolate syrup.

What other types of coffee are you interested in learning about or would like to share? Leave a comment below and let’s discuss!

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Animals were of prime importance in the classical world: agriculture in the Roman Empire depended on domesticated oxen (L., bos) to plow the fields, crowds of thousands cheered on the races at the Circus Maximus, as drivers atop their chariots urged on the fastest horses (L., equus) in the land, and sacrifices of sheep (L., ovis), and pigs (L., porcus) were necessary to please the gods. So too were animals important to ancient scientists and physicians. It was the dissection of and the experiments on animals that formed the basis for early understanding of human anatomy and physiology. In addition, there are countless anatomic terms whose etymologies derive from the Greek and Latin names of animals.

Cauda equina
Origin: Latin, cauda (tail) + equus (horse)
Horse’s tail

cauda equina

Sitting within and protected by the vertebral column, the spinal cord consists of nerve cells and their extensive myelinated tracts that carry motor, sensory, and autonomic data to and from the brain. One would think that the spinal cord extends all the way to the bottom of the vertebral column, but in fact it stops looking like a cord at the level of the L2 vertebra in adults. At that point, it gives rise to the so-called cauda equina where individual nerves arising from the lower part of the spinal cord descend down the vertebral column until they exit through the proper foramina. It’s no wonder then why lumbar punctures must be done below L2: the individual nerves of the cauda equina can easily accommodate the lumbar puncture needle unlike the large-diameter spinal cord. So the next time you consent a patient for an LP, be sure to ask yea or neigh.

Coccyx
Origin: Greek, kokkux (cuckoo)

sacrum

The vertebral column consists of seven cervical, twelve thoracic, and five lumbar vertebrae. The primary role of these bones is to protect the spinal cord. However, their articulations allow flexion, extension, lateral motion, and rotation of the back, explaining their derivation from vertere (L., to turn). There are two more bones that lie below L5. The sacrum, which the Romans called the os sacrum (L., sacred bone) and which the Greeks named the hieron osteon (Gk., sacred bone), sits within the pelvis and allows the sacral nerves of the cauda equina to exit through its foramina. It’s not clear why this bone was considered “sacred.” One thought is that its sacredness derives from its location in the pelvis and therefore an association with reproduction. Another theory suggests that the ancients used this bone during sacrificial ceremonies. Finally, below the sacrum sits the coccyx, the small bony remnant of a vestigial tail. The ancient anatomists who named this bone thought that, when viewed from its side, it bears resemblance to a cuckoo’s beak.

Tragus
Origin: Greek, tragos (goat)

traigus

The tragus is that small piece of cartilaginous tissue situated next to the opening of the ear canal. And for some strange reason, it’s derived from the Greek word for goat. Perhaps some Greek anatomist had particularly hairy ears and thought it resembled the hair on a goat’s chin. Whatever the reason, the association with goats definitely stuck: the medical term describing hair on the ears is barbula hirci, literally meaning “little beard of the goat” [L., barbus (beard) + hircus (goat)]. No kidding.

Concha
Origin: Greek, konkhe (mussel, shell)

concha

Within the nose lie the superior, middle, and inferior nasal conchae. These long shelves of bone on the lateral aspects of the nasal cavity are covered with mucosa and supplied by a rich network of blood vessels. Their most important function is to warm and humidify the air as it passes from the nasal cavity to the lungs. If I look really hard, I can make myself believe they look like little mussels. Astute readers will notice that concha also appears in the labeled anatomy of the outer ear: concha also describes the fossa next to the opening to the ear canal.

Pes Anserinus
Origin: Latin, pes (foot) + anser (goose)
Goose’s foot

pes anserinus

Three muscles of the leg, the gracilis [L., gracilis (slender)], sartorius [L., sartor (tailor)], and semitendinosus [L., semi (half) + tendere (to stretch)], give rise to tendons that travel in parallel before attaching to the same location on the tibia. The ancient anatomists who saw this arrangement must have been reminded of the tripartite webbed feet of the goose and named it as such. There is a clinical condition called “pes anserinus pain syndrome,” also known as “pes anserine bursitis,” that describes pain around these tendons on the medial side of the knee. Interestingly enough, pes anserinus is not only a structure in the leg: it also is another name for the parotid plexus, where the facial nerve branches after exiting the stylomastoid foramen.

