infections and itises

So last time, I wrote about disease versus infection following the phrase sexually transmitted, and I started thinking (again) about how we talk about medical things--technical or non-technical? In the book I'm writing (for you!), I've touched on it a little with respect to bodily functions:

Sitting in my doctor’s waiting room, I’m amused and a bit astonished to find posters about what to do if there is blood in your pee or poo.* The equivalent American public-service advertisements say urine and stool. In the medical context, America avoids being crude by sounding more scientific, and Britain uses baby-talk.
* Make an appointment with your doctor immediately!
The discussion hits on things like BrE waterworks ('urinary tract') and back passage ('rectum') and  classes given to foreign nurses in the NHS on British slang--aka British euphemism. (It's a bit of the book that looks at the stereotype of Americans as euphemists, so yes, there's a lot of attention in the other direction.)

The "Americans use overly technical terminology" aka "Americans like jargon" stereotype that I contribute to in the quote above is one worth taking apart as well. I've been encouraged in that stereotype when I hear friends talk about their chest infections where I tend to have bronchitis. But then they're also talking about having cystitis (my poor, unhealthy friends), which I hadn't heard of before moving here. An infected cyst? Ew... No, it's a bladder infection. In AmE I'd call it a UTI (urinary tract infection). (The NHS website tells us that cystitis is a common type of UTI, so the terms are slightly different--but that's the case with bronchitis and chest infection too.)

So far, we're tied: Itises: BrE 1, AmE 1. Infections: BrE 1, AmE 1.

So I thought I'd have a look at which things Americans and Brits call infections and which they use Medical Greek -itis names for.

 The tables below are the statistically "most American" (left) and "Most British" (right) nouns that come before infection in the GloWBE corpus. (If you click on the table, it should get bigger.)
"Most American" and "Most British" words preceding infection
What you can notice there (if you can read the small print) is that the "more British" preceding nouns include things that can get infected (wounds, chests, throats), whereas the "more American" ones tend to be the microbes that do the infecting. In AmE, I think I'd say someone has an infected wound rather than that they have a wound infection. And one kind of wound infection you can have is a staph infection (in the US list), which is a very familiar term from my AmE childhood (we were constantly being told that gym mats were very dangerous). I don't know that I've ever heard staph infection in the UK.

In the BrE column you can also see urine infection, another BrE way of saying urinary tract infection. This one names neither the pathogen nor the organ, and always strikes me as a bit odd. Urine might have germs in it, but can urine itself be infected?

BrE has more throat infections because Americans are more likely to say they have strep throat. In my experience, scarlet fever is heard more in BrE these days (which is not to say you never hear it in AmE). When my child was diagnosed with it (in the UK), I really felt like I'd been taken back to Victorian times. She wasn't all that sick. But when I looked it up and found that it's the strep germ, I thought: maybe you hear scarlet fever more often in UK because AmE has strep infection.

Some of the numbers up there, though, are art{e/i}ifacts of the corpus. AmE has 56 instances of HSV infection but all of them come from a single website (virologyj.com), so we shouldn't take too much from that. American, like British, English would typically call that herpes. HBV infection is found on a greater range of sites, but they are mostly medical journals and such. Laypeople would generally say Hepatitis B.

But that does seem to sum up the difference between the AmE table and the BrE table: a lot of the AmE infection cases are use of medical jargon in a medical context--staph infection was the only one I knew as a layperson. Whereas in BrE the body-part+infection cases are terms that non-medical people would use when talking about their maladies.

If we look at the infections that American and British English have in common, we can see  that Americans do talk about infections too, sometimes with body parts, even.


But what about -itises? Is it mostly Americans using the fancy words? No, but there again maybe some effects here of one source being over-sampled in the corpus. Here I'm showing what came up as 'most American' (left) and 'most British' (right), with a bit of the 'neither one nor the other' showing in white. This is going to be very hard to read on a phone (sorry!), but I'll write up the highlights below.


I've given a comment in red if (a) the things are not diseases, but just coincidentally spelled with -itis, or (b) if it's a spelling issue. Though oesophagitis shows up in the British list, it's not because Americans don't use an -itis name for the problem, but because we spell it esophagitis. (Click here for my old post on oe/e spellings.) The British list is lengthened by a misspelling of arthritis and having two spellings for tonsil(l)itis.

After discounting those, the British list is still a lot longer than the American one, but I'm very much suspecting some bad corpus effects here. Tonsillitis, colitis, dermatitis, gastroenteritis, appendicitis, pancreatitis--I or members of my family have had all of these and that's just what they were called in the US. The numbers for these diseases are greater than expected in the British part of the corpus--but they're hardly absent in the American part. For example, note that there are 756 AmE occurrences of meningitis--which is here counting as "rather British", while only 16 AmE hits for phlebitis make it "very American". Some of these cases are going to seem "more British" or "more American" to the software just because the corpus happened to hit on some websites that talked about these things a lot. But I think what we can say from this exercise is that we have no particular evidence for British English avoiding -itis words, despite its greater use of body-part+infection.

Still there are a few itises worth mentioning for BrE/AmE interest. One is labyrinthitis, which I had an unfortunate encounter with this spring. When I described my symptoms (the room going upside-down and inside-out every time I turned my head left), lots of British friends said "Oh, that's labyrinthitis. I've had it. It's horrible!" But it was not a word that my American friends seemed to have at their fingertips--to them it was an inner-ear infection. (Why do Brits seem to get it more often, though?)


Conjunctivitis shows up on the British list, though it is a word that Americans use too. But Americans have another informal term for the problem: pink-eye. That will push the US conjunctivitis numbers down. (There are a few UK hits for pink-eye--with or without the hyphen, but a lot of US hits.)

In the white part of the table--where the numbers are similar for AmE and BrE -- are the two itises that are earlier in this post: cystitis, which I've experienced as more British, and bronchitis, which I've experienced as more American. Because the corpus is imperfect, I'm not going to totally discount my experience on these. But it would be interesting to hear if others (particularly transatlantic others who can compare) think I'm off my rocker...

I was surprised to see only one made-up disease in the list: boomeritis on the AmE side. (It was the name of a book--click on the word to learn more.) I would have bet that (AmE) senioritis would appear. (As it happens, there were only two US examples of it in the corpus--most are Canadian.) To quote Wikipedia:

Senioritis is a colloquial term mainly used in the United States and Canada to describe the decreased motivation toward studies displayed by students who are nearing the end of their high school, college, and graduate school careers.
For a minute there, I was worried that I expected senioritis to be there because I am OLD and UNCOOL. But I'm happy to report that in both the Corpus of Historical American English and in Google Books, the rate of senioritis use has only gone up in the decades since I was a high-school/college senior. Not happy for the teachers who have to teach these seniors, but happy that my vocabulary is not a complete dinosaur--yet.

If you're interested in other disease names, do have a look at the medicine/disease tag--thanks to (a) having a small child and (b) being a complete hypochondriac, quite a few have come up over the years--but there are still many more to cover in future.

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STD, STI

Is a Manchester sexual health clinic
trying to tell me something?
I just feel that I should say this up front: there is nothing autobiographical about this post. There. Got that out of the way. The topic only came up because I was in a conversation that involved an allusion to leaflets in doctors' (AmE) offices/(BrE) surgeries

Those leaflets are sometimes about (AmE, old-fashioned) social diseases. In either country it's possible to find references to  Sexually Transmitted Diseases or STDs or  Sexually Transmitted Infections or STIs. Is there a difference? Not really. To quote one (US) site on the matter:
STI stands for sexually transmitted infection, and many people, mostly the medical community, have begun transitioning from “STD” to “STI” in an effort to clarify that not all sexually transmitted infections turn into a disease. For instance, the vast majority of women who contract HPV (human papilloma virus) will not develop the resulting disease cervical cancer. In fact, most cases of infection will clear up within two years. Additionally, people who use this term believe that it also eliminates some of the shame that’s been associated with the acronym “STD.”
The UK seems to be far ahead of the US in adopting the "new" term.

The GloWBE corpus has about 5 times as many STD(s) in AmE as STI(s), but about 1.2 times as many STIs in BrE as STDs. The numbers for the non-abbreviated forms were not as strongly separated by country, but there were still more sexually transmitted diseases in the US and infections in the UK.

GloWBE is useful because relatively current and country-coded, but  it's counting up phrases from the web and there's no guarantee of the Britishness of someone writing a comment on a British news site (etc.). I wanted to check further because the UK numbers weren't as stark as I had expected. The friend in the aforementioned conversation has a nurse for his partner, a (UK) nurse, and his experience/impression was that in the medical profession it is almost always STI in the UK. That's been my impression too.

So, I searched for the terms on the National Health Service (UK) website and found about 4 times as many sexually transmitted infection(s) as sexually transmitted diseases but similar numbers of STI and STD. This seemed to be because almost whenever the NHS site uses the abbreviation, they use both abbreviations, as in "Sexual health testing for people with symptoms or who have had sex with someone who has a confirmed STI/STD" on a list of clinic services. In some cases, when I clicked through on a hit for STD there was no visible STD on the page, just STI. Which is why, boys and girls, it is generally better to use a corpus rather than Google for getting word-frequency counts. Some SEO magic seems to be going on on there.

On the National Institutes of Health (US) website there are twice as many sexually transmitted diseases as sexually transmitted infections.

Was STI coined in the UK? Not necessarily, but it's hard to tell. Only sexually transmitted disease (first citation, 1962) is in the OED. Searching Google Books, I find instances of sexually transmitted infection going back at least as far, but there's no clear separation between US (red) and UK(blue) books at the start of the term's history.



Why has STI caught on more in the UK? Some possibilities:
  • A more enlightened approach to sexual health? 
  • Better management of terminology due to the dominance of the National Health Service in delivering patient information and treatment?
  • It fits better with other names for illnesses in the dialect?
In terms of the last point, a first thing to wonder is whether STD is more popular in the US because Americans are more used to calling such things diseases, as in venereal disease. The answer seems to be "no". Venereal disease is and was just as well used in BrE, as far as I can tell.

What about the word infection, is that more common in BrE more generally? The answer is complicated, so I've decided to make that a separate post. It's half-written, so it might even be the next one!

And I leave you with what may be my favo(u)rite disease joke, from Cyanide and Happiness:

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the fourth of July

John Trumbull
Signing of the Declaration of Independence
When I (or a guest blogger) have talked about dates here, it's mostly been about how dates are written. (One exception was about how we say the year.) One thing we've not really talked about is how we read dates out loud.

I've been struck by the mismatch a couple of times when British people have tried to "go American" and put the day after the month. In one case, it was The Telegraph on complained-about Americanisms on the BBC. One of these was July 5. And I thought: but Americans hardly ever say July 5. We write it, but in the context of a sentence we'd pronounce that date as July 5th. Not It's on July 5, but It's on July 5th.

The same happens in BrE. People write 5 July, but they pronounce the 5 as the ordinal version: fifth. People don't go about saying "My birthday is five July". So, I've never understood: when people complained about July 5 on the radio, had they heard someone say July five, or is that their way of writing that someone said July fifth?

It happened again today, when @BoswellAffleck forwarded to me a tweet in which someone else wished Americans a "Happy July 4". Maybe the tweeter was saying that