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A primer in the rheumatic diseases for east Tennessee
MEDICINE, SCIENCE, AND SOCIETY
A Primer in the Rheumatic Diseases for East Tennessee CHARLES
W. SIENKNECHT,
W
hen I returned to east Tennessee eight years ago after a lo-year absence, I thought I knew a lot. What I didn’t know I felt sure could be elucidated by the appropriate textbook. In extreme cases of confusion and/or ignorance, I could pick up the telephone (it used to get me in trouble-now it gets me out) and call one of my mentors. My first week in private practice was terribly disorganized, and I often resorted to the inward spoken rallying cry of “at least I know what I am doing medically.” During the second week, that bastion of selfesteem crumbled. It happened when I was interviewing for the first time a young woman from a narrow cleft of a valley between Walden’s Ridge to the east and the Cumberland Plateau to the west. People who live in this valley don’t get out of it often. Everyone there takes a pilgrimage at least once in their life to the Grand 01 Opry,butittakesa&a&ophesuchasasuddenattack of rheumatism or the ague to get them to travel the 25 twisting miles over Walden’s Ridge to Chattanooga. Such an attack of acute rheumatism had brought this young woman to see me. Her gray-blue eyes and black hair whispered of ancestors in ancient Celtic tribes. She was as pale as an Irish mist. She told me that she had had some risins and that round about those risins the skin had become pieded and that then the flaish got strutted. She said that it had hurt right smart, and she had almost gotten stoved up. She was talking but I wasn’t understanding. My mind was reeling. I guessed that risins must be localized swellings. Had she said “potted”? No, it sounded more like pieded. Oh yes, as in Pied Piper! I remembered his wonderful par&colored suit and guessed that pieded meant mottling or erythema of the skin. Stoved up I knew but strutted still baffled me. It was months later that one of the nurses
M.D.,
F.A.C.P.
at the hospital told me that it meant filled to capacky or swollen. Then the nurse had asked, with a slightly contemptuous smile, “Haven’t you ever milked a cow?” I realized that I was on very shaky ground. I lacked the basic tool of history taking. I didn’t know the language! When this young woman returned two weeks later to tell me, “Dot, the medicine ain’t holped me,” I said to myself with a superior air, “doesn’t she mean it hasn’t helped!” That was in my early days when I described this strange speech as slang. I have forgiven myself since then for that arrogant and false assessment. How could I have known that she was speaking the King’s English more perfectly than I. I have kept a record of some of the words used to describe their ailments that I have heard used by the inhabitants of the Cwmberiand Mountains and other sequestered and protected settlements in east Tennessee, north Georgia, and north Alabama where the King’s English has remained in a purer form than that taught today in ar universitii. I hops the following glossary will help someone avoid a crisis of ignorance. I realize that this glossary is incomplete, but unfortunately my Aunt Pearl died two years ago. Aunt Pearl used to accompany my mother on her nighttime obstetric missions in Windrock, Tennessee, a mining community where my mother was the only doctor. Mother was just out of medical school. Aunt Pearl was probably more important as an authority figure (she was six feet tall) than as an assistant, but she also was invaluable as an interpreter. She really knew the language, my Aunt Pearl. When my mother instructed a miner that he was not to have intercourse with his wife because of a threatening premature delivery, Aunt Pearl
From the University of Tennessee Clinical Education Center, Chattanooga, Tennessee. Requests for reprints should be addressed to Dr. Charles W. Sienknecht, Arthritis Associates, Rheumatology, Suite 404, Medical Center Plaza North, 979 East Third Street, Chattanooga, Tennessee 37403.
