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Metaphor in medicine: Do you have chocolate cysts or watermelon stomach?

REUTERS/Luke MacGregor
Eventually doctors developed tools to enhance their senses, such as the stethoscope in 1816, which amplified the body’s sounds, and x-rays in 1895, which made it possible to see inside the body.

Physicians and others in the medical community have long used the imagery of food — its smells, shapes, colors and texture — to describe and understand disease, as an article published recently in the journal Medical Humanities points out.

Some of this imagery — the use of the term beer belly for a protruding abdomen, for example, and port wine stains for certain types of birthmarks — are well known to most of us. But how many of us are aware that ovarian cysts caused by endometriosis are referred to as chocolate cysts because they contain dark brown fluid, or that a cervix inflamed with a trichomonas infection is called a strawberry cervix?

Such food references can “reinforce, through imaginative imagery, audiovisual and olfactory understanding of diseases,” writes the article’s author, Dr. Ritu Lakhtakia, a pathologist at Sultan Qaboos University in Oman.

But, “alternatively,” she adds (a bit facetiously), “they may distance the reader from some foods altogether.”

Specific gastronomic allusions

You can be the judge of that. Here are some of the other examples provided by Lakhtakia:

  • Enlarged spleens caused by the disease amyloidosis are described as lardaceous because they have a wax-like discoloration that resembles pork fat.
  • The whitish plaque that forms on the outer membranes of an inflamed heart (a condition known as pericarditis) is referred to as milk patches.
  • The thick, white, granular discharge associated with a vaginal yeast infection is said to have a curd-like or cottage cheese appearance.
  • A particular fungal skin disease (caused by the yeast Malassezia furfur) is described as looking like spaghetti and meatballs under a microscope.
  • The thick, bloody mucousy sputum coughed up by patients with Klebsiella pneumonia is referred to as current jelly sputum.
  • Livers damaged by right-sided heart failure are said to turn the color of nutmeg.
  • The nucleus of a spindle-cell schwannoma, a noncancerous tumor that develops on the peripheral nerves, is described as looking like a croissant.
  • Watermelon stomach is the common name given to the uncommon condition gastric antral vascular ectasia (GAVE). The condition causes the blood vessels that line the stomach to bleed, making the stomach resemble the striped rind of a watermelon.

Using all five senses

Writing last week for the academic news-and-information website The Conversation, James Bradley, a medical historian at the University of Melbourne, provides more background to Lakhtakia’s article, explaining just “how sense-laden the history of medicine is.”

“For millennia, healers, in their encounters with patients, used all their senses most of the time,” he writes.

And he does mean all.

The British physiologist and surgeon Herbert Mayo (1796-1852) wrote, for example, that “diabetic urine is almost always of a pale straw or greenish colour. Its smell is commonly faint and peculiar, sometimes resembling sweet why or milk.”

And its taste, he added, was “always decidedly saccharine.”

Technology takes over

Eventually, of course, doctors developed tools to enhance their senses, such as the stethoscope in 1816, which amplified the body’s sounds, and X-rays in 1895, which made it possible to see inside the body.

And “during the 20th century,” writes Bradley, “the clinical use of the senses has been further eroded. Now there is a battery of technology dedicated to detecting what the senses cannot.”

Still, he notes, “the senses remain vitally important to the practice of medicine and medical education. … For like all sciences, medicine must not only observe but describe, and in shifting from observation to description, metaphor becomes crucial.”

“But metaphor will only get you so far,” he adds. “Today, while a medical practitioner might possibly agree with Mayo that a diabetic’s urine smelled like ‘sweet whey or milk,’ she’s unlikely to sip the urine for a sugar-like taste; much easier — and safer — to test for glucose levels in the blood. And more reliable, too.”

You can read Bradley’s article on The Conversation’s website. Lakhtakia’s article can also be read in full on the Medical Humanities website.

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