5. SCALING IT UP: WORDHOOD SQUARED?

(Part of a series based upon Stiles, The Anatomy of Medical Terminology (Radix Antiqua 2015; copyright 1993; ISBN 978-1-988941-240; to be revised by Stiles and Russell 2017)

            Before the invitation to controversy, the pragmatic conclusion to the third post was that we can generate real (but unattested) words in Medical Terminology by means of rules based upon well-established words:  "For example, since any word of the form X-ectopia means 'the displacement of x,' we might postulate a...rule:

                        If generic OSTE-ectopia is a real word

                                    (where OSTE- denotes 'a bone' or 'bones'),

                        then the set of all real words in Medical Terminology also includes

                        all words x-ectopia

                                    such that 'x' names any one (or several) of the (more than two hundred)

                                    specific bones found in the human body."

            From here on in, I am going to take it as given that you are at least willing to consider the wild idea that, "while the reality of the CONCEPT named by a specific word generated by one of our rules might be disputed by anatomists, or by logicians--or perhaps welcomed by surrealist painters--(what exactly would 'the displacement of the skull' look like, anyway?), no such dispute calls into question the reality of the WORD itself."

            Still reading?  Good, because these premises bring us, by a long way around, to consideration of the possibility of "meta-rules" that could generate much larger sets of words. To begin, the existence of a single rule like the one about generic oste-ectopia would seem to suggest that other rules could be formulated by an analogy that as it were takes us off in a direction which (by another, related analogy!) represents another dimension.

             To see this in action, consider that the combining form oste- meaning "a bone or bones" (as opposed to the substance "bone") begins at least 30 words listed as main entries in any large Medical Dictionary.  This means we should be able to postulate at least 30 additional rules, in each case replacing -ectopia in the previous rule by one of those 30 word-remnants; thus we should be able to write analogous rules introduced by, for example,

            OSTE-otomy                            the cutting of a bone; or

            OSTEO-neur-algia                    pain involving the nerves of a bone; or even

            OSTEO-lipo-chondr-oma         a tumor involving cartilage and fat, involving a bone.

            So far so good.  But perhaps we could better describe this much larger set of real words by one new "meta-rule," a much more abstract one formed again by analogy to those we have already derived:

                        If generic OSTE-Z  is a real word in Medical Terminology

                                    (where OSTE- denotes "a bone" or "bones" AND

                                    where "Z" stands for the word parts added to it to form a real word):

                        then the set of all real words in Medical Terminology also includes

                        all words x-Z such that "x" names any specific bone or bones.

This plan would save us writing out all the individual rules we would have otherwise been forced to generate separately.  Caution is required however; note that we have dramatically increased or "scaled up" the number of real but perhaps unattested words we are describing by our new rule, from something in the neighborhood of ("on the scale of") 200 words in the case of oste-ectopia to (very) approximately 200 times 30 = 6,000 words in the case of x-Z.  This is a difference in "order of magnitude"--a difference of scale.  The very number suggests caution, in that, by the act of changing scale, we make it difficult to spot any small or "local" constraints emanating from the smaller scale--at the scale of, say, oste-ectopia--while at the same time distortions or problems caused by such constraints might seem to be themselves "scaled up."

            But before I get us all any more confused, let's consider an actual example.  Can we substitute the name of just any bone at all for the generic osteo- in the case of

            OSTEO-arthri-tis          the inflammation of a joint, involving a bone or bones?

That is, would a simple rule made on the direct analogy of oste-ectopia generate a full complement of words on the scale of 200?   Or would the words in this particular subset be limited to those bones which can be said to be "involved" with other bones in the structures called "joints?"  Given our lack of expertise, we will have to leave such distinctions to the anatomists (and the logicians!).  But we can postulate the constraint, even if we can't specify the details of its real-world application; and (here is the really cool part) even though the number of words generated by the specific "level one" rule based on osteo-arthr-itis might be seriously affected by this constraint, the scale of the number of words in the subset generated by the "meta-rule" is not: if the rule predicts "around 200" words and observable constraints limit the number to (a guess, to make the point) 100 words, that is huge difference between hypothesis and "reality."  But if the rule predicts a number "on the scale of 6,000" words and observable constraints limit that number to, say, 5,900 words, the difference is not as important--the rule is not seriously challenged.  To put the finishing touches to the discussion at this point we would need to add a statistician to our pool of expert consultants; but the general point remains I think valid.

