Microsoft Word - Contens verjin
Armenian Folia Anglistika Linguistics
38
Metaphor through the Lens of Clinical Medicine:
The Case of Specialty-Specific Signs
Svetlana Margaryan
Yerevan Brusov State University of Languages and Social Sciences
Alina Petrosyan
Mkhitar Heratsi Yerevan State Medical University
Abstract
The present paper aims at discussing certain metaphors which name diseases
resembling specialty-specific signs manifested in different occupations. An attempt
is made towards showcasing the cognitive value that metaphor entails when used in
a clinical setting to verbalize different diseases. Stedman’s Medical Dictionary –
currently the most content-rich medical dictionary – has served a major reference
point for the analysis of specialty-specific metaphors in Medicine.
Key words: metaphor, medicine, specialty-specific signs, clinical practice,
medical agenda, chemical, physical and biological agents.
Introduction
In different periods of time the world has witnessed key advancements in
industry and technology which have in turn led to the emergence of new fields of
specializations in order to keep pace with the ever-changing reality. However, this
has also given rise to new forms of diseases which have been associated with the
activities or workings conducted within these specialty fields or occupations. These
health conditions which manifest specialty-specific signs have also been observed
in humans not exposed to particular working conditions. In furtherance, the study
of targeted medical literature has revealed that such health conditions can be
verbalized through metaphors which make reference to specialty-specific signs. In
other words, the field of specialty-specific signs serves a useful source in
borrowing the needed term to name a particular health condition in the target
domain. These borrowed terms better communicate the nature and specificities of
the disease.
As to the application of metaphor for scientific purposes, it should be stated,
that generally there are two strands of debate over the usage of metaphor in
science, one of which is organized around the conceptual theory of metaphor and
Linguistics Armenian Folia Anglistika
39
claims that metaphor is indispensable in scientific thought and understanding
(Lakoff and Johnson 2003; Richards 1936). The other strand is around the
philosophical concerns regarding metaphor considering the latter as an instrument
in the art of rhetoric (Vickers 1970; Locke 2007). This paper embraces the
conceptual approach and showcases the cognitive value of metaphor from the
clinical perspective and medical rationality coupled with succinct summary of
some of the major claims made by the school of conceptual theory.
An Outline of Conceptual Approach to Metaphor
Back in 1936 A. Richards was the first to present the cognitive theory of
metaphor and further claim that metaphor should be regarded as a constituent
component of language. In particular, Richards stated the following in “The
Philosophy of Rhetoric” (1936:92), “Even in the rigid language of the settled
sciences we do not eliminate or prevent it [i.e. metaphor] without great difficulty.
In the semi-technicalised subjects, in aesthetics, politics, sociology, ethics,
psychology, theory of language and so on, our constant chief difficulty is to
discover how we are using it and how our supposedly fixed words are shifting their
senses. In philosophy, above all, we can take no step safely without an unrelaxing
awareness of the metaphors we, and our audience, may be employing; and though
we may pretend to eschew them, we can attempt to do so only by detecting them.
And this is the more true, the more severe and abstract the philosophy is. As it
grows more abstract we think increasingly by means of metaphors that we profess
not to be relying on.”
According to Lakoff and Johnson (2003:4), metaphor “… is pervasive in
everyday life, not just in language but in thought and action. Our ordinary
conceptual system, in terms of which we both think and act, is fundamentally
metaphorical in nature.” The authors make an important claim in “Metaphors We
Live By” (2003) by arguing that metaphor forms a central component of the human
cognitive system. Another claim on metaphor by Gibbs (1994:122) states that
metaphors “not only serve as the foundation for much everyday thinking”, but also
“continue scholarly theory and practice in a variety of disciplines.”
