MARGARITA KAY
LEXEMIC CHANGE
AND SEMANTIC
SHIFT
IN D I S E A S E N A M E S
ABSTRACT. The lexicon of illness terms used by Mexican American women is affected by the practice of speaking both Spanish and English and by the coexistence of several health systems. When there is changing participation in various health systems, with increasing interference and code switching, linguistic evidence for these changes may be found. In some cases an English disease name is borrowed. In others, a cognate is coined from an English disease name. Some terms, now no longer useful, are dropped. Finally, some Spanish disease names which do not have equivalents in English or in scientific medical theory may be retained, but there is a shift in the meaning of the words themselves. The direction of the shift is towards semantic correspondence with the concepts of scientific medicine. In these ways the medical lexicon is changed, with the changes reflecting a new medical culture. Illness is a frequent topic for discussion among Mexican American women. When housewives meet taking their children to the school bus or sitting at the laundromat, when they telephone their mothers, or go to their sisters to borrow masa ('dough') for tortillas, they talk about their worries. They speak of the passing ailments that make their children cross, the incapacitating diseases that prevent a breadwinner from working, and the disorders that are the result of careless habits. Their conversations range from an infant disease that struck suddenly in the night and caused lights to go on in the house across the street to the progress o f chronic disability in an aged grandmother. But when these same women talk with practitioners o f official medicine, they have little to say. What they do say m a y be misunderstood. Even in the rare event that patient and practitioner share the same language, there may be confusion. This inadequate communication affects health care profoundly, for the practitioner cannot obtain an adequate history, while the patient cannot understand either the diagnosis or the therapeutic regime. The health care provider may recognize the unsatisfactory" nature o f these encounters and seek to improve them by reading ethnographies (Samora 1961; Clark 1959; Madsen 1964; and Rubel 1966) or attending lectures on 'the' Mexican American. Such education should improve communication, but may only confound it. As pointed out by Chrisman (1977), anthropological research has tended to obscure the heterogeneity o f health beliefs in folk medicine. There are few discussions o f social a n d cultural variability within a group. The ethnographic literature that is well known appears to present stereotypes, giving little mention of diversity. Culture as an organization o f diversity with nonsharing o f cognitive features expected (Wallace 1970; Pelto and Pelto 1975) is rarely understood by health care providers. Moreover, most studies o f folk medicine are synchronic, with the exact ethnographic present
6klture, Medicine and Psychiatry 3 (1979) 73-94. 0165-005X/79/0031-007352.20. Copyright © 1979 by D. Reidel Publishing Co., Dordrecht, Holland, and Boston, U.S.A.
74
MARGARITA KAY
inadequately specified. Folk diseases are assumed to be changeless. Traditional people are expected to 'believe in' folk diseases, with denial of such beliefs a mark of 'acculturation.' The following essay is a discussion of a speech community of Mexican American women, the words that are used when women discuss illness, the sources of their lexicon of illness terms, changes in the meanings of these words, and factors which have influenced these changes. My point of view, which does not dispute the idea that many Mexican Americans share a distinctive folk medicine, suggests that lexemic change and semantic shift obscure the nature and variation of this folk medicine. THE SPEECH COMMUNITY Linguistic informants were women who lived in one barrio ('Mexican neighborhood'). This barrio was selected because it was a locus of the traditional life style of Mexican Americans in Tucson, Arizona. It was the home of several generations who had originally crossed the border from Sonora, Mexico, to settle and farm during the territorial period of Arizona. Some of these women cultivated vegetable gardens or fed domestic animals, so the barrio continued to look like northwest Mexico, to which it had once belonged, rather than looking like a part of the urban American city it now is. The principal informants came from four families who lived in this barrio. They were grandmothers, mothers, daughters, sisters, sisters-in-law, or cousins to each other. They often strengthened this relationship by naming each other godmother to their children in various ritual events such as baptism, confirmation, marriage and after cure from illness. The women ranged in age from 19 to 78 years, and had spent from two to ten years in school, in Mexico or the United States. They married men who also varied in age, generation removed from Mexico and educational attainment. The men were construction laborers whose incomes placed them just above poverty, as federally defined, when they were employed. These families participated in several health systems, seeking the assistance of Mexican curanderos ('folk healers'), Yaqui (migrant Mexican Indian) bru]os ('Witches') and Black folk healers, as well as both official and marginal practitioners of scientific Western medicine on both sides of the U. S.-Mexican border. Thus, these women illustrate the potential variance that exists within perhaps the most stable and homogeneous barrio in Tucson. Chrisman (1977) has suggested the concept of insularity, the degree to which one restricts networks of social relationships, as one explanation of the health seeking process. Insularity may also explain how people talk about disease. Although each family has a car or pick-up truck, and uses it regularly for grocery shopping or taking a child to well baby Clinic, the women are enclaved in a small
LEXEMIC CHANGE IN DISEASE NAMES
75
community. The outside world intrudes via the Spanish language radio stations and the mostly English television programs. The women reach out rather rarely, for domestic duties in their society with rigid sex role prescriptions leave little time. Their friends are their neighbors. THE CODE The women are speakers of a variant of Spanish which Barker (1972) designated as Southern Arizona Spanish, noting that it derives from the Spanish that is spoken by people of northwest Mexico, Nortefios, and that it retains some archaic Spanish forms while it is also influenced by English in verb endings and plural forms. The disease vocabulary is similarly influenced by archaic Spanish, on the one hand, and English on the other, as we shall see. There is a difference in the Spanish used by recent migrants and by American-born women in this barrio. Mexican women who attended Mexican elementary school speak more standard Spanish and have larger Spanish vocabularies. Barrio-born women have had no training in reading or writing Spanish, and speak very apologetically about their linguistic competence. Nevertheless, the women are able to communicate efficiently and effectively with one another. Weinreich (1963:69) states that the speech of bilinguals is usually colored by one language. In the speech community under discussion, the dominant language is Spanish, but there are varying degrees of interference. The most extreme is the oscillating shift from one language to the other, producing a mixed utterance style of speech that is called "code-switching" (Gumperz 1969). An example comes from a third-generation American: Las anginas get to the point that se hinchan y uno no puede swallow, mientras que no estan infected.
('The tonsils get to the point that they swell, and one cannot swallow even though they are not infected.') Older, Mexican-born women use the fewest English words, and younger, American-born women mix their utterances regularly. Their English is also affected by phonetic and morphemic interference. 'The eyes got swallowed,' is intended to say: 'My eyes were swollen.' Similarly, the women 'drink' pills, for in Spanish tomar ('drink') is used for the ingestion of both solids and liquids. The effect of code switching and discomfort in two languages is to make the women laconic when talking to the doctor. They answer questions with an unqualified 'yes' or 'no'. Later, they may overhear someone saying, "Oh, she
Seasonal Hay fever Catarrh Cold Allergy
Throat spasm Eye tremor Nerve pain Air in the heart
Del tiempo /Jey fiver/
Catarro Resfriado Alergia
(del cam bio)
Frio de la garganta
Temblor de o]o Dolor de nervio Aire en el coraz6n
1.12 1.121
1.122 1.123 1.124
1.13
1.131
1.132 1.133 1.134
Physical illness Temporary Of Childhood Teething Whooping cough Mumps Pox 3 day measles
Enf. del Cuerpo Temporal Juvenil Denticibn Tosferina La Chanza Viruela Sarampi6n de 3 dias
1. 1.1 1.11 1.111 1.112 1.113 1.114 1.115
English n a m e
Spanish name
Number
+
+
+ + + +
+ +
+
+ +
+
+ + +
+
+ +
+ +
General features
+ +
+
+ +
+
++ ++++~ +++÷
+ +
Class features
TABLE I T a x o n o m i c key to enfermedad
+ + +
+
÷ + w+
g
Malaise following rapid environmental change. Sudden pain in throat after drinking ice water. Muscles surrounding eye twitch. Stabbing pain in various places. Stabbing pains in the heart.
Occurs at certain times o f year. Red itching eyes and pain in bone under eyes. R u n n y nose. Bones acheRonchas, 'hives.'
Affects body. Cannot be avoided. Affects children. Sore germs, m u c h saliva. 'Very bad' cough. Prominent swellings of neck and jaw. Itching blisters on body. Red rash which disappears quickly.
Defining features
Weak blood Boil Sore Abscess Decayed t o o t h Pinkeye Injury Nosebleed Infected scratch Infected w o u n d Infected cut Burn Broken bone Displacement Sprain Digestive disorders Chronic indigestion Heartburn Inadequate digestion Attack of gas Hangover Dirty s t o m a c h Serious illness Painful illness
Enf. benigna Simple Anginas Jaqueca
Sangre dhbil Grano enterrado Llaga Postemilla Muela podrida Mal de o]o Lastimada Sangreada de la nariz Rasgu~a infectada Herida infectada Cortada infectada Quemadura Quebrado de un hueso Descompostura
Torcedura Malestares Dispepsia cronica Acedfas Falta de digestion Ataque de viento Crudo Puerco del estomago
Enfermedad grave Enfermed. dolorosa
1.2 1.21 1.211 1.212
1.213 1.214 1.215 1.216 1.218 1.219 1.22 1.221 1.222
1.226 1.23 1.231 1.232 1.233 1.234 1.235 1.236
1.3 1.31
1.223 1.224 1.226
Attack of gas
Ataque de viento
1.137 Mild illness Simple Tonsillitis Migraine
Stitches Rheumatism
Punzadas R e~ma
1.135 1.136
+
4-
+
+
+
+ +
+
+
+ +
4.
+
+
+
+ +
4-
+
+ + +
+ +
+ +
+
+ +
+
+
+ + +
+ 4+ + + 4-
Serious, possibly fatal. Pain.
(Or w o u n d or cut). Skin is red, burned. Palpable break or alteration in shape. Pain in affected joint, something o u t of place. Swelling with pain in affected joint. Ingestion of disagreeing food. Frequently occurring indigestion. Sour taste. Feeling of fullness. Pressure on chest relieved by belching. Follows too m u c h alcohol. Constipation with nausea.
Yields to uncomplicated treatment. Mild pain or discomfort. Sore throat, swollen tonsils. Head hurts in one part. Black spots in vision. Lack of red cells in the blood. + Hard red lesion below surface of skin. + Skin lesion with pus. + Lesion is located in the gums. T o o t h ache, decay is often visible. Eye is red, sore and crusted in morning. Specific episode. Bleeding from the nose. Scratch has red and painful edges.
Sticking pains, especially in eye. Aching of bones or joints, especially fingers. Pain in chest relieved by belching.
Maledades Mal de ritlbn Bilis
1.311
Epidemic disease Measles Poliomyelitis Meningitis Hepatitis Malaria Diphtheria
Mal. de andanc ia Sarampion malo Polio Meningitis Hepatitis Paludismo Difteria
Maledades Mexieanas Empacho
1.312 1.3121 1.3122 1.3123 1.3!24 1.3125 1.3126
1.313
1.3131
1.3118
Intestinal (Ileus) infection
Earache Heart disease Heart attack Stroke Cancer Leukemia Internal tumors Malignant wound Liver disease
Maladies Kidney disease 'Bile'
English name
Dolor de oMo Mal de coraz6n Ataquealcoraz6n /estrok/ Cancer Leucemia Tumores internas Cancer de herida Mal. de Higado
1.311.4 1.3115 1.3116 1.3117
1.3113
1.3111 1.3112
Spanish name
Number
Table 1 (continued).
+
+
4-
4-
+
+
+
+
+
+
4-
+
+
-I+
+
+
+
-I-
-I-
4-
-I-
+
-I-
4-
+
4-
-I-
4-
General features
4-
+
+
4-
4-
+
+
4-
4-
4-
4-
Class features
Taxonomic key to enfermedad
+
+
+
+
+
4-
4-
+
4-
+
Not recognized by Anglo doctors. Mildew on affected fecal particles.