            A more serious objection might be made on the basis of an extant dictionary word (one of the 30 or so of the form oste-Z) like

            oste-otom-e                an instrument for cutting a bone.

The related word or "parallel" word, denoting the surgical operation which the instrument is used for, namely,

            oste-otom-y                 the cutting of a bone,

is an excellent individual example of our "meta-rule;" we can easily imagine a perfectly real word denoting "the cutting of x" where x names any specific bone or bones--if you can cut one bone, you can cut 'em all!  But can we say the same for the instrument used for that operation?  To perform an operation called

            femor-otom-y              the cutting of the femur

would we really need to go and find ourselves a clean

            femor-otom-e             an instrument for cutting the femur,

or would any old osteotome do the trick?

            Pretty clearly, we've just lost us another 200 or so words!  But one last time, at the scale at which our "meta-rule" is operating, does the loss of a few hundred words make much difference?

            And finally, can't you imagine an imaginary scenario in which the tense surgeon, after hours of careful cutting, and sawing, and filing away at a stubborn femor mutters to her aides, "pass me the damn femorotome!"--and, if someone else without a second thought reaches for the osteotome?  The only real test of the reality of a linguistic utterance, after all, is whether one of us might utter it and another of us understand it. 

                                                                        - o -

4. FIGHTING WORDS

(Part of a series based upon Stiles and Russell, The Anatomy of Medical Terminology (Radix Antiqua 2017 ISBN 9781988941240)

            The previous post closed with a statement that some might construe as "fighting words"--as a purposefully provocative challenge to your preconceptions.  To paraphrase:

while the reality of any of the concepts named by the words I am alleging to exist as members of the set of all real words in Medical Terminology may well be (should be, even) disputed; and while the validity (the "strength" or appropriateness) of any individual word may also be legitimately called into question, neither of these concerns has any effect upon the reality of the word itself.  I find it useful to tabulate these statements for quick reference:

            REALITY of the WORD                     vs         REALITY of the CONCEPT

                                                                       vs         VALIDITY of the WORD

            A few explanatory examples and comments are needed here.    To begin with an extreme case, we can probably all agree that "headache involving my fingernail" is not likely to be a real concept; I am claiming that we nevertheless must accept as a real word any of several plausible names for this imaginary ailment, for example (the hyphens, as in all these blogs, are added for purposes of analysis only, and do not appear in the wild):

            dactyl-onycho-cephal-odynia              pain in the head, involving the nail of a digit--

remember those colorless green ideas, and their sleep style?

            But the point at issue here may in the end come down to a matter of belief.  Let me try a more pragmatic approach.  Would you be more comfortable with my "fighting words" if I added a qualification, so as to claim only that a word's reality is not a whit diminished by a non-specialist's opinion as to the lack of reality of the concept it names?  This is a pragmatic argument rather than a linguistic or philosophical one, designed so that we don't so to speak toss any babies along with the bathwater, rejecting in our ignorance both words and concepts which in fact are demonstrably real.

            For example, you might dispute the REALITY of the CONCEPT if I claim that a doctor sometimes needs to measure or otherwise examine "the pelvis and the head," or "the head, involving the pelvis"--the body parts in question being so far apart in the normal patient that it is difficult to see why anyone would want to refer to them as it were in the same breath.  But a medical specialist in gynecology would never dispute it, nor would many mothers.  In fact, a whole suite of words has long been "in The Dictionary:"

            cephalo-pelv-ic                       p.t. the pelvis and head

            cephalo-pelvi-metry               see pelvicephalometry

                                                (that is, cephalopelvimetry is "less preferred"--but equally "real")

            pelvi-cephalo-metry               the measurement of the head, involving the pelvis

            pelvi-cephalo-graphy              the recording of the head, involving the pelvis

            You might at this point either flatly disbelieve me (in which case, I invite you to consult your medical dictionary); or you might wonder if you are sure you know what a "pelvis" is, out there in the real world of medicine, perhaps, far from the broken hips and other disasters here where we non-medics live.  But this otherwise promising line of thought dies the death of all dead ends or blind alleys when we learn that the only other piece of the human body commonly named a "pelvis" lives in the kidney (the so-called, from its shape and function, "renal pelvis," as in

            pelvio-plasty                the surgical repairing of the renal pelvis)--

the possibility that

            cephalo-pelv-ic           means             pertaining to the the renal pelvis and the head

doesn't get the disparately located body parts much closer together!