Metaphors Doctors Act by
Doctors and clinicians follow different agendas in their routine therapeutic and
clinical practice. They may be engaged in taking histories, treating diseases,
examining and running patients, diagnosing disorders and pathologies and perform
Armenian Folia Anglistika Linguistics
40
other healthcare activities as deemed necessary in a medical setting. Whatever the
pattern of agenda, they communicate their ideas and conceptions of a particular
clinical condition through various linguistic means, and the usage of metaphors
appears to be central in such activities. Gerald Holton, Professor of Physics and
Professor of the History of Science at Harvard University, states that “in the work
of the active scientist there are not merely occasions for using metaphor, but
necessities for doing so [...] the necessity built into the process of scientific
rationality itself” (Holton 1998:236). Meanwhile, Anatole Broyard, American
writer and literary critic, claims that “Metaphors may be as necessary to illness as
they are to literature. […] At the very least, they are a relief from medical
terminology” (Broyard 1992:18). Apparently, metaphors help to transfer the
intended idea and the complex nature of a phenomenon effectively and in a time-
efficient manner. In addition, metaphors allow fulfilling certain goals in a clinical
environment: doctors may use a metaphor to make a differential diagnosis
(woolsorter’s disease, baker’s eczema, cobbler’s chest) based on findings of
radiological imaging or laboratory examination; make the clinical picture easy for
understanding (ballerina pose, clown nose, obstetrician’s hand) instead of using
long and complex definitions, and most importantly, save time which is very
precious in everyday clinical practice.
As to specialty-specific signs, usage of metaphor in such cases is also
conditioned by the sociocultural aspect of perception of these health conditions.
According to Paul Unschuld (1998:23), “The ideas of a nature of a healthy
organism, or illness, and of appropriate therapeutic interventions that develop in
medical systems […] are highly reflective of the social and physical environment
of the thinkers who developed these systems. Systems of medical ideas are,
therefore, metaphors in themselves, revealing at least as much of the world where
their authors lived, or would have preferred to live, as of what they tried to
explain.” Physicians are not isolated from the society, environment, culture,
technology and many other factors which play a central role in shaping their
understanding and interpretation of different phenomena, their experience and also
background and professional knowledge. Specifically in the case of diseases by
target organ systems activated through various infections and agents, physicians
resort to metaphors in order to clearly verbalize the underlying cause of the disease
since treatment or prevention can (in the majority of cases) be achieved if the cause
or agent of the disease is clearly identified and known. Consequently, this will
allow for an accurate diagnosis followed by a targeted route of treatment or
Linguistics Armenian Folia Anglistika
41
selection of prevention options. Hence, in this case it is through metaphor that
doctors highlight the agent of the disease, thus establishing a precise diagnosis and
selecting certain option of treatment.
Specialty-Specific Signs as Metaphors for Diseases
Exposure to different risk factors which arise from the occupation or
professional activity may lead to numerous health conditions and disorders. Quite
frequently these diseases manifest specific signs which are then attributed to the
same conditions seen in other humans who are not engaged in that particular
activity giving rise to these abnormalities. In such cases the association between
two different conceptions from different realms of knowledge plays a major role in
shaping the requisite term to name the disease. Consequently, health conditions
with resemblance to specialty-specific signs are often verbalized through
metaphors. Such signs may arise from inhaling certain chemical, physical and
biological agents and dusts as well as from performing certain type of activities
which cause skin diseases and musculoskeletal disorders. Hence, this paper is an
attempt to make a selection from the group of such distinctions and study those
diseases which are named through metaphors based on association of resemblance
of a specialty-specific sign.
As Sisakyan states, inhalation of airborne and mineral dusts can cause lung
diseases, in particular (Sisakyan, Ayvazyan 2011). These dusts are later deposited
in the lungs thus affecting them and causing severe damage. One of such
conditions is metaphorically named woolsorter’s disease, which is a pulmonary
infection acquired by inhalation of dust containing “Bacillus anthracis.” Typical
signs include initial chill followed by pain in the back and legs, rapid respiration,
cough, fever, rapid pulse, and extreme cardiovascular collapse. This disease is also
known by series of synonyms such as ragpicker’s disease, rag sorters’ disease or
woolsorter’s pneumonia. Similar diseases are flax-dresser’s disease, which is a
chronic obstructive pulmonary condition caused by inhalation of particles of
unprocessed flax; and weaver’s cough – the term for cough, dyspnea, and sense of
constriction of the chest, caused by mildewed yarn.