192
February
1985
The American
Journal
of Medlclne
Volume
79
MEDICINE,
stepped up and explained “Dr. Willson says you’re not to service Mrs. Tucker or you’ll lose the child.” For those physicians practicing in east Tennessee who don’t have access to someone with my Aunt Pearl’s knowledge, I would recommend that they obtain a copy of Dr. Samuel Johnson’s A Dictionary of the English Language. It will prove as valuable an addition to his/her library as Cecil and Loeb’s Textbook of Medicine or Kelley et al’s Textbook of Rheumatology. The first edition of this very first ever English dictionary was published in 1755, but there is a recent edition available through Folio Books Ltd. I learned of this book later than I should have, but it has proved invaluable. Without it I would never have learned that holp is the old preterit and participle passive of help. However, Dr. Samuel Johnson’s A Dictionary of the English Language does not contain all the answers. For example, I had to arrive at my own definition of pone based on common usage. Although Dr. Johnson is probably the all-time-number-one authority on the English language, still he spent most of his time in London and surely missed some words used commonly in the remote reaches of Scotland, Ireland, and Tennessee. We have been taught that the signs of inflammation-pain, swelling, warmth, and redness-were first described by the Greeks as dolor, tumor, calor, and rubor. Such teaching helps connect us with our intellectual patriarchs. But perhaps it jumps back too far without giving proper credit to the more recent contributions of the Angles, Saxons, and Celts whose description of inflammation comes down to us through the mouths of east Tennesseans as stoved, strutted, fevered, and pieded. GLOSSARY beal (v): to gather matter: to come to a head “The flaish got pieded, then it become bealed.” bloody flux (n): hemorrhagic corruption
(n): (1) the principle
diarrhea by which bodies tend to the
separation of their parts (2) putrescence (3) matter or pus “It swolled up and then I squeezed come out.”
it, all matter of corruption
fall off (v): (1) to deteriorate (2) to weaken (3) to lose weight “After leavin’ the operating table, he began to fall off.” fester (v): to form pus flalsh (n): the soft tissues of the body as opposed to the bones and joints “Dot, I don’t think it’s arthritis, it hurts all in the flaish.” flower (v): (1) to get worse (2) to flare up “When I stopped that cortisone, my arthritis Georgia
mule (n): a depressed
flowered.”
or morose person
SCIENCE,
AND
SOCIETY-SIENKNECHT
“You look like a bunch of Georgia mules eating mush.” grine (n): the depressed part where the abdomen thigh “This pain’s got me in the grine.”
joins the
groan (n): see grine holp (v): past tense form of to help “That Motrin tablet ain’t holped me.” job (v): (1) to stab (2) to have an effect like the drawing a sharp instrument “It was a sharp pain that jobbed me in the shoulder.”
In of
klndly (adi): to some degree; somewhat (see sortie) “That’s kindly touchous where you’re pokin.” lalg (n): lower extremity matter (n): purulent running: that which is formed by suppuration “That matter had suppurated and had to be lanced.” pleded (ad]]: (1) mottled in appearance colored “My laig swolled up and got pieded.”
(2) variegated;
part-
plerin (n): an ill humour such as that one causing arthritis “Those golden shots sure drove the piezln out.” poke (n): (1) sack (2) pocket, small bag (archaic) “You’ll find my medicines in the poke.” pone (n): lump, usually painful “After I hit my laig, a pone rose up on it.” possible (n): perineum “I noticed this cyst when I washed my possible.” proud flesh (also proud flalsh) (n): (1) granulation tissue (2) inflamed, swollen tissue “A week after surgery, the stitches broke and the wound opened up to show proud flaish.” “When the vessels are too lax and do not sufficiently resist the reflux of the liquid, that begets a fungus or proud flesh.” l pulse (n): purulent
material
right smart (adv): a lot; very much “It hurts right smart.” rlsin (n): (1) soft tissue swelling (2) abscess “When I squeezed that risin, some pulse come out.” scorch cloth (n): a cloth that has been burnt to the point of charring and that is believed to be beneficial in drawing out corruption service (v): to have sexual intercourse “To Thee a woman’s services are due.” (Shakespeare)
l Arbuthnot on ailments. Example taken from Samuel Johnson’s dictionary.
February 1985
The American Journal of Medlclne
Volume 78
183
MEDICINE,
SCIENCE,
AND
SOCIETY-SIENKNECHT
sortie (ad’: somewhat; sort of “My iaig’s got sortie pieded.”
tote (v): to carry “I was so stoved up they had to tote me.”
stoved up (ad]): pain or aching resulting in inability to move “The hurting started on Friday and by Sunday ha was stoved up in bed.”
touchous (adj): painful, tender, sore to touch “it’s sortie touchous to press.”
strutted (ad)): filled to capacity; swollen to maximum volume “it swoliad up and then it got strutted.” takes your eye teeth away: extremely painful
184
February
1985
The American
Journal
of Mediclne
Volume
wellup (n): localized swelling of subcutaneous tissue, wheals ACKNOWLEDGMENT I want to thank Janice Presley and Glenda Eiler for typing assistance, and my patients for their patience.
78
A Primer in the Rheumatic Diseases for East Tennessee CHARLES
W. SIENKNECHT,
W
hen I returned to east Tennessee eight years ago after a lo-year absence, I thought I knew a lot. What I didn’t know I felt sure could be elucidated by the appropriate textbook. In extreme cases of confusion and/or ignorance, I could pick up the telephone (it used to get me in trouble-now it gets me out) and call one of my mentors. My first week in private practice was terribly disorganized, and I often resorted to the inward spoken rallying cry of “at least I know what I am doing medically.” During the second week, that bastion of selfesteem crumbled. It happened when I was interviewing for the first time a young woman from a narrow cleft of a valley between Walden’s Ridge to the east and the Cumberland Plateau to the west. People who live in this valley don’t get out of it often. Everyone there takes a pilgrimage at least once in their life to the Grand 01 Opry,butittakesa&a&ophesuchasasuddenattack of rheumatism or the ague to get them to travel the 25 twisting miles over Walden’s Ridge to Chattanooga. Such an attack of acute rheumatism had brought this young woman to see me. Her gray-blue eyes and black hair whispered of ancestors in ancient Celtic tribes. She was as pale as an Irish mist. She told me that she had had some risins and that round about those risins the skin had become pieded and that then the flaish got strutted. She said that it had hurt right smart, and she had almost gotten stoved up. She was talking but I wasn’t understanding. My mind was reeling. I guessed that risins must be localized swellings. Had she said “potted”? No, it sounded more like pieded. Oh yes, as in Pied Piper! I remembered his wonderful par&colored suit and guessed that pieded meant mottling or erythema of the skin. Stoved up I knew but strutted still baffled me. It was months later that one of the nurses
M.D.,
F.A.C.P.
at the hospital told me that it meant filled to capacky or swollen. Then the nurse had asked, with a slightly contemptuous smile, “Haven’t you ever milked a cow?” I realized that I was on very shaky ground. I lacked the basic tool of history taking. I didn’t know the language! When this young woman returned two weeks later to tell me, “Dot, the medicine ain’t holped me,” I said to myself with a superior air, “doesn’t she mean it hasn’t helped!” That was in my early days when I described this strange speech as slang. I have forgiven myself since then for that arrogant and false assessment. How could I have known that she was speaking the King’s English more perfectly than I. I have kept a record of some of the words used to describe their ailments that I have heard used by the inhabitants of the Cwmberiand Mountains and other sequestered and protected settlements in east Tennessee, north Georgia, and north Alabama where the King’s English has remained in a purer form than that taught today in ar universitii. I hops the following glossary will help someone avoid a crisis of ignorance. I realize that this glossary is incomplete, but unfortunately my Aunt Pearl died two years ago. Aunt Pearl used to accompany my mother on her nighttime obstetric missions in Windrock, Tennessee, a mining community where my mother was the only doctor. Mother was just out of medical school. Aunt Pearl was probably more important as an authority figure (she was six feet tall) than as an assistant, but she also was invaluable as an interpreter. She really knew the language, my Aunt Pearl. When my mother instructed a miner that he was not to have intercourse with his wife because of a threatening premature delivery, Aunt Pearl
From the University of Tennessee Clinical Education Center, Chattanooga, Tennessee. Requests for reprints should be addressed to Dr. Charles W. Sienknecht, Arthritis Associates, Rheumatology, Suite 404, Medical Center Plaza North, 979 East Third Street, Chattanooga, Tennessee 37403.
192
February
1985
The American
Journal
of Medlclne
Volume
79
MEDICINE,
stepped up and explained “Dr. Willson says you’re not to service Mrs. Tucker or you’ll lose the child.” For those physicians practicing in east Tennessee who don’t have access to someone with my Aunt Pearl’s knowledge, I would recommend that they obtain a copy of Dr. Samuel Johnson’s A Dictionary of the English Language. It will prove as valuable an addition to his/her library as Cecil and Loeb’s Textbook of Medicine or Kelley et al’s Textbook of Rheumatology. The first edition of this very first ever English dictionary was published in 1755, but there is a recent edition available through Folio Books Ltd. I learned of this book later than I should have, but it has proved invaluable. Without it I would never have learned that holp is the old preterit and participle passive of help. However, Dr. Samuel Johnson’s A Dictionary of the English Language does not contain all the answers. For example, I had to arrive at my own definition of pone based on common usage. Although Dr. Johnson is probably the all-time-number-one authority on the English language, still he spent most of his time in London and surely missed some words used commonly in the remote reaches of Scotland, Ireland, and Tennessee. We have been taught that the signs of inflammation-pain, swelling, warmth, and redness-were first described by the Greeks as dolor, tumor, calor, and rubor. Such teaching helps connect us with our intellectual patriarchs. But perhaps it jumps back too far without giving proper credit to the more recent contributions of the Angles, Saxons, and Celts whose description of inflammation comes down to us through the mouths of east Tennesseans as stoved, strutted, fevered, and pieded. GLOSSARY beal (v): to gather matter: to come to a head “The flaish got pieded, then it become bealed.” bloody flux (n): hemorrhagic corruption
(n): (1) the principle
diarrhea by which bodies tend to the
separation of their parts (2) putrescence (3) matter or pus “It swolled up and then I squeezed come out.”
it, all matter of corruption
fall off (v): (1) to deteriorate (2) to weaken (3) to lose weight “After leavin’ the operating table, he began to fall off.” fester (v): to form pus flalsh (n): the soft tissues of the body as opposed to the bones and joints “Dot, I don’t think it’s arthritis, it hurts all in the flaish.” flower (v): (1) to get worse (2) to flare up “When I stopped that cortisone, my arthritis Georgia
mule (n): a depressed
flowered.”
or morose person
SCIENCE,
AND
SOCIETY-SIENKNECHT
“You look like a bunch of Georgia mules eating mush.” grine (n): the depressed part where the abdomen thigh “This pain’s got me in the grine.”
joins the
groan (n): see grine holp (v): past tense form of to help “That Motrin tablet ain’t holped me.” job (v): (1) to stab (2) to have an effect like the drawing a sharp instrument “It was a sharp pain that jobbed me in the shoulder.”
In of
klndly (adi): to some degree; somewhat (see sortie) “That’s kindly touchous where you’re pokin.” lalg (n): lower extremity matter (n): purulent running: that which is formed by suppuration “That matter had suppurated and had to be lanced.” pleded (ad]]: (1) mottled in appearance colored “My laig swolled up and got pieded.”
(2) variegated;
part-
plerin (n): an ill humour such as that one causing arthritis “Those golden shots sure drove the piezln out.” poke (n): (1) sack (2) pocket, small bag (archaic) “You’ll find my medicines in the poke.” pone (n): lump, usually painful “After I hit my laig, a pone rose up on it.” possible (n): perineum “I noticed this cyst when I washed my possible.” proud flesh (also proud flalsh) (n): (1) granulation tissue (2) inflamed, swollen tissue “A week after surgery, the stitches broke and the wound opened up to show proud flaish.” “When the vessels are too lax and do not sufficiently resist the reflux of the liquid, that begets a fungus or proud flesh.” l pulse (n): purulent
material
right smart (adv): a lot; very much “It hurts right smart.” rlsin (n): (1) soft tissue swelling (2) abscess “When I squeezed that risin, some pulse come out.” scorch cloth (n): a cloth that has been burnt to the point of charring and that is believed to be beneficial in drawing out corruption service (v): to have sexual intercourse “To Thee a woman’s services are due.” (Shakespeare)
l Arbuthnot on ailments. Example taken from Samuel Johnson’s dictionary.
February 1985
The American Journal of Medlclne
Volume 78
183
MEDICINE,
SCIENCE,
AND
SOCIETY-SIENKNECHT
sortie (ad’: somewhat; sort of “My iaig’s got sortie pieded.”
tote (v): to carry “I was so stoved up they had to tote me.”
stoved up (ad]): pain or aching resulting in inability to move “The hurting started on Friday and by Sunday ha was stoved up in bed.”
touchous (adj): painful, tender, sore to touch “it’s sortie touchous to press.”
strutted (ad)): filled to capacity; swollen to maximum volume “it swoliad up and then it got strutted.” takes your eye teeth away: extremely painful
184
February
1985
The American
Journal
of Mediclne
Volume
wellup (n): localized swelling of subcutaneous tissue, wheals ACKNOWLEDGMENT I want to thank Janice Presley and Glenda Eiler for typing assistance, and my patients for their patience.
78