I wish to b egin by th an kin g th e seven sch olars wh o kin d ly co n sen ted to rea d in g a n d co m -m en tin g o n -m y p a p er. Th e esp ecia lly b ro a d ra n ge of su ggestion s a n d criticism s will p rove h igh ly u sefu l in m y o n go in g stu d y o f m ed ica l sla n g a n d p o in ts to fu tu re lin es o f resea rch in th e area of lan gu age an d h ealth .
Don ald Pollock h igh ligh ts id en tifyin g m ed-ica l sla n g fo r h ea lth ca re in stitu tio n s in a d d i-tion to th at u sed for p atien ts an d oth er p h ysi-cia n s. Sin ce th is p erta in s to m y co m m en ts o n th e work by Gord on , I sh ou ld take ad van tage of th e op p ortu n ity to say h ow im p ortan t h is stu d y on h osp ital slan g in Californ ia was for m y own in terp retation . I ob served th at Gord on con cen -tra te d o n m e d ica l sla n g fo r p a tie n ts a n d n o t (addition ally) for h ealth care in stitu tion s th em -selves. Th is sh ou ld b e taken m ore as an ob ser-vation th an a criticism . As Pollock n otes, eith er th ere m ay h ave b een little or n o m ed ical slan g fo r h ea lth ca re in stitu tio n s in th e USA in th e early 1980s, or Gordon chose n ot to focus on the issu e, i.e., h e d id n ot n ecessarily overlook it. Al-though I disagree with som e of Gordon’s con clu-sion s (see b elow, in resp on se to Trostle), I agree with him on two cen tral prem ises, without which th e rest of th e an alysis b ecom es fru itless for ei-th er h is p ap er or m in e: ei-th at m edical slan g exists as a lin guistic en tity am en able to study, an d that it h as a relevan t b earin g on th e m ed ical eth os. Regard in g slan g an d ch an ges in h ealth care in stitu tio n s, a lth o u gh I d id n o t in terview a n y p h ysician s workin g in th e Un ited States, I h ave received a n u m b er of p ertin en t jokes circu lat-in g on th e In tern et, esp ecially jests con cern lat-in g h ealth m ain ten an ce organ ization s an d th e con -d itio n s im p o se-d o n a ccess to trea tm en t fro m th em . In terestin gly, a lth o u gh th e o rigin a l a u -th ors are an on ym ou s, -th e jokes h ave b een sen t o r fo r wa rd ed b y Am erica n p h ysicia n s. I a m m o re fa m ilia r with th e h ea lth field in Bra zil, b u t a n in terestin g a sp ect in th e Un ited Sta tes (or for a com p arative stu d y) m igh t b e to in ves-tigate wh eth er ch an ges are occu rrin g in p h ysi-cian d iscou rse th at reflect wh at I u n d erstan d to b e th e ra d ica l a d o p tio n o f co st-effectiven ess an alysis in ch oice of treatm en t (with all its p o-ten tial ben efits for variou s segm en ts of society).
O autor responde
The autho r re p lie s
Ja m es Tro stle, a lso in rega rd to Go rd o n’s stu d y, is correct in p oin tin g ou t th at com atose p a tien ts ca n a ctu a lly ‘cla im’ trea tm en t in th e literal sen se of ‘requ irin g’ rath er th an ‘d em an d -in g’ it. Still, it is -in terest-in g th at Gord on ch ose th e p olysem ou s ‘claim’ rath er th an th e less am -b igu ou s ‘req u ire’ wh en h e classified com atose p atien ts togeth er with th ose d escrib ed by Cali-forn ia h osp ital slan g as wh in ers: crocks, cricks, b ellrin gers, etc. In th is sen se, p erh a p s u n in -ten tion ally, th e origin al m ean in g of claim , cla-m a re‘to cr y o u t’ ten d s to in tru d e figu ra tively
on th e term as u sed .