Quite interesting appears to be the case of legionnaire’s disease where the
etiology of the disease and the etymology of the metaphoric naming are
interrelated. According to various research sources and scientific data (World
Health Organization; Mayo Clinic, Diseases and Conditions; Skinner1949) this is a
severe form of bacterial pneumonia or a serious lung inflammation which is usually
Armenian Folia Anglistika Linguistics
42
caused by infection. The agent of this infection is the bacterium widely known as
“Legionella pneumophila” (“pneumophila” meaning “lung-loving” from Greek
pneum n (lung), and phila (friendship) or philos (dear) denoting “fondness,
especially an abnormal love for a specified thing” (Oxford Dictionaries) which was
first identified after an outbreak of severe pneumonia in 1976 among participants
of convention of the American Legion (U.S. military veterans’ organisation) in
Philadelphia (World Health Organization). According to key facts provided by the
WHO, inhalation of contaminated aerosols through air conditioning and similar
systems is the most common mode of Legionnaires’ disease transmission. The
breakdown of the name of this disease shows that the Legionella refers to the
legionnaires infected at the Philadelphia convention.
Certain health conditions widely observed in general public relate to skin
diseases as a result of exposure to various exogenous agents. For instance, fair-
skinned, blue-eyed persons are prone to experience dry, wrinkled skin if they are
exposed by occupation or sport to sunshine for prolonged periods and over many
years. This skin condition is called golfer’s skin and is also known as sailor’s skin
or farmer’s skin. Another metaphor which permeates the field of forensic medicine
relates to swelling of the skin tissue as a result of being immersed in water. These
changes are referred to as washerwoman’s changes or washerwoman syndrome in
which the skin absorbs a great amount of water. This triggers skin proteins to
increase in length followed by enlargement of the skin being folded up and
wrinkled. People engaged in sporting activities may also experience skin
conditions one of which is widely known as athlete’s foot. This is a fungal
infection of the skin between the toes and on the plantar surface of the foot which
is commonly seen in athletes since the bacteria causing this skin condition mostly
survives in dark, moist and warm environments usually around the swimming
pools, bathrooms and locker rooms used by athletes. Reaction to flour, yeast, or
other substances may cause a skin disease called baker’s eczema which describes
an allergic eruption on the hands and arms. It mostly occurs among bakers, though
can well be observed in people not involved in baking. It can also happen due to
the grain itch mite leading the disease to be also known as baker’s itch. Skin
conditions can occur not only due to a certain reaction to a particular agent but also
due to some insects, for example, body lice. It can inhabit the skin tissue and cause
pigmentation or discoloration if the skin has long been exposed to uncleanliness as
a result of not maintaining proper hygiene. This skin condition is named
Linguistics Armenian Folia Anglistika
43
vagabond’s disease or vagrant’s disease and is mostly seen in people who have an
allergic reaction to louse bites.
Among musculoskeletal disorders numerous descriptions of fractures or
malformations of upper and lower limbs can be found. One of them is called clay
shoveler’s fracture which is a fracture through the spinous process of a lower
cervical vertebra or upper thoracic vertebrae. The etymology of the disease dates
back to 1930s when men digging deep ditches in Australia tossed clay ten, twelve
or even fifteen feet above their heads using long-handled shovels. This sticky clay
didn’t separate from the shovel and sticking to the instrument it added greater
weight and posed hazard to the health of the worker. The clinical picture was as
follows: sudden pain between the shoulders and then inability to continue the work.
Hence, the term started to be widely applied in medicine and currently is also used
with reference to similar fractures among workers engaged in shoveling other
materials or employed in occupations which require lifting weight (with upper
extremities stretched) and throwing it above over a certain distance (Hall, Perth &
Australia 1940). Another condition is connected with the fracture of the neck of a
metacarpal bone in the hand. Typically, these are the metacarpal bones which
connect the bones in the fingers to the wrist. The metaphor which is used to name
this fracture is boxer’s fracture. People are likely to sustain such fractures when
punching an object or mechanism. Consequently, the name derives from this
specific activity of punching or striking an immovable or hard object (for example,
a wall) with unprotected fist. Hence, any metacarpal fracture is referred to as
boxer’s fracture by most clinicians and pathologists (WebMD).