• No appetite, cramps.
Wide variety of symptoms, portmanteaux category. Contagious. + Severe headache.
Sudden death. Numbness of one side of body, "clots'. (Depends on type).
Painful, frequent or unable to urinate. Severe pain in abdomen and chest with anger. Atr in ear.
Defining features
Griping Infection Severe cramps
Bronchitis Venereal disease Chronic disease Inherited disease Diabetes
Pu]o Pasmo
Cblicos
Piedras e n d vedculo Ulceras gastr[ticas quemantes heridas Apendicitis Pardsitos Mal de ijar Fdo del vientre (Consequencias} Almorranas Roto de la aldilla Desombligado Insolaeidn Pulmonia Sinusitis (Catarro constipado } Bronquitis Enf. ven&eas
Enf. cr6nica Enf. hereditaria Diabetis
1.3135 1.3136
1.314
1.3141
1.32 1.321 1.3211
1.3157 1.3158
1.3143 1.3144 1.3134 1.3146 1.315 1.3151 1.3151 1.3153 1.3154 1.3155 1.3156
+ +
+ +
+
+
+
+
+
+
+ + +
+
+ +
+ +
+ +
+ + +
Biliary stones + Ulcers stomach burning wound Appendicitis Parasites + Flank pain + Inflammation of the belly + Consequences Hemorrhoids Hernia of groin Umbilical hernia Sunstroke + + Pneumonia + + Sinusitis
Emaciation Locked intestines
Latido Tripa ida
1.3133 1.3134
1.3142
(Dehydration)
Ca[da de la mollera
1,3132
+
+
+
+ +
+ +
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Does n o t appear suddenly. Comes from family inheritance. Sugar in t h e urine.
Yellow m u c u s f r o m nose. Headache. Difficult breathing. + Follows extra-marital affairs.
Illness follows unwise action. Very painful anus. Swelling of groin. Swelling of navel, no other features. Episode of absorbing too m u c h sun. Painful breathing.
Continuous pain in lower part of a b d o m e n . Worms come out o f anus or even m o u t h . Pain in lower a b d o m e n comes and goes.
Stomach pulse is visible, no appetite, extreme thinness. Severe constipation after frightening experience. A b d o m i n a l cramps, m a y have m u c u s or blood in excrement. Swelling and redness at affected place, rash around it. Pain in abdomen. Stones shown after X-ray or operation. Pain in m o u t h of stomach. 3 subtypes differ in degree o f pain.
Swollen belly, great thirst. Cannot suck, eyes fall back in head, palate feels lumpy.
English name
Enlarged heart Weak heart Large kidney High (blood) pres= Sequential diseases Arthritis Deforming arthritis Dry rheumatism (Sciatica) Severe anemia Tuberculosis Convulsions Asthma Severe constipation
Spanish name
Coraz6ngrande Coraz6nd~bil Rihon grande Alta presion
Sobrevenidera Artritis Artritis que tuerza Refimaseca
Anemia aguda
Tuberculosis
Alfereda
Asrna
Peritonitis
Number
1.3212 1.3213 1.3214 1.3215
1.322 1.3221 1.3222 1.3223
1.3224
1.3225
1.3226
1.3227
1.3228
+
+
+
+
+
+
+
+
+
+
+ +
+
+
+
+
4-
+
+
+
+
Class features
+
+
4- 44- + 4- + 44-
General features
Table 1 (continued). Taxonomic key to entermedad
44-
Follows after recovery from high fever (neglected sarampi6n). Choking, suffocating with breathing (neglected hay fever). No bowel movement.
anemia).
Like sangre debil except that vigorous treatment is now required. Blue ear lobes and finger tips (neglected
Comes from neglecting other enfermedad. Body aches at times of weather change. Specific places are twisted (neglected pasmo). Pain moves down the leg (neglected rekma).
Progressive exhaustion. Heart beats too much. Sufferer needs artificial kidney. Dizziness and headache.
Defining features
Mental disease Derangements F r o m a blow Amnesia Craziness F r o m a shock Hysteria Nervous breakdown F r o m thinking Pressure Anxiety Witchcraft Evileye Bewitchment Envy Hereditary Idiocy Epilepsy
Enfermedad Emocional
Enfermedad mental Trastornos (degolpe) Amnesia Locura de susto Histeria AtaquedeNervios
(depensar) Congo]a Tirisia
Daaos
Malo]o
Hechicerfa Envidia
Enf. hereditaria lnocencia Epilepsia
2.
2.1 2.11 2.111 2.1111 2.1112 2.112 2.1121 2.1122
2.113
2.1132
2.12
2.121
2.122 2.123
2A3 2.131 2.132
2.1131
Emotional disease
Spanish name
Number
English name
T A B L E II
+
+
+
+
+
+ + +
+
+ +
+ +
+ +
+
+ + + +
+ +
General features
+
+ +
+
+ + + +
+ +
4-
+
+
+
=
Class features
Taxonomic key to enfermedad metal
+
+
+
+
+
+
+
4-
+ +
Similar behavior has occurred in family line. Various degrees of mental retardation. Convulsions not related to any illness.
Wide variety of physical symptoms persist despite treatment. Eyes are sunken, severe headache following encounter with admiring stranger. Physical symptoms after unfaithfulness. Physical illness result of others' envy.
Involuntary mental effects. Behavior uncontrollable. Result of blow to head or injury. Victim does not know identity. Irrational actions, Result of sudden fright. Heavy and sore in neck, uncontrollable crying. Intensification of hysteria plus swelling over left chest. Victim is preoccupied with worries. Shortness of breath, feeling of pressure. Sorrowful wan face, no appetite.
Affects emotions or nerves.
Defining features
Uncontrolled emotions
Emociones mal controladas Cora/e Celos Envidia Debilidaddel caracter Alcoholismo Cleptomania Gorduramala Vfcios Mari/uanero Drogadicto
2.21
*Class features not known.
Rage Jealousy Envy Weakness of character Alcoholism Kleptomania Overweight Vices User of marijuana User of drugs
Moral disease
Enfermedad moral
2.2
2.211 2.212 2.213 2.22 2.221 *2.222 2.223 2.23 "2.231 *2.232
English name
Spanish name
Number
+
+
÷
+
+
+
+
+
-I-
+
~ O
.~q
+
.~
÷
+
Class features
~.~ ~
General features
T A B L E III Taxonomic key to enfermedad moral
•
~.~
Affects character. Individual wants to be bad or has no willpower. Normal responses are allowed to get out of control. Anger grows to fury, then mania. Envy of another's attributes or status. Envy of another's possessions. Succumbs to temptations. Regular drinking bouts until drunk. Compulsive stealing habit. 'Bad' fatness. Incorrigible or hardened character. Smoking of marijuana. Taking narcotic pills and injections.
Defining features
LEXEMIC CHANGE IN DISEASE NAMES
83
knows more English than she lets on". Such remarks further discourage communication.
DATA COLLECTION Words were learned by informal and formal methods. Informally, words were collected during observations or participations in conversations about illness. When a disease name was mentioned, those conversing would be asked what it meant. Sometimes there were arguments about the 'correct' meaning. Another source of terms was telephone conversations between comrades ('ritual kin') concerning what the doctor said when mother was driven to the doctor. Procuring medicinal herbs from the drug store or herberia ('herb store') or collecting them in the monte or chaparral provided more terms, as well as discussions of medicinal contents of kitchen or bathroom cabinets. The formal method was the linguistic procedures of ethnoscience.lThese techniques rest on the fundamental assumption that words encode specific combinations of features of meaning, and that such combinations contrast at different levels of abstraction. These levels may be arranged hierarchically, forming a taxonomy. At the highest level of its taxonomy, the domain enfermedad ('illness' or 'disease') is divided into two kinds, disease of the body and disease of the mind. There are two kinds of mental disease, emotional and moral. Physical disease is partitioned into temporary, mild and grave categories. At the species level of the taxonomy, the actual disease names are located. This level is based on unique aggregates of symptoms as the features which define each disease name or lexeme. The women's principles of classification are ultimately based on therapy. The general partitioning of disease is illustrated in Table I, Taxonomic Key to Enfermedad and Table II, Taxonomic Key to Enfermedad Metal and Table III, Taxonomic Key to Enfermedad Moral. The information is presented in a matrix form, modeled after a botanical key, with a numerical system like that conventionally used by linguists. After the taxonomic number, the Spanish term for the disease is given, followed by an English gloss. Next, each general feature of disease and class feature of type is listed in a column, with the presence of the feature in any given disease noted by a + mark. Finally, there is a succinct statement of defining features After the list of disease names was compiled (Kay 1972, 1977a, 1977c), it was submitted to another group of women for replication or redefinition. These other informants were Mexican American women of the same social class encountered at a neighborhood health center where they were employed as
84
MARGARITA KAY
health workers. They were given a written test in which they were asked to define Mexican disease names, cures, and curers. There has been disenchantment (Micklin, Durbin and Leon 1975; Kay 1977b) with limiting data collection to formal methods alone, without attending to situational circumstances. In this case, variations occurred depending upon experience with an illness, age of informant, age of those dependent upon her care, and recency of migration. 2 As pointed out by D'Andrade (1972, 1976), the linguist learns highly idiosyncratic classifications and features with this method. The taxonomic key represents consensus, and when there was disagreement about definition, informants would generally choose the statements of the older and more experienced women among themselves. As Friedrich (1976 : 32) states, "in any given society sharing a language, most people understand each other's messages most of the time." The concepts of cognitive non-sharing and intracultural diversity make neither ethnosemantic research nor dictionary definition invalid, but rather serve to keep the ethnoscientist and lexicographer either cautious or unpublished. DISEASE NAMING Diseases are commonly named by the symptom, such as pain, rash, or limitation of function. Examples are dolor de oido ('earache'), co]o ('lame'), tos retina ('whooping cough', literally 'fierce cough'). Or, the disease may be named by the alleged cause: susto ('fright'), insolaci6n ('sunstroke'), sangre debil ('weak blood'). Naming by symptom or cause has a long tradition everywhere in the labeling of disease. But today, scientific nosology emphasizes etiology rather than symptoms. This change contributes further to poor commun cation between patient and physician. Spanish and English words for disease share the same etymology. Many words are thus cognates, deriving from the same Latin and Greek words, and having a long history in western medical diagnosis. The dominant or official medical system always used Latin or Greek disease names. When Arabs were the intermediaries for medical knowledge, they reintroduced Latin and Hellenic expressions (Lapesa 1968 : 102-110). Amnesia, histeria, asma, and c6lico are the names of a few conditions that have been identified since antiquity. Barrio dwellers also speak of catarro, reuma, cancer, fdcera, diabetes, artritis, and epilepsia. The shared tradition is continued by the introduction of new words with Latin roots, both in English and ha Spanish. As Lapesa (1968 : 286) has noted, technological progress in science and technology has created the need for new words. With the designation of a new disease, or with new understanding of a pathological process, neologisms are frequently created from Latin or Greek roots. Thus, in the barr/o, animalitos ('little animals') ,as disease agents have given
LEXEMIC CHANGE IN DISEASE NAMES
85
way to vfruses ('viruses') and microbios ('microbes')which are treated by antibi6ticos ('antibiotics'). When disease names have been learned in settings of official scientific medicine, where English is spoken, English words are used in the mixed utterance. Thus: Dicen que es a viY-rus, not Dicen que es un virus. ('They say it is a virus.')