            In fact you might get a lot further if you knew or discovered the fact that the word "head" in Medical Terminology names not only the body part which the neck usually keeps up off the shoulders (fans of early Newman and Taylor will remember the "no-neck monsters"), but also any "head-like" structure (the "head of the femur" for example; which gets us pretty close to the pelvis after all), as well as the extremity of any vaguely elongated body part that can be contrasted with a more or less opposite number called the part's "bottom" (or even "tail," as in the directional term

            cephalo-caud-ad         from the head to the tail);

but these lines of inquiry are red herrings, both.

            Figured it out yet?  The clue is in the mention of mothers, and the medical speciality called gynecology: the pelvis in question, the familiar body part joining the abdomen to the legs, belongs to the pregnant mother, the head to the fetus--at issue of course is the often vital question of the "fit" between the two in late-stage pregnancy.

            A fascinating--and relevant--digression here springs from the fact that my dictionary more specifically defines

            pelvi-cephal-ometry   as         the measurement "of the diameters of the head of the fetus
                                                           in relation to those of the mother's pelvis"

(emphases mine; this definition expands what our students would generate, namely,

                                                            the measurement of the head, INVOLVING the pelvis).

I predict that the real (though as yet unattested) word

            cephalo-pelvi-metry               the measurement of the pelvis INVOLVING the head,

where the reversed word order reverses the focus, will hit the dictionary soon, in the form,

                                                            the measurement of "the diameters of the mother's pelvis

                                                            in relation to those of the fetus' head"--

just as soon as someone decides in a learned article that it is for some specific reason useful or otherwise important to focus upon maternal pelvic size as the more problematic of the two sets of measurements--this kind of "focus" being fairly common in medical words.  But this claim, that the set of all real words in Medical Terminology includes a special place for all words which name concepts not now known or needed but which will at some future time become important, deserves as one might say "a special place" of its own--perhaps a post!

            To put another way what we have considered so far, even if "the tyranny of The Dictionary" still holds you in thrall (so that you feel squeamish about accepting as a real word one which is not in it), the existence of words which are in it, but which name concepts which you might suspect don't exist, should help open your mind.

            One more example might help further this process.  You might reject the diagnosis of "an abnormal condition involving the heart and the head" as a concept which if it has any reality at all would find that reality in pop psychology rather than in medicine proper; but the (well-dictionaried) word

            a-cephalo-card-ia       an abnormal condition involving the absence

                                                of the heart and head

names a fetal abnormality involving both those body parts, so-called because of the conspicuousness of their absence.  That this condition represents perhaps the only specific example of a subset of medical words described by the generic concept "an abnormal condition involving the heart and the head" does not make the latter an "unreal" concept.  But, please notice, questioning the reality of the concept gives no grounds for arguments about the reality or unreality of the word naming it, cephalo-card-ia; such arguments would return us to the belief-country of the fingernail headache with which we began, and so I am not inviting them here and now.  For now, I only want you to consider that as non-specialists our opinions about the reality or unreality of medical concepts are not useful for making judgements about the reality of the medical words which "embody" those concepts.

            But what about our judgements concerning the VALIDITY--as opposed to the reality--of medical words?  Surely here, as non specialists in medicine but serious students of medical terminology we deserve an opinion?  Yes, we do; but one more time, the validity, or invalidity, of a particular word as the "right expression" of a concept in no way calls into question the reality of that word.

            To take an extreme example (on the order of the "headache of the fingernail" with which we began), if I told you that the centuries-old standard medical term defined as "the conversion of mental experiences or states into bodily symptoms" names a body part or organ possessed only by females, would you agree with me that the "validity" of that word would be at least questionable?

            The venerable word I am referring to, of course, is

            hyster-ia                      an abnormal condition involving the uterus

(as our students would define it).  The word was originally used to describe what is now called premenstrual syndrome, but quickly became generalized.  Perhaps the most remarkable example of its use is King Lear's address to his own uterus as the source of his madness:

            O how this mother swells up toward my heart!

            Hysterico passio, down, thou creeping sorrow,

            Thy element's below               (King Lear, 2.4.55-7)

Note here that to the Renaissance mind, "mother" translates Latin mater, used to denote the "mother-organ" (as in for example

            endo-metr-itis             the inflammation of something inside the uterus),

while hysterico passio, "suffering pertaining to the uterus" is a synonym for our word hyster-ia.

            In conclusion, by way of reviewing the categories under discussion here, in this particular case

            1) the WORD is unquestionably REAL;

            2) the CONCEPT is accepted as REAL;

            3) but the WORD is clearly not VALID; the most recent edition of my medical dictionary seems to support this conclusion by referring us to a newly preferred for term for classical hysteria, namely (believe it or not) somatization disorder.

