by Ralph Keyes
The dysentery so often suffered by tourists is commonly named after settings where it’s contracted, perhaps as a form of payback. Geographic euphemisms for this condition include Bangalore bowels, Bali belly, Basra belly, Bombay crud, Delhi belly, Lahori looseness, Spanish tummy, Thai-del wave, Tokyo trots, and Tunis stomach. Burma’s Rangoon takes a double hit, with Rangoon itch being euphemistic for a penile infection contracted from a prostitute, and Rangoon runs referring to diarrhea. Montezuma’s revenge is a euphemism for diarrhea contracted in Mexico. A low point in Jimmy Carter’s presidency came when the humor-challenged president made a feeble joke about Montezuma’s revenge while visiting Mexico City. His hosts were not amused.
AUNT FLO’S COME
Euphemisms for menstruation used to be big on floral themes, presumably because of the “flow” of menstrual blood as well as the redness of so many blossoms. At flower-time, medieval Englishwomen endured their monthly flowers. “I’ve got my flowers,” they told one another.
Nowadays, Englishwomen are more likely to say “Aunt Flo’s come” when alluding to this monthly flow of blood. Personalizing periods this way is particularly popular among modern speakers of English. In this gambit they might say “Harvey’s here,” “Charlie’s come,” or “Little Audrey’s arrived.” Aunt Flo herself might appear or make an appearance. This notion prompted a popular medical yarn about a woman who told her doctor, “I ain’t seen nothin’ in three months.” In response, he referred her to an ophthalmologist.
A cross-cultural study conducted after World War II by anthropologist Natalie Joffe found that English was especially rich in the range, variety, and imagery of its euphemisms for menstruation. Those who spoke other languages were more constrained. Even Yiddish, so colorful in other figures of speech, yielded a mere handful of pallid references to the time, a guest in the house, or the red king.
Euphemisms based on the color red are ubiquitous among the many allusions to menstruation: in the red, a red-letter day, fly the red flag, surf the red wave, as well as grandma’s here from Red Creek. Alternatively, my friend Tom’s come over to paint the house red (“Tom” being an acronym for the “time of month”). Referring to provisional license plates that sport a red P, some Australian women say “I’ve got my P-plates.”
Natalie Joffe found that the French were especially partial to red-based euphemisms but used them with imaginative indirection: tomatoes, cardinals, having the painters in. Most creatively euphemistic of all was their reference to garibaldians (referring to Garibaldi’s revolutionary “redshirts”) and have the English, alluding to the traditional nickname for English soldiers, “redcoats.”
But it was Americans who Joffe found had the most “vivid and luxuriant” euphemisms for menstruation. Among the more inventive of a hundred she tallied were the Red Sea’s in, the chick is a communist (“red”), and her cherry is in sherry. These euphemisms were primarily used by men, of course, as was flying baker. This referred to the naval alphabet in which “baker” stands for B, and the semaphore flag for B is red. That flag also warns of danger, when, say, ammunition is about to be loaded and the message is “Beware. Stay away.” Postwar American women alerting men that having their period made them sexually unavailable said the flag is up. They were off duty.
Americans have uniquely incorporated materials used to absorb the flow of menstrual blood into their euphemisms: on the rag, ragtime, riding the cotton pony. In her book The Body Project, Joan Jacobs Brumberg depicts a fifth-grade girl in the postwar period who can’t join friends sledding because, she says, “I’m practicing Kotex.” Brumberg thinks the fact that feminine hygiene refers euphemistically to menstruation reflects the way this event has come to be treated as health-related rather than maturational. Traditional rituals of menarche have been replaced by buying one’s first sanitary napkins. One appeal of this switch, suggests Brumberg, is that it provides a neutral, quasi-professional vocabulary to use when discussing this delicate topic. Thus, the curse of Eve and the monthly blues give way to sanitary protection and menstrual health.