Recurrent Laryngeal Nerve

galen dissection

Galen demonstrating the effects of the recurrent laryngeal nerve during the dissection of a pig

The recurrent laryngeal nerves are branches of the vagus nerves that control nearly all of the intrinsic muscles of the voice box. Therefore, injury to one or both may cause hoarseness or even a complete inability to phonate. The etymology is nothing to write home about, but the story of their discovery definitely is. The famed Greek physician Galen, while conducting an experiment on a live, strapped-down pig, accidentally cut both laryngeal nerves; the pig continued to struggle but completely stopped squealing. He ultimately traced out the path of the nerves and confirmed that they originated from the vagus nerves. He noted that “there is a hairlike pair [of nerves] in the muscles of the larynx on both left and right, which if ligated or cut render the animal speechless without damaging either its life or functional activity.” Galen held a public demonstration of his experiment in Rome that was well-attended by distinguished politicians and scholars of the time. Those readers interested in learning more can read the article “Galen and the Squealing Pig,” linked here.

Thanks for taking a trip to the zoo with me. I’m off to see the capybara exhibit.

P.S.: Can you think of the English adjectives derived from the Latin words mentioned in the first paragraph? As a bonus, what about the adjective that describe wolves? Fish? Ducks?

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When we think of the deadliest diseases of the world, things like Ebola and the Black Death come to our minds. However, it turns out that cardiovascular disease (CVD) is the world’s leading cause of death in this day and age. In the 1970s, we were convinced that CVD was caused by dietary fat. Indeed, there was a public campaign to stamp out fat and replace it with carbohydrates. People didn’t realize that fat wasn’t the issue. Rather, fat has the highest calorie/mass ratio (9 calories per gram) and excess consumption of fat leads to obesity and its milieu of problems, including CVD. The food industry replaced fat with carbohydrates to meet this craze, and “fat-free” foods were instead pumped with sugar. Of course, calories are calories—and when people consumed these foods in earnest, not much changed with regards to the incidence of CVD.

So what exactly is fat? Chemically, fat is a glycerol molecule + three fatty acids. Fatty acids are long-chained aliphatic carboxylic acids that are either saturated (only single bonds) or unsaturated (one or more double/triple bonds). Quick aside: in popular culture, we hear about “omega-3 fatty acids” and “omega-6 fatty acids.” This refers to the position of the first double bond in the fatty acid, with the omega position being the last carbon in the chain (see picture below). So an omega-3 fatty acid is a fatty acid that has its first double bond on the 3rd carbon from the omega position.

Glycerol
Origin: Greek, glykeros (sweet) + –ol (chemical suffix for alcohols)
So named because glycerol is, in fact, sweet (and is an alcohol)

triglyceride glycerol

Aliphatic
Origin: Greek, aleiphar (oil)
Refers to hydrocarbons that do not contain benzene rings

What about the term lipid [Gk. lipos (fat)]? In the vernacular, people equate the word “lipid” to “fat,” and its etymology certainly vindicates such an equation. But of course, we must be rigorous with our definitions. To start, fats (i.e., triglycerides) are certainly a lipid subclass. Other subclasses include waxes (fatty acid esters such as beeswax; article’s featured image) and sterols (isoprene-derived steroids such as cholesterol). One classical definition of a lipid is the following: lipids are hydrophobic (some also include amphiphilic) small molecules that can dissolve in organic solvents but not water.

