1636 BRITISH MEDICAL JOURNAL 22-29 DECEMBER 1979

Occasional Review

Gastrology: the use of culinary terms in medicine

S I TERRY, B HANCHARD

In the era of the SI unit everything in medicine is supposed to be permeation by infiltrating carcinoma of the breast. The neuro-
accurately measured and standardised. Nevertheless, medicine anatomist is familiar with olives, both superior and inferior. The
remains essentially a descriptive science, particularly where the radiologist will find melon-seed bodies on x-ray film of a
communication of appearance is concerned: whether abnormal tuberculous arthritis. Condylomata accuminata are sometimes
physical signs, techniques of surgery, radiological shadows, or referred to as fig warts. The popular name of tl.e larynx is a
pathological abnormalities of organs or cells. The frequency with continual reminder of the part the apple played in Adam's
which allusions are made in medical writing to food and drink downfall. A colonic tumour may produce an apple-core picture
is impressive. We have culled 99 items of food and distilled 22 on barium enema.
beverage-related items from various publications, and present Not all food is unprocessed. The lesions of lupus vulgaris are
an analysis of this harvest. the colour of apple jelly. Classically, stools passed by a child with
intussusception are described as redcurrant jelly. A processed
plum lends its name to a congenital disorder where
Fruit there is a deficiency of the abdominal musculature-prune belly
syndrome. A chronic, passively congested liver appears not like
The more delectable the fruit the more likely it is to be the outer surface, but like the cut inner surface of a nutmeg.
mentioned, although most of the references are to temperate Another tropical nut is the coconut, and the coconut sound may
fruits. The strawberry seems to lend itself particularly to be elicited from percussion of a cracked water coconut or the
descriptive analogy: easily remembered are the strawberry nose skull of a person with Paget's disease.
(rhinophyma) and naevus (cavernous haemangioma), as well as
the strawberry gall bladder (cholesterolosis). In addition, a
strawberry tongue is seen, with a coating, in scarlet fever; when Vegetables
this coating disappears-uncovering congested, oedematous
papillae resulting in a darker red colour-a raspberry tongue is Vegetable names are used much less frequently than fruits;
produced. The cutaneous lesions of secondary (framboesiform) the strawberry clearly has the advantage in the medical mind
yaws are evidently thought to resemble the raspberry, as does over the potato, although chip-bone grafts are well recognised.
enteroteratoma or raspberry tumour. A single angioma of the Dark green, porridgy stools are known as spinach stools. The
retinal vessels may also produce a raspberry appearance. cauliflower lends its name to many neoplasms, as well as the
All kinds of berries are mentioned and they seem to lend traumatised ear. The histopathology of systemic lupus erythe-
themselves to vivid analogy. There is the blackcurrant rash seen matosus reveals onion-skin lamination of splenic arterioles and
with xeroderma pigmentosum. Abnormal teeth due to congenital
syphilis are known as mulberry molars. Indeed, the mulberry is
surprisingly popular-as morula (Latin), the early stage of the
dividing fertilised ovum, as the mulberry bladder calculus
composed of calcium oxalate, the mulberry cell (a vacuolated
plasma cell), or with the mulberry rash of typhus. A non-specific
berry is the description applied to the aneurysmal dilatation of
major intracerebral arteries. Staphylococci and Streptococci also
resemble berries, their names coming from kokkus, Greek for
berry.
References to grapes are more common than to wine: there
are racemose glands, grape endings of axons, and Carswell's
grapes-where there are masses of tubercles in primary tubercu-
losis clustered around the finer bronchioles. The derivation of
botryoid rhabdomyosarcoma of children is from the Greek for
bunches of grapes.
In the eye, occlusion of the central retinal artery produces a
cherry-red spot; a cherry-red spot may also be seen in Tay-
Sachs disease. Peau d'orange is seen in the skin with lymphatic
Gastrology (1810): The science of catering for the stomach (Shorter Oxford
English Dictionary).

University of the West Indies, Mona, Kingston 7, Jamaica

S I TERRY, MB, MRcP, lecturer in medicine (gastroenterology)
B HANCHARD, MB, FRcp(c), lecturer in pathology
BRITISH MEDICAL JOURNAL 22-29 DECEMBER 1979 1637
choroiditis of Doyne is a genetic degenerative disease of the
choroid. Maple syrup urine disease is an inborn error of
tryptophan metabolism. Chocolate cysts are found in the ovary
implicated in endometriosis. Chocolate stools typically occur in
amoebic dysentery. A sugar-icing spleen is of anatomical
pathological interest only, indicating a non-specific perisplenitis.
Bull's eye lesions in the small intestine, indicative of metastases,
probably refer to the animal, rather than the sweet.
The spleen of Hodgkin's disease is said to be "hardbake"
because it resembles toffee studded with almonds.