On the street, things are a bit different, of course. There, it’s vampire time. Old faithful’s back. Bloody Mary. Time to put my plug in. One woman calls her tampons spark plugs (as in “Gotta go change a spark plug”). Another has named her period Fred, which makes it easier to tell her husband, “Sorry, honey. Fred’s visiting.” Then there’s the moon goddess (who shows up every twenty-eight days). Technological advances have produced their own vocabulary for menstruation of course. The most up-to-date euphemism of all is rebooting the ovarian operating system.
From VD to STD
When Columbus’s sailors brought what we now call “syphilis” back from the New World, English speakers called it “Spanish pox.” This neatly combined the disease’s origins with British disdain for Spaniards. After French soldiers who besieged Naples late in the fifteenth century exported this ailment to France, it became known there as the Neapolitan disease. As Keith Allan and Kate Burridge note in Forbidden Words, Italians preferred French malady. Poles called it German disease. Polish disease was preferred by Russians. Because they believed it was imported from England, Tahitians settled on British disease. Turks termed it Christian disease; Japanese, Portuguese disease; and Portuguese, Castilian disease.
You see the trend.
The challenge of naming diseases is tied to political and ethnic rivalries. Nowhere can this be seen more clearly than in the area of sexually transmitted diseases such as the one brought to Europe by Columbus’s sailors. Their reputation for licentiousness made the French the most popular nationality of all when naming this disease, especially among the English. In Shakespeare’s All’s Well That Ends Well, Bertram infects a woman with “French Pox.” The Bard’s contemporaries also called this illness Malady of France or French gout. French crust, French distemper, French aches, and Gallic disease were other popular synonyms favored by English speakers during the Elizabethan era.
An epic poem published in 1530 by Venetian physician Girolamo Fracastoro featured a shepherd infected with “the French sickness.” His name was Syphilis. In time, the shepherd’s name was applied to the disease itself. It stuck. As the word “syphilis” took on the taint of the malady, however, vaguer terms such as special disease, social disease, secret disease, vice disease, Cupid’s disease, a certain disease, blood disease, and blood poison emerged. Doctors sometimes called syphilis specific stomach or specific ulcer. The great pox was another name bestowed on this ailment, to keep it from being confused with smallpox. Pox alone was often a euphemism for the sore-inducing malady. When Shakespeare wrote “A pox on’t” in Cymbeline, syphilis was what he had in mind.
The most generic name for such maladies was venereal disease. Before Columbus set sail, “venereal” simply meant “of Venus” and alluded to sexual matters in general. By the mid-seventeenth century, it referred more specifically to sexually transmitted diseases. Despite the spread of these diseases during World War I, and despite pressure from the Army Medical Corps, American newspapers would refer to this subject only in the most evasive terms. Even “venereal disease” was considered too suggestive for public consumption. A 1919 article in the New York Tribune discussed preventable diseases, social diseases, certain dangerous diseases, communicable diseases, and, simply, diseases. London’s News of the World subsequently used the term a certain illness when reporting on this subject. For the movie version of A Farewell to Arms (1932), British censors changed “venereal disease” to imaginary disease. As late as 1961, a line in the West Side Story song “Gee, Officer Krupke” that went “No one wants a fella with a social disease” did not make the journey from stage to screen.
A satisfactory alternative eventually presented itself in predictable form: an abbreviation. Shortening “venereal disease” to VD provided a suitably vague name for this lethal scourge. That approach came to the rescue again when “sexually transmitted disease” became STD. After an unusually virulent new form of STD appeared in the
early 1980s, the question of what to call it was complicated by the fact that this disease primarily affected homosexuals, intravenous drug users, and immigrants from Haiti. An early candidate was GRID (for gay-related immunodeficiency). In addition to being inaccurate, this acronym had a stark, ominous sound, bringing to mind gridlock or power grids. Donald Armstrong of New York’s Memorial Sloan-Kettering Cancer Center apparently was the first to suggest calling the disease AIDS, an acronym of its technical name, acquired immuno deficiency syndrome. This benign term for a deadly scourge made it an ideal euphemism. “It has an almost saintly sound,” observed David Black in The Plague Years, “as though it were the Saint Francis of epidemics.”
Medspeak
When a new strain of influenza appeared in Vera Cruz, Mexico, in 2009, the Centers for Disease Control and Prevention simply called it a “febrile respiratory illness.” Mexican flu was more popular among Americans but not Mexicans themselves. Since it apparently originated in pigs, this viral infection soon became known as swine flu. Unhappy hog farmers suggested hybrid flu as an alternative. The technically correct H1N1 was finally settled on as the least controversial option.
Abbreviations and acronyms are the quintessential modern form of euphemism for medical conditions: SARS (severe acute respiratory syndrome), GERD (gastroesophageal reflux disease), COPD (chronic obstructive pulmonary disease), etc. Cattle ranchers, understandably, would much rather we call mad cow disease MCD or, better yet, BSE, an abbreviation of bovine spongiform encephalopathy. This trend to identify maladies by initials owes a lot to pharmaceutical copywriters. An ad for Orencia refers to rheumatoid arthritis as RA. Plavix treats PAD (peripheral artery disease). Flomax is for “BPH, also known as an enlarged prostate.” (BPH actually stands for benign prostatic hyperplasia.)
Cancer is not named in such ads, of course. This word is simply too ominous. Ironically, its root is something of a euphemism or at least a metaphor. Twenty-five centuries ago, Hippocrates compared the veins snaking out from tumors to crabs, karkinos in Greek. Its Latin translation was “cancer.” That disease has supplanted tuberculosis as our most dreaded and hence most unnamable scourge. Its many euphemistic designations include the initial C. During a remission from the lung cancer that eventually killed him, swaggering John Wayne said he’d beat “the big C.” Australian linguist Kate Burridge once heard a cancer patient described as “having a touch of the c’s.” The c-word is a close cousin. The terrible sickness is a street euphemism for cancer; a long illness or a lingering illness, the obituary writer’s staple. Generically, any tumor can be called a lump, a growth, or a mass. Among medical personnel, it can be referred to as a protuberance, a neoplasm, or a carcinoma if it’s malignant. Mitotic disease or mitosis (referring to cell multiplication) has become a common medical term for what we’re hesitant to call “cancer.”
When Ulysses S. Grant died of throat cancer in 1885, his doctors characterized the ex-president’s affliction as an “inflammation of the epithelial membrane of the mouth.” Previously, they’d discussed his condition in terms of “epithelioma,” “malignancy,” and “infiltration.” Using medical lingo this way is a longtime strategy for trying to avoid alarming patients and those concerned about them. When an elderly W. B. Yeats returned to Dublin from a vacation in Spain, he carried with him a letter from his Spanish doctor to his counterpart in Ireland that read, “We have here an antique cardio-sclerotic of advanced years.” At Yeats’s insistence, his Irish doctor read him this ominous diagnosis aloud. When the doctor tried to mumble a bit, Yeats demanded that he read it again, slowly and distinctly. “After all, it’s my funeral,” said the poet. As the doctor repeated the diagnosis, Yeats rolled its key words on his tongue, keeping cadence with one finger: “cardio-sclerotic… cardio-sclerotic… cardio-sclerotic.” He then said, “Do you know, I would rather be called ‘cardio-sclerotic’ than ‘Lord of Lower Egypt’!”
Perhaps it’s clear-eyed literary types such as Yeats who are best qualified to break through the euphemistic jargon of modern medicine. Novelist Diane Johnson, whose husband is a physician, compares contemporary medspeak to the magic language shamans use when casting spells. The professional vocabulary of today’s doctors is rooted in Latin and fertilized by science, creating an aura of mystery that can be wielded strategically. In some cases, a physician might want to brace up a patient with words that sound frightening. Telling one with a mild heart murmur that he has mitral valve prolapse could help scare him straight into a healthier lifestyle. Alternatively, a doctor can use medspeak to soothe and mollify. Certainly, a little spot on your lung sounds far less menacing than “a possible tumor.”