Hydrophobic
Origin: Greek, hydor (water) + phobos (fear)
Fear of water, i.e., not dissolvable in water or other polar solvents

Amphiphilic
Origin: Greek, amphi – (both) + philia (love)
Love of both water and fat, i.e., dissolvable in polar and nonpolar solvents

For those who love math, recall that for a statement to be proven true, it must be true in all instances. For a statement to be proven false, one need only provide a counterexample. So my counterexample for this definition of lipid is the molecule carbon tetrachloride (CCl4). CCl4 is a small molecule, it is hydrophobic, it dissolves in organic solvents, and it doesn’t dissolve in water. Now, to patch the definition up, one can make an addendum to include “naturally-occurring.” Needless to say, CCl4 is not naturally-occurring. Is there another definition of lipid that you prefer? Let me know in the comments!

lipids

Before ending this post, I would like to touch on the significance of fat in disease. There are a number of disease states that manifest with malabsorption; one of them is coeliac disease. The diarrhea that coeliac patients experience after ingesting gluten is more accurately termed steatorrhea:

Steatorrhea
Origin: Greek, stear (fat) + rhein (to flow)
Flow of fat (through the intestines), i.e., fat in the stools

How can you identify steatorrhea? If the stool is especially foul-smelling and sticks to the sides of the porcelain shrine, you’ve got yourself a flow of fat.

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Thanksgiving is upon us, and next to the fastidious references to pumpkin spice lattes and the like, the reference that we perpetuate and perhaps look forward to is that of the classic Thanksgiving postprandial somnolence.

Postprandial
Origin: Latin, post- (after) + prandium (meal)
After a meal, especially dinner

Somnolence
Origin: Latin, somnus (sleep)

Now, what is the soporific agent responsible for sending us on our merry way to the arms of Hypnos? Most people would tell you that copious amounts of tryptophan are responsible. Tryptophan is one of the 20 amino acids that are used to synthesize proteins in our bodies, and it is said to be abundant in turkey meat.

Tryptophan was first isolated in 1901 by Frederick Gowland Hopkins through the hydrolysis of casein; casein is one of the proteins that are abundant in milk. (Interesting aside: casein has an affinity for the molecule capsaicin, which is found in chili peppers. This is why dairy products neutralize the spice from peppers.) Hopkins conducted an animal study in which he removed tryptophan from the diets of mice. He found that tryptophan was necessary for the mice to grow, and concluded that tryptophan is one of the “essential” amino acids, i.e., it must be obtained through the diet. In 1912, he conducted another animal study in which he supplied mice with pure proteins, fats, carbohydrates, and minerals. He found that the mice did not grow, and postulated that there exist unidentified “accessory food factors” necessary for growth and survival. These “accessory food factors” are better known to us now as vitamins, and for this realization, Hopkins was awarded the Nobel Prize in Physiology or Medicine in 1929.

hopkins tryptophan

Now, regarding tryptophan: where does the word come from? Let’s start with some etymology:

Tryptophan
Origin: Greek, trypsin (digestive enzyme) + phanein (to show)
Something that is shown when trypsinized

Thus, tryptophan is so named because it is “shown” (produced) when proteins are digested with the enzyme trypsin. The etymology behind trypsin is rather cool as well:

Trypsin
Origin: Greek, tribein (to rub)
So named because it was first obtained with rubbing the pancreas

Anyways, it turns out that tryptophan is not the agent responsible for the ol’ Thanksgiving food coma. It has been shown that chicken and beef contain similar quantities of the amino acid. Instead, it is the large amount of carbohydrates ingested through classic Thanksgiving dishes such as mashed potatoes, yams, stuffing, etc. I won’t bore you with the posited mechanisms behind this, but there are a number of online resources that could fill you in if you so choose. Let us part with another fun Thanksgiving etymology:

acholeus rev

The Banquet of Acholeus by Rubens (1577-1640)
(Heracles fought against Acholeus for the hand of Deianeira, and when Acholeus transformed himself into a bull, Heracles took one of his horns. Acholeus offered him the horn of the goat Amalthaea, and Heracles in turn gave it to the Naiads who transformed the horn into the cornucopia)

Cornucopia
Origin: Latin, cornu (horn) + copia (wealth)
Horn of wealth, taken to mean horn of plenty
In classical mythology, it was an infinite source of food and drink from the goat Amalthaea

And thus I wish you all a Happy Thanksgiving, and may it be filled with a cornucopia of food, family, and fun.

