I have tried to make my own little mark in this world. My career as a Medical Educator and Clinician in Gastroenterology (see www.gastroindia.net) and my flirtations with Health Promotion, especially amongst school children (see www.hope.org.in) are shown elsewhere.This blog contains my attempts at creative writing, most being write-ups for Health Adda column of HT City of Hindustan Times (also see www.healthaddaindia.blogspot.com) as well as a few others, and some reflections and thoughts that have struck me from time to time on my life journey.Please leave your footprint on this blog with your comment.


Friday, January 8, 2016

Food Fetish in Medical Descriptions


Strange as it may sound, doctors have an obsession for food items when describing body parts, organs or even human excrements.
It often starts with the relatively innocuous description of kidneys as bean-shaped organs and the human brain as walnut shaped, that most students of biology are familiar with.
But they soon go on to use “cafĂ©-au-lait” marks, salmon patches, and cherry red spots to describe different types of skin lesions that tell tales of diseases from a brown nevus or angioma or bleeding spots.
And when doctors, who by the way derive their professional origin from butchers, delve inside the human body while cutting up corpses during autopsy, they resort to food items to describe what they see. If the liver shows alternating red and white stripes as in early cirrhosis the description goes as “nut meg liver”. If the intestine shows a central narrowing due to a cancerous tumour, an “apple core lesion” seems to depict it best.
Familiar fruits are most commonly used to describe the size and shape of tumours and swellings: from “ berry like” small ones, to “lemon” sized bigger ones, to “orange” shaped yet bigger ones and then on to “melon” shaped large tumours. References to our familiar fruits mango and coconut are however conspicuously absent as most writers of modern medicine have been of British or American origin.
When doctors start peeping into the stomach or other organs through the endoscope, this food-based description takes yet another turn. Scattered erosions of the stomach are described as “salt and pepper”, polyps as “pea-like” and a gastric antral vascular ectasia as “water melon stomach".
“Bunch of grapes” is a common descriptive term used for large varices (dilated blood vessels) located in the stomach or rectum, while “cherry red spots” help depict if they are in imminent risk of bleeding. “Curd like” or “cheese like” white patches suggest fungal infections of the food pipe while “cauliflower” lesions depict large cancerous growths in the gut.
When an abscess forms in the liver as often happens in amoebic infection, the reddish brown liquefied content is described as “anchovy sauce”.
Radiologists are not far behind in this race. Apart from the “apple core” lesions of luminal cancers, the swollen pancreas in auto-immune pancreatitis is likened to a “sausage” and shadows in the lungs to seeds of millet to castor, depending on their size.
But the most nauseating description is of human excrements. It is “rice water” stools in cholera, “pea-soup” stools in typhoid and “currant jelly” stools in intussusception.
It could be hazardous to have a doctor over for dinner. If you see him getting too chatty with guests, make sure you keep him well away from this topic the entire evening, should you want your guests to eat well rather than retch and scamper to the wash-room when food is served.

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