Tuesday, January 17, 2017

2017.01.25

J. C. McKeown, Joshua M. Smith, The Hippocrates Code: Unraveling the Ancient Mysteries of Modern Medical Terminology. Indianapolis; Cambridge: Hackett Publishing Company, Inc., 2016. Pp. xxiii, 370. ISBN 9781624664649. $50.00 (pb).

Reviewed by Rebecca Fallas, Open University (Rebecca.Fallas@open.ac.uk)

Version at BMCR home site

Preview

The Hippocrates Code is a textbook designed for medical students to help them understand English medical terminology derived from ancient Greek and Latin. Learning Ancient Greek and Latin is, of course, no longer a compulsory part of medical education as it was until well into the 19th century. However, teaching ancient medical terminology as a way of understanding modern medical terms does feature in many medical schools, particularly in central Europe and the US. In the Czech Republic, for example, learning Latin medical terminology is compulsory for first year medical students.1

Whilst there are, of course, some names for bodily parts, diseases and drugs in English that do not stem from the ancient languages, the authors of this book, McKeown and Smith, suggest studies have shown that 90% of biomedical terms in English are derived from Greek, Latin or a combination of the two. Unfortunately the authors do not cite the study in question but it is certainly the case that both Greek and Latin have had an influence in medical terminology for over 2000 years and this book provides an excellent insight into this.

Although this book is aimed at medical students, the focus is very firmly on the development of medical terminology in the ancient languages. A variety of diseases and conditions that are common in modern society are discussed but, as the authors state, the focus is not on providing encyclopaedic knowledge of what a given term means so much as understanding where the word comes from. As Mckeown and Smith say 'We're classicists, not doctors!' (p.xix).

Their classical background is visible in the arrangement of the book, which is structured not by specific areas of the body or types of diseases but according to linguistic elements such as nouns, adjectives, prefixes and suffixes. Whilst textbooks aimed at teaching the Classical languages would not normally start with prefixes and suffixes, for a book aiming to help students understand modern medical terms this is a sensible structure.

In total there are 28 chapters. The first 14 chapters focus on Latin: these are followed by a further 10 chapters on Greek. The final considers other kinds of constructions, for example, terms that are produced from a combination of Greek and Latin such as appendectomy, 'cutting out the appendix', which derives from append (Latin) + ectomy (Greek).

Opting to begin the book with the Latin language and not the Greek might seem something of an anomaly considering the language of medicine throughout antiquity was primarily Greek. However, the authors acknowledge this and state this is for reasons of pedagogy because students are likely to be more familiar with terminology derived from Latin than that from Greek. I think that this is a reasonable assumption and a good reason for organising the book in this way.

Each chapter follows a similar pattern: after an introduction to the grammar covered in the chapter, there is a list of vocabulary to be learnt followed by a series of exercises. These include naming medical terms or filling in the missing part of a word from a given description and coining your own terms based on what you have learnt in the chapter.

The exercises are interesting and offer a chance to explore the languages from different points of view. The exercises in the book are complemented by those on the website that accompanies this book (Hippocratescode.com) for those who want more practice.

In addition to exercises, each chapter is complemented by another 4 sections giving background to both the languages and history. 'Word to the Wise' gives explanations of medical terms that the authors have identified as having interesting histories. Another section, 'Know Yourself', looks at a different part of the anatomical system in each chapter with details of the etymologies of the names of each part. In chapter 1 the skeleton is the focus and the authors describe how the names of bones come either indirectly or directly from Latin, for example the tibia, which means flute in Latin, being named so because of the supposed resemblance of the bone to a flute.

There are many textbooks that aim to teach medical students the principles of medical terminology. However, rather than providing a long list of words and grammar to be memorised by medical students as many textbooks do, McKeown and Smith state their approach is one that is focused on understanding how these languages work. They do this with a combination of exploring the grammar behind the languages alongside exercises to test knowledge and introducing the history of ancient medicine to put these into context.