Some disease names employ the same metaphor in Spanish and English. For example, the term punzadas and its gloss 'stitches' both call attention to a particular sensation of pain by likening its localization to the stabs of a needle and thread. The Spanish word aced[as signals the same type of gastric discomfort as the English 'heart burn.' Ampolla, like its equivalent 'blister' calls on the image of an air bubble (although the etymology is not common knowledge of either Spanish or" English speakers). In enfermedades que andan ('epidemic diseases', literally 'diseases that go around') one sees the same Horseman of the Apocalypse, moving from one place to another. The private experience of pain is often similarly labeled in both languages, for example, ardor ('burning') and adormido ('asleep', as in numbness). VARIATION Each informant has her own reportoire of disease lexemes, related to her own experiences. The mother of young children knows the names of childhood diseases, and lists dentici6n ('teething'), la chanza ('mumps'), sarampi6n ('measles'), tosferina ('whooping cough'), polio ('polio'), while old women list four kinds of artritis ('arthritis') including sidtica and reuma seca. Natives of the barrio rarely know the names of parasitic diseases, which are uncommon in this area. But women who have come from tropical Mexico will talk about paludismo ('malaria') and lombrices ('worms'). Just as the content of the lexicon is related to experience, word choice depends upon the setting in which the disease is diagnosed. If an infant is born in an American hospital with a congenital deformity, such as 'congenital hip', only the English word is known. Some disease terms are known only by older informants. Enconoso ('infected'), although part of the ethnomedicine of northern New Mexico, is unknown to most young informants in Tucson. It seems likely that enconoso is no longer functional since the cognate, infectado is a word that is reinforced daily when women hear about infections and their treatment on television and radio. On the other hand, tiricia ('anxiety'), which is an equally archaic term, is
86
MARGARITA KAY
retained in Tucson, even by young informants. Tiricia is a useful term because there is no other to encode the emotions experienced by the toddler who is inconsolable because his mother seems to have vanished. There is a scientific term in English that glosses the same idea, 'separation anxiety', but this term has not found its way into common usage for the barrio women to hear. Certain archaic anatomical terms are used to describe disease. There are words from animal anatomy. Gaznate ('windpipe') and pata ('hoof') are more commonly used than the scientifically proper traquea ('trachea'), or pie ('foot'), as is vientre ('belly') instead of abdomen ('abdomen'). If the scientific term has been learned in a hospital setting, it may not even be noted that the same anatomical part is referred to in the two lexemes. In the context of medical conversations, code switching then seems to be an example of what Haugen (1961:402) calls coordinate bilingualism. In the taxonomy of illness vocabulary it is notable that Spanish words are used for mild diseases, treated at home, and English words or their Spanish scientific cognates are used for grave, or serious disorders treated by a special practitioner, either a doctor of official medicine or a person who occupies one of several statuses of folk healer. Code-switching may occur because one word may be known in Spanish and another only in English. Jey fiver ('hay fever') has a Spanish gloss, fiebre de heno. The Spanish term, however, is never used in the barrio, even by Mexican migrants. This is a diagnosis that is used to explain the symptoms of runny nose and sneezing only within the last two decades, and has only slowly worked its way into popular health culture. Thus
Tengo /ey fiver, not Tengo fiebre de heno. ('I have hay fever'.) MEXICAN DISEASES Scattered thoughout the taxonomy of disease names are labels which do not have equivalents in English. Most are grouped together in a category known in the barrio as 'Mexican disease', and so classified together because they all share one feature - official medicine does not recognize them.
Los m~dicos no creen en mollera. ('Doctors don't believe in mollera.') The diseases include bilis ('bile'), daho ('harm' caused by witchcraft),envidia ('envy'), mollera cafda ('fallen soft spot'), empacho ('intestinal infection'), fr{o de la matriz ('sterility', literally 'cold womb'), pasmo ('spasm'), latido ('cachexia', literally 'beat'),aIferecfa ('convulsions that follow febrile illness'), pu]os ('gripings'), mal o]o ('evil eye'), insolacirn ('sunstroke'), and entablazrn
LEXEMIC CHANGE IN DISEASE NAMES
87
('intestinal obstruction'). Most of these diseases have been noted in the many studies of Mexican and Mexican American illness beliefs (Clark 1959; Samora 1961; Madzen 1964; Rubel 1966; Foster 1967). They appear not to have English counterparts. These words are used in daily conversation, together with labels for conditions such as 'cold', 'allergy', 'heart attack', and other diseases that are readily translatable between the two languages (although the reciprocal terms may not necessarily encode the same features), and indicate a common tradition of illness concepts. Why do these words for Mexican diseases remain in the lexicon of people who participate in official scientific medicine? Folk etymology traces these diseases and their treatments to Indians. Mexican American activists, who prefer the term Chicanos, believe that the Aztecs were the source of superior medical knowledge, and that this culture has been preserved in oral tradition by Indians. But also informants reared in Mexico who identify with the middle class believe that this folk medicine originated with Indians. These women tell how Indians "come down from the mountains" with herbs to sell on village or city market days or at religious fiestas. The packaged herbs are labeled 'para el bills' ('for bilis'), 'rihon' ('kidney'), etc. Such herb lots eventually are repackaged in plastic zip-lock bags with pharmaceutical labels. Both Chicanos and middle class Mexican women are misinformed. These Mexican disease names were once part of the corpus of scientific nosology of the Spaniards and other Europeans, not the Indians. All these disease terms and their descriptions can be found in a medical text, the Florilegio Medicinal (Kay 1976) written by a German (Moravian) Jesuit lay brother in 1711 to guide the medical care of Indians and Spaniards for all of northwest Mexico, when the territory included what is now southwestern U. S. A. I believe that Mexican nosology before Cort6s has been hopelessly confused because the Spanish data in accounts purporting to present preconquest medicine such as the Florentine Codex (Dibble and Anderson 1961) and the Badianus Codex (del Pozo 1964)were too contaminated by the medical theory of its sixteenth century investigators. 3 Moreover, bills, pasmo, moUera caida, etc., can be found in European texts o f the fifteenth and sixteenth centuries. However, it is true that these concepts have been preserved in insular or enclaved groups, to be resurrected for political reasons by Chicanos. For they recognize as does Rubel (1960) that disease is an aspect of life that helps perpetuate Mexican American culture as a unique entity. In many cases, lexical changes have not caught up with changes in medical culture. As has been pointed out by Friedrich (1967), social change precedes lexical change. Participation in official medicine has occurred only when there was economic access to this care. Friedrich (1967:32), suggests that "fundamental changes in any basic social institution should be reflected within a generation or two by correspondingly fundamental changes in the semantic
88
MARGARITA KAY
system." The Mexican American women that were interviewed showed much variation in their medical ideolects, as discussed above. This variance may be explained by differential participation in official scientific medicine, leading to differential acculturation to its concepts. SEMANTIC CHANGE Basso (1967:471) states "acculturation involves changes in cultural content which in turn may be reflected in shifts in the meaning of words." The mechanisms of semantic change have been condensed into three processes by which a lexicon may adjust to new ideas, and which may also occur without a precipitating cause in non-linguistic culture (Greenberg, Osgood, Saporta 1965). There are: (1) borrowing, or coining of new terms, (2) obsolescence and subsequent dropping of lexemes, and (3) semantic extension or shift of meaning. The first, borrowing or coining of new terms, has been applied above in the discussion of Latin and Greek neologisms in scientific disease names. The process operates at the lay level as well. Thus, Mexican American women suffer from sinusitis ('sinusitis'), or require calmantes ('tranquilizers') for nervios ('nerves'). A second adjustment of the vocabulary may be made by the dropping of old terms. Some informants failed to recognize the names of 'Mexican diseases', and others denied these conditions. They dropped words such as 'witchcraft' and 'evil eye' from their individual vocabularies, or classified them as either 'curious' or 'dangerous' superstitions. These are individuals who have comparatively higher levels of education and are unwilling to identify themselves with folk medicine. Many are third generation Americans whose parents rejected ethnomedicine themselves and did not enculturate their children to its concepts. Most were not found among the families living in the barrio but rather among the health professionals at the neighborhood health center that was the source for replicating disease names. Mexican American activists, as discussed above, are attempting to reverse the process and add these 'Mexican' disease terms as part of their search for their culture. The most interesting change, however, has been a shift in the meanings of the words themselves. 4 The same lexemes are used, but they do not mean the same things. They are terms which, in Kany's (1960:8) words, "although outwardly appearing intact have shifted their semantic values." Some label conditions that are no longer considered diseases. This includes emotional disorders. For most of my informants, envidia ('envy') is not a disease. It is not a form of witchcraft unconsciously inflicted on the sufferer as it is for Rubel's (1966) informants. Envidia is simply a word that is synonymous with celos ('jealousy'), and indicates poor mental habits which are widespread but not seriously pathological. If it causes illness, the disease is a condition in the individual who feels this emotion, not one that is projected on to the one who is envied.