With o u t in ten d in g to b elea gu er Go rd o n’s stu d y, b u t to resp on d to Trostle a ga in , I fou n d th e stu d y m eth o d o lo gica lly m eticu lo u s, b u t em p h a size a d ifferen ce in o u r co n clu sio n s. Go rd o n co n clu d es th a t h o sp ita l sla n g ser ves p rim arily to p rom ote rap p ort am on g th e h ealth ca re sta ff a n d exp licitly p la ys d own a n y ca l-lou sn ess or social b ias it m ay con n ote. I agree th a t th e p h a tic fu n ctio n o f h o sp ita l sla n g ca n serve as on e m ean s, am on g oth ers, for p rom otin g rap p ort am on g h ealth p erson n el, b u t con -ten d th a t th is is o n ly h a lf th e sto r y. I su ggest th at, far from eith er en cou ragin g or cen su rin g m ed ica l sla n g, we a ccep t th a t so m e o f it m a y b e, for lack of a b etter term , “p olit ically in cor-rect” ( Jo h n so n , 1998) a n d a ttem p t to u n d er-stan d wh at it m ean s for m ed ical p ractice. Su ch an u n d erstan d in g m igh t u ltim ately foster m ore h u m a n e h ea lth ca re, b en efitin g b o th p a tien ts a n d p h ysicia n s. Alth o u gh th e Ca lifo rn ia a n d Ca rio ca tro p es fo r p a tien ts b ea r n o tewo rth y sim ilarities, th e d ivergen t con clu sion s m ay al-so reflect d ifferen ces in m ed ical p ractice in th e Un ited Sta tes a n d Bra zil, th e 15-yea r tim e la g b etween th e two stu d ies, a n d / o r m y p erso n a l b ias, h avin g worked in p u b lic h ealth care facili-ties in Brazil.
Tro stle h elp fu lly req u ests a d efin itio n o f certa in term s. I u se ch ia sm u s a s d efin ed b y Du crot & Tod orov (1979/ 83:277): “th e rep etition a n d sim u lt a n eou sly in v ersion of t h e rela t ion sh ip b et w een t w o w ord s in t h e cou rse of a sen -t en ce”. A va ria tio n o n th is p a ttern is u sed in several sayin gs con cern in g th e m ed ical field s, o f wh ich I ga ve o n ly o n e o r two exa m p les b e -ca u se o f lim ited sp a ce, e.g., “Th e clin icia n k n ow s everyth in g an d solves n oth in g, w h ile th e su rgeon k n ow s n oth in g an d solves everyth in g.”
I fo u n d th e fo rm releva n t to th e d iscu ssio n o f a cq u isitio n o f m ed ica l kn owled ge, sin ce th is form of in ter-sp ecialization jab is rep eated by m ed stu d en ts an d resid en ts d u rin g th eir train -in g an d p rovid es a sort of op p osition or cross-over b etween th e variou s field s at a tim e wh en th ey a re p o n d erin g over th eir fu tu re field o f
sp ecialization . (Coin cid en tally, ch iasm u sis al-so a n eu roan atom ical term , referrin g to th e d e-cu ssation or crossin g of two n eu ral tracts.)
I also u se p aron om asiaas defin ed by Du crot
& Tod orov (1979/ 83:278): “th e ju x tap osition of w ord s t h a t h a v e t h e sa m e sou n d b u t d ifferen t m ea n in gs”, e.g., in m y a rticle, th e ca se o f th e
exp ert m ed ica l o p in io n , p a recer, referred to
iron ically as p arece ser(‘it ap p ears to be...’). Th is is o n e wa y p u n s a re fo rm ed , th e typ e Freu d (1905:31) ca lled k la n gw it z, o r ‘so u n d -jo kes’
(wh ich h e co n sid ered in ferio r to m o re ela b o -ra te wo rd p la y). An o th er typ e o f tro p e o ccu rs wh en th e two term s a re n o t ju st p h o n etica lly sim ilar, as in p aron om asia, b u t wh ere on e an d
th e sa m e wo rd is u sed in a figu ra tive sen se with in th e sam e con text (a form of an tan acla -sis– Du cro t & To d o rov, 1979/ 83:277), e.g., th e p la y o n th e verb d ren a r, ‘to d ra in’ a p a tien t. I
ca ll a tten tio n to th is d istin ctio n b eca u se it h igh ligh ts Trostle’s oth er qu estion ab ou t a con -fu sin g sen ten ce co n cern in g th e co n n o ta tive u sage of slan g. A layp erson catch in g th e sh ift of sou n d in a p a ron om a st icp u n m igh t gu ess th e
m ea n in g, o r a t lea st in fer th a t so m e jo kin g is go in g o n . Bu t it wo u ld b e d ifficu lt fo r h im to d iscover th a t to ‘d ra in’ a given p a tien t is to tran sfer h im to th e d octor’s p rivate office. Sin ce th e word s are n ot ju st sim ilar, b u t id en tical, th e situ ation is p erh ap s on e wh ere con n otation is m ost h eavily con text-d ep en d en t.
I u se ca t a ch resisn o t in th e sta n d a rd sen se
of m isu se or strain ed u se of word s, b u t con cu r-rin g with Bla ck (1962:32-33), a s “t h e u se of a w ord in som e n ew sen se in ord er t o rem ed y a gap in th e vocabu lary; catach resis is th e p u ttin g of n ew sen ses in t o old w ord s”. As Bla ck p o in ts o u t, wh en “ca t a ch resis serv es a gen u in e n eed , t h e n ew sen se in t rod u ced w ill q u ick ly b ecom e p art of th e literal sen se.”
My a rticle o p en s a n d clo ses with a m etap h orical exercise p osin g a con u n d ru m : d o all m etap h ors ‘d ie’, i.e., ten d in exorab ly to cat-a ch resis? (By th e wcat-a y, th e o p en in g cat-a ctu cat-a lly h a p p en ed , wh ile th e en d in g is fictio n a l.) Ca t-ach resis is exem p lified by clavicle, coin ed by an an cien t an atom ist to p lu g a gap in th e lexicon (sin ce th ere wa s n o n a m e fo r th a t b o n e), wh o at th at very m om en t ‘p u t a n ew sen se’ in to th e o ld m ea n in g o f ‘little key’. Cla v icleso o n b e -ca m e a d ea d m eta p h o r a n d fo r cen tu r ies h a s req u ired a n etym ologica l exercise to u n veil it. To th e exten t th a t wh a t is sign ified is seen a s ‘n atu ral’, th e m etap h or dies. Live m etap h ors, on th e oth er h an d , are th ose wh ich d o n ot m erely ‘p lu g gap s’, b u t wh ich con tin u e to exp ress d ou -b le or com p lex m ean in g an d p rovoke su rp rise, am u sem en t, d iscom fort, d isagreem en t.
Trostle su ggests an im p ortan t p roviso to m y ap p roach : I h ave en com p assed u n d er th e term ‘m ed ical slan g’ wh at actu ally con stitu tes n ot a distin ct register, bu t a collection of term s cu lled from d ifferen t styles of m ed ical d iscou rse. Fu -tu re resea rch sh o u ld fo cu s o n wh a t La b o r (1972:186) p rop oses as a su p erord in ate/ su b or-d in ate h ierarch y am on gst styles. In th e case of m ed ical d iscou rse, th is m igh t p lace form al sci-en tific, d eon tological, an d clin ical d iscou rse at th e form er p ole an d h osp ital-locker-room an d ou t-of-p atien t-earsh ot con versation at th e lat-ter. Wh a t I h a ve cla ssified th u s fa r a s sla n g wou ld b e fou n d p rim arily toward s th e su b ord i-n ate p ole, b u t ii-n tersp ersed elsewh ere aloi-n g th e gam u t. For exam p le, m ed ical con feren ces an d clin ical case reviews cou ld b e exp ected to fea-tu re scien tific, som etim es h yp ercorrect sp eech , b u t m igh t a lso b e h ea vily p u n ctu a ted with jokes, n ot on ly for d id a ctic p u rp oses, b u t a lso sin ce th e p a rticip a n ts wo u ld p erceive th em -selves a s b ein g a m o n g p eers. Situ a tio n a l sh ift b etween d ifferen t sp eech styles in th e op erat-in g room was d escrib ed n icely b u t erat-in d irectly by on e of th e an esth esiologists I in terviewed , an d it wo u ld b e im p o r ta n t to d irectly reco rd th is a n d o th er p h ysicia n d isco u rse styles (a n im -p ortan t referen ce is Mish ler, 1984). In ad d ition to co n sid era tio n fo r o b ser va tio n a l b ia s, m o re com p lex eth ical im p lication s are obviou sly in -volved in su ch d irect record in g of m ed ical p roced u res, with d u e resp ect fo r p h ysicia n , p a -tien t, an d fam ily con sen t.
Th ree of th e d iscu ssan ts h igh ligh t con cep ts p a rticu la rly releva n t to sla n g d u rin g m ed ica l tra in in g. Pollock refers to wh a t h e ca lls p h ysi-cia n s’ ‘tra in in g ta les’, a n d h ere I a m rem in d ed o f h a vin g o b ta in ed m eta p h o r ica lly rich re-sp on ses from m y in terviewees by askin g th em to d escrib e th eir first sh ift o n wa rd d u ty o r wh eth er th ey h ad ever felt afraid wh ile p rovid -in g care, follow-in g su ggestion s by Lab ov (1972: 180-83) o n typ es o f q u estio n s likely to elicit sh ifts in sp eech style. Qu o tin g Go o d , Kn a u th p oin ts ou t th at learn in g m ed icin e is like ‘learn -in g a fo reign la n gu a ge’ a n d su ggests situ a t-in g slan g with in th is m ore overall con text of m ed -ical d iscou rse. An d Deslan d es su ggests th at th e d erogatory term s often u sed for m ed stu d en ts a re p a rt of th e h u m ilia tion th ey exp erien ce in th e ‘rite of p assage’ d u rin g train in g.
a n d wh en th e sa m e p h ysicia n sta tes th a t th e p a tien ts will b e trea ted in a m u la m b u la t ório, b ased on a p erform ative an alysis of th is sp eech act (Searle, 1979:75-116), th e p h ysician h as p er-fo rm ed b o th ‘exp ressio n’ (exp ressin g h is feelin gs an d attitu d es) an d ‘assertion’ (tellfeelin g oth -ers h ow th in gs are, in th is case th e p atien ts an d th e trea tm en t fa cility). Th e term m u la m b ois
n ot a ran d om u tteran ce from on e in d ivid u al in society to d escrib e an oth er. A p h ysician’s asser-tion s are in vested by th e state an d society with scien tific an d m oral au th ority, an d th e p atien t co n firm s th is a u th o rity (a lth o u gh n o t n eces-sa rily u n critica lly) by seekin g trea tm en t fro m h im . Th e sp eech act d oes n ot h ave to b e a n ec-essary or su fficien t con d ition in ord er to ‘h elp cre a te’ (i.e., se rve a s a co fa cto r fo r, o r co n -trib u te to) p atien t exclu sion or d iscrim in ation . Su ch sp eech acts wou ld on ly fail to h elp create exclu sion if th ey were totally d ivorced from th e accom p an yin g m ed ical acts. If we cou ld exten d th is Deb a te, a n d h o p efu lly we ca n in a n o th er fo ru m , I wo u ld a sk Desla n d es a n d Ca rra ra to exp lain h ow su ch total estran gem en t m igh t b e a ch ieved b etween sp eech a cts a n d o th er a cts. We m igh t e ve n p ro d u ct ive ly co n sid e r, b a se d o n Searle (1979:85-93) th at tru th assu m p tion s ab ou t th e m etap h or’s literal m ean in g n eed n ot h old in ord er for it to fu n ction as su ch . Th at is, su p p ose th at a m u lam bo d oes n ot ‘really’ h ave t h e p ro p e r t ie s we a sso cia t e wit h a ‘ra g’ d is-ca rd e d , in e r t , sile n t b u t ra t h e r is a ct ive a n d vocal. Th is lack of ‘tru th’ (i.e., u n eq u ivocal d e-n o t a tio e-n ) ie-n th e litera l m ea e-n ie-n g o f th e term wou ld n ot alter wh at th e sp eaker m ean s by th e m etap h orical u tteran ce.
It ca n a lso b e a rgu ed , a s Ca rra ra su ggests, th at th e p h ysician is d oin g h is b est to treat th e p atien t u n d er ad verse con d ition s, an d th at, as b o th h e a n d Desla n d es su ggest, th e term m u -la m b u -la t ório m a y b e a critiq u e o f th e p h ysi-cia n’s ‘ra gged y’ wo rkin g co n d itio n s. Bo th d is-crim in a to ry a sse rtio n a n d e xp o sé o f m e d ica l wo rkin g co n d itio n s m a y o p era te in th is sa m e m etap h or. Wh ile th e p h ysician is ap p aren tly at-tem p tin g to p la ce a d ista n ce b etween h im self an d th is con text, h is exten sion of th e term m u -lam boto m u lam bu latórioen d s u p n am in g th e
en tire p ro cess, en co m p a ssin g th e lin e o f low-in com e p atien ts, th e cllow-in ic itself, an d th e h eath care staff, in clu din g, m ost im p ortan tly, h im self. Carrara also n otes correctly th at racial b ias ca n n o t b e in ferred fro m th e Africa n o rigin o f th e term m u lam bo, alth ou gh , coin cid en tally, it lab els lowin com e or h om eless Brazilian p u b -lic o u tp a tien ts a m o n gst wh o m p eo p le o f Africa n gen etic o rigin a re h ea vily overrep re-sen ted . He p o in ts o u t p ro p erly th a t Bra zilia n
Po rtu gu ese h a s m a n y o th er etym o lo gica lly Ban tu word s, an d th at, b esid es, p eop le d o n ot walk arou n d with an etym ological d iction ary in th eir h ead s, an d gen erally sp eak with ou t th in k-in g twice a b o u t wh ere th e wo rd s ca m e fro m . Fo r exa m p le, we co u ld ea sily p ra ise a skilled Brazilian su rgeon by callin g h im a bam ba, an d
etym ologically we wou ld b e com p arin g h im to a m ’b a m b a, or Ba n tu exp ert or officia l (a n a b -su rd com p arison , sin ce Brazilian s are obviou s-ly n o t Africa n s, a n d in a d d itio n , fo r h isto r ica l reason s, th ere are p reciou s few b lack su rgeon s in th e co u n tr y). Bu t Ca rra ra’s o b jectio n ra ises th e im p ortan t p oin t of wh eth er racial d ifferen -tia tion in h ea lth con d ition s a n d h ea lth ca re is m ea su ra b le in Brazil an d th e relation sh ip th is m igh t b rin g to b ea r o n a d ero ga to r y term fo r certa in p a tien ts. In th is sen se h is d isco m fo rt fo cu ses a tten tio n o n wh a t is n o t sa id (o r ca n -n ot b e scie-n tifically tested ) ab ou t race a-n d health in the coun try. Un der the term s of a Pres-id en tial d ecree (Min istério d a Ju stiça, 1995), a Workin g Grou p of exp erts was con ven ed th ree yea rs a go by th e Min istry o f Hea lth to d iscu ss an d p rop ose m easu res con cern in g h ealth con d ition s an d h ealth care am on g th e b lack p op u -lation . Th e Grou p p u b lish ed a rep ort with th is aim , on e of wh ose recom m en d ation s read s:
“Prom otion of k n ow led ge con cern in g th e re-la t ion sh ip b et w een h ea lt h ca re p rofession a ls a n d b la ck p a t ien t s, w h o a re su b ject t o a n ega -tive social stereotyp e, in ord er to id en tify in ad e-qu ate form s of beh av ior an d , con see-qu en tly, th e a d op t ion of ed u ca t ion a l m ea su res t o correct th em” (Min istério d a Saú d e, 1996:17).
I d ou b t wh eth er th ere is an y m ore th an th e Workin g Grou p m em b ers’ own exp ert op in ion s to su p p ort th is recom m en d ation . Bu t th e m ain reason for th is lack of evid en ce is su ggested by th e rep ort itself (Min istério d a Saú d e, 1996:17), wh ich also recom m en d s:
“In clu sion of th e item ‘color’ or racial id en ti-fication on p atien t record s an d[ad m in istrative
fo rm s] in t h e Un ified N a t ion a l Hea lt h Sys-t em ...so a s Sys-t o a llow for a n ep id em iologica l an alysis of racial/eth n ic grou p s...”