                                                                        - o -

3. WORDHOOD: HOW A WORD CAN TAKE ON A LIFE OF ITS OWN

(Part of a series based upon Stiles, The Anatomy of Medical Terminology (Radix Antiqua 2017; ISBN 978-1-988941-240)

            You don't achieve wordhood by being put "in The Dictionary;" you achieve wordhood when one speaker of a language utters you and another speaker of that language understands what she means.  Much later, someone might for some reason or other "write you down" in some more or less official place and then eventually you might get noticed by a dictionary-maker who adds you into her newest edition--where eventually some pedant or scrabble-player (checking "to see if it is a real word") might find you.

            No, you achieve wordhood by useage....  The dictionary can only record evidence of past useage; it can't honestly describe the present; and it certainly can't "prescribe" (or proscribe!)  or predict the future.  The set of real words in any language is not bounded by considerations of time, if it comes to that; except in the case of so-called "dead" languages--and Medical Terminology, whatever else it may be is certainly not dead!

            These notions lead us to consider postulating a new way to think of whether or not a given word in Medical Terminology can be said to "exist" or "not exist," based entirely on whether it is "real enough" both to be created at need, and to be immediately understood, by anyone fully conversant with Medical Terminology as a whole.

            A useful observation at this point is that in many ways the complex words of Medical Terminology behave more like phrases (or even clauses and sentences) than they do like "normal" English (or even Latglish) words.  All linguists (at least since Chomsky's decades-old "colorless green ideas sleep furiously" woke everyone up) accept that the set of all the sentences of a given language includes not only every past sentence ever made and understood in that language, but also every present or future sentence that any native speaker makes, understands, or could make or understand.  This set is of course far too large for anyone to even dream of trying to list all its members.  Note, however, that the word "sentence" does impose constraints upon our set's membership.

            Can we postulate any constraints that would make it possible to begin to describe "the set of all real words in Medical Terminology?"

            A fairly obvious example might be that, where a word containing a combining form denoting a generic body part can be proven to have existed (we can find it "in The Dictionary!"), then any word formed by replacing that GENERIC combining form by one denoting a SPECIFIC item included in the generic category would seem to qualify.  For example,

if ARTHR-itis ("the inflammation of a joint") is a word, then so should be the following, in which specific joints are named by the "replacement" combining forms:

            ANCON-itis                  the inflammation of (the specific joint known as) the ELBOW

            COX-itis                       the inflammation of (the specific joint known as) the HIP

            GON-itis                      the inflammation of (the specific joint known as) the KNEE

            CARP-itis                     the inflammation of (the specific joint known as) the WRIST

            It needs to be repeated, that whether these words are "in the dictionary" or not is irrelevant.  Whether or not they have ever been or ever will be used is also irrelevant.  (If "here comes the bus" is a sentence in English, then so to is "here comes the furiously sleeping colorless green idea.")

            In fact, we could sum up what we are saying so far in a rule:

                        If generic ARTHR-itis is a a member of the set of all real words
                                    in Medical Terminology

                                    (where ARTHR- denotes "a joint" or "joints" in general),

                        then that set of real words also includes

                        all words x-itis

                                    such that "x" names a specific joint or joints.

           Other rules might follow by analogy.  For example, since any word of the form X-ectopia means "the displacement of x," we might postulate another rule:

                        If generic OSTE-ectopia is a real word

                                    (where OSTE- denotes "a bone" or "bones"),

                        then the set of all real words in Medical Terminology also includes

                        all words x-ectopia

                                    such that "x" names any one (or several) of the (more than two hundred)

                                    specific bones found in the human body.

            Note finally that, while the reality of the CONCEPT named by a specific word generated by one of our rules might be disputed by anatomists, or by logicians--or perhaps welcomed by surrealist painters--(what exactly would "the displacement of the skull" look like, anyway?), no such dispute calls into question the reality of the WORD itself.  The "validity" of the word--its "strength" or usefulness as the name of something in the real world--is another matter, which does not concern those of us engaged in learning the rules of Medical Terminology!