People are likely to sustain injuries in the lower extremities as well. One of such
injuries is called dancer’s fracture which is an avulsion fracture caused by twisting
injury to the ankle and foot. In this case a small fragment of bone is pulled away
from the rest of the bone by a strong ligament (O’Malley, Hamilton & Munyak
1996). Typically, this is a break of the long bone on the outside of the foot. The
name may derive from the widespread perception that dancers may be prone to
numerous fractures and injuries of foot, ankle and feet bones due to the dancing
practices and performances.
Another metaphor denoting abnormalities connected with feet and anatomical
parts of the feet is called dancer’s heel. It describes a bony formation at the back of
the ankle. This affects the posterior of the ankle and prevents from performing
certain movements (Midwest Orthopaedics at Rush). Another condition affecting
the foot is known as dancer’s foot malformation which refers to a vigorous
Armenian Folia Anglistika Linguistics
44
posteromedial contraction of the left ventricle coupled with convexity anteriorly
sometimes resulting from poor contraction of the opposing anterior wall.
Resembling a ballerina’s foot this condition is also called ballerina foot. Repetitive
activities of running, jumping, climbing, or kicking can also cause a condition
known as jumper knee which describes a patellar or quadriceps tendonitis in feet.
Some other conditions related to lower extremities are known as a rider’s leg
which describes a strain of the adductor muscles of the thigh; and a tennis leg
which is a rupture of the gastrocnemius muscle at the musculotendinous junction,
resulting from forcible contractions of the calf muscles. The latter is often seen in
tennis players due to frequent quick stopping and starting movements.
Certain diseases are associated with the position or stance of human bodies. In
particular, the disease called ballerina’s pose is a type of cerebral palsy
characterized by congenital spastic paralysis of the upper and lower extremities. In
children it is described as a neurological disorder due to the impairment of the
brain. In this case both the arms and legs are abnormally stiff; limbs are in a
vertical position with the child’s head dropped to the chest. This clinical picture
forms a ballerina’s pose. This condition was first observed by Dr. William John
Little (1810 - 1894) who was himself suffering from a certain congenital deformity
afflicting his left foot (Pearce 1988). In forensic medicine the metaphor pugilistic
attitude or pugilistic stance describes a “defensive” position likened to the posture
adopted by pugilists-boxers found in severely burned bodies. It is characterized by
flexion of elbows, knees, hip, and neck, and clenching of hand into a fist. Another
position called fencing position or fencing response is a peculiar position of the
upper extremities, namely, a position assumed by the arms following a concussion
of head and injured hemispheres of the brain. This condition resembles the position
taken to initiate fencing in which one arm is extended and the other is raised.
Certain target organs may be affected as a result of various causative agents.
Thus, people may be diagnosed with what doctors call a cobbler’s chest. This is a
congenital deformity of the anterior wall of the chest and produces a distinctly
sunken chest seen in cobblers due to sitting in a certain position over a continued
period. The movements of the head of a human body may as well bear
abnormalities one of which is widely known as bishop’s nod. This is a rhythmic
bobbing or nodding of the head in synchrony with the heartbeat in aortic
regurgitation and aortic aneurysm.
Hands can manifest signs of medical conditions one of which is likened to the
position of the obstetrician’s hand when examining the female genitals. It is
Linguistics Armenian Folia Anglistika
45
therefore called obstetrician’s hand or hand of the obstetrician. This condition is
associated with tetany and is characterized with extension of the hand at the
metacarpophalangeal and interphalangeal joints, and adduction of the thumb. In
other words, the hand contracts and assumes cramped posture, flexed at the wrist
with fingers at the metacarpophalangeal joints and extended at the interphalangeal
joints; meanwhile the thumb is strongly flexed against the palm.