wh ere th ere is resea rch o n go in g elsewh ere in th e world con cern in g race as a p oten tial cofac-tor in d ifferen tial exp ression of card iovascu lar an d oth er d iseases. In ad d ition , racial id en tifi-cation cou ld p rovid e im p ortan t in form ation on d ifferen tia l a ccess to (o r d iscrim in a tio n in ) h ea lth ca re a n d fo r red ressin g in eq u a lity, if it sh o u ld exist, th ro u gh sp ecific p u b lic p o licies. Lack of in clu sion of ‘color’ on h ealth care form s p rod u ces a sort of colorb lin d alley, wh ere racial in eq u ality is Presid en tially d ecreeab le b u t sci-en tifica lly u n sa ya b le. Ca rra ra n o tes co rrectly th a t it wo u ld b e p o ssib le to test th e sp ecific p o in t o f p h ysicia n b ia s b y clo ckin g exa m in a -tio n tim es fo r wh ite a n d b la ck p a tien ts, b u t it sh o u ld a lso b e n o ted th a t cu rren t p a tien t reco rd s wo u ld b e u seless fo r su ch a stu d y, fo r th e reason s d iscu ssed ab ove.
Sérgio Carrara h as corrected m e on th e ori-gin of p it iá t ico: n ot p et it m a l, b u t ‘p ith ia tism’,
“a m orb id con d it ion cu ra b le b y su ggest ion”, a co n cep t rela ted to h ysteria a n d a ttrib u ted to Ba b in ski (1857-1932) (Cu n h a , 1982:610). Th e o u td a ted term h a s su r vived a s a ca tch -a ll fo r p atien ts p erceived as m alin gerin g or overly vo-ca l ra th er th a n th o se a ctu a lly p resen tin g with h ysterical n eu rosis.
An a Ma ria Ca n e sq u i m a ke s se ve ra l va lu -a b le m eth od ologic-a l -a n d b ib liogr-a p h ic-a l su g-gestion s aim ed at m ore exten sive an d in -d ep th con textu alization of m ed ical m etap h or. My ar-t icle d iscu sse s so m e fo r ar-t y ar-t ro p e s (a m o n gsar-t oth ers exclu d ed for lack of sp ace) relatin g to a ran ge of asp ects in m ed ical exp erien ce, classi-fie d t e n t a t ive ly in t o t h re e t h e m a t ic a re a s a s d iscu sse d p re vio u sly a n d co m p a re d wit h t h e Bra zilia n litera tu re o n th e resp ective issu es (e.g., Min ayo on ep id em ic social violen ce, Ma-chado on m edical p rofession alism , etc.). Can es-q u i’s co m m en ts, d irected to m ed ica l p ro fessio n a lism a n d d efen se o f p h ysicia n s’ co rp o -ra tist in terests, rela te m a in ly to th e th ird o f th ese, p h ysicia n s’ rela tio n s to th e h ea lth ca re system . Her su ggestion s are esp ecially relevan t to h ow m ed ica l sla n g con tra sts with scien tific d iscou rse (as exp ressin g p h ysician s’ exclu sive com m an d of “esoteric an d abstract k n ow led ge”)
a n d d eo n to lo gica l d isco u rse, govern in g th e p rofession in its en tirety an d sp ecificity. Sh e is correct th at d ifferen ces in gen d er, gen eration , an d sp ecialization can b e reflected in m ed ical d isco u rse a n d req u ire fu rth er in vestiga tio n . An esth etists d o in d eed h ave sp ecial ch aracter-istics, two o f wh ich a re th a t th ey ‘co n tro l’ th e p atien t’s vital fu n ction s d u rin g in terven tion ist p rocedu res an d th at, as com p ared to oth er sp e-cialized field s in Brazil, th ey h ave su cceed ed in n egotiatin g relatively favorab le workin g con d
i-tion s with h ea lth m a in ten a n ce orga n iza i-tion s. In addition , I on ly in terviewed p h ysician s in Rio d e Ja n eiro, so extra p o la tio n to Bra zilia n m ed -ical p ractice as a wh ole is n ecessarily sp ecu la-tive. A m ore com p lete p ictu re of th e h ealth field wou ld also ben efit from lin gu istic research with oth er actors, esp ecially oth er h ealth p rofession -a ls -a n d p -a tien ts. With reg-a rd to th e l-a tter, Du arte (1986) p rovid es a fascin atin g read in g of workin g-class Brazilian s’ d escrip tion of illn ess.
Ma ria Eliza b eth Uch o a a p p ea rs to h a ve agreed with th e th ru st of m y in terp retation an d h a s p rovid ed m e with a clea r syn th esis o f m y own p ap er, for wh ich I am very gratefu l.
Resp o n d in g to Ca rra ra’s o b jectio n to th e p ap er h avin g b een written in En glish : I wrote it o rigin a lly in Po rtu gu ese a n d tra n sla ted it in to En glish a t th e req u est o f Ca d ern os d e Sa ú d e Pú blicaas p art of th e jou rn al’s larger ed itorial
p olicy to in crease th e volu m e of its work reach -in g th e n on -Portu gu ese-sp eak-in g com m u n ity. Tra n sla tin g th e m a teria l o u t o f Po rtu gu ese p osed several p rob lem s, as Carrara n otes, sin ce it h in ges so exten sively o n cu ltu ra lly im p reg-n ated trop es. Bu t th is m erely com p ou reg-n d ed two p re vio u s p ro b le m s. First, e ve n in th e o rigin a l la n gu a ge, live m e ta p h o r ca n n o t b e sim p ly ‘tra n sla te d’ in to its ro o ts. As Rico e u r n o te s, m e ta p h o r p ro d u ce s a ‘su rp lu s o f m e a n in g’ m a kin g it m ore th a n th e su m of its p a rts. Sec-o n d , a n d p riSec-o r tSec-o in terp retin g th e m a teria l, m ed ical slan g h ad to b e tran sp osed from a sp o-ken to a written m ed iu m , with an u n avoid ab le loss of in ton ation an d oth er p rosod ic traits. So even b efore tacklin g m y in terp retation of m ed-ica l sla n g p er se, th e rea d er is fo rced to m a ke th is trip le leap of faith . Hop efu lly th e resu ltin g d eb ate will h ave com p en sated for th e effort.
I p articu larly th an k Carrara for referrin g m e to m y origin al in terest in th e th em e of m ed ical m etap h or. Wh ile d oin g written an d sim u ltan e-o u s tra n sla tie-o n e-o f m ed ica l te-o p ics in gen era l, I n o ticed th a t p la ys o n wo rd s were a lm o st a l-wa ys ‘u n tra n sla ta b le’ (to th e p o in t o f d efyin g th e laws of p h ysics in th e case of sim u ltan eou s tran slation , i.e., two id eas attem p tin g to occu-p y th e sa m e soccu-p a ce a t th e sa m e tim e), b u t th a t su ch trop es were rich in m ean in g in a way th at literal sp eech an d catach resis were n ot. Th ere-fo re, it wa s th e ch a llen ge o f tra n sla tio n th a t origin ally m otivated m e to write th is p ap er.
Th e com m en ts by Nan cy Flowers, alth ou gh sen t by h er o n Au gu st 5, fo r so m e rea so n o n ly rea ch ed m e to d a y (Nov. 19), wh en I a m to ld th a t th is issu e o f Ca d ern osis a b o u t to go to
Flowers focu ses p recisely on wh at I h ave asserted to b e th e m o st releva n t a sp ect o f m ed -ical slan g, th at it exp resses ch an ges occu rrin g in th e h ea lth ca re system . I a m p a rticu la rly gra tefu l to h er fo r in clu d in g referen ces I h a d n o t a ccessed p revio u sly a n d wh ich I a m a n x-iou s to read . Her referen ce to Coom b s an d h is con clu sion s regard in g m ed ical slan g at d iffer-en t stages in p h ysician s’ careers are con sistiffer-en t with m y ob servation s of jokes an d sayin gs d u r-in g m ed ica l tra r-in r-in g, a lth o u gh I d id n o t ra ise th e sp ecific p oin t of tren d s across gen eration s. An d th e referen ce to Kon n er tou ch ed a p erson -a l n o te, sin ce I -a lso stu d ied m ed icin e in m y th irties.
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