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There are a number of ways of diagnosing disease: tissue biopsy, symptom matching, and of course, clinical signs. People often use the latter two terms interchangeably, especially since they are often paired together via the phrase “signs and symptoms.” But rigorously, these two words refer to two different things. Perhaps their etymologies will help differentiate them:

Sign
Origin: Latin, signum (sign/image)
Something the clinician notes in during a clinical encounter

Symptom
Origin: Greek, sym- (together) + piptein (to fall)
Something a patient reports to the clinician; something that “falls together” with something else

In other words, symptoms are subjective experiences while signs are objective experiences. For example, if I tell my doctor I have a fever, that is considered a symptom, but if he or she were to measure my temperature and find it elevated, it would be a sign. Another good example: pain is a symptom, since the perception of pain is unique to each patient. Tenderness, however, is a sign, since it is elicited by a clinician, e.g., applying pressure to the abdomen and eliciting an “ouch!”

stigmata rev

St. Francis Receives the Stigmata, by Antoni Viladomat (1678-1755)

There is another pair of terms that are often used together that is also often conflated. These words are stigma (plural stigmata) and sequela (plural sequelae). A stigma is a readily-visible (cutaneous or otherwise) or discernable sign that is characteristic of some disease. A classic stigma of liver disease is jaundice.A sequela, on the other hand, is an abnormal state or complication that results from a previous disease. A classic sequela of diabetes is diabetic nephrophaty. The etymologies of these words are relatively straight-forward:

Stigma
Origin: Greek, stizein (to mark/tattoo)

Sequela
Origin: Latin, sequi (I follow)

Interestingly enough, the word “stigmata” is also used in theology to refer to the bodily marks or sensations of pain associated with the crucifixion [Origin: Latin, crux (cross) + figere (to fix/bind)] of Jesus. Those who bear these stigmata are called “stigmatics” or “stigmatists,” and a common motif in classical painting is St. Francis of Assisi’s reception of the stigmata (see above). St. Francis supposedly received the stigmata of Christ for his great piety during the Feast of the Exaltation of the Cross after a forty-day fast.

Regarding jaundice, a stigma of liver disease, we know it to be the yellowing of the skin due to increased levels of bilirubin. Jaundice can, of course, be caused by a number of other conditions, e.g., deficiencies in certain enzymes (cf. Gilbert syndrome). There is one part of the body that is not said to be jaundiced when yellow; that honour falls on the eyes. When the eyes turn yellow due to, say, liver disease, we call it scleral icterus.

icterus rev

Jaundice
Origin: Latin, galbinus (yellow/yellow-green)

Icterus
Origin: Greek, ikteros
A bird said to cure jaundice when spotted

Hence we call it scleral icterus because it is with our eyes that we see the ikteros and become cured of our jaundice!

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Enzymes are biological catalysts that allow a host of chemical reactions to take place in organisms. They can also be used in synthetic chemistry to perform difficult reactions, e.g., forming carbon-carbon bonds. Enzymes (and more generally, all catalysts) do this by lowering the activation energy of a reaction and stabilizing the transition state. Where does the word enzyme come from?

Enzyme
 Origin: Greek, en– (in) + zyme (leavened)
Something leavened in

Louis Pasteur (Pasteur pipettes, pasteurization, etc.), a titanic French chemist of the 1800s, was studying the fermentation of alcohol by yeast.  He postulated that the agent responsible for fermentation was a “vital force,” and that only living organisms could perform the task. Wilhelm Kühne coined the term “enzyme” to refer to the process, but it was Eduard Büchner (Büchner funnel) who showed that cell-free yeast extracts could still ferment sugar into alcohol. For this, Büchner received the 1907 Nobel Prize in Chemistry. He named the agent responsible zymase.

pasteur and buchner

Left: Pasteur; Center: Kühne; Right: Büchner

Zymase
Origin: Greek, zyme (leavened) + –ase (enzyme suffix)
That which cleaves “leavened,” i.e., the substrate is from the yeast

Following Büchner’s convention, we use the suffix –ase to denote the substrate of an enzyme, e.g., an enzyme that catalyzes a reaction involving a peroxide is called a peroxidase. Note that this convention is not used for all enzymes. Here are some enzymes with interesting etymologies that are important for digestion:

Amylase
Origin: Greek, a– (without) + myle (mill) + –ase
That which cleaves something unmilled, i.e., starch

Pepsin
Origin: Greek, peptein (to digest)
That which cleaves proteins into peptides

Lipase
Origin: Greek, lipos (fat) + –ase
That which cleaves fats, e.g., triglycerides

Some enzymes require organic or inorganic cofactors in order to function. The organic cofactors can either be prosthetic groups, which are covalently bound to the enzyme, or they can be coenzymes, which are cleaved from the active site during the reaction. Some cofactors may be involved in allosteric modulation; here, an ion or molecule binds to an area away from the enzyme’s active site to modulate its activity.

biotin cofactor

Biotin (left) is a cofactor of pyruvate carboxylase (right)

Allosteric
Origin: Greek, allos (other) + stereos (solid, taken to mean 3D shape/position)
Pertaining to another space/position

Are there any cool enzymes with puzzling etymologies that you can think of? Leave a comment below and let’s explore!

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Death and disease were commonplace during medieval times, and this is perhaps best exemplified by the Black Death—an instantiation of bubonic plague that ravaged Europe between 1347 and 1353. To give a quick background on the Black Death: early in the fourteenth century, a Gram-negative bacterium Yersinia pestis spread via Mongol horsemen and environmental factors from the Gobi Desert (in China) to India, the Middle East, and finally to the Mediterranean Basin. Late in 1347, the Black Death had reached Italian port cities such as Genoa and then traveled across Europe. While the worst of the plague had subsided by 1350, it had killed millions of people during its short tenure in Europe.

Bubonic
Origin: Latin, bubo (pustule, growth, swelling); from Greek boubon (groin)
An inflamed swelling of a lymph node, especially in the armpit or groin

Plague
Latin, plaga (stripe/wound)
The pestilent disease caused by the virulent bacterium Yersinia pestis

Yersinia pestis
Origin: Latin, pestis (plague/pestilence)
Yersinia: named after its discoverer Alexandre Yersin, a Swiss/French physician

yersinia rev2

Characterized by delirium, chills, fever, vomiting, diarrhea, and the formation of buboes, plague is often fatal when untreated. This is exemplified by the 30 to 50 percent mortality rate observed during the Black Death. Medieval physicians found themselves at a loss to explain what caused the plague, how it was transmitted, and why certain individuals survived while others perished. Despite the lack of information, the plague was largely perceived as contagious via “bad smells” through the miasmatic [Origin: Greek, miasma (stain, pollution)] theory of disease. Though not a form of treatment, the best recommendation for dealing with plague at the time came from the wisdom of Galen and Hippocrates: “Cito, longe, tarde” (Latin: [leave] immediately, to a great distance, for a long time). For the unlucky individuals infected with plague, both patients and physicians made frantic attempts to cure the disease. These “treatments” included:

  1. Consuming arsenic, crushed emeralds, or rotten treacle (uncrystallized syrup)
  2. Our personal recommendation: blood-letting
  3. Introduction of “good smells” to replace the bad ones via herbs and posies
  4. Sitting in the sewers to practice self-flagellation.

Self-Flagellation
Origin: Latin, flagellum (whip, lash, scourge)
Hitting oneself with a whip, usually as part of a religious ritual

black death2 rev

While it is commonly known as the bubonic plague, several forms of plague existed during the Black Death including pneumonic and septicaemic forms. These different classifications are defined by the bodily location of the affliction.

Pneumonic
Origin: Greek, pneumon (lung) + -ikos (pertaining to)
Pertaining to the lungs

Septicaemic
Origin: Greek, septein (to make rotten) + haima (blood)
Invasion and persistence of bacteria in the bloodstream

While plague is much less common in the modern era, it continues to affect about 5,000 people annually throughout the world. The prognosis today is much better than it once was, given that modern physicians possess an arsenal of antibiotics, e.g., streptomycin, gentamicin, chloramphenicol, tetracycline, and sulfonamide.

