{"id":50130,"date":"2021-04-26T16:49:39","date_gmt":"2021-04-26T15:49:39","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50130"},"modified":"2021-05-07T15:36:06","modified_gmt":"2021-05-07T14:36:06","slug":"jeffrey-aronson-when-i-use-a-word-a-difficult-infection","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/04\/26\/jeffrey-aronson-when-i-use-a-word-a-difficult-infection\/","title":{"rendered":"Jeffrey Aronson: When I Use a Word . . . A difficult infection"},"content":{"rendered":"

Surveying new biomedical words listed in the <\/span>Oxford English Dictionary<\/span><\/i> (<\/span>OED<\/span><\/i>) since 1970, I have found fewer examples each year. For example, the 1970 list contained 61 words and the 1980 list 27; in the 1990 list (Table 1) there are 12. However, the list still contains much of interest. \u201cNutraceutical\u201d, for instance, which I previously discussed in a <\/span>paper<\/span><\/a> titled \u201cDefining nutraceuticals: neither nutritious nor pharmaceutical\u201d, highlighting the widespread inconsistencies and contradictions in the many published definitions of \u201cnutraceuticals\u201d and a term that is often regarded as synonymous with it, \u201cfunctional foods\u201d.<\/span><\/p>\n

Here, however, I shall focus on another item in the list, \u201cC. diff.\u201d<\/span><\/p>\n

Table 1. <\/b>Biomedical words (n=12) in the <\/span>OED<\/span><\/i> for which the earliest citations are from 1990 (out of a total of 129); I have found two antedatings (1 and 90 years)<\/span>
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*<\/span> Antedatings: nutraceutical (1989); oversupinate (<\/span>1900<\/span><\/a>)<\/span>
\nThe antedating of \u201coversupinate\u201d is unusual, in that the word is incompletely defined in the dictionary, and a proper definition would encompass earlier examples; \u201coversupination\u201d is defined as \u201cExcessive supination of the feet, esp. when running\u201d and \u201coversupinate\u201d as \u201cTo run or walk so that the weight falls upon the outer sides of the feet to a greater extent than is necessary, desirable, etc.; to supinate excessively. Also with the feet as subject.\u201d But the definition should have extended, as it were, to the arms, which can also be oversupinated. The earliest instance of \u201coversupination\u201d referring to the arms that I have found is from <\/span>1871<\/span><\/a>, in a paper by John Lyell in the <\/span>Glasgow Medical Journal<\/span><\/i>, \u201cPartial displacement of the head of the radius in children\u201d (\u201cIt seems to me that the radius somehow from over-supination catches on the adjacent ulna and is there retained\u201d); \u201coversupinate” can be found in 1900: \u201cFractures of the neck of the radius may occur from ligamentous strain either by putting the obicular ligament [<\/span>sic<\/span><\/i>] on a stretch by oversupinating the forearm or by forcing the ulnar away from the radius by violent dislocation backward\u201d (<\/span>Philadelphia Medical Journal<\/span><\/i> 1900; 5: 564)<\/span>
\n\u2020<\/span> C. diff.<\/span><\/i> has its own entry in the <\/span>OED<\/span><\/i>, as do <\/span>C. difficile<\/span><\/i> and <\/span>Clostridium<\/span><\/i>, but <\/span>Clostridium difficile<\/span><\/i> has somehow evaded inclusion; however, an etymological note under <\/span>C. difficile<\/span><\/i> tells us that it is a shortened form of the scientific Latin term <\/span>Clostridium difficile<\/span><\/i>, \u201c[the] name of a species of bacterium (1939 or earlier)\u201d<\/span><\/p>\n

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Adam Pra\u017cmowski first described the <\/span>Clostridium<\/span><\/i> genus of bacteria in a dissertation, <\/span>Untersuchung \u00fcber die Entwickelungsgeschichte und Fermentwirking einiger Bacterien-Arten<\/span><\/i> (Leipzig: Hugo Voigt, 1880). A reviewer (\u201cDr. K.M.\u201d), writing in the <\/span>\u00d6sterreichische Botanische Zeitschrift<\/span><\/i><\/a>, described it as \u201c[a] treatise, rich in new observations, \u2026and a highly valuable contribution to our understanding of morphological and evolutionary relationships among bacteria.\u201d Pra\u017cmowski derived the term \u201c<\/span>Clostridium<\/span><\/i>\u201d from the diminutive form of the Greek word \u03ba\u03bb\u03c9\u03c3\u03c4\u03ae\u03c1, a spindle, because of the shape of the organism (Figure 1).<\/span><\/p>\n

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\nFigure 1. <\/b>Spindle-shaped organisms (\u201c<\/span>Bacillus difficilis<\/span><\/i>\u201d) isolated from infants\u2019 stools by Hall & O\u2019Toole in 1935, grown on blood agar alkaline pyrogallol stained by Gram’s method<\/span><\/p>\n