Ear tissue can be diagnosed with certain conditions one of which is identified as
boxer’s ear in which thickening and induration of the auricle is observed with
distortion of its contours. An infection to the outer ear canal, which runs from the
eardrum to the outside of the head is known as swimmer’s ear. This is an
inflammation of the external auditory canal and is caused by bacteria commonly
found in water and soil. People usually experience swimmer’s ear when water
remains in ears after swimming since this creates the most beneficial moist
environment triggering bacterial growth. One more metaphor characterizes a
reddish-brown bulge involving the tip of the nose. This is a condition known as
clown nose which reminds of the fake red nose clowns usually wear during their
performances (Colletti et al 2014). Another condition with the nose tissue is
metaphorically named toper’s nose which describes enlargement (hypertrophy) of
the nose. Increased vascularity of the nose skin and follicular dilation is observed
followed by multiple red-coloured bumps on the nose. This condition is said to be
associated with excessive consumption of alcoholic beverages and is also known as
rum nose, rum-blossom or brandy nose. Alcohol consumption also impacts the
caution measures exercised by people employed as gardeners. They are said to
suffer from alcoholic rose gardener syndrome since they show less concern for
caution measures and infections and to the skin abrasions. Such condition is
commonly seen among alcoholics working as gardeners who have increased skin
abrasions, and the metaphor alcoholic rose gardener syndrome is used to verbalize
chronic mycosis and the above mentioned behaviour among them.
This list of metaphors can be characterized as comprising multiple expressions.
However, this paper is not aimed at a comprehensive study of metaphors in
medical discourse since that would require a lot of time and multifaceted medical
literature. It should, nevertheless, be mentioned, that the listed metaphors
succinctly communicate disease configurations and allow doctors to explain a
particular clinical condition in a time-efficient manner and help to make the clinical
picture of a disease easily recognizable based on associations of notions from
different realms of knowledge.
Armenian Folia Anglistika Linguistics
46
Conclusion
Given the statements above, it can be concluded that the metaphor facilitates the
understanding of certain specialty-specific signs. In particular, it fosters clarity and
saves time in communicating the intended idea in a more economic manner.
Nowadays medical literature is replete with papers and research on specialty-
specific signs and descriptions of certain diseases and disorders which are quite
frequently verbalized through metaphors. In such cases the metaphor serves as a
cognitive device since it is accurate in the description of signs, causative agent and
the outline of the disease. In addition, the usage of the metaphor justifies certain
patterns of agenda doctors follow: they are precise and unambiguous and allow
establishing a differential diagnosis thus helping to quickly proceed to the
prevention and treatment of various diseases and pathologies which showcase
specialty-specific signs.
References:
1. American Lung Association, Lung Health & Diseases, Pneumoconiosis.
Available at: [Accessed June 2016].
2. Avetisyan, A.G. (2007) Latineren-angleren-ruseren-hayeren bzhshkakan
bararan. Yerevani M. Heratsu anvan petakan bzhshkakan hamalsaran. Yerevan:
Heghinakayin hratarakutyun.
3. BONES. Foot and Ankle Injuries in Dancers – Midwest Orthopaedics at Rush.
Available at:
[Accessed August 2016].
4. Broyard, A. (1992) Intoxicated by My Illness: and Other Writings on Life and
Death. New York: C. Potter.
5. Centers for Disease Control and Prevention. Available at:
[Accessed July 2016].
6. Colletti, G.; Allevi, F.; Moneghini, L.; & Palvarini, M. (2014) Clown Nose: A
Case of Disfiguring Nodular Squamous Cell Carcinoma of the Face. Case
Reports, 2014 (Jan30/2). doi: 10.1136/bcr-2013-200471.
7. Davis, F.A. (2016) Taber’s Quick Reference for Rehabilitation Professionals.
Publisher: F.A. Davis.
8. Gibbs, R.W. (1994) The Poetics of Mind: Figurative Thought, Language, and
Understanding. Cambridge: CUP.
Linguistics Armenian Folia Anglistika
47
9. Holton, G.J. (1998) The Advancement of Science, and Its Burdens: With a New
Introduction. Cambridge, MA: Harvard University Press.
10. Lakoff, G.; Johnson, M. (2003) Metaphors We Live By. London: The
University of Chicago Press.
11. (2007) Legionella and the Prevention of Legionellosis. // World Health
Organization. / Ed. by J. Bartram, Y. Chartier, J.V Lee, K. Pond and S.
Surman-Lee. WHO Library Cataloguing-in-Publication Data. Available at:
[Accessed August 2016].
12. Legionellosis, Fact Sheet. / World Health Organization. Available at:
[Accessed July 2016].
13. Locke, J. (2007) An Essay Concerning Human Understanding. Book III:
Words. Available at:
[Accessed September 2016].