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I often find myself taking many modern medical advancements for granted. For instance, I can take over-the-counter medication to treat a cold or receive a vaccine to prevent the flu. We have countless specialists and medical professionals that can treat a whole host of illnesses and billions of dollars are poured into medical research each year. Truly, many of these medical achievements are miraculous, if one stops to think about them.

But consider: there was a time when the primary treatment for many diseases was a miracle. This is perhaps no where more evident than in medieval Europe, where a myriad number of saints could be invoked and relied upon to cure illness. The decline of the pagan religions of Greece and Rome was paralleled by the rise of Christianity in most of Western Europe. The god Asclepius, who was purported to cure those who slept at his temples, declined in popularity and gave rise to a pantheon of Christian saints with their own formidable healing powers. This is not to say that physicians did not exist in medieval times, but they were mostly reserved for the rich, leaving the vast majority of people reliant upon these holy persons. Let’s look at a few of these figures and examine their role in medieval and modern medicine.

Saint Anthony (251-356 AD) was an Egyptian Christian monk known for his asceticism and extreme piety. He is perhaps most remembered for his temptation in the desert, the subject of many paintings which depict this gruesome scene. In the middle ages, this saint was invoked when one was afflicted with either erysipelas [Gk. erythros (red) + pellas (skin)], a skin infection producing a bright red rash, or ergotism [Fr. argot (spur)], poisoning by the ingestion of a fungus that afflicts grains. Both conditions are known as “Saint Anthony’s Fire.” How did our friend Anthony come to be associated with these diseases? His remains were discovered and credited with the miraculous recovery of a French nobleman’s son from ergotism. In gratitude, he founded The Order of Saint Anthony in 1095 (an order which still exists today), and their monastery became famed for treating erysipelas and ergotism. It is interesting to note that ergot poisoning has been suggested as an explanation for “bewitchment” as it produces spasms, skin tingling, headaches,  and even psychosis.

temptation revThe Temptation of Saint Anthony, by Grünewald

Another Saint to have a disease named after him is Saint Vitus (died 303 AD). Vitus was a Sicilian Christian monk, known as the patron saint of dancers, actors, and comedians. This came about from the manic dancing that would take place in front of his statue during his feast day in the middle ages in order to venerate the saint. (This evokes images of the Maenads and their frenzied dancing for the god Bacchus.) With this in mind, which affliction(s) do you think Vitus was associated with? If you said epilepsy, you’d be correct. However, his name is attached to another disorder: Sydenham’s chorea [Gk. choreia (a dance)], otherwise known as St. Vitus’s Dance. This is a sign of acute rheumatic fever, a childhood infection caused by Group A streptococci. Thomas Sydenham (1624-1689), the “English Hippocrates,” first characterized the disorder. You can imagine what symptoms are produced by Sydenham’s chorea from its name alone: jerking and uncontrollable spasms of the face, hands, and feet, as if the patient were dancing manically. It is no wonder that the saint venerated by frenzied dancing should come to be associated with Sydenham’s chorea centuries before Sydenham made his observations. 

strep pyo and vitus

Left: S. pyogenes, the causative agent of acute rheumatic fever; right: the man himself, Saint Vitus

Let’s end with a look at the brother saints, Cosmas and Damian (died 287 AD). The brothers were born in Cilicia (Asia Minor) and their chief miracle is truly fascinating: they hold the distinction of successfully completing the first transplant surgery. The story goes that they amputated the gangrenous leg of a patient, which in those times was the best one could hope for. However, being imbued with divine power, the brothers were said to have taken the leg from a dead Moor (in some versions of the story, an Ethiopian) and miraculously transplanted it to the amputee. This predates the first modern organ transplants by centuries, and it is quite a tall tale. The fact remains that human beings were considering organ transplants long before they were feasible. What did the brothers get in return for their miraculous healing powers? Unfortunately, they lived during a time of great persecution against Christians by the Roman emperor Diocletian, and were thus incarcerated, pelted with stones, burned at the stake, shot full of arrows, sawn in half, and decapitated. But their legacy lived on, and the brothers became the patron saints of medicine during the middle ages. Christiaan Barnard, eat your heart out!

cosmos and damian

Left: Saints Cosmas and Damian at work with angelic assistants; right: how the pair met its end

You may be asking yourself, how were these saints invoked? How exactly did the masses interact with these larger-than-life figures? Many were venerated in monasteries and churches and could be prayed to in times of need. Priests and monks could give advisement on how and when to pray, and in many cases, acted like middlemen between the holy and the sick. Perhaps the most common way to interact with a saint was through relics. The importance of these objects cannot be understated. Relics could be articles of clothing, pieces of wood purported to be from the cross, and even body parts such as bones and blood. These objects were housed in healing shrines and places of worship—being in their mere presence could ensure health and recovery.