Meat and poultry

There are few meaty analogies unless a chicken chest or
pigeon breast appearance can' be included. In arthritis, difficulty
of movement may give rise to a waddling goose gait. The changes
of the erector pili muscles of the skin may give rise to the well-
known gooseflesh. Deformity of the foot may produce pigeon
toes. One poultry analogy is to chicken broth fluid of pan-
creatitis. Egg-shell calcification of the gall bladder wall may be
found radiologically. It is rare to find a direct analogy to un-
processed meat, even if an acromegalic has sausage fingers.
Pretibial-myxoedema is sometimes called pigskin. A bacony or
lardaceous spleen is found in amyloidosis where amyloid occurs
diffusely throughout the pulp. Wharton's jelly is found in the
umbilical cord and it is difficult to find an alternative word to
a similar description is given to hypertensive arteriolar changes replace jelly for this mucous, gelatinous, connective tissue.
in the kidney. Chicken fat clots are common necropsy findings in the major
The tongue in pellagra resembles a boiled beetroot. Inevitably blood vessels.
the food analogies are culture bound, the tomato ketchup spleen With meat must go seasoning. Hyperparathyroidism may give
secondary to non-specific inflammation is a post-prandial rise to the pepperpot skull x-ray appearance. Salt and pepper
inspiration of a North American. The stools of a typhoid patient duodenitis is now increasingly commonly found by the gastro-
are described as pea soup. Presumably the name comes from the intestinal endoscopist, whereas the ophthalmologist sees pepper
green garden pea of Europe rather than the red pea of Africa. and salt fundi. The acetabulum of the hip joint derives its name
from the Latin meaning vinegar cup.

Grain and cereals

Fish
An anaplastic variant of bronchogenic carcinoma is
characterised by small "oat cells." Sago spleen is characteristic The dermatologist recognises dry skin as icthyosis. The split
of amyloidosis where the amyloid is deposited in Malpighian hand or foot deformity is called lobster claw. Crab yaws may be
corpuscles and central arteries. Miliary tuberculosis derives its produced by Treponema pertenue lesions affecting the feet. More
name from the millet seed; a corn is a callous usually on the foot. exotically, varicose veins under the tongue are thought to look
In secondary yaws, if the cutaneous lesions appear as Indian like sturgeon's eggs-hence caviar lesions of the tongue. The
corn they may be called guinea-corn yaws. A rice body may be
seen in a hygroma or in a tendon sheath. All that the radiologist
may see, to suggest a diagnosis of a duodenal ulcer is a fleck of
"barium rice." For the stools of a cholera patient to be known as
rice water denotes not only a fertile imagination but also poor
cooking technique, as the most nutritious way of boiling rice is
to ensure that the water to rice ratio is such that the rice absorbs
just enough moisture to be cooked, but not soft. Throwing away
excess water from parboiled rice must be a British trait.
A hot cross bun head indicates widespread periostitis of the
skull in congenital syphilis. But a bread and butter pericarditis
is usually associated with acute rheumatic fever. The cottage loaf
appearance on a chest x-ray film is due to total anomalous
pulmonary venous drainage to the left innominate vein. Sugar
loaf shoulder is a deformity produced by dislocation of the
acromioclavicular joint. Finally, a tart cell is a histiocyte con-
taining a second, characteristic nucleus filling the concavity of
the major nucleus.

Sweets
Medical practitioners are fond of sweets. The most obvious
name arising from this delight is diabetes mellitus. Note the use
of the term honey and not simply sugar or sweet. The honeycomb
lung, as its name vividly suggests, is an example of end-stage
fibrotic and cystic disease of the lung. Similarly, honeycomb
1638 BRITISH MEDICAL JOURNAL 22-29 DECEMBER 1979

