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A taste of medicine: When food has other meanings…

food in medicine

Food imagery ideal for teaching doctors…who must have strong stomachs!

From ‘beer belly’ to ‘port wine stain’, food imagery has a long history of being used in medicine to identify the diagnostic features of a wide range of conditions and ailments, says pathologist Dr Ritu Lakhtakia, in Medical Humanities.

The helpful visual and diagnostic clues food provides are ideal for enhancing doctors’ understanding of disease and are part of a tradition that is worth celebrating, despite its admittedly European bias, she says.

In a gastronomic tour of some of the many food descriptors used in medicine, the author highlights imagery such as ‘anchovy sauce’ to describe the pus from a liver abscess, through ‘sago spleen’ to indicate protein (amyloid) deposits, to ‘oat cell carcinoma,’ which describes the appearance of a highly aggressive form of lung cancer.

Mushrooms and cauliflowers also describe types of tumours that can grow in the gastrointestinal tract, while the root of the word cancer is from the crab owing to its crab-like grip and infiltration into surrounding tissues along many fronts.

Dairy products feature prominently in the medical lexicon: ‘milk patch’ describes the appearance of healed inflamed membranes surrounding the heart (rheumatic pericarditis), while café au lait describes the tell-tale skin pigmentation of von Recklinghausen’s disease – a genetic disorder characterised by nerve tumours. And ‘egg shell crackling’ denotes the grating sound indicative of the bone tumour ameloblastoma.

Candida (thrush) infection is commonly described as curd-like or having a cottage cheese appearance.  When two well-buttered slices of bread are pulled apart, the resultant shaggy appearance of the buttered surfaces generates the phrase bread and butter for fibrinous pericarditis, a heart condition.

Chocolate also makes an appearance with chocolate cysts of the ovaries to describe cysts containing dark-brown fluid caused by endometriosis.

Fruit is also popular, as in ‘apple’ or ‘pear’ shape to describe the appearance of fat distribution around the body, or ‘strawberry cervix’ which indicates inflammation in the neck of the womb brought about by Trichomonas infection.

Water melon, oranges, currant jelly, grapes, and cherry all find their way into visual clues for a range of conditions.

Long before scale measurements came into vogue, a three-dimensional estimate of the size of tumours could be easily documented by being compared with peanuts or walnuts. If larger, lemons or oranges also came in handy for sizing!

Breakfast food is common too. A ‘croissant’ appearance in a cell nucleus is indicative of a benign growth on peripheral nerves. Similarly, a ‘blueberry muffin’ rash is characteristic of congenital rubella, while the appearance of a red blood cell is referred to as ‘doughnut’ shaped.

There’s even a reference to an entire dish, as a skin condition called tinea versicolor is denoted by its ‘spaghetti and meatball’ appearance.

Dr Lakhtakia,  suggests that food descriptors reflect a basic human need for survival, or perhaps the fact that many medical practitioners are forced to grab their meals on the job.

cheeseBut doctors must have strong stomachs, she says. “It is a wonder that, in the midst of the smells and sights of human affliction, a physician has the stomach to think of food at all,” she suggests.

She does admit though that “the delights of the cheese counter at the delicatessen have been changed forever for me!”

But she adds: “These time honoured allusions have been, and will continue to be, a lively learning inducement for generations of budding physicians.”

Source: BMJ Medical Humanities Twist of taste: gastronomic allusions in medicine Online First doi 10.1136/medhum-2014-010522 Dr Ritu Lakhtakia, Department of Pathology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman Pub: 9th July 2014

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