Food imagery ideal for teaching doctors... who must have strong stomachs

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

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

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

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

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

Water melon, oranges, currant jelly, grapes, and cherry all find their way into visual clues for a range of conditions, while breakfast food imagery is common.

A 'croissant' appearance in a cell nucleus is indicative of a benign growth on peripheral nerves. Similarly, a 'blueberry muffin' rash is characteristic of congenital rubella, while the appearance of a is referred to as 'doughnut' shaped.

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

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

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

But she adds: "Whatever the genesis, these time honoured allusions have been, and will continue to be, a lively learning inducement for generations of budding physicians."

More information: Twist of taste: gastronomic allusions in medicine, Medical Humanities, Online First, DOI: 10.1136/medhum-2014-010522

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