LEXEMIC CHANGE IN DISEASE NAMES
89
Meaning shifts may be described using the figures of speech of traditional rhetoric, hyperbole, elevation, degradation, etc. A few disease lexemes have shifted meaning from the concrete to the abstract, as Bloomfield predicted (quoted in Ullman 1966). Aire, identified by Madsen (1964) among others as 'a volitional wind causing disease', is now defined as 'gas' especially in the intestines or around the heart. The new definition returns the meaning back to the way aire was identified in the 1711 manuscript cited above. Fiebre ('fever'), was a disease classification which grouped daily, intermittent, tertian or quartan fevers, all specific diseases. Now fiebre is seen as a feature of many, if not most diseases. Susto ('fright') is hyperbole now. Formerly a great shock which was also an illness, the present meaning is only an 'unpleasant surprise,' at most, 'trauma'. Empacho, a disease 'caused' by the adherence of undigested food in the gastrointestinal tract which then molds, is firmly 'believed in' by all informants. But for many, empacho has become a more Serious version of 'irregularity' ('constipation') featured in television commercials. Thus, empacho has degenerated in meaning. Bilis ('bile') has been elevated to scientific status so that its gloss is more appropriately 'disease of the ball bladder.' Since ancient times the emotion of anger has been seen as the stimulus for releasing bile by the gall bladder. Official medicine denies this cause today. Barrio women say that bilis viene de cora]e ('bile comes from anger'), as always. But today they state that the condition is treated by removal of the affected organ, or decreasing its dietary stimulation, exactly the position of scientific medicine. Similarly, mollera ca[da ('fallen soft spot') is moving toward legitimization as the scientific condition of dehydration. Mollera is recognized as a disease of infancy characterized by fever, vomiting and poor sucking, with the depression of the soft spot or fontanelle at the crown of the head as the distinctive feature. Informants note that while practitioners of official medicine who have heard of the concept vigorously attack its magical cure by curanderos ('folk healers'), these same scientific doctors will still measure the soft spot and check its elevation when an infant has fever and diarrhea. The curanderos themselves urge that the infants be taken to doctors of Western medicine for treatment of the diarrhea and fever, reserving for themselves the magical formulae that will elevate the 'fallen' fontanelle. Three conditions that go back to the Bible have had different fates in the barrrio. Daho ('witchcraft') and mal ojo ('evil eye') have been impervious to meaning change from scientific medicine, for these are not diseases that would be brought to a medical doctor, or are last resorts in folk diagnosis to be used when explanations from scientific medicine fail. On the other hand, fr[o de la matriz ('sterility') caused by transgressions of rules of hygiene after childbirth
90
MARGARITA KAY
such as the interdiction of bathing until forty days had elapsed, has not stood up to proof. It was difficult for women who deliver in the hospital to avoid forced acculturation by attendants whose identity is the bath. These women then found no problem with subsequent fertility, and so discarded frfo. The field theory of semantic change (Kany 1960:11; Basso 1967:473; Ullman 1966) suggests that rather than analyze the single lexeme, meaning change should be considered in an entire domain against a comprehensive background of social structure and function. We have also seen that semantic changes in disease lexemes appear to have been precipitated by exposure to Western medicine, both the official practice of science and folk medicine of the mass media. Official contacts occur through participation in clinics and offices of Western, scientific medicine. Folk concepts of the dominant systems are learned via television or radio. Some terms are retained or relearned by those who reject the dominant system, or those who have no access to it. The result for these bilinguals is a vocabulary of disease terms that reflects both linguistic and cultural interference. It also suggests that cognitions of illness occur in a single unified theory, that the disease names do not represent compartmentalized participation in different health systems. It supports the possibility of a single semantic system, perhaps different from the semantic system of either Mexicans of Americans, as hypothesized by Young (1973). The model of lexical change and semantic shift demonstrated for Mexican American Spanish illness terms can be applied to English disease names, too. As with American Spanish, the American English category of arthritis has new meanings. For example, gout has narrowed in meaning from subsuming all arthritis to one specific type. Lumbago as a type of arthritis is now known only to elderly people, and rheumatism has degenerated from a scientific to a lay term. Changes have occurred in all classes of disease. Brain fever has been deleted, remembered only by students of nineteenth-century novels. Acid indigestion has become a folk disease, leaving the Merck Manual for the television, screen. Flu, a disease name which was once derived from influenza, has changed from a specific bacterial infection to a vague virus. Its meaning has broadened to include various syndromes. Thus flu may mean an upper respiratory infection or a gastro-intestinal infection. The latter may be subdivided into stomach flu and intlestinalflu by some English speakers. There are some regional differences in ascribing distinctive attributes, but these are unstable in our mobile society. Lexemic change and semantic shift in any language thus have implications for health care. For the practitioner who wishes to share responsibility with his or her client, this study offers exciting prospects, for it suggests communications which are dialogues for diagnosis rather than one-sided imperatives. The practi-
LEXEMIC CHANGE IN DISEASE NAMES
91
tioner may find certain questions used by linguists helpful in obtaining a medical history. He or she may say, "There are different facts about bilis (pasmo, mollera, artntis, etc.). Tell me your thoughts about this condition. In your case, what caused it? What do you think would be the best treatment?". If the patient's explanation differs from that of official medicine, the practitioner may convey the idea of semantic shift, saying, "That is what we used to mean when we said - - , but the term today means - ". The intracultural variation in disease concepts may thus be decreased to manageable levels. Using the concepts of lexemic change and semantic shift requires that the health care provider respect his client in the same way that the anthropologist values his informant, as an expert. We may also gain a better understanding of health seeking behavior and compliance with a therapeutic regime when we attend to the meanings that are attached to disease labels. In the system of the Mexican Americans whom I have described above, diseases are classified according to treatment. Thus diseases categorized as 'temporary' will receive no therapy, those classed as 'mild' are referred to experienced older women, and 'serious' illnesses are referred to curing specialists. For the informants of this study, disease concepts today are usually more congruous with categories of Western medicine than with traditional folk ideas. But folk medicine remains as an alternative that is very useful to dissatisfied or desperate clients. The physician of Western medicine may assume that he or she is the only curer consulted when a patient is brought suffering from what might be labeled as 'dehydration,' 'cholecystitis,' or 'gastroenteritis' instead of mollera caida, bilis and empacho. However, the patient may be simultaneously consulting one or more curers. For example, one child, who was being seen for abdominal pain, went through the Western scientific diagnos~ tic categories of parasites, malignancy and finally school phobia, but was alse having procedures to rule out empacho, mal o]o, and histerica or frio de la matriz by curanderas, one of whom finally diagnosed hechiceria ('witchcraft'). Her patient care (the case is summarized in Stafford 1978)might not have been nearly so lengthy if medical history taking had included these linguistic techniques earlier. The excellent command of English shown by her mother, a third generation Mexican American, distracted practitioners from considering her use of alternative systems. Finally, when asked directly about consulting folk healers, the child's mother gave a complete history, for she was questioned in a respectful and interested manner. Her doctors in turn were pleased that they could discontinue expensive and painful diagnostic workups. The opposite situation has also occurred. When a monolingual Spanish speaking woman asked about her infant's mollera, it was assumed that she wanted to sign her baby out of the hospital to obtain magical treatment. In fact, the
92
M A R G A R I T A KAY
m o t h e r was s i m p l y s e e k i n g i n f o r m a t i o n f r o m t h e nurses a b o u t t h e r a p y t h a t was b e i n g a d m i n i s t e r e d t h r o u g h a scalp vein. T h u s , l e x e m i c c h a n g e a n d s e m a n t i c s h i f t and their intracultural variations should be dealt with whenever a medical h i s t o r y is t a k e n .
College of Nursing, The Unh,ersity of Arizona ACKNOWLEDGMENTS D a t a were g a t h e r e d w h i l e t h e w r i t e r was a Special Nurse P r e d o c t o r a l fellow 4 F O - N U - 2 7 , 1 3 4 - 0 5 . This p a p e r was w r i t t e n w i t h U S P H S R O 2 N U 0 0 3 5 8 - 0 3 NPC s u p p o r t , a n d t h e e n c o u r a g e m e n t o f J a c o b O r n s t e i n a n d William Mackey,
NOTES 1 Question frames included: Is X a disease? Is X a disease of Y class or Z class? Why? How does X start? A full treatment of the resuRant taxonomy with key is given in Kay 1972. 2 Statistical techniques ranging from simple frequency tabulations, Chi-square analyses, Guttmann scaling and BC-Try cluster analysis resulted in a certain degree of over-kill, and some rather surprising findings, too. The most significant association was found between age and adherence to ethnomedicine. Women over 50 recognized a greater number of traditional disease names, significant at the 0.01 level. The association between generation removed from Mexico and number of Mexican disease names was not quite as great, with the association significant at the 0.02 level. Monolingualism in Spanish was not a strong predictor of Mexican disease name recognition, for the young immigrants from Mexico know only a few more of these names than their American-born age mates. Finally, consanguinal kinswomen had better correspondence in their use of Mexican disease names than affinal kinswomen, but only when age was held constant. 3 See Kelly (1965) and Ortiz de Montallano (1975) for discussions of the influence of European disease concepts on early colonial Aztec medicine. 4 This section has been adapted in part from Kay, Health and illness in a Mexican American Barrio, In Ethnic Medicine in the Southwest, Edward H. Spicer, ed., pp. 164-165. Tuscon: University of Arizona Press, 1977.
REFERENCES Anderson, A. J. O. and Dibble, C. E. 1 9 5 0 - 1 9 6 9 Florentine Codex, General History of the Things of New Spain, Salt Lake City: University of Utah Press. Barker, George C. 1972 Social Functions of Language in a Mexican American Community. Anthropological Papers of the University of Arizona, Number 22. Tucson, Arizona. Basso, Keith H. 1967 Semantic aspects of linguistic acculturation. American Anthropologist 69:471. Chrisman, Noel J. 1977 The health seeking process: an approach to the natural history of illness. Culture, Medicine and Psychiatry 1 : 351 - 377.
LEXEMIC C H A N G E IN D I S E A S E N A M E S
93
Clark, Margaret 1959 Health in the Mexican American culture. Berkeley and Los Angeles: University of California Press. D'Andrade, R., Quinn, N., Nerlov, S. B. and Romney, A. K. 1972 Categories of disease in American English and Mexican-Spanish. In Multidimensional Scaling: Theory and Applications in the Behavioural Science Vol. II: Applications, A. K. Romney et al. (eds.). New York: Seminar Press. D'Andrade, R. G. 1976 A propositional analysis of U.S. American reliefs about illness. In Meaning in Anthropology, Keith H. Basso and Henry A. Selby, eds. Albuquerque: The University of New Mexico Press, School of American Research Advanced Siminar Series. del Pozo, E. C. ed. 1964 Martin del la Cruz' LibeUus de Medicinalibus Indorum Herbis. Mexico City. IMSS. Esteyneffer, Juan de 1711 Florilegio Medicinal. Mexico. Foster, George C. 1967 Tzintzuntzan. Mexican Peasants in a Changing World. Boston: Little, Brown and Company. Friedrich, Patti 1967 The linguistic reflex of social changes from Isarist to Soviet Russian kinship. In Explorations in Sociolinguistics. S. Lieberson, ed. Indiana University Research Center in Anthropology, Folklore and Linguistics Publishers. Number 44. Greenberg, Joseph, Osgood, Charles and Saporta, Sol. 1965 Language change. In Psycholinguistics. Charles E. Osgood and Thomas A. Sebeok, eds. Bloomington: University of Indiana Press. Gumperz, John and Hernandez, Edward. 1969 Cognitive aspects of bilingual communication. Working Paper Number 28, Language-Behavior Research Laboratory. Berkeley: University of California. Haugen, Einer 1961 The bilingual individual. In Psycholinguistics. S. Saporta, ed. New York: Holt, Rinehart and Winston. Kany, Charles E. 1960 American-Spanish Semantics. Berkeley and Los Angeles: University of California Press. Kay, Margarita Artschwager 1972 Health and Illness in the Barrio: Women's Point of View. Dissertation for the Ph.D. University of Arizona, Tucson. 1976 The Fusion of Utoaztecan and European ethnogynecology in the Florilegio Medicinal. Proceedings XLI International Congress of Americanists. III 323-330. 1977a Southwestern Medical Dictionary, Spanish-English, English-Spanish. Tucson: University of Arizona Press. 1977b Mexican American Fertility Regulation. In Communicating Nursing Research M. Batey ed. 10: 278-295. Boulder, Colorado: Western Interstate Commission for Higher Education. 1977c Health and illness in a Mexican American Barrio. In Ethnic Medicine in the Southwest, E. H. Spicer ed. p. 124. Tucson: University of Arizona Press. Kelly, Isabel 1965 Folk Practices in North Mexico. Austin: University of Texas Press. Lapesa, Rafael 1968 Historia de la Lengua Espanola. Septima Edition. Madrid. Escelicer, S. A. Madsen, William 1964 The Mexican Americans of South Texas. New York: Holt, Rinehart and Winston.
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Micklin, Michael, Durbin, Marshall and Leon, Carlos A. 1974 The lexicon for madness in a Columbian city. American Ethnologist 1 : 143-156, Pelto, Pertti and Pelto, Gretel H. 1975 Intraeultural diversity: some theoretical issues. American Ethnologist 2 : 1 - 1 8 . Rubel, Arthur 1960 Concepts of disease in Mexican American culture. American Anthropologist 62 (5) : 7 9 5 - 8 1 5 . 1966 Across the Tracks: Mexican Americans in a Texas City. Austin: University of Texas Press. Samora, Julian 1961 Conceptions of health and disease among Spanish Americans. American Catholic Sociological Review XXII (4) : 3 1 4 - 3 2 3 . Stafford, Anita M. 1978 The application of clinical anthropology to medical practice: case study of recurrent abdominal pain in a preadolescent Mexican-American Female. In E. Bauwens, ed. The Anthropology of Health. St Louis: C. V. Mosby. Ullman, Stephen 1966 Semantic universals. In Universals of Language, Second Edition. Joseph Greenberg, ed. Cambridge: M. I. T. Press. Wallace, Anthony F. C. 1970 Culture and personality. 2nd edition. New York: Randon House. Weinreich, Uriel 1963 Languages in contact. The Hague: Mouton Press. Young, Rodney W. 1973 The Question of Linguistic Deficiency in the Bilingual Setting. Paper presented to Symposium on the Education of Mexican Americans, Society for Applied Anthropology, University of Arizona at Tucson, April 1 2 - 1 4 .
(Final revised version received 14 October, 1978)
LEXEMIC CHANGE
AND SEMANTIC
SHIFT
IN D I S E A S E N A M E S
ABSTRACT. The lexicon of illness terms used by Mexican American women is affected by the practice of speaking both Spanish and English and by the coexistence of several health systems. When there is changing participation in various health systems, with increasing interference and code switching, linguistic evidence for these changes may be found. In some cases an English disease name is borrowed. In others, a cognate is coined from an English disease name. Some terms, now no longer useful, are dropped. Finally, some Spanish disease names which do not have equivalents in English or in scientific medical theory may be retained, but there is a shift in the meaning of the words themselves. The direction of the shift is towards semantic correspondence with the concepts of scientific medicine. In these ways the medical lexicon is changed, with the changes reflecting a new medical culture. Illness is a frequent topic for discussion among Mexican American women. When housewives meet taking their children to the school bus or sitting at the laundromat, when they telephone their mothers, or go to their sisters to borrow masa ('dough') for tortillas, they talk about their worries. They speak of the passing ailments that make their children cross, the incapacitating diseases that prevent a breadwinner from working, and the disorders that are the result of careless habits. Their conversations range from an infant disease that struck suddenly in the night and caused lights to go on in the house across the street to the progress o f chronic disability in an aged grandmother. But when these same women talk with practitioners o f official medicine, they have little to say. What they do say m a y be misunderstood. Even in the rare event that patient and practitioner share the same language, there may be confusion. This inadequate communication affects health care profoundly, for the practitioner cannot obtain an adequate history, while the patient cannot understand either the diagnosis or the therapeutic regime. The health care provider may recognize the unsatisfactory" nature o f these encounters and seek to improve them by reading ethnographies (Samora 1961; Clark 1959; Madsen 1964; and Rubel 1966) or attending lectures on 'the' Mexican American. Such education should improve communication, but may only confound it. As pointed out by Chrisman (1977), anthropological research has tended to obscure the heterogeneity o f health beliefs in folk medicine. There are few discussions o f social a n d cultural variability within a group. The ethnographic literature that is well known appears to present stereotypes, giving little mention of diversity. Culture as an organization o f diversity with nonsharing o f cognitive features expected (Wallace 1970; Pelto and Pelto 1975) is rarely understood by health care providers. Moreover, most studies o f folk medicine are synchronic, with the exact ethnographic present
6klture, Medicine and Psychiatry 3 (1979) 73-94. 0165-005X/79/0031-007352.20. Copyright © 1979 by D. Reidel Publishing Co., Dordrecht, Holland, and Boston, U.S.A.
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MARGARITA KAY
inadequately specified. Folk diseases are assumed to be changeless. Traditional people are expected to 'believe in' folk diseases, with denial of such beliefs a mark of 'acculturation.' The following essay is a discussion of a speech community of Mexican American women, the words that are used when women discuss illness, the sources of their lexicon of illness terms, changes in the meanings of these words, and factors which have influenced these changes. My point of view, which does not dispute the idea that many Mexican Americans share a distinctive folk medicine, suggests that lexemic change and semantic shift obscure the nature and variation of this folk medicine. THE SPEECH COMMUNITY Linguistic informants were women who lived in one barrio ('Mexican neighborhood'). This barrio was selected because it was a locus of the traditional life style of Mexican Americans in Tucson, Arizona. It was the home of several generations who had originally crossed the border from Sonora, Mexico, to settle and farm during the territorial period of Arizona. Some of these women cultivated vegetable gardens or fed domestic animals, so the barrio continued to look like northwest Mexico, to which it had once belonged, rather than looking like a part of the urban American city it now is. The principal informants came from four families who lived in this barrio. They were grandmothers, mothers, daughters, sisters, sisters-in-law, or cousins to each other. They often strengthened this relationship by naming each other godmother to their children in various ritual events such as baptism, confirmation, marriage and after cure from illness. The women ranged in age from 19 to 78 years, and had spent from two to ten years in school, in Mexico or the United States. They married men who also varied in age, generation removed from Mexico and educational attainment. The men were construction laborers whose incomes placed them just above poverty, as federally defined, when they were employed. These families participated in several health systems, seeking the assistance of Mexican curanderos ('folk healers'), Yaqui (migrant Mexican Indian) bru]os ('Witches') and Black folk healers, as well as both official and marginal practitioners of scientific Western medicine on both sides of the U. S.-Mexican border. Thus, these women illustrate the potential variance that exists within perhaps the most stable and homogeneous barrio in Tucson. Chrisman (1977) has suggested the concept of insularity, the degree to which one restricts networks of social relationships, as one explanation of the health seeking process. Insularity may also explain how people talk about disease. Although each family has a car or pick-up truck, and uses it regularly for grocery shopping or taking a child to well baby Clinic, the women are enclaved in a small
LEXEMIC CHANGE IN DISEASE NAMES
75
community. The outside world intrudes via the Spanish language radio stations and the mostly English television programs. The women reach out rather rarely, for domestic duties in their society with rigid sex role prescriptions leave little time. Their friends are their neighbors. THE CODE The women are speakers of a variant of Spanish which Barker (1972) designated as Southern Arizona Spanish, noting that it derives from the Spanish that is spoken by people of northwest Mexico, Nortefios, and that it retains some archaic Spanish forms while it is also influenced by English in verb endings and plural forms. The disease vocabulary is similarly influenced by archaic Spanish, on the one hand, and English on the other, as we shall see. There is a difference in the Spanish used by recent migrants and by American-born women in this barrio. Mexican women who attended Mexican elementary school speak more standard Spanish and have larger Spanish vocabularies. Barrio-born women have had no training in reading or writing Spanish, and speak very apologetically about their linguistic competence. Nevertheless, the women are able to communicate efficiently and effectively with one another. Weinreich (1963:69) states that the speech of bilinguals is usually colored by one language. In the speech community under discussion, the dominant language is Spanish, but there are varying degrees of interference. The most extreme is the oscillating shift from one language to the other, producing a mixed utterance style of speech that is called "code-switching" (Gumperz 1969). An example comes from a third-generation American: Las anginas get to the point that se hinchan y uno no puede swallow, mientras que no estan infected.
('The tonsils get to the point that they swell, and one cannot swallow even though they are not infected.') Older, Mexican-born women use the fewest English words, and younger, American-born women mix their utterances regularly. Their English is also affected by phonetic and morphemic interference. 'The eyes got swallowed,' is intended to say: 'My eyes were swollen.' Similarly, the women 'drink' pills, for in Spanish tomar ('drink') is used for the ingestion of both solids and liquids. The effect of code switching and discomfort in two languages is to make the women laconic when talking to the doctor. They answer questions with an unqualified 'yes' or 'no'. Later, they may overhear someone saying, "Oh, she
Seasonal Hay fever Catarrh Cold Allergy
Throat spasm Eye tremor Nerve pain Air in the heart
Del tiempo /Jey fiver/
Catarro Resfriado Alergia
(del cam bio)
Frio de la garganta
Temblor de o]o Dolor de nervio Aire en el coraz6n
1.12 1.121
1.122 1.123 1.124
1.13
1.131
1.132 1.133 1.134
Physical illness Temporary Of Childhood Teething Whooping cough Mumps Pox 3 day measles
Enf. del Cuerpo Temporal Juvenil Denticibn Tosferina La Chanza Viruela Sarampi6n de 3 dias
1. 1.1 1.11 1.111 1.112 1.113 1.114 1.115
English n a m e
Spanish name
Number
+
+
+ + + +
+ +
+
+ +
+
+ + +
+
+ +
+ +
General features
+ +
+
+ +
+
++ ++++~ +++÷
+ +
Class features
TABLE I T a x o n o m i c key to enfermedad
+ + +
+
÷ + w+
g
Malaise following rapid environmental change. Sudden pain in throat after drinking ice water. Muscles surrounding eye twitch. Stabbing pain in various places. Stabbing pains in the heart.
Occurs at certain times o f year. Red itching eyes and pain in bone under eyes. R u n n y nose. Bones acheRonchas, 'hives.'
Affects body. Cannot be avoided. Affects children. Sore germs, m u c h saliva. 'Very bad' cough. Prominent swellings of neck and jaw. Itching blisters on body. Red rash which disappears quickly.
Defining features
Weak blood Boil Sore Abscess Decayed t o o t h Pinkeye Injury Nosebleed Infected scratch Infected w o u n d Infected cut Burn Broken bone Displacement Sprain Digestive disorders Chronic indigestion Heartburn Inadequate digestion Attack of gas Hangover Dirty s t o m a c h Serious illness Painful illness
Enf. benigna Simple Anginas Jaqueca
Sangre dhbil Grano enterrado Llaga Postemilla Muela podrida Mal de o]o Lastimada Sangreada de la nariz Rasgu~a infectada Herida infectada Cortada infectada Quemadura Quebrado de un hueso Descompostura
Torcedura Malestares Dispepsia cronica Acedfas Falta de digestion Ataque de viento Crudo Puerco del estomago
Enfermedad grave Enfermed. dolorosa
1.2 1.21 1.211 1.212
1.213 1.214 1.215 1.216 1.218 1.219 1.22 1.221 1.222
1.226 1.23 1.231 1.232 1.233 1.234 1.235 1.236
1.3 1.31
1.223 1.224 1.226
Attack of gas
Ataque de viento
1.137 Mild illness Simple Tonsillitis Migraine
Stitches Rheumatism
Punzadas R e~ma
1.135 1.136
+
4-
+
+
+
+ +
+
+
+ +
4.
+
+
+
+ +
4-
+
+ + +
+ +
+ +
+
+ +
+
+
+ + +
+ 4+ + + 4-
Serious, possibly fatal. Pain.
(Or w o u n d or cut). Skin is red, burned. Palpable break or alteration in shape. Pain in affected joint, something o u t of place. Swelling with pain in affected joint. Ingestion of disagreeing food. Frequently occurring indigestion. Sour taste. Feeling of fullness. Pressure on chest relieved by belching. Follows too m u c h alcohol. Constipation with nausea.
Yields to uncomplicated treatment. Mild pain or discomfort. Sore throat, swollen tonsils. Head hurts in one part. Black spots in vision. Lack of red cells in the blood. + Hard red lesion below surface of skin. + Skin lesion with pus. + Lesion is located in the gums. T o o t h ache, decay is often visible. Eye is red, sore and crusted in morning. Specific episode. Bleeding from the nose. Scratch has red and painful edges.
Sticking pains, especially in eye. Aching of bones or joints, especially fingers. Pain in chest relieved by belching.
Maledades Mal de ritlbn Bilis
1.311
Epidemic disease Measles Poliomyelitis Meningitis Hepatitis Malaria Diphtheria
Mal. de andanc ia Sarampion malo Polio Meningitis Hepatitis Paludismo Difteria
Maledades Mexieanas Empacho
1.312 1.3121 1.3122 1.3123 1.3!24 1.3125 1.3126
1.313
1.3131
1.3118
Intestinal (Ileus) infection
Earache Heart disease Heart attack Stroke Cancer Leukemia Internal tumors Malignant wound Liver disease
Maladies Kidney disease 'Bile'
English name
Dolor de oMo Mal de coraz6n Ataquealcoraz6n /estrok/ Cancer Leucemia Tumores internas Cancer de herida Mal. de Higado
1.311.4 1.3115 1.3116 1.3117
1.3113
1.3111 1.3112
Spanish name
Number
Table 1 (continued).
+
+
4-
4-
+
+
+
+
+
+
4-
+
+
-I+
+
+
+
-I-
-I-
4-
-I-
+
-I-
4-
+
4-
-I-
4-
General features
4-
+
+
4-
4-
+
+
4-
4-
4-
4-
Class features
Taxonomic key to enfermedad
+
+
+
+
+
4-
4-
+
4-
+
Not recognized by Anglo doctors. Mildew on affected fecal particles.
