When I use a word . . . . The spectrum of medical slang

What is medical slang?

The answer to the question “What is medical slang” may appear to be simple. Medical slang, one might suppose, is slang used by members of the healthcare professions. But that formulation breaks one of the canonical rules of definition, namely that one should not include in a definition any of the terms in the definiendum, the term to be defined, in this case “slang.” This is known as circularity and is akin to defining a medication error as an error in medication.

So the challenge is to define “slang” itself, without, at first at least, any modifier, such as “medical.”

The Oxford English Dictionary (OED) lists three relevant definitions of slang.1 The first is “The special vocabulary used by any set of persons of a low or disreputable character; language of a low and vulgar type.” The cited examples that illustrate usage of the term in this sense date from the middle of the 18th century, and each illustrates more or less the lowlife aspect referred to.

The second definition shows the meaning changing: “The special vocabulary or phraseology of a particular calling or profession; the cant or jargon of a certain class or period.” The examples, dating from 1801, cover “the sentimental slang of philanthropy,” “lawyer's slang,” and “scientific slang.” And there is also a telling quotation from Middlemarch (1872): “Correct English is the slang of prigs who write history and essays. And the strongest slang of all is the slang of poets.” But the two parts of this definition feel disconnected. On the one hand, we learn that slang consists of a special vocabulary, one that, for example, doctors and scientists, lawyers and accountants, builders and plumbers, poets and playwrights, might use. And on the other hand we are told that it is cant or jargon. Can it be both of those things?

The dictionary defines “cant”2 as “The peculiar language or jargon of a class” and specifies two subtypes: “a. The secret language or jargon used by gipsies, thieves, professional beggars, etc.; transferred any jargon used for the purpose of secrecy” and “b. The special phraseology of a particular class of persons, or belonging to a particular subject; professional or technical jargon.” Part (b) seems to be consistent with the second part of the second definition of “slang” above, but then the dictionary adds “Always depreciative or contemptuous,” which gibes with the first part of the second definition.

“Jargon”3 is defined, picking the least pejorative alternative from the dictionary, as “any mode of speech abounding in unfamiliar terms, or peculiar to a particular set of persons, as the language of scholars or philosophers, the terminology of a science or art, or the cant of a class, sect, trade, or profession.” More confusion.

The third definition of “slang” is: “Language of a highly colloquial type, considered as below the level of standard educated speech, and consisting either of new words or of current words employed in some special sense.”

Other terms overlap with slang, cant, and jargon; here are some of them, with their dictionary definitions:

● argot: “The jargon, slang, or peculiar phraseology of a class, originally that of thieves and rogues”

● colloquialism: “A form of speech or phrase proper to, or characteristic of, ordinary conversation; a colloquial expression”

● patois: “jargon or informal speech distinctive to a particular age group, occupation, etc”

● patter: “any language not generally understood, esp. the jargon of a social group or subculture”

A spectrum of meanings

Of course, words are constantly changing their meanings, some faster than others, and it is the lexicographer’s job to document how they are used by different people and at different times. And so what we see in these definitions is how changes in the usages of these words from time to time, and differences in the ways in which they have been used, have caused them to be confused with one another.

My own view of this is that there is a spectrum of meanings, from high to low:

technical terms—jargon—slang—colloquialisms—cant.

Technical terms

Technical terms are at the highest level of meaning in any discipline. The OED defines “technical” in this sense as “Of or relating to a particular art or science; originally and chiefly referring to the specialized use or meaning of language in a particular field.”4

Medical examples include: the names of anatomical structures or systems, such as lymphatic system, cardiovascular system, central nervous system; the names of diseases or disorders, such as diabetes mellitus, diabetes insipidus, Parkinson’s disease, Down’s syndrome; procedures, such as endoscopy, laparoscopic surgery, caesarean section; and the names of medicaments, such as bevacizumab, dextropropoxyphene, para-aminosalicylic acid.

Jargon

Jargon terms are one step down from technical terms. In medicine they are often abbreviations of technical terms. “Parkinson’s,” “Dupuytren’s,” and “Tay–Sachs,” for instance, are jargon terms for the corresponding diseases.

“A Caesar” is jargon for a caesarean section. The OED cites the earliest example from Richard Gordon’s novel Doctor in the House (1952). The narrator, also called “Richard Gordon,” but in later books and in the film version “Simon Sparrow,” meets his predecessor in midwifery, Lamont:

“‘How many babies have you had?’ I asked.

‘Forty-nine. That includes a couple of Caesars. I’d have made a half-century if I hadn’t missed a B.B.A.’”