small intestine. Coffee may also be found as the cafe au lait spots
of neurofibromatosis and coffee ground vomitus of an upper
gastrointestinal bleed.
There are few other drinks. Prune-juice sputum appears
because of haemoptysis of altered blood. The vascular surgeon
may call phlegmasia alba dolens "milk leg," and the pathologist
will see fleckmilz in a spleen which has undergone multiple
small infarcts. Milk spots are also seen in omentum or epi-
cardium. Also, chyluria may be known as milk urine. Milk is not,
however, associated with the terminology of pinta nor Milkman's
syndrome and will not be considered further. Processed milk, as
well, in the form of cheese appears in tuberculosis with caseous
necrosis and in endometrial hyperplasia as Swiss cheese. Butter
cysts are foci of saponified, necrotic tissue in a lipoma. Butter
stools are synonymous with steatorrhoea.
Further analysis of the descriptive terms shows that patholo-
gists have provided 32 of the culinary terms, radiologists 16,
gastroenterologists 15, dermatologists 13, general physicians 12,
paediatricians 10, surgeons 8, ophthalmologists 8, and anatomists
7. There are three possible explanations for this difference in
frequency of use of food terminology in different branches of
medicine. Firstly, the spectrum of disease truly differs from
high-usage specialty to low-usage specialty. We doubt really
whether this is so, for, whereas the pathologist may see all the
diseases, the gastroenterologist cannot. A second explanation is
that pathologists and gastroenterologists may use their eyes
more in the course of their work. Most certainly this is true
compared with the auditory skills of the cardiologist, for example,
but does not provide the entire explanation. Thirdly, the use of
descriptive terms may be a reflection of the inexactitude of the
specialties concerned. That we were unable to find any bio-
chemical or chemical pathological analogies and yet lots of
radiological and anatomical-pathological ones supports our
ophthalmologist may see salmon patches in the fundus occuli in belief. Finally, perhaps the frequency with which food terms are
sickle haemoglobinopathies, but may also see a salmon patch of
interstitial keratitis. The gastroenterologist in the tropics
aspirates anchovy sauce from an amoebic liver abscess. Mitral
stenosis may be so severe that the deformed opening resembles

r^^^w>r
.. :..F

a fishmouth. The cut surface of sarcomas is described as "fish

flesh" in appearance.
Microbiologists and immunologists show what to do with all
this raw material by describing opsonisation or preparation of the
victuals for eating. In addition, radiologists demonstrate the
.v 2_=bd
* sS
...w, \
tables of the skull and napkin-ring deformities of colonic
neoplasms. Neurologists assess clasp-knife rigidity, orthopaedic
surgeons see a silver fork deformity in Colles's fracture and
general physicians observe spoon nails in iron deficiency
anaemia. The food may be eaten from a dish (a congenital
deformity of the face) or dishpan (seen as a depressed skull
fracture). Note also that the cardiologist dines only from
Dresden china, a frequent appearance in aortic stenosis.

Beverages
Indirect allusions to beverages may be found as the leather-
bottle stomach of an infiltrating tumour. A more benign finding
is a cup and spill deformity, also of the stomach. Alternatively,
there is a cup arthroplasty for ball and socket joints. The
presence of the cup is physiological in medicine, especially in the
optic disc. The radiologists' observation of the "corkscrew
oesophagus" of oesophageal spasm may be grouped with the
hock-bottle femora (of Gaucher's disease) and anatomical
pathologists' "goblet cells" (of the intestine). Nevertheless, there
is not an excess of alcoholic terms in medicine, even though the
dermatologist -thinks of port wine when he sees a capillary
haemangioma. The odour of the patient may remind the
paediatrician of an oasthouse in an abnormality of methionine
metabolism (oasthouse syndrome).
Caffeine in various guises figures in the medical mind as the
teapot stomach, but coffee seems more popular. The coffee
bean appears radiologically in strangulation obstruction of the
BRITISH MEDICAL JOURNAL 22-29 DECEMBER 1979 1639