• No appetite, cramps.
Wide variety of symptoms, portmanteaux category. Contagious. + Severe headache.
Sudden death. Numbness of one side of body, "clots'. (Depends on type).
Painful, frequent or unable to urinate. Severe pain in abdomen and chest with anger. Atr in ear.
Defining features
Griping Infection Severe cramps
Bronchitis Venereal disease Chronic disease Inherited disease Diabetes
Pu]o Pasmo
Cblicos
Piedras e n d vedculo Ulceras gastr[ticas quemantes heridas Apendicitis Pardsitos Mal de ijar Fdo del vientre (Consequencias} Almorranas Roto de la aldilla Desombligado Insolaeidn Pulmonia Sinusitis (Catarro constipado } Bronquitis Enf. ven&eas
Enf. cr6nica Enf. hereditaria Diabetis
1.3135 1.3136
1.314
1.3141
1.32 1.321 1.3211
1.3157 1.3158
1.3143 1.3144 1.3134 1.3146 1.315 1.3151 1.3151 1.3153 1.3154 1.3155 1.3156
+ +
+ +
+
+
+
+
+
+
+ + +
+
+ +
+ +
+ +
+ + +
Biliary stones + Ulcers stomach burning wound Appendicitis Parasites + Flank pain + Inflammation of the belly + Consequences Hemorrhoids Hernia of groin Umbilical hernia Sunstroke + + Pneumonia + + Sinusitis
Emaciation Locked intestines
Latido Tripa ida
1.3133 1.3134
1.3142
(Dehydration)
Ca[da de la mollera
1,3132
+
+
+
+ +
+ +
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Does n o t appear suddenly. Comes from family inheritance. Sugar in t h e urine.
Yellow m u c u s f r o m nose. Headache. Difficult breathing. + Follows extra-marital affairs.
Illness follows unwise action. Very painful anus. Swelling of groin. Swelling of navel, no other features. Episode of absorbing too m u c h sun. Painful breathing.
Continuous pain in lower part of a b d o m e n . Worms come out o f anus or even m o u t h . Pain in lower a b d o m e n comes and goes.
Stomach pulse is visible, no appetite, extreme thinness. Severe constipation after frightening experience. A b d o m i n a l cramps, m a y have m u c u s or blood in excrement. Swelling and redness at affected place, rash around it. Pain in abdomen. Stones shown after X-ray or operation. Pain in m o u t h of stomach. 3 subtypes differ in degree o f pain.
Swollen belly, great thirst. Cannot suck, eyes fall back in head, palate feels lumpy.
English name
Enlarged heart Weak heart Large kidney High (blood) pres= Sequential diseases Arthritis Deforming arthritis Dry rheumatism (Sciatica) Severe anemia Tuberculosis Convulsions Asthma Severe constipation
Spanish name
Coraz6ngrande Coraz6nd~bil Rihon grande Alta presion
Sobrevenidera Artritis Artritis que tuerza Refimaseca
Anemia aguda
Tuberculosis
Alfereda
Asrna
Peritonitis
Number
1.3212 1.3213 1.3214 1.3215
1.322 1.3221 1.3222 1.3223
1.3224
1.3225
1.3226
1.3227
1.3228
+
+
+
+
+
+
+
+
+
+
+ +
+
+
+
+
4-
+
+
+
+
Class features
+
+
4- 44- + 4- + 44-
General features
Table 1 (continued). Taxonomic key to entermedad
44-
Follows after recovery from high fever (neglected sarampi6n). Choking, suffocating with breathing (neglected hay fever). No bowel movement.
anemia).
Like sangre debil except that vigorous treatment is now required. Blue ear lobes and finger tips (neglected
Comes from neglecting other enfermedad. Body aches at times of weather change. Specific places are twisted (neglected pasmo). Pain moves down the leg (neglected rekma).
Progressive exhaustion. Heart beats too much. Sufferer needs artificial kidney. Dizziness and headache.
Defining features
Mental disease Derangements F r o m a blow Amnesia Craziness F r o m a shock Hysteria Nervous breakdown F r o m thinking Pressure Anxiety Witchcraft Evileye Bewitchment Envy Hereditary Idiocy Epilepsy
Enfermedad Emocional
Enfermedad mental Trastornos (degolpe) Amnesia Locura de susto Histeria AtaquedeNervios
(depensar) Congo]a Tirisia
Daaos
Malo]o
Hechicerfa Envidia
Enf. hereditaria lnocencia Epilepsia
2.
2.1 2.11 2.111 2.1111 2.1112 2.112 2.1121 2.1122
2.113
2.1132
2.12
2.121
2.122 2.123
2A3 2.131 2.132
2.1131
Emotional disease
Spanish name
Number
English name
T A B L E II
+
+
+
+
+
+ + +
+
+ +
+ +
+ +
+
+ + + +
+ +
General features
+
+ +
+
+ + + +
+ +
4-
+
+
+
=
Class features
Taxonomic key to enfermedad metal
+
+
+
+
+
+
+
4-
+ +
Similar behavior has occurred in family line. Various degrees of mental retardation. Convulsions not related to any illness.
Wide variety of physical symptoms persist despite treatment. Eyes are sunken, severe headache following encounter with admiring stranger. Physical symptoms after unfaithfulness. Physical illness result of others' envy.
Involuntary mental effects. Behavior uncontrollable. Result of blow to head or injury. Victim does not know identity. Irrational actions, Result of sudden fright. Heavy and sore in neck, uncontrollable crying. Intensification of hysteria plus swelling over left chest. Victim is preoccupied with worries. Shortness of breath, feeling of pressure. Sorrowful wan face, no appetite.
Affects emotions or nerves.
Defining features
Uncontrolled emotions
Emociones mal controladas Cora/e Celos Envidia Debilidaddel caracter Alcoholismo Cleptomania Gorduramala Vfcios Mari/uanero Drogadicto
2.21
*Class features not known.
Rage Jealousy Envy Weakness of character Alcoholism Kleptomania Overweight Vices User of marijuana User of drugs
Moral disease
Enfermedad moral
2.2
2.211 2.212 2.213 2.22 2.221 *2.222 2.223 2.23 "2.231 *2.232
English name
Spanish name
Number
+
+
÷
+
+
+
+
+
-I-
+
~ O
.~q
+
.~
÷
+
Class features
~.~ ~
General features
T A B L E III Taxonomic key to enfermedad moral
•
~.~
Affects character. Individual wants to be bad or has no willpower. Normal responses are allowed to get out of control. Anger grows to fury, then mania. Envy of another's attributes or status. Envy of another's possessions. Succumbs to temptations. Regular drinking bouts until drunk. Compulsive stealing habit. 'Bad' fatness. Incorrigible or hardened character. Smoking of marijuana. Taking narcotic pills and injections.
Defining features
LEXEMIC CHANGE IN DISEASE NAMES
83
knows more English than she lets on". Such remarks further discourage communication.
DATA COLLECTION Words were learned by informal and formal methods. Informally, words were collected during observations or participations in conversations about illness. When a disease name was mentioned, those conversing would be asked what it meant. Sometimes there were arguments about the 'correct' meaning. Another source of terms was telephone conversations between comrades ('ritual kin') concerning what the doctor said when mother was driven to the doctor. Procuring medicinal herbs from the drug store or herberia ('herb store') or collecting them in the monte or chaparral provided more terms, as well as discussions of medicinal contents of kitchen or bathroom cabinets. The formal method was the linguistic procedures of ethnoscience.lThese techniques rest on the fundamental assumption that words encode specific combinations of features of meaning, and that such combinations contrast at different levels of abstraction. These levels may be arranged hierarchically, forming a taxonomy. At the highest level of its taxonomy, the domain enfermedad ('illness' or 'disease') is divided into two kinds, disease of the body and disease of the mind. There are two kinds of mental disease, emotional and moral. Physical disease is partitioned into temporary, mild and grave categories. At the species level of the taxonomy, the actual disease names are located. This level is based on unique aggregates of symptoms as the features which define each disease name or lexeme. The women's principles of classification are ultimately based on therapy. The general partitioning of disease is illustrated in Table I, Taxonomic Key to Enfermedad and Table II, Taxonomic Key to Enfermedad Metal and Table III, Taxonomic Key to Enfermedad Moral. The information is presented in a matrix form, modeled after a botanical key, with a numerical system like that conventionally used by linguists. After the taxonomic number, the Spanish term for the disease is given, followed by an English gloss. Next, each general feature of disease and class feature of type is listed in a column, with the presence of the feature in any given disease noted by a + mark. Finally, there is a succinct statement of defining features After the list of disease names was compiled (Kay 1972, 1977a, 1977c), it was submitted to another group of women for replication or redefinition. These other informants were Mexican American women of the same social class encountered at a neighborhood health center where they were employed as
84
MARGARITA KAY
health workers. They were given a written test in which they were asked to define Mexican disease names, cures, and curers. There has been disenchantment (Micklin, Durbin and Leon 1975; Kay 1977b) with limiting data collection to formal methods alone, without attending to situational circumstances. In this case, variations occurred depending upon experience with an illness, age of informant, age of those dependent upon her care, and recency of migration. 2 As pointed out by D'Andrade (1972, 1976), the linguist learns highly idiosyncratic classifications and features with this method. The taxonomic key represents consensus, and when there was disagreement about definition, informants would generally choose the statements of the older and more experienced women among themselves. As Friedrich (1976 : 32) states, "in any given society sharing a language, most people understand each other's messages most of the time." The concepts of cognitive non-sharing and intracultural diversity make neither ethnosemantic research nor dictionary definition invalid, but rather serve to keep the ethnoscientist and lexicographer either cautious or unpublished. DISEASE NAMING Diseases are commonly named by the symptom, such as pain, rash, or limitation of function. Examples are dolor de oido ('earache'), co]o ('lame'), tos retina ('whooping cough', literally 'fierce cough'). Or, the disease may be named by the alleged cause: susto ('fright'), insolaci6n ('sunstroke'), sangre debil ('weak blood'). Naming by symptom or cause has a long tradition everywhere in the labeling of disease. But today, scientific nosology emphasizes etiology rather than symptoms. This change contributes further to poor commun cation between patient and physician. Spanish and English words for disease share the same etymology. Many words are thus cognates, deriving from the same Latin and Greek words, and having a long history in western medical diagnosis. The dominant or official medical system always used Latin or Greek disease names. When Arabs were the intermediaries for medical knowledge, they reintroduced Latin and Hellenic expressions (Lapesa 1968 : 102-110). Amnesia, histeria, asma, and c6lico are the names of a few conditions that have been identified since antiquity. Barrio dwellers also speak of catarro, reuma, cancer, fdcera, diabetes, artritis, and epilepsia. The shared tradition is continued by the introduction of new words with Latin roots, both in English and ha Spanish. As Lapesa (1968 : 286) has noted, technological progress in science and technology has created the need for new words. With the designation of a new disease, or with new understanding of a pathological process, neologisms are frequently created from Latin or Greek roots. Thus, in the barr/o, animalitos ('little animals') ,as disease agents have given
LEXEMIC CHANGE IN DISEASE NAMES
85
way to vfruses ('viruses') and microbios ('microbes')which are treated by antibi6ticos ('antibiotics'). When disease names have been learned in settings of official scientific medicine, where English is spoken, English words are used in the mixed utterance. Thus: Dicen que es a viY-rus, not Dicen que es un virus. ('They say it is a virus.')