14. McKellar Hall, R.D. (1940) Clay-Shoveler’s Fracture. Archive, 22(1), pp. 63-
75. Available at: [Accessed July 2016].
15. Mayo Clinic, Diseases and Conditions, Legionnaires’ Disease. Available at:
[Accessed July 2016].
16. Nerkin hivandutyunneri propedevtika. (2011) Usumnakan dzernark. / Khmb. –
H.S. Sisakyan, A.A. Ayvazyan. Yerevan: Yerevani M. Heratsu anvan petakan
bzhshkakan hamalsarani hratarak.
17. O’Malley, M.J.; Hamilton, W.G. & Munyak, J. (1996) Fractures of the Distal
Shaft of the Fifth Metatarsal: Dancer’s Fracture. // The American Journal of
Sports Medicine, 24(2), pp. 240-243. doi:10.1177/036354659602400223.
18. Oxford Dictionaries. Available at: [Accessed July 2016].
19. Richards, I.A. (1936) The Philosophy of Rhetoric. Oxford: OUP.
20. Segen, J.C. (1992) The Dictionary of Modern Medicine. Carnforth, Lancs,
UK: Parthenon Pub. Group.
21. Skinner, H.A. (1949) The Origin of Medical Terms. Baltimore: Williams &
Wilkins Co
22. Stedman’s Online Medical Dictionary. Available at: ,
[Accessed September 2016].
23. Unschuld, P.U. (1998) Forgotten Traditions of Ancient Chinese Medicine.
Brookline, MA, USA: Paradigm Publications.
Armenian Folia Anglistika Linguistics
48
24. Vickers, B. (1970) Classical Rhetoric in English Poetry. London: Macmillan
and Co.
25. Tufenkjian, K., & Lüders, H.O. (2012) Seizure Semiology: Its Value and
Limitations in Localizing the Epileptogenic Zone. // Journal of Clinical
Neurology (Seoul, Korea), 8(4): pp. 243-250. Available at: [Accessed July 2016].
26. Pearce, J. (1988) Little’s Disease. // Journal of Neurology, Neurosurgery, and
Psychiatry, 51(12), p.1593. Available at:
[Accessed July
2016].
27. WebMD. Available at: [Accessed July 2016].
28. World Health Organization. Available at: [Accessed July 2016].
öá˳ »ñáõÃÛáõÝÝ»ñÁ ÏÉÇÝÇÏ³Ï³Ý ÅßÏáõÃÛ³Ý ï»ë³ÝÏÛáõÝÇó.
Ù³ëݳ·Çï³Ï³Ý Ýß³ÝÝ»ñÇ ßáõñç
êáõÛÝ Ñá¹í³ÍÁ ùÝÝáõÙ ¿ ÷á˳ »ñáõÃÛáõÝÝ»ñÇ ³ÛÝ ß³ñùÁ, áñáÝù ³Ýí³-
ÝáõÙ »Ý ÑÇí³Ý¹áõÃÛáõÝÝ»ñ` Ù³ëݳ·Çï³Ï³Ý áñ¨¿ ·áñÍáõÝ»áõÃÛ³ÝÁ ѳïáõÏ
Ýß³ÝÝ»ñÇ Ñ³Ù³ÝÙ³ÝáõÃÛ³Ù : öáñÓ ¿ ³ñí»É í»ñ Ñ³Ý»É ÷á˳ »ñáõÃÛ³Ý
׳ݳãáÕ³Ï³Ý ³ñÅ»ùÁ, áñÁ ¹ñë¨áñíáõÙ ¿ ³Ûë ÑÇí³Ý¹áõÃÛáõÝÝ»ñÇ ÏÉÇÝÇϳ-
Ï³Ý Ýß³ÝÝ»ñÇ ³éϳ۳óÙ³Ý å³ñ³·³ÛáõÙ: лﳽáïáõÃÛ³Ý ³é³ÝÛáõÃÁ
í»ñóí³Í ¿ áí³Ý¹³Ï³ÛÇÝ ³éáõÙáí ·»ñѳ·»ó³Í ³ß˳ïáõÃÛáõÝÇó êﻹ-
Ù³ÝÇ ³ñ¹Ç ÅßÏ³Ï³Ý ³é³ñ³ÝÇó: