(the) menopause, (the) flu, (the) hospital

My friend (and fellow datebook-sayer) the Recyclist arrived in the UK this weekend, and was surprised by the springiness of the spring here. (This week, it's worth coming to Southern England for the weather.) As we were walking around Notting Hill on Sunday, she marvel(l)ed at the wisteria in bloom, and lamented to the Networker that while hers used to bloom all the time, it has become very irregular. I (jokingly!) hypothesi{s/z}ed that her wisteria might be going through (BrE) the menopause. Having not heard me, she asked me to repeat myself and I found myself switching to the AmE version: menopause (without the). The is a definite determiner (search 'determiner' on that link), which means that it is used to indicate the uniqueness of something within a particular context (well, that's a good enough description for present purposes). And you could say, 'ok, that makes sense, since it only comes once in a lifetime.' But that explanation would predict that BrE would also use the before puberty, which it generally doesn't. So I don't know why it's there, but it's been there in BrE from the earliest example in the OED (1872).

On the other hand, AmE tends to say the flu and BrE tends to do it without the the (and often with an apostrophe: 'flu). The Networker tells me that she was more used to hearing it with the the when she was a child, and sure enough, it is the (')flu in the OED until the last example, 1957 (which is before the N was born, but no doubt the the lingered beyond that date). In a sense, the AmE the is a bit out-of-date--after all, we usually don't know which unique influenza bug we're referring to when we use the term. (And, annoyingly, many people use flu for bad colds, which, like using migraine to refer to any headache, should be a punishable offen{c/s}e.)

So one's tempted to say that there's a the balance at work here: if a the goes missing in one dialect, it has to be replaced somewhere else within that dialect. But if I said that, someone would bring up hospital as evidence that AmE has one more the than BrE.) As is well known (so well known that I'm not supposed to be mentioning it), in BrE one ends up in hospital and in AmE one ends up in the hospital when (the) flu gets too bad. Americans often express wonder that there's no the in this phrase in BrE, but note that there's no the in go to school or go to church in either dialect. When referring to being in the institution for that institution's main purpose, there is no the for church, school or (AmE) college or (BrE) university. So, if you're a (BrE) pupil/(AmE) student (or a teacher) you could say (1), but if you're not, you'd have to say (2).
  1. I left my pen at school.
  2. I left my pen at the school.
BrE carries this through for hospitals, in that if one is engaged in the business of the hospital in the role of a patient, then the the is left out. So, we get no the with the description of patient in the sickhouse, but a the for a visitor to it, as in (3) and (4).
3. She was in hospital for weeks. (AmE in the hospital)
4. I was at the hospital to visit her. (=AmE)
Note that (5) (the hospital equivalent of (1)) is no good because while the person in (1) is still the school's student after they leave the school for the day, the person in (5) is no longer the hospital's patient (or at least not an in-patient) after they leave the hospital. So, (5) sounds like someone took their sick pen to the pen hospital for treatment.
5. *I left my pen in hospital.
And now I'm going to bed. Which is not the same thing as going to the bed, which wouldn't involve getting under the (AmE) comforter /(BrE) duvet and dreaming of determiners.

Postscript: Since writing this, I've written about this issue again (possibly better) in Babel magazine, number 4. If you like reading things like this blog, you might want to consider a subscription...

Post-postscript:I've got much better research on this topic now in the book, The Prodigal Tongue.


  1. I think that it's the Irish influence on American English that gives us so many extra thes. In the 19th century, when the huge immigration of Irish people to the U.S. happened, Hiberno-English was still tracking Irish uses of the definite article closely, so people were saying things like I am good at the Latin. That one didn't make it into American English, but it wouldn't astonish me if other Irish thes did.

  2. "The flu" and "the hospital" are also used in Scotland. Did they reach America from there before the 19th century? Dunno. Were they used in Scotland before the 19th century? Ditto.

  3. But when one works at a school, Am/E one would say, "I left my bag at the school."

  4. The commonality between IrE and ScotE here raises the question of whether it's Gaelic-influenced (I have no clue), but it doesn't need to be that, either. Could just be something that those Englishes do that English-English doesn't...

    When I lived in Texas, I occasionally heard the AIDS (I see it's also used intermittently in the AIDS song from the show Family Guy) and I have also heard the cancer (here's an example of that). It sounds very non-standard to my ears--I'd associate it with older country folk.

    Zhoen, I think if you work as a teacher in the school, you can say "I left the pen at school" (I certainly say things like that), but if you're the janitor, you'd say "the school". That goes back to the issue of being or not being part of the mission of the institution.

  5. One thing that struck me as odd in this posting is the use of an apostrophe at the beginning of "(')flu". As letters have been cut from both the beginning and end of "influenza", shouldn't it be written as "'flu'", with an apostrophe at each end?

    I agree with Lynn about it being an older, southern habit of using "the" with many afflictions. One that always sounds funny to me is "the diabetes".

  6. Apologies to the author for misspelling her name -- perhaps I should have said Lynn' to account for the missing "e"?

  7. Similarly, a politician can come to office and come to the office, at least in AmE. Any other examples?

  8. @Hodge- Thanks, you made me laugh :)

    @James- To me, (AmE), if you say "the politician is in office", you're saying he's serving his term, not that he's physically in his office. For that, you'd have to say he's in his/the office.

  9. An archaic BrE usage was the university meaning university, as in "when I was at [the] university". On British radio, the announcement of Hitler's death was attributed to the German wireless whereas we'd now say German radio. In The Ballad of the Sneak on the Homestar Runner website, a parody of old-time singing done in pseudo-BrE accents, the lyric includes: "Who's been drinking bootleg hooch/And listening to the jazz?" Modernly, one would say listening to jazz.

  10. Canadians as usual come down the middle.

    the flu
    in hospital

  11. Do we/did we at least agree on THE Ukraine, THE Argentine and so on? THE Dordogne?

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  13. Hodge, I think the only reason that it's not written 'flu' is that it then looks like it's in (BrE) inverted commas/(AmE) quotation marks. But that has always bothered me, too.

    Dearieme, the dialects definitely don't agree on thes in country names (but I'm guessing you knew that), but let's please NOT DISCUSS THAT HERE any further! I'll make it my next posting, and then we can have the comments on that topic together with the blog entry and therefore searchable. Ta!

  14. Oooh, it's too late! The topic-changing has already started!

  15. My memory of ScE (which, granted, has been isolated in AusE for more than 50 years) in our family with a medico as a father was "the infirmary" and I don't think dropping the definite article would sound at all right to my ears.

  16. And here in Aus, we have been known to like a drop of the Guinness.

  17. On the subject of (the) menopause, have you noticed how Brits say "hot flush" while Americans say "hot flash"?
    First time I saw a written reference to "hot flashes" I thought it was a mistake, especially considering one the other British meanings of "flash" - indecent exposure.

  18. Flash means to expose oneself in AmE too--we're just not dirty-minded enough to associate other uses with that meaning. ;)

    Flush is no better, really, it's associated with toilets! It's just that people tend to be struck by things that they don't say, rather than those that they do say.

  19. Dearime asks if we can agree on use of the definite determiner with at least some country-names. Always one to promote peace and concord, I'd point out, as well as the Argentine there's also Argentina. The Argentine used to mean the country but, during the Falklands/Malvinas war 25 years ago (before most of you SBACLers were born), excited pressmen started calling people from that country Argentines. Another linguistic casualty of that war was Argentinian which got re-spelled as Argentinean. (I compose this stuff in Word and Bill doesn't like Argentinian.) Then there was the affectionate tabloid nickname for our south American foes: the Argies, which conveniently connoted argy bargy.

    Is all this getting to me or did we once say the Lebanon and have we since dropped the article/determiner? Also, mightn't the determiner be gradually dropping off the Ukraine and, for that matter, the Gambia. The Vatican is funny because, although it's a sovereign state, I bet it connotes for many people a building and/or an institution. Most of it's indoors anyway.

    Countries in French have genders and, frequently, definite determiners (as do so many nouns from which we'd leave them off). Most nations are (in my recollection) helpfully feminine but you need to remember the persecuted masculine minority, including [the] Lebanon and the UK (as in ). Canada's masculine too, so in Canada isn't *en Canada but au Canada which I believe is conveniently also more or less the English-language title of the national anthem. In French, at least two cities I've heard of always have a (masculine) determiner: Cairo and Le Havre. You write à Paris but au Caire, and always le Caire, never just Caire. Galicia's A Coruña seems to come with a mandatory determiner, and in English (but not in England) there's the Hague.

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  21. Sorry about the post above, folks. The link-text (which disappeared) was le Royaume-Uni: nul points.

  22. Paul, you are very naughty. (See my comment after dearieme's.)

  23. I have always believed the extra thes in US English and elsewhere to be Celtic in origin, as Lynne said here. Up here in Scotland we sometimes use the definite article in front of people's names, as in "she's some linguist the Lynne." I suppose that is a determiner rather than an article. Anyway, added articles (relative to English) are very common indeed in Scottish Gaelic. For instance, the Gaelic for "in Glasgow" is "ann an Glaschu", literally "in the Glasgow." And that also gets done far more consistently and constantly than in English, in Bavaria, which is the Celtic region in Germany. The German language overall uses far more articles than English, but those personal determiners are unknown outwith the south (Bavaria, Austria). Does anyone know whether the same holds true in Spain's Celtic Galicia?

  24. Very sorry. I understood your: "Dearieme, the dialects definitely don't agree on thes in country names (but I'm guessing you knew that), but let's please NOT DISCUSS THAT HERE any further!" to mean that we weren't to discuss disagreements between AmE and BrE on definite determiners. My post was about pretty well everything else but not that. Just as well I didn't add the joke about Concord(e). Ah well: another forum, another ban,

  25. the only ban is on topics, not on people! :)

  26. And it's go to the mosque in AmE and BrE.

  27. Why do you suppose we say (AE) "on the radio" but "on TV"?

  28. 'Pick up the phone' implies that there are multiple phones in existance but the speaker is referring to a specific one.

    Therefore going to the hospital makes perfect sense (there are many but the speaker is referring to a particular one).

    Also, going to hospital makes perfect sense but is more generic.

    Saying 'the menopause' is ridiculous. How many menopauses can one woman have?? Theoretically there could be many but under normal physiological circumstances there is only one.

    Saying 'the menopause' implies that there are multiple menopauses to choose from and the speaker is referring to one specifically.

    No wonder it sounds wrong!

    Does anyone agree???

  29. It sounds wrong to you because it's not what you say, presumably. It sounds right to others because it is what they say. If you start looking for logic in linguistic expressions, you'll run into trouble quickly.
    Did you go to the school?

  30. Back in the olden days, every ailment had its determiner.

    "I can cure the Itch, the Stitch, the Pox and the Gout..."

    We the English would no more dream of a visit to the hospital to have the aforementioned devils knocked out, than we would go to library to borrow a book on the topic.

    Ms. Guist, please don't tell me my comment is "off the topic"!

    "Englishman in New York" Andy

  31. I think a better analogy for BrE "in hospital" would be "in prison" (or "in jail"). I think both dialects use that the same way we (UK) use "hospital" - an inmate is "in prison", but the building is "the prison" and a visitor might be in/at "the prison" for an hour - so any AmE speakers who can't intuit how BrE "hospital" works could extrapolate from that.

    (Sorry for the late comment - just discovered your excellent blog this week and have been catching up with the archives.)

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  33. Coming late to this discussion but to answer Paul Danon, I don't know if people in general ever said "The Lebanon," but the Human League sang it: http://www.youtube.com/watch?v=QEsRYkRpySY

  34. And now I'm going to bed. Which is not the same thing as going to the bed,

    In Scotland they say going to my bed.

    It's possibly a myth that they say You'll have had your tea, but they definitely do say have my tea, have your tea etc.

  35. @The Lebanon, etc.
    Israelis (or at least spokespeople for the nation) also refer to "the Galilee". That's not something I remember hearing/reading until the past couple of decades.
    As for Ukraine, if my memory is correct (big if), the article was dropped when the country became independent. I suppose the Ukrainians were tired of being referred to as "the border".

  36. Tom V

    It's the rule rather than the exception to use The X as a short form for The X Sea — provided that X is a unique name like Caribbean, not an everyday adjective like North.

    The Israelis have generalised this to a shortening of The Sea of X.

  37. Massachusetts-

    I wonder if these superfluous "the"s are being, or started out being used as intensifiers.

    Various illnesses such as (the) flu and (the)cancer which merit a stay in (the) hospital are dramatic and adding/keeping "the" in referring to them emphasizes that.

    RE (the) menopause:

    I think hot flashes and hot flushes are referring to different characteristics of the event.

    Hot flush refers to sensitive tissue being flushed with blood.(as in blushing)

    Hot flash refers to the sudden onset of the condition.

  38. I've posted on another thread that BrE recognises a set of nouns with two potential senses used in two grammatical categories. They are:

    • referring only to places (usually buildings) where particular activities take place
    • used as countable nouns

    • implying a primary reference to the activity associated with the building
    • used as uncountable nouns — typical for so-called abstract nouns

    1(BrE) The ambulance went to the hospital.
    2 (BrE)

    Comparable noun-classes and nouns that I remembered were
    school, college, university, etc
    prison, barracks

    I then remembered
    market — now usually a virtual place where buying and selling takes place

    Now I remember
    • places of worship, certainly church, chapel and possibly others (although not shrine, cathedral. I've heard to/in shool (or however you spell the anglicised Yiddish), but I'm not at all sure about to/in synagogue, to/in temple, to/in mosque

    Correct me if I'm wrong, but I believe AmE can make distinctions such as

    1. The mortician's vehicle drove to the church. (or whatever the AmE is for undertaker's hearse)
    2. The funeral party drove to church.

    I remember hearing that when Martin Luther King, at Mahalia Jackson's urging, tagged his I have a dream riff onto his Lincoln Memorial speech, she said words to the effect

    These people don't know it, but they are going to church!

  39. On that other thread, Dick Hartzell reacted to my proposed [1] 'mere building' countable noun[2] 'activity associated with the building' uncountable noun explanation with

    You've offered a rationale for British English that is completely silent on the matter of American English.

    On the contrary, I said

    The American usage requires no explanation. You state the physical facts with no indication as to purpose.

    He also said

    In any case, you might be astonished to know that American English does make the distinction between

    1 taking visitors to the market

    2 taking sheep to market

    Of course I'm far from astonished. This matches the AmE use of to the church/to church and to the school/to school. The difference between Br E and AmE is that we have more members of this class of nouns — including hospital, which is where we started.

  40. I don't mix with AmE speakers nowadays, so I tend to base my hunches on song lyrics and memorable quotes.

    I remembered the going to church quote from Mahalia Jackson without difficulty, but it's taken a while to pin down this quote from the adored Black boxer Joe Louis.

    After a meteoric rise, and the total adulation of the African American population, Joe Louis suffered a shock defeat in 1936 at the glove of the avowedly Nazi Max Schmelling. His only comment was the laconic

    'Me and Chappie's going back to school'.


    I see that something has disappeared from my posting above — no doubt because I mistyped an 'angle bracket' symbol ('<' or '>').

    It should read

    1(BrE) The ambulance went to the hospital.
    2 (BrE) The injured man went to hospital.

  42. Habitually, I read ALL the comments before posting one. This time I think I'm here via a link from Fritinancy; and I'm not (re?)-reading them all.
    It suddenly occurred to me that in the United States you could be in ANY hospital. The Veterans Hospital. Saint Joseph ['s?] Hospital, Children's Hospital, University Hospital...
    whereas...in NHS country, hospitals are not so competitive/differently orient[at]ed, &c.
    What do you think?
    How many hundreds of people have proposed this excuse previously?


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AmE = American English
BrE = British English
OED = Oxford English Dictionary (online)