These are but a few of the many, many saints associated with their own diseases, each fascinating in their own right. Hopefully I’ve shed a bit of light on the medical practices and beliefs of our medieval forebears!

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At some point in our lives, we inevitably fall into some form of ill health. This usually necessitates a visit to a local physician or the hospital, and it may sometimes necessitate a visit from emergency medical services. Thus, it is not unreasonable to assume that most of us have seen the symbol of medicine in one of these settings as a logo of sorts. Except there is a slight problem: there are two snakes on that staff. That staff is, in fact, not the symbol of medicine. It is instead the caduceus, the staff of Hermes. The caduceus was the symbol of commerce, for Hermes is the god of commerce (and thieves…). The U.S. military adopted the caduceus as its symbol of medicine in the 1850s, and it erroneously stuck. The real symbol of medicine is the rod of Ascelpius (Gk. Asklepios).

rod vs caduceusAsclepius was a son of Apollo, and Asclepius took on Apollo’s role as the god of healing in the Greco-Roman pantheon. The etymology behind his name is contested, so I unfortunately have no insights on that matter. There are multiple versions of the story regarding how Asclepius acquired his legendary abilities, and one of the more common ones is this: Asclepius was once asked to cure a man named Glaucus. While doing so, a snake slithered up his staff, and Asclepius promptly killed it. Another snake slithered by with an herb in its mouth and Asclepius placed the herb in the dead snake’s mouth. Sure enough, the dead snake returned to life! Regardless of his “origin story,” long story short, he learned how to raise the dead. Using a snake as a symbol of healing is somewhat paradoxical, since in those days, a snake bite was a death sentence. But Asclepius, utilizing his newfound knowledge, could cure even snake bites—and was thus eventually deified as the god of medicine.

asclepius vs zeus

Asclepius (left) and Zeus (right) share many facial features in classical sculptures

Asclepius was so skilled in medicine that he was asked by Artemis to revive Hippolytus, the son of Theseus and Hippolyta. He was able to do so successfully, and when Hades got word of this, he complained to Zeus that Asclepius was robbing him of his souls. Zeus struck Asclepius down with a thunderbolt to end this traveshamockery (travesty + sham + mockery). Apollo was so enraged that he killed the Cyclopes (singular: Cyclops), who fashioned Zeus’s thunderbolts. Outraged in turn, Zeus forced Apollo to be a servant to King Admetus of Thessay for one year. When Apollo returned to Olympus, Zeus revived the Cyclopes and resurrected Asclepius, turning him into a god.

Outside of the myth, why a snake coiled around a stick? One theory is that the symbol represents the painful process of treating dracunculiasis, better known as Guinea worm disease.

Dracunculiasis
Origin: Neo-Latin, draco (dragon) + -cule (diminutive) + -iasis (condition of)
Condition of small dragons/serpents

Perhaps a picture would illustrate why this makes sense:

guinea worms rev

As a side note, former president Jimmy Carter has been monumental in the global effort to eradicate the Guinea worm, for dracunculiasis is a truly wretched condition. He was recently interviewed and said “I would like the last Guinea worm to die before I do.” (Jimmy Carter was recently diagnosed with melanoma with metastases to the brain and liver.)

Back to our story: many temples were built throughout Greece dedicated to Asclepius. Those who were sick would come and spend a night at the Asclepion, and Asclepius would visit the patient in his or her dreams and relay to them the cure to their disease. One other interesting tidbit is that there were hordes of nonvenomous snakes, colloquially called Aesculapian snakes (Zamenis longissima), that would slither around the temples to promote healing!