Some disease names employ the same metaphor in Spanish and English. For example, the term punzadas and its gloss 'stitches' both call attention to a particular sensation of pain by likening its localization to the stabs of a needle and thread. The Spanish word aced[as signals the same type of gastric discomfort as the English 'heart burn.' Ampolla, like its equivalent 'blister' calls on the image of an air bubble (although the etymology is not common knowledge of either Spanish or" English speakers). In enfermedades que andan ('epidemic diseases', literally 'diseases that go around') one sees the same Horseman of the Apocalypse, moving from one place to another. The private experience of pain is often similarly labeled in both languages, for example, ardor ('burning') and adormido ('asleep', as in numbness). VARIATION Each informant has her own reportoire of disease lexemes, related to her own experiences. The mother of young children knows the names of childhood diseases, and lists dentici6n ('teething'), la chanza ('mumps'), sarampi6n ('measles'), tosferina ('whooping cough'), polio ('polio'), while old women list four kinds of artritis ('arthritis') including sidtica and reuma seca. Natives of the barrio rarely know the names of parasitic diseases, which are uncommon in this area. But women who have come from tropical Mexico will talk about paludismo ('malaria') and lombrices ('worms'). Just as the content of the lexicon is related to experience, word choice depends upon the setting in which the disease is diagnosed. If an infant is born in an American hospital with a congenital deformity, such as 'congenital hip', only the English word is known. Some disease terms are known only by older informants. Enconoso ('infected'), although part of the ethnomedicine of northern New Mexico, is unknown to most young informants in Tucson. It seems likely that enconoso is no longer functional since the cognate, infectado is a word that is reinforced daily when women hear about infections and their treatment on television and radio. On the other hand, tiricia ('anxiety'), which is an equally archaic term, is
86
MARGARITA KAY
retained in Tucson, even by young informants. Tiricia is a useful term because there is no other to encode the emotions experienced by the toddler who is inconsolable because his mother seems to have vanished. There is a scientific term in English that glosses the same idea, 'separation anxiety', but this term has not found its way into common usage for the barrio women to hear. Certain archaic anatomical terms are used to describe disease. There are words from animal anatomy. Gaznate ('windpipe') and pata ('hoof') are more commonly used than the scientifically proper traquea ('trachea'), or pie ('foot'), as is vientre ('belly') instead of abdomen ('abdomen'). If the scientific term has been learned in a hospital setting, it may not even be noted that the same anatomical part is referred to in the two lexemes. In the context of medical conversations, code switching then seems to be an example of what Haugen (1961:402) calls coordinate bilingualism. In the taxonomy of illness vocabulary it is notable that Spanish words are used for mild diseases, treated at home, and English words or their Spanish scientific cognates are used for grave, or serious disorders treated by a special practitioner, either a doctor of official medicine or a person who occupies one of several statuses of folk healer. Code-switching may occur because one word may be known in Spanish and another only in English. Jey fiver ('hay fever') has a Spanish gloss, fiebre de heno. The Spanish term, however, is never used in the barrio, even by Mexican migrants. This is a diagnosis that is used to explain the symptoms of runny nose and sneezing only within the last two decades, and has only slowly worked its way into popular health culture. Thus
Tengo /ey fiver, not Tengo fiebre de heno. ('I have hay fever'.) MEXICAN DISEASES Scattered thoughout the taxonomy of disease names are labels which do not have equivalents in English. Most are grouped together in a category known in the barrio as 'Mexican disease', and so classified together because they all share one feature - official medicine does not recognize them.
Los m~dicos no creen en mollera. ('Doctors don't believe in mollera.') The diseases include bilis ('bile'), daho ('harm' caused by witchcraft),envidia ('envy'), mollera cafda ('fallen soft spot'), empacho ('intestinal infection'), fr{o de la matriz ('sterility', literally 'cold womb'), pasmo ('spasm'), latido ('cachexia', literally 'beat'),aIferecfa ('convulsions that follow febrile illness'), pu]os ('gripings'), mal o]o ('evil eye'), insolacirn ('sunstroke'), and entablazrn
LEXEMIC CHANGE IN DISEASE NAMES
87
('intestinal obstruction'). Most of these diseases have been noted in the many studies of Mexican and Mexican American illness beliefs (Clark 1959; Samora 1961; Madzen 1964; Rubel 1966; Foster 1967). They appear not to have English counterparts. These words are used in daily conversation, together with labels for conditions such as 'cold', 'allergy', 'heart attack', and other diseases that are readily translatable between the two languages (although the reciprocal terms may not necessarily encode the same features), and indicate a common tradition of illness concepts. Why do these words for Mexican diseases remain in the lexicon of people who participate in official scientific medicine? Folk etymology traces these diseases and their treatments to Indians. Mexican American activists, who prefer the term Chicanos, believe that the Aztecs were the source of superior medical knowledge, and that this culture has been preserved in oral tradition by Indians. But also informants reared in Mexico who identify with the middle class believe that this folk medicine originated with Indians. These women tell how Indians "come down from the mountains" with herbs to sell on village or city market days or at religious fiestas. The packaged herbs are labeled 'para el bills' ('for bilis'), 'rihon' ('kidney'), etc. Such herb lots eventually are repackaged in plastic zip-lock bags with pharmaceutical labels. Both Chicanos and middle class Mexican women are misinformed. These Mexican disease names were once part of the corpus of scientific nosology of the Spaniards and other Europeans, not the Indians. All these disease terms and their descriptions can be found in a medical text, the Florilegio Medicinal (Kay 1976) written by a German (Moravian) Jesuit lay brother in 1711 to guide the medical care of Indians and Spaniards for all of northwest Mexico, when the territory included what is now southwestern U. S. A. I believe that Mexican nosology before Cort6s has been hopelessly confused because the Spanish data in accounts purporting to present preconquest medicine such as the Florentine Codex (Dibble and Anderson 1961) and the Badianus Codex (del Pozo 1964)were too contaminated by the medical theory of its sixteenth century investigators. 3 Moreover, bills, pasmo, moUera caida, etc., can be found in European texts o f the fifteenth and sixteenth centuries. However, it is true that these concepts have been preserved in insular or enclaved groups, to be resurrected for political reasons by Chicanos. For they recognize as does Rubel (1960) that disease is an aspect of life that helps perpetuate Mexican American culture as a unique entity. In many cases, lexical changes have not caught up with changes in medical culture. As has been pointed out by Friedrich (1967), social change precedes lexical change. Participation in official medicine has occurred only when there was economic access to this care. Friedrich (1967:32), suggests that "fundamental changes in any basic social institution should be reflected within a generation or two by correspondingly fundamental changes in the semantic
88
MARGARITA KAY
system." The Mexican American women that were interviewed showed much variation in their medical ideolects, as discussed above. This variance may be explained by differential participation in official scientific medicine, leading to differential acculturation to its concepts. SEMANTIC CHANGE Basso (1967:471) states "acculturation involves changes in cultural content which in turn may be reflected in shifts in the meaning of words." The mechanisms of semantic change have been condensed into three processes by which a lexicon may adjust to new ideas, and which may also occur without a precipitating cause in non-linguistic culture (Greenberg, Osgood, Saporta 1965). There are: (1) borrowing, or coining of new terms, (2) obsolescence and subsequent dropping of lexemes, and (3) semantic extension or shift of meaning. The first, borrowing or coining of new terms, has been applied above in the discussion of Latin and Greek neologisms in scientific disease names. The process operates at the lay level as well. Thus, Mexican American women suffer from sinusitis ('sinusitis'), or require calmantes ('tranquilizers') for nervios ('nerves'). A second adjustment of the vocabulary may be made by the dropping of old terms. Some informants failed to recognize the names of 'Mexican diseases', and others denied these conditions. They dropped words such as 'witchcraft' and 'evil eye' from their individual vocabularies, or classified them as either 'curious' or 'dangerous' superstitions. These are individuals who have comparatively higher levels of education and are unwilling to identify themselves with folk medicine. Many are third generation Americans whose parents rejected ethnomedicine themselves and did not enculturate their children to its concepts. Most were not found among the families living in the barrio but rather among the health professionals at the neighborhood health center that was the source for replicating disease names. Mexican American activists, as discussed above, are attempting to reverse the process and add these 'Mexican' disease terms as part of their search for their culture. The most interesting change, however, has been a shift in the meanings of the words themselves. 4 The same lexemes are used, but they do not mean the same things. They are terms which, in Kany's (1960:8) words, "although outwardly appearing intact have shifted their semantic values." Some label conditions that are no longer considered diseases. This includes emotional disorders. For most of my informants, envidia ('envy') is not a disease. It is not a form of witchcraft unconsciously inflicted on the sufferer as it is for Rubel's (1966) informants. Envidia is simply a word that is synonymous with celos ('jealousy'), and indicates poor mental habits which are widespread but not seriously pathological. If it causes illness, the disease is a condition in the individual who feels this emotion, not one that is projected on to the one who is envied.