The authors of this book correctly note that understanding Greek and Roman medicine is an important aspect of learning about medical terminology as it can help us understand how medicine has developed through time and, of course, languages do not operate in a vacuum but are influenced by the culture within which they operate. To do this, McKeown and Smith insert Hippocratic quotations at regular intervals throughout the book. These quotes tend to focus on how a doctor should behave, the doctor-patient relationship and how to diagnose a disease, with many of the quotes coming from the Hippocratic texts The Art, Precepts and On Ancient Medicine, all of which seems befitting for the audience of this book.

Each chapter closes with a section on a different disease (e.g. epilepsy in chapter 5) or area of medicine (e.g. chapter 11 covers gynaecology). Each follows the formula of a series of quotations from the ancient texts followed by a short analysis. What is particularly impressive in these sections is the wide range of sources utilised by Mckeown and Smith, which go beyond not only the Hippocratic Corpus but also the ancient medical texts. There are quotes from Galen, Soranus and Celsus, as one might expect, but also Herodotus, Xenophon and Pliny the Elder to name but a few. Of course, the analysis of these sources is by no means comprehensive and many of the nuances of ancient medicine maybe lost (for example the problems associated with the authorship and dating of many of the Hippocratic treatises) but what is offered is impressive for a textbook of this kind.

While other textbooks do offer coverage of ancient Greek and Latin grammar in order to understand modern medical terminology I have not come across any that introduce ancient medicine in anything close to the amount of detail McKeown and Smith do.2 Feeding the background of ancient medicine and some of the theories involved throughout the book not only helps make the grammar more relevant to the student but also breaks up the grammar and exercises. The sources and quotes have clearly been chosen to be relevant and interesting to the medical students who are the intended audience.

Although the emphasis of this book is on medical language, the authors note that it may be useful for students of a variety of scientific disciplines including botany, zoology, physics and astronomy. However, the audience for this book could be potentially wider than the authors suggest. Anyone studying the history of medicine in the western world will be faced with terminology stemming from ancient Greek and Latin, whether in historical texts or in the modern medical terminology applied to them. This book could, therefore, appeal to medical historians. From the point of view of a Classicist who studies ancient medicine and ancient medical terminology, I found this textbook a very interesting read. It allowed me to increase my knowledge of modern medical terms and the anatomy of parts of the body, both areas which are outside my area of research.

This is a very comprehensive textbook and offers a very detailed approach to how modern medical terms have developed from ancient Greek and Latin. It explores the theory behind different aspects of grammar and offers a wide range of exercises that suit different learning styles. The background of ancient medicine is interesting and places the language into its historical context.

One of the positives in this book is certainly the detailed approach to how English medical terms have developed from ancient Greek and Latin. However, this could also be viewed as a negative. It is a somewhat hefty book, and going through each of the chapters and associated exercises would take an awful lot of dedication and time. However, should someone wish to learn the roots of modern medical terminology in ancient Greek and Latin, this is an excellent textbook from which to do so.



Notes:


1.   There have been several studies exploring both the use and effectiveness of teaching of medical terminology through ancient languages. See for example M. Bukalkov√° (2013) 'Are the methods to use historical lexicology (etymology) in contemporary medical terminology teaching reasonable?' JAHR 4.7, pp. 469-478 and J.D. Pampush and A.J. Petto (2011) 'Familiarity with Latin and Greek anatomical terms and course performance in undergraduates' Anatomical Sciences Education 4.1. pp. 9-15. Although Bukalkov√° is quite positive about the teaching of Latin medical terminology Pampush and Petto suggest that teaching medical terminology through the teaching of ancient grammar only provides marginally better results than learning a list of terms and vocabulary.
2.   For example in C. Walker-Esbaugh, L.H. McCarthy and R.A. Sparks' (2004) book Dumore and Fleicher's Medical Terminology: Exercises in Etymology the basics of both Greek and Latin grammar are covered (the order being Greek and then Latin), followed by discussion of the various anatomical systems. However, there is no background dealing with how the language relates to the understanding of the body and the theories current in ancient medicine.

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