                                                            - o -

2. THE OSSIFICATION OF SOMETHING INSIDE A BONE?

(Part of a series based upon Stiles, The Anatomy of Medical Terminology (Radix Antiqua 2017; ISBN 978-1-988941-240)

            Recently we learned that one of our favorite test-words, endo-osteotic, is actually not found out there in the real world--it is not found "in the wild."  This observation is potentially alarming--it could be used to cast doubt upon our whole project.  After all, if we can't guarantee that the words we use in our exercises and for testing are REAL, then what guarantee do our students have that we are not teaching them something about as useful as Advanced Klingon?

            The good news of course is that (Klingon or no Klingon) we are not trying to teach our students whole words and their definitions at all.  What we are trying to do is something just a little different: to teach you how to translate ANY word you find out there ("real" or "unreal"), based on your knowledge of their very real combining forms and the (equally real) rules that govern their combinations.  Thus, in all our course materials (the main textbook, a Workbook, Online Exercises, Videos, and--yes--examinations), you will typically not find any given whole word used more than once.  To repeat, we are in the business of teaching WORD-PARTS, and PREDICTABLE COMBINATIONS, not whole words.

            For example, our students should have not have seen the whole word endo-oste-ot-ic until the exam; what they will have seen before the exam--and carefully learned, by all kinds of instruction and practice--are the WORD PARTS -endo-, -oste-, -ot- and -ic-, as well as the rules that govern how you translate words that contain parts LIKE them in the ORDER they are found in here; our students would therefore generate the following correct translation: "pertaining to an abnormal condition involving something inside a bone."

            So, have I distracted you from the tiny detail here, that our word is not "real?"  Let's look at all the related words found in a large Medical Dictionary.  We present them below, along with our translations and comments.

WORDS FOUND           TRANSLATIONS by Our Method,

"in the Dictionary"                WITH COMMENTS

en-ost-osis                  an abnormal condition involving something inside a bone

                                                ("something inside a bone" is called "the endosteum")

                                    No other words beginning en-ost- are found; but the following

                                    sequence is:

end-oste-al                  p.t. something inside a bone (called the "endosteum")

end-oste-itis                the inflammation of something inside a bone ("endosteum")

end-oste-oma              a tumor involving something inside a bone ("endosteum")

end-oste-um                something inside a bone

end-ost-itis                  (see) endosteitis

end-ost-oma                (see) endosteoma

                                    Therefore, since the Dictionary's preferred form for -ost- is in two cases

                                    -ostE-, the word

en-ost-osis                  is probably a sloppy coinage, probably recent, an ERROR in fact for a

                                    more plausible word like

                                    *en-ostE-osis

                                    (the asterisk "*" indicates that a word is not found in the Dictionary);

                                    but since we have only one word with en- against six with end-, then an

                                    even more plausible target word for the concept would have been

                                    *enD-ostE-osis

                                    Now, since the adjective for any word x-os-is is x-otic (just as the

                                    adjective for any x-itis is x-itic, and for any x-oma it is x-omatous),

                                    then the adjective for our "more plausible" word is

                                    *enD-ostE-ot-ic

                                    Finally, strict adherence to the rule about prefixes ending in vowels

                                    (that such a prefix generally keeps that vowel; cf hypo-orchidia and

                                    thousands of other examples; note antE- "before" vs antI- "against"),

                                    generates

                                    *enDO-ostE-otic         (which is, of course, our "unreal" test word!).

            One final note.  Any student using our text, The Anatomy of Medical Terminology, would have also learned early (in Chapter 3) that ostE- (along with both ossE- and oss-, but NOT ost- reliably means "bone," while any word of the form x-ost-osis (with no "E") equally reliably means "THE OSSIFICATION OF x."  Thus our students, unprepared for a badly-constructed word, would try to translate en-ost-osis as "the ossification of something inside something" (and would mutter against their teachers).  But no one can be "prepared for" badly-constructed words, of course; which is why responsible coiners of medical words have historically taken this sort of thing into account when making them.

            Out of all this emerges a conclusion, a hypothesis, and a proposal:

1) we conclude that enostosis is a badly-formed word, because

            a) it doesn't follow the well-established pattern set by endosteum and the rest, and

            b) it is confuseable with the completely different, but also well-established pattern

            symbolized by x-ostosis;

2) we hypothesize that it is a relatively recent word, coined well after the "Golden Age of Medical Terminology;"

3) we herewith humbly propose (to the Esteemed--but, fortunately, imaginary--Members of the Committee for the Supervision of Medical Terminology) that the word enostosis be purged, and that endo-osteosis (or, to be consistent, and therefore better!) endosteosis be enshrined as its replacement.

            Klingon, anyone?

                                                                        - o -