LEXEMIC CHANGE IN DISEASE NAMES
89
Meaning shifts may be described using the figures of speech of traditional rhetoric, hyperbole, elevation, degradation, etc. A few disease lexemes have shifted meaning from the concrete to the abstract, as Bloomfield predicted (quoted in Ullman 1966). Aire, identified by Madsen (1964) among others as 'a volitional wind causing disease', is now defined as 'gas' especially in the intestines or around the heart. The new definition returns the meaning back to the way aire was identified in the 1711 manuscript cited above. Fiebre ('fever'), was a disease classification which grouped daily, intermittent, tertian or quartan fevers, all specific diseases. Now fiebre is seen as a feature of many, if not most diseases. Susto ('fright') is hyperbole now. Formerly a great shock which was also an illness, the present meaning is only an 'unpleasant surprise,' at most, 'trauma'. Empacho, a disease 'caused' by the adherence of undigested food in the gastrointestinal tract which then molds, is firmly 'believed in' by all informants. But for many, empacho has become a more Serious version of 'irregularity' ('constipation') featured in television commercials. Thus, empacho has degenerated in meaning. Bilis ('bile') has been elevated to scientific status so that its gloss is more appropriately 'disease of the ball bladder.' Since ancient times the emotion of anger has been seen as the stimulus for releasing bile by the gall bladder. Official medicine denies this cause today. Barrio women say that bilis viene de cora]e ('bile comes from anger'), as always. But today they state that the condition is treated by removal of the affected organ, or decreasing its dietary stimulation, exactly the position of scientific medicine. Similarly, mollera ca[da ('fallen soft spot') is moving toward legitimization as the scientific condition of dehydration. Mollera is recognized as a disease of infancy characterized by fever, vomiting and poor sucking, with the depression of the soft spot or fontanelle at the crown of the head as the distinctive feature. Informants note that while practitioners of official medicine who have heard of the concept vigorously attack its magical cure by curanderos ('folk healers'), these same scientific doctors will still measure the soft spot and check its elevation when an infant has fever and diarrhea. The curanderos themselves urge that the infants be taken to doctors of Western medicine for treatment of the diarrhea and fever, reserving for themselves the magical formulae that will elevate the 'fallen' fontanelle. Three conditions that go back to the Bible have had different fates in the barrrio. Daho ('witchcraft') and mal ojo ('evil eye') have been impervious to meaning change from scientific medicine, for these are not diseases that would be brought to a medical doctor, or are last resorts in folk diagnosis to be used when explanations from scientific medicine fail. On the other hand, fr[o de la matriz ('sterility') caused by transgressions of rules of hygiene after childbirth
90
MARGARITA KAY
such as the interdiction of bathing until forty days had elapsed, has not stood up to proof. It was difficult for women who deliver in the hospital to avoid forced acculturation by attendants whose identity is the bath. These women then found no problem with subsequent fertility, and so discarded frfo. The field theory of semantic change (Kany 1960:11; Basso 1967:473; Ullman 1966) suggests that rather than analyze the single lexeme, meaning change should be considered in an entire domain against a comprehensive background of social structure and function. We have also seen that semantic changes in disease lexemes appear to have been precipitated by exposure to Western medicine, both the official practice of science and folk medicine of the mass media. Official contacts occur through participation in clinics and offices of Western, scientific medicine. Folk concepts of the dominant systems are learned via television or radio. Some terms are retained or relearned by those who reject the dominant system, or those who have no access to it. The result for these bilinguals is a vocabulary of disease terms that reflects both linguistic and cultural interference. It also suggests that cognitions of illness occur in a single unified theory, that the disease names do not represent compartmentalized participation in different health systems. It supports the possibility of a single semantic system, perhaps different from the semantic system of either Mexicans of Americans, as hypothesized by Young (1973). The model of lexical change and semantic shift demonstrated for Mexican American Spanish illness terms can be applied to English disease names, too. As with American Spanish, the American English category of arthritis has new meanings. For example, gout has narrowed in meaning from subsuming all arthritis to one specific type. Lumbago as a type of arthritis is now known only to elderly people, and rheumatism has degenerated from a scientific to a lay term. Changes have occurred in all classes of disease. Brain fever has been deleted, remembered only by students of nineteenth-century novels. Acid indigestion has become a folk disease, leaving the Merck Manual for the television, screen. Flu, a disease name which was once derived from influenza, has changed from a specific bacterial infection to a vague virus. Its meaning has broadened to include various syndromes. Thus flu may mean an upper respiratory infection or a gastro-intestinal infection. The latter may be subdivided into stomach flu and intlestinalflu by some English speakers. There are some regional differences in ascribing distinctive attributes, but these are unstable in our mobile society. Lexemic change and semantic shift in any language thus have implications for health care. For the practitioner who wishes to share responsibility with his or her client, this study offers exciting prospects, for it suggests communications which are dialogues for diagnosis rather than one-sided imperatives. The practi-
LEXEMIC CHANGE IN DISEASE NAMES
91
tioner may find certain questions used by linguists helpful in obtaining a medical history. He or she may say, "There are different facts about bilis (pasmo, mollera, artntis, etc.). Tell me your thoughts about this condition. In your case, what caused it? What do you think would be the best treatment?". If the patient's explanation differs from that of official medicine, the practitioner may convey the idea of semantic shift, saying, "That is what we used to mean when we said - - , but the term today means - ". The intracultural variation in disease concepts may thus be decreased to manageable levels. Using the concepts of lexemic change and semantic shift requires that the health care provider respect his client in the same way that the anthropologist values his informant, as an expert. We may also gain a better understanding of health seeking behavior and compliance with a therapeutic regime when we attend to the meanings that are attached to disease labels. In the system of the Mexican Americans whom I have described above, diseases are classified according to treatment. Thus diseases categorized as 'temporary' will receive no therapy, those classed as 'mild' are referred to experienced older women, and 'serious' illnesses are referred to curing specialists. For the informants of this study, disease concepts today are usually more congruous with categories of Western medicine than with traditional folk ideas. But folk medicine remains as an alternative that is very useful to dissatisfied or desperate clients. The physician of Western medicine may assume that he or she is the only curer consulted when a patient is brought suffering from what might be labeled as 'dehydration,' 'cholecystitis,' or 'gastroenteritis' instead of mollera caida, bilis and empacho. However, the patient may be simultaneously consulting one or more curers. For example, one child, who was being seen for abdominal pain, went through the Western scientific diagnos~ tic categories of parasites, malignancy and finally school phobia, but was alse having procedures to rule out empacho, mal o]o, and histerica or frio de la matriz by curanderas, one of whom finally diagnosed hechiceria ('witchcraft'). Her patient care (the case is summarized in Stafford 1978)might not have been nearly so lengthy if medical history taking had included these linguistic techniques earlier. The excellent command of English shown by her mother, a third generation Mexican American, distracted practitioners from considering her use of alternative systems. Finally, when asked directly about consulting folk healers, the child's mother gave a complete history, for she was questioned in a respectful and interested manner. Her doctors in turn were pleased that they could discontinue expensive and painful diagnostic workups. The opposite situation has also occurred. When a monolingual Spanish speaking woman asked about her infant's mollera, it was assumed that she wanted to sign her baby out of the hospital to obtain magical treatment. In fact, the
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M A R G A R I T A KAY
m o t h e r was s i m p l y s e e k i n g i n f o r m a t i o n f r o m t h e nurses a b o u t t h e r a p y t h a t was b e i n g a d m i n i s t e r e d t h r o u g h a scalp vein. T h u s , l e x e m i c c h a n g e a n d s e m a n t i c s h i f t and their intracultural variations should be dealt with whenever a medical h i s t o r y is t a k e n .
College of Nursing, The Unh,ersity of Arizona ACKNOWLEDGMENTS D a t a were g a t h e r e d w h i l e t h e w r i t e r was a Special Nurse P r e d o c t o r a l fellow 4 F O - N U - 2 7 , 1 3 4 - 0 5 . This p a p e r was w r i t t e n w i t h U S P H S R O 2 N U 0 0 3 5 8 - 0 3 NPC s u p p o r t , a n d t h e e n c o u r a g e m e n t o f J a c o b O r n s t e i n a n d William Mackey,
NOTES 1 Question frames included: Is X a disease? Is X a disease of Y class or Z class? Why? How does X start? A full treatment of the resuRant taxonomy with key is given in Kay 1972. 2 Statistical techniques ranging from simple frequency tabulations, Chi-square analyses, Guttmann scaling and BC-Try cluster analysis resulted in a certain degree of over-kill, and some rather surprising findings, too. The most significant association was found between age and adherence to ethnomedicine. Women over 50 recognized a greater number of traditional disease names, significant at the 0.01 level. The association between generation removed from Mexico and number of Mexican disease names was not quite as great, with the association significant at the 0.02 level. Monolingualism in Spanish was not a strong predictor of Mexican disease name recognition, for the young immigrants from Mexico know only a few more of these names than their American-born age mates. Finally, consanguinal kinswomen had better correspondence in their use of Mexican disease names than affinal kinswomen, but only when age was held constant. 3 See Kelly (1965) and Ortiz de Montallano (1975) for discussions of the influence of European disease concepts on early colonial Aztec medicine. 4 This section has been adapted in part from Kay, Health and illness in a Mexican American Barrio, In Ethnic Medicine in the Southwest, Edward H. Spicer, ed., pp. 164-165. Tuscon: University of Arizona Press, 1977.
REFERENCES Anderson, A. J. O. and Dibble, C. E. 1 9 5 0 - 1 9 6 9 Florentine Codex, General History of the Things of New Spain, Salt Lake City: University of Utah Press. Barker, George C. 1972 Social Functions of Language in a Mexican American Community. Anthropological Papers of the University of Arizona, Number 22. Tucson, Arizona. Basso, Keith H. 1967 Semantic aspects of linguistic acculturation. American Anthropologist 69:471. Chrisman, Noel J. 1977 The health seeking process: an approach to the natural history of illness. Culture, Medicine and Psychiatry 1 : 351 - 377.
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Clark, Margaret 1959 Health in the Mexican American culture. Berkeley and Los Angeles: University of California Press. D'Andrade, R., Quinn, N., Nerlov, S. B. and Romney, A. K. 1972 Categories of disease in American English and Mexican-Spanish. In Multidimensional Scaling: Theory and Applications in the Behavioural Science Vol. II: Applications, A. K. Romney et al. (eds.). New York: Seminar Press. D'Andrade, R. G. 1976 A propositional analysis of U.S. American reliefs about illness. In Meaning in Anthropology, Keith H. Basso and Henry A. Selby, eds. Albuquerque: The University of New Mexico Press, School of American Research Advanced Siminar Series. del Pozo, E. C. ed. 1964 Martin del la Cruz' LibeUus de Medicinalibus Indorum Herbis. Mexico City. IMSS. Esteyneffer, Juan de 1711 Florilegio Medicinal. Mexico. Foster, George C. 1967 Tzintzuntzan. Mexican Peasants in a Changing World. Boston: Little, Brown and Company. Friedrich, Patti 1967 The linguistic reflex of social changes from Isarist to Soviet Russian kinship. In Explorations in Sociolinguistics. S. Lieberson, ed. Indiana University Research Center in Anthropology, Folklore and Linguistics Publishers. Number 44. Greenberg, Joseph, Osgood, Charles and Saporta, Sol. 1965 Language change. In Psycholinguistics. Charles E. Osgood and Thomas A. Sebeok, eds. Bloomington: University of Indiana Press. Gumperz, John and Hernandez, Edward. 1969 Cognitive aspects of bilingual communication. Working Paper Number 28, Language-Behavior Research Laboratory. Berkeley: University of California. Haugen, Einer 1961 The bilingual individual. In Psycholinguistics. S. Saporta, ed. New York: Holt, Rinehart and Winston. Kany, Charles E. 1960 American-Spanish Semantics. Berkeley and Los Angeles: University of California Press. Kay, Margarita Artschwager 1972 Health and Illness in the Barrio: Women's Point of View. Dissertation for the Ph.D. University of Arizona, Tucson. 1976 The Fusion of Utoaztecan and European ethnogynecology in the Florilegio Medicinal. Proceedings XLI International Congress of Americanists. III 323-330. 1977a Southwestern Medical Dictionary, Spanish-English, English-Spanish. Tucson: University of Arizona Press. 1977b Mexican American Fertility Regulation. In Communicating Nursing Research M. Batey ed. 10: 278-295. Boulder, Colorado: Western Interstate Commission for Higher Education. 1977c Health and illness in a Mexican American Barrio. In Ethnic Medicine in the Southwest, E. H. Spicer ed. p. 124. Tucson: University of Arizona Press. Kelly, Isabel 1965 Folk Practices in North Mexico. Austin: University of Texas Press. Lapesa, Rafael 1968 Historia de la Lengua Espanola. Septima Edition. Madrid. Escelicer, S. A. Madsen, William 1964 The Mexican Americans of South Texas. New York: Holt, Rinehart and Winston.
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Micklin, Michael, Durbin, Marshall and Leon, Carlos A. 1974 The lexicon for madness in a Columbian city. American Ethnologist 1 : 143-156, Pelto, Pertti and Pelto, Gretel H. 1975 Intraeultural diversity: some theoretical issues. American Ethnologist 2 : 1 - 1 8 . Rubel, Arthur 1960 Concepts of disease in Mexican American culture. American Anthropologist 62 (5) : 7 9 5 - 8 1 5 . 1966 Across the Tracks: Mexican Americans in a Texas City. Austin: University of Texas Press. Samora, Julian 1961 Conceptions of health and disease among Spanish Americans. American Catholic Sociological Review XXII (4) : 3 1 4 - 3 2 3 . Stafford, Anita M. 1978 The application of clinical anthropology to medical practice: case study of recurrent abdominal pain in a preadolescent Mexican-American Female. In E. Bauwens, ed. The Anthropology of Health. St Louis: C. V. Mosby. Ullman, Stephen 1966 Semantic universals. In Universals of Language, Second Edition. Joseph Greenberg, ed. Cambridge: M. I. T. Press. Wallace, Anthony F. C. 1970 Culture and personality. 2nd edition. New York: Randon House. Weinreich, Uriel 1963 Languages in contact. The Hague: Mouton Press. Young, Rodney W. 1973 The Question of Linguistic Deficiency in the Bilingual Setting. Paper presented to Symposium on the Education of Mexican Americans, Society for Applied Anthropology, University of Arizona at Tucson, April 1 2 - 1 4 .
(Final revised version received 14 October, 1978)