used is a reflection of the use of euphemisms in medicine. Who countries? How many know what an oasthouse is, let alone
but the gastroenterologist could see a foodstuff in a pathological what is its smell? Who in Britain is familiar with the taste of
specimen of stool as in redcurrant jelly or chocolate ? This last maple syrup ?
explanation may be considered the most likely, since, in dealing As may be expected in English medical publications, the food
with unpleasantness, a natural defence mechanism is sublimation terms employed show a strong regional and temporal bias. But
-to turn the unpleasant into something much more appealing. does every,one outside England know what a strawberry is ? Yet,
In other words, we suggest that some doctors are obsessed with if strawberry gall bladder were called equally accurately a lychee
the basic human instinct of eating and drinking and would gall bladder many people who had never seen a fresh lychee
prefer to reflect on the pleasures of life while following less would be totally misled if they imagined that the tinned lychee
aesthetic pursuits. Gastroenterologists may really be gastrologists has the same appearance.
at heart. Since the purpose of descriptive terminology is to convey
It is doubtful whether there will ever be SI units of description accurately the meaning to other doctors throughout the world,
to replace food terms in medicine. We recommend, however, any new attempts to introduce culinary terminology in medicine
that all doctors periodically review their own use of these should be done with caution and the terminology should be kept
descriptive terms to ensure that others derive a similar under- simple rather than exotic.
standing as the user-for example, would doctors nowadays
recognise the inside of a nutmeg if they saw one, since nutmeg Illustrations are from Transactions of the Hor ticultural Society and are
is presented ground-up, packaged in little bottles in many reproduced by kind permission of the Royal Horticultural Society.

Postmortem medicine-an essential new new subspecialty

BERRILL YUSHOMERSKI YANKELOWITZ

With increasing technical knowledge, medical care has necess- plan to offer a series of electives for interested students in
arily become more and more subspecialised.'-10 Both the local funeral parlour physiology.
community and the government have tried to approach the At the postgraduate level we have a pilot postmortem ward
problem of delivering this care to as broad a segment of the (separate from the morgue), which is staffed by two fellows who
population as possible. Especially notable are the heavily are supported by a National Institutes of Health (NIH) career
funded programmes in geriatrics research, as all segments of development grant. The fellows are supervised by a senior
society have come to recognise the increasing proportion of attending physician, who is himself dead and therefore has an
old people in the population. The time has now come for us to in-depth understanding of the specialty. The ward promotes
focus on the medically most underserved population in the active house-staff and nursing education and is a model for
world today-the deceased. The urgency of this is quite apparent. future programmes of similar type in the community. House
There are more people who have already died than are alive staff who have just been on a ward with live patients have
today, and their number is increasing at an alarming rate. responded enthusiastically to the leisurely pace of the post-
Physicians have not focused on the problems of the dead. Aside mortem ward.
from anatomy, it is not a subject taught in most medical schools; Research projects are going on, and we are fortunate to have
as a result, early sensitivity of the medical student to the needs received extensive Federal and local grant support for such
of the dead is never formally developed. Postmortem medicine studies as postmortem wound healing, the impact of embalming
is not a mere extension or subspecialty of geriatric medicine, on social acceptability of the dead, management of the person
but a major specific and unique problem in health-care delivery. who died before penicillin was available, and so on.
We have therefore undertaken a pilot project to determine how A series of new subspecialties is already appearing-post-
the medical profession might better serve the dead patient, mortem endocrinology, postmortem podiatry, and postmortem
and this is the subject of the present paper. neurosurgery to name a few. Some of our staff have developed a
The University of East Dakota Medical Center's pilot project special interest in the long-dead patient, and we are considering
on postmortem medicine is a broad-based multidisciplinary a subsubspecialty of neanderthalogy.
undergraduate and postgraduate study programme designed to In co-operation with the NIH and Rand Corporation, we
investigate all aspects of diagnosis and care for the dead patient. have developed an extensive computerised programme of health-
Early in their training our medical students are given a one- care services, delivery evaluation, assessment of the dead
sernester course in psychosocial problems of the deceased patient with peer review panels, and HMO (Heaven's Medical
hunan. In addition to didactic sessions, students are taken on Offices). Our social-professional interface is progressing nicely.
field trips to cemeteries and funeral parlours, because we feel We already have a board certifying examination, and member-
that classroom sessions alone depersonalise the dead patient in ships are now open for our National College of Postmortem
the student's mind. The members of our psychiatric faculty Medicine. The women's auxiliary of the American Dead Society
have responded enthusiastically and like this subject because has actively supported our many community efforts.
they get to do most of the talking during patient interviews. We have made substantial inroads in a neglected area and
Psychoanalysts are especially happy because of the long, it is our hope that other universities will benefit from the billions
meaningful silences they get when treating a dead patient. that our government now wants to spend in this exciting new
In the second year of medical school we provide courses in subspecialty.
pharmacology and physiology in the dead patient. We have
found that the pharmacokinetics of drugs in the formalinised
patients are quite different from those in the living. So far we References
provide only one clinical clerkship in cemetery medicine, but 1 Parlov, S M, Death as a Subspecialty, Sem Death, 1979, 1, 6.