Then in <\/span>1935<\/span><\/a> Ivan Hall and Elizabeth O\u2019Toole described an organism that they called <\/span>Bacillus difficilis<\/span><\/i>, because it seemed to belong to the <\/span>Bacillus<\/span><\/i> genus and was hard to grow in vitro, being an obligate anaerobe. It was later identified as a member of the <\/span>Clostridium<\/span><\/i> genus by Andr\u00e9 Romain Pr\u00e9vot who called it \u201c<\/span>Cl difficilis<\/span><\/i>\u201d (Figure 2), forgetting, or being unaware, that while \u201c<\/span>Bacillus<\/span><\/i>\u201d in Latin is masculine, \u201c<\/span>Clostridium<\/span><\/i>\u201d is neuter. He included <\/span>C. difficile<\/span><\/i> among the types of clostridia that he labelled \u201cpeu pathog\u00e8nes\u201d. Wrong again.<\/span><\/p>\n

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\nFigure 2.<\/b> Extracts from Andr\u00e9 Romain Pr\u00e9vot\u2019s review of the organisms that he considered belonged to the <\/span>Clostridium<\/span><\/i> genus, including \u201c<\/span>Cl. difficilis<\/span><\/i>\u201d (<\/span>Annales de l’Institut Pasteur<\/span><\/i> 1938; 61 (1): 78-99); since then it has been <\/span>recognized<\/span><\/a>, based on 16S rRNA gene sequence analysis, that many of the organisms that have been assigned to that genus are not proper members of what is now called <\/span>Clostridium sensu stricto<\/span><\/i>; <\/span>Clostridium difficile<\/span><\/i> has therefore been renamed <\/span>Clostridioides difficile<\/span><\/i><\/p>\n

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Pseudomembranous colitis had been described in <\/span>1893<\/span><\/a> by John Miller Turpin Finney, before the advent of antibacterial drugs. But in 1977 it was <\/span>shown<\/span><\/a> that clindamycin-associated colitis in Syrian hamsters was due to a toxin-producing species of <\/span>Clostridium<\/span><\/i>, <\/span>Clostridium difficile.<\/span><\/i>\u00a0It was <\/span>sensitive<\/span><\/a> to vancomycin, treatment with which was effective in 49 patients.<\/span><\/p>\n

In the 1980s, when infection with <\/span>Clostridium difficile <\/span><\/i>became a major problem in UK hospitals, clinicians started to refer to \u201cC. diff.\u201d, partly because abbreviations like this are common (e.g. \u201cstrep\u201d and \u201cstaph\u201d) and perhaps also because they were unsure about how to pronounce the second part of the name. Might it be \u201cdee-fee-seel\u201d as in French? Or \u201cdee-fee-chillay\u201d as in Italian, for example? Neither. It\u2019s \u201cdi-<\/span>\u00b4<\/span>fi-ki-lay\u201d as in Latin, the hard <\/span>c<\/span><\/i> being justified by contemporary scholarship on the way in which classical Latin was pronounced.<\/span><\/p>\n

In the summer of 2007, infections with <\/span>C. difficile<\/span><\/i> in UK hospitals became headline news. The BBC in particular took to pronouncing it \u201cdee-fee-seel\u201d. Dot Wordsworth in <\/span>The Spectator<\/span><\/i> (18 August 2007, page 18) took exception to this and quoted the BBC\u2019s Pronunciation Unit, which justified its quasi-French pronunciation of \u201cdifficile\u201d as follows: “This pronunciation is in line with the usage of the various microbiology and infection control experts the BBC has consulted. Medical Latin is commonly anglicized [<\/span>sic<\/span><\/i>].\u201d \u201cMy difficulty,\u201d wrote Wordsworth, \u201cis with the dropping of the final vowel of difficile. When people trot out the Latin tag mirabile dictu they manage to keep the \u2013e. The alchemists’ idea of drinkable gold was aurum potabile. If the Queen, instead of speaking of an annus horribilis, had referred to a tempus horribile, she would not have dropped the final e any more than the initial h.\u201d<\/span><\/p>\n

Then Professor Graham Anderson, professor of Classics at the University of Kent, wrote to <\/span>The Times<\/span><\/i> (15 October 2007): \u201c[<\/span>Clostridium difficile<\/span><\/i>] looks like a normal piece of medical Latin, the language used for historical reasons to classify bacteria. But because the form difficile is common to Latin and French to the eye, the broadcasting media choose quite wrongly to call it clostridium dee-fee-seel and not the four-syllable dif-fi-ci-le of Latin. What is offensive is not so much the ignorance, but the fancy that one is being correct: it looks foreign, so it must have a foreign pronunciation, n\u2019importe quelle langue. I wonder what members of the Acad\u00e9mie Fran\u00e7aise would make of this outrageous piece of franglatine?\u201d<\/span><\/p>\n

Saying \u201cC. diff.\u201d completely avoids the problem.\u00a0<\/span><\/p>\n

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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><\/span><\/p>\n

Competing interests:<\/strong> None declared.<\/p>\n\n\n\n
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This week’s interesting integer: 320<\/b><\/p>\n

Geometric numbers<\/b><\/p>\n