Repetition of the first sound or letter of a succession of words - alliteration - is regularly used for effect not only in everyday parlance ('safe and sound', 'home and hearth', etc), in tongue twisters (the sixth sick sheikh's sixth sheep is sick), and in literature (the weary wayworn wanderer - Poe; I sing of brooks, of blossoms, birds and bowers - Robert Herrick; Whereat with blade, with bloody blameful blade/ He bravely broach'd his boiling bloody breast - Shakespeare), but in medicine as well. For instance, the classical sufferer of gallstones is a fat, fertile, flatulent female of fifty. General fullness of abdomen may be attributed to fat, fluid, flatus or faeces to which writers have added foetus, fibroid and full bladder. Osler's nodes seen in infective endocarditis are painful, pea sized, pink nodules, palpable on the pulp of fingers. The hands and feet of the patients of acrodynia or pink disease are painful, paraesthetic, peeling, perspiring, pinkish and puffy.
Hormones of the adrenal medulla prepare us for fight, flight and fright. In chronic simple glaucoma a sickle-shaped scotoma called Seidel's sign may be seen as a significant field defect. A cardiologist lives by three drugs; Digitalis, diuretics and Dindevan, to which he sometimes adds diet (salt restricted). A dehydrated child is asked to slowly sip sugar salt solution. Three important indicators of intra-cranial tension are pulse, pallor and pressure. The tongue is dehydrated, dry and dirty in meningitis. Dermatitis, diarrhoea and dementia are symptoms of pellagra, a disease caused by thriving on a diet of maize meal, molasses and meat (salt pork).
If the alcohol in 1 cc of an -alcoholic's urine is less than 1 mg he is dry and decent; if 1-2 mg, delighted and devilish; if 2-3 mg, delinquent and disgusting; if 3-4 mg, dizzy and delirious; if 4-5 mg, dazed and dejected and if more than 5 mg, dead drunk. He could be dead as a dodo if you catheterize him and find the level more than 7 mg.
The spleen dislikes, distrusts and devours spheroidal red cells. Sudden pain, paralysis, paraesthesia and pallor of the lower limb is indicative of leg vein thrombosis. The essentials of first aid are paying attention to breathing, bleeding and breaks. Gradenigo's syndrome is an intracranial complication of chronic suppurative otitis media characterized by discharge, deafness, diplopia and deep seated pain. Chronic lead poisoning is common in painters, pewters, plumbers, potters and printers. Dhatura poisoning results in delirium, dysphagia, diplopia and dryness (of mouth and skin). Pontine haemorrhage results in pinpoint pupils, pyrexia and paralysis. Tremors, thumb-sucking, temper tantrums and timidity are some of the common behavioral problems of children. A blue, battered and bruised baby is diagnosed as battered baby syndrome. Hazards of obesity are disfigurement, discomfort, disability, disease and death.
All diseases are associated with signs, symptoms, suffering, syndromes and sequelae. Primary health care has to be essentially acceptable, accessible and affordable to the community. Drug therapy should be specific, suppressive, supportive and symptomatic. Medieval doctors were concerned only with potency, pregnancy and poisons. According to homoeopathic physicians the root of all disease lies in imbalance of psora, psychosis and syphilis. AIDS is common in haemophiliacs, homosexuals, heroin addicts and Haitians. A psychotic patient often presents symptoms of day-dreaming, depression and delusions.
Leukoplakia is often associated with smoking, spicy food, sharp tooth, spirit, sepsis and syphilis. Some important criteria for rheumatic disease are polyarthralgia, pyrexia, prolonged P-R interval, previous history (of rheumatic fever) and positive acute phase reactions. The doctor can be successfully prosecuted for negligence in cases of duty, dereliction, damage and direct causation. Infamous conduct by a doctor comprises association (with unqualified persons), advertising, abortions (unlawful), adultery (arising out of professional relationships), addiction and alcoholism.
Although the clinical features and functional abnormalities in both emphysema and chronic bronchitis overlap, patients with predominant bronchitis are termed 'blue bloaters' while those with predominant emphysema are 'pink puffers'. Diarrhoea in jaundice is characterized by 'silvery stools'. A popular alliteration used in neutralization of bites and stings of. bees and wasps is 'bicarbonate for bee, vinegar for wasp'.
Gastric lavage is contraindicated in children, corrosives, convulsions and comatose conditions. Paint pellet purpura is a persistent peril for pistol pecking paramilitary personnel. Main surgical causes of bleeding per anum are polypus, prolapse, piles, papilloma and peptic ulcer. Pessaries are mainly used for prolapse, preventing pregnancy and persistent infections. Complete physical fitness means strength, stamina and suppleness. Largest and only named sesamoid bones in the body are patella and pisiform. Elastic cartilage is found only in ear, Eustachian canal and epiglottis.
Besides being useful in teaching and learning medicine, these few examples serve to remind us that medical writing sometimes (perhaps subconsciously) approaches literary writing. It is hardly surprising, therefore that some famous doctors were noted literary figures as well - Rabelais, Smollett, Holmes, Treves, Doyle, Maugham, Keats and Sir William Osler to name just a few.
1. Hayden GF (1999) Alliteration in medicine: a puzzling profusion of p's.BMJ. 1999 Dec 18-25;319(7225):1605-8 [Department of Pediatrics, Children's Medical Center of the University of Virginia, Charlottesville, VA 22908, USA. email@example.com] Available free online at
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