And that’s another bit of jargon, as Lamont explains: “Born before arrival. Terrible disgrace for the midder clerk, of course.” And “midder” is more jargon still.

Gordon’s Doctor books are a rich source of jargon. For example, “keyhole surgery,” which is now jargon for laparoscopic surgery, started its jargonal life when Gordon put it humorously into the mouth of Sir Lancelot Spratt:

“’Where are we going to make the incision?’ he asked.

I drew a modest line over the lesion.

‘Keyhole surgery!’ said Sir Lancelot with contempt. ‘Damnable! Give me the pencil!’ He snatched it away. ‘This gentlemen, will be our incision.’

He drew a broad, decisive, red sweep from the patient’s ribs to below his umbilicus.”

Slang

Slang is sometimes hard to distinguish from jargon, just as colloquialisms are sometimes hard to distinguish from slang. Indeed, they might all be included under the general heading of “slang,” which lies somewhere between the other two.

For example, “arrest” is slang for cardiac arrest, particularly when it is used as a verb, as in “he arrested.” Flatline is slang for the image seen on a cardiac monitor or an encephalographic tracing when there is no electrical activity. Salman Rushdie, ever alive to medical matters, used it and a derivative in his 1999 novel The Ground beneath her Feet:

“For one hundred and fifty seconds he genuinely checked out, kicked the bucket, bought the farm. Ormus the flatliner. He went down that tunnel towards the light. Then he turned right round and came on back. … Blip blippety blip not-fade-away on the monitor screen, the flatline starts jumping, oh doctor, doctor, he's alive.”

The verb to go flatline, or simply to flatline, is also used, both literally and metaphorically.

On the other hand, “check out,” “kick the bucket,” and “buy the farm” are more general types of slang, almost colloquialisms, demonstrating the difficulty of dogmatic classification.

There is also a form of medical slang in which technical terms are used in non-technical ways, in order to communicate with other professionals, particularly in the presence of the patient. For example, “a mitotic lesion” for “cancer” and “supratentorial” for “all in the mind.” Although, according to the dictionary definition, these might well be regarded as cant, being used as they are for secret purposes.

Colloquialisms

Whereas slang tends to be used by members of the profession who have turned their technical terms into jargon and their jargon into slang, colloquialisms are expressions that tend to be used more generally. For example, “side effect [of a drug]” is not slang, but a colloquialism for “adverse effect” or “adverse reaction.”5 Diabetes is a colloquialism for diabetes mellitus; if you want to talk about diabetes insipidus you have to use its complete name. And “plasma level” is a colloquialism for “plasma concentration.”

Cant

Dictionary definitions of “cant” invariably imply that it is the lowest of the low. One would not therefore expect to find examples nestling in medical terminology. However, some examples come to mind.

When John Langdon Haydon Down first described what we now call Down’s syndrome, or Down syndrome, he wrote that “The great Mongolian family has many representatives, and it is to this division, I wish, in this paper, to call special attention.”6 This led to the widespread introduction of the term “mongolism.” However, in 1961, a group of 19 physicians wrote to The Lancet from Denmark, England, France, Japan, Sweden, Switzerland, and various parts of the USA, pointing out that “the terms ‘mongolian idiocy’, ‘mongolism’, ‘mongoloid’, &c., as applied to a specific type of mental deficiency, have misleading connotations.”7 They proposed terms such as “Langdon–Down anomaly,” “Down’s syndrome or anomaly,” “congenital acromicria,” or “trisomy 21 anomaly.” Later that year, an editorial comment in The Lancet reported that “Our contributors prefer Down's syndrome to mongolism because they believe that the term ‘mongolism’ has misleading racial connotations and is hurtful to many parents.”8 The OED calls the term “misleading and offensive” (the dictionary’s italics). It can be regarded as medical cant and is no longer acceptable as a descriptive term. Down, incidentally, also used the term “congenital idiots,” now equally unacceptable.6

In 1965, Harry Angelman, a British paediatrician, described a syndrome in three unrelated children “with similar physical abnormalities of congenital origin, reminiscent of puppet children, and profound mental retardation.”9 The term “Angelman syndrome” was subsequently applied to this condition, but so also was the term “happy puppet syndrome,”10 cant that is no longer acceptable, being, as the OED puts it, depreciative.

A final thought

There is no simple way to categorise these different expressions—technical terms, jargon, slang, colloquialisms, cant, and the other near synonyms. One person’s jargon is another person’s slang, one person’s slang is another person’s cant, and we all use colloquialisms.