One doctor told Johnson that he was advised to use scientific-sounding euphemisms in front of patients to keep them out of the loop. Thus, an alcoholic discussed among interns in that person’s presence would suffer from hyper-ingestation of ethynol. Syphilis can be called sigma phi, shorthand for this illness based on Greek letters. For their own convenience, and when discussing cancer around patients, doctors routinely initialize it as c.a. Initials abound in medspeak. Not just ER and OR but MI (myocardial infarction), NAD (no acute distress), LOC (loss of consciousness), and DNR (do not resuscitate). A patient is a pt, a headache an HA. Patients “brought in by ambulance” are BIBA. TLC refers to the type of palliative care given to the terminally ill. Such abbreviations don’t just save time but “are used to covertly convey confidential information in a less than confidential setting,” one doctor tells me. Thus, a physician who says, “This SOB pt complained of DOE five days PTA” simply means, “This short-of-breath patient complained of dyspnea on exertion five days prior to admission.”
Not all initials are professional code, of course. Some are a cross between slang and black humor. Before it became a popular online abbreviation, LOL was a euphemism for “little old lady” in hospital corridors. When they can’t determine what—if anything—is wrong, some doctors say a patient has TEETH (“tried everything else; try homeopathy”). Out of public earshot, medical personnel use abbreviations like FLK for “funny-looking kid” (one with an odd appearance but unspecified malady), FFFF for “female, forty, fat, and flatulent,” COP for “crotchety old patient,” and DDD— “definitely done dancing”—for those who are failing. They are PBAB, “pine box at bedside”; or GFPO, “good for parts only” (i.e., transplantable organs).
There is a stark contrast between the bland euphemisms doctors use with patients and the black-humorous ones they use among themselves. Depending on the setting, some common in-house terms include gomer for a sorry, disheveled type of patient, grume for a smelly one (from “grumous,” a medical term for coagulated liquids), groupie for emergency room regulars, and buff up for improving the appearance of a patient about to be released. (“Buff” also refers to cleaning up medical records to discourage possible lawsuits.) Other euphemisms heard in hospital corridors include code brown (fecal incontinence), wallet biopsy (checking patient’s ability to pay), and positive suitcase sign for patients who arrive at the ER with a packed suitcase, suggesting no sense of urgency on their part. To understand some of these terms, one needs to be up on dated pop-culture allusions. Zorro belly refers to a patient whose abdomen has many scars from previous surgeries. A Camille is one who continually feels on the verge of dying and lets everyone know this, loudly. A dying swan feels the same way but doesn’t make as much fuss.
In some hospitals, coded is a euphemism for “died” (“That woman in 304 coded last night”), drawing on the code nomenclature commonly used in this setting, such as “Code Blue” for heart failure. One doctor was startled to hear “demise” used as a verb when he was told that a patient had demised. Professionally speaking, doctors’ patients don’t die, they experience a negative outcome, one that might have resulted from a therapeutic misadventure. Most often, doctors, like the rest of us, simply say a patient went (“she went peacefully”) or that they’ve lost a patient. The latter led one immigrant doctor to observe how odd this seemed to him when h
e arrived in the United States: “I wanted to say, ‘Well, we didn’t really lose your husband,’ ” this oncologist told medical researcher James Sexton. “ ‘We know where he is. It’s just that he’s not breathing any more.’ ”
Through liberal use of euphemisms, doctors shield both patients and themselves from trauma. Thoughtful physicians recognize that the many evasive expressions they use for disease, dying, and death are for their own benefit as much as that of their patients. As one put it, “Euphemisms… mitigate the macabre, but more for practitioners than for patients.” Surprisingly, studies have found that physicians are more afraid of dying than the average person. It has even been suggested that studying medicine can be a counterphobic way to deal with this fear. In the words of one young doctor, “I think it is the innate fear of one’s own death that draws a person into medicine because he feels that it is as close as he can come to conquering it.” Practicing medicine gives physicians powerful tools to try, particularly a sense of scientific detachment in the face of death as well as a sanitized vocabulary to discuss this issue. In the ways they talk of dying, doctors are no less euphemistic than the rest of us.