{"id":44192,"date":"2019-03-08T15:57:22","date_gmt":"2019-03-08T14:57:22","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=44192"},"modified":"2019-03-15T15:01:48","modified_gmt":"2019-03-15T14:01:48","slug":"jeffrey-aronson-when-i-use-a-word-lupus-minimus-and-esthiomene","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/03\/08\/jeffrey-aronson-when-i-use-a-word-lupus-minimus-and-esthiomene\/","title":{"rendered":"Jeffrey Aronson: When I use a word . . . Lupus minimus and esthiomene"},"content":{"rendered":"

\"jeffrey_aronson\"<\/a>Latin adjectives mostly form regular comparatives and superlatives: for example, longus, longior, longissimus (long, longer, longest), a self-descriptive sequence; or sapiens, sapientior, sapientissimus (wise, wiser, wisest). But there are exceptions. The most striking is bonus, melior, optimus (good, better, best), which comes from three different roots. Others, less irregular, include magnus, maior, maximus (big, bigger, biggest), malus, peior, pessimus (bad, worse, worst), and parvus, minor, minimus (small, smaller, smallest).<\/span><\/p>\n

In Latin <\/span>minimus<\/span><\/a> meant the smallest or least important, the least amount, the lowest in rank, the latest born. And <\/span>digitus minimus<\/span><\/a> meant the smallest finger. The contracted form, \u201cminimus\u201d, an animal\u2019s little finger or toe, first appeared in English in the late 19<\/span>th<\/span> century.<\/span><\/p>\n

\"\"
James Matthews Duncan (1826-90)<\/figcaption><\/figure>\n

\u201cMinimus\u201d in English is also a shortened form of lupus minimus, \u201ca form of chronic ulcerative disease of the vulva that is of limited extent\u201d (<\/span>OED<\/span><\/i>). The dictionary gives only one example, from the 3<\/span>rd<\/span> edition of J M Duncan\u2019s <\/span>Clinical Lectures on Diseases of Women<\/span><\/i> (1886). However, The BMJ<\/em> contains an <\/span>earlier example<\/span><\/a>, in a report of a meeting of the Obstetrical Society of London on 25 May 1885 (pictures). When asked why he called it \u201clupus\u201d, when the histology was different from that of proper lupus, Dr Duncan said that he did so because others had done so and referred to Charles West\u2019s <\/span>Diseases of Women<\/span><\/i> (1857). But West had called it \u201clupus of the vulva\u201d not lupus minimus\u201d.<\/span><\/p>\n

\"\"
Two extracts from a report from the Obstetrical Society of London, published in The BMJ<\/em> on 30 May 1885. \u201cMatthews Dunban\u201d is J M Duncan. It is clear from the discussion that \u201clupus minimus\u201d was probably not either lupus vulgaris or lupus erythematosus, but some other condition.<\/figcaption><\/figure>\n

The BMJ<\/em> reported a meeting of the same society on 6 June 1888. Dr R A Gibbons described cases of chronic metritis, endocervicitis, lupus minimus, caruncle of the urethra, and cancer of the uterus, and their treatment by electrolysis. In 1912 he also <\/span>described<\/span><\/a> cases of lupus minimus, one or more ulcers usually situated around the orifice of the vagina beyond the hymen, sometimes on the hymen itself. \u201cThese little ulcerations heal up with or without treatment, and break out in other parts. They are usually associated with little hypertrophies, such as hypertrophies of bits of the hymen or of the orifice of the urethra. [They] are exquisitely sensitive, and [can cause] dyspareunia … vaginismus … [and] pruritus.\u201d He also described slightly larger ulcers at the posterior fourchette. \u201cThe size seems to depend on the amount of time the ulcer has been in existence, for the edges are apt to be slowly extended, but the growth in circumference is extremely slow.\u201d He hypothesized that \u201cmany cases of pruritus have these small ulcerations as their starting point, leading to exposure of the terminal filaments of the sensory nerves distributed to the vulva and vagina.\u201d He recommended searching for them carefully so that full treatment could be offered.<\/span><\/p>\n

In 1885 Duncan also linked \u201clupus minimus\u201d to another term, \u201cesthiomene\u201d, as if it was a synonym. Esthiomene, a gangrenous sore, came from the Greek \u1f10\u03c3\u03b8\u03b9\u03cc\u03bc\u03b5\u03bd\u03bf\u03c2, \u201ceaten\u201d, as in \u1f40\u03b4\u03cc\u03bd\u03c4\u03b5\u03c2 \u1f10\u03c3\u03b8\u03b9\u03cc\u03bc\u03b5\u03bd\u03bf\u03b9, decayed teeth. This awkward word (Duncan\u2019s description) is, says the <\/span>OED<\/span><\/i>, obsolete. The dictionary gives only two examples, both from works by Robert Copland in around 1541. <\/span><\/p>\n

However, the word is by no means obsolete. It has since appeared from time to time in medical publications, and still does. For example, in 1932, the President of the Section of Tropical Diseases and Parasitology of the Royal Society of Medicine gave an <\/span>address<\/span><\/a> titled \u201cThe history of the recognition of a new venereal disease, comprising climatic bubo, lymphogranuloma inguinale, esthiom\u00e8ne, chronic elephantiasis and ulceration of the vulva, the genito-ano-rectal syndrome, inflammatory stricture of the rectum\u201d, referring to \u201ca series of conditions often individually described under the terms elephantiasis vulvae, lupus vulva, syphil\u00f4me ano-rectal, inflammatory stricture of the rectum; or when they are associated, as the genito-ano-rectal syndrome, and with them elephantiasis of the male pudenda, [all of which] may be associated with the inguinal adenopathy of climatic bubo or lymphogranuloma inguinale.\u201d Most recently, in a 2011 <\/span>paper<\/span><\/a>, \u201cCutaneous tuberculosis and esthiomene\u201d, V Ramesh described it as \u201clymphatic obstruction occurring in the late stage of lymphogranuloma venereum, leading to vulval elephantiasis\u201d, which is not the same as lupus minimus.<\/span><\/p>\n

However, \u201clupus minimus\u201d has disappeared from the medical record. It seems to have had minimal exposure as a technical term.<\/span><\/p>\n

Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford’s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n

Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"

Latin adjectives mostly form regular comparatives and superlatives: for example, longus, longior, longissimus (long, longer, longest), a self-descriptive sequence; or sapiens, sapientior, sapientissimus (wise, wiser, wisest). But there are exceptions. […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":38359,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5762],"tags":[],"class_list":["post-44192","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-jeff-aronsons-words"],"yoast_head":"\nJeffrey Aronson: When I use a word . . . Lupus minimus and esthiomene - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/03\/08\/jeffrey-aronson-when-i-use-a-word-lupus-minimus-and-esthiomene\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Jeffrey Aronson: When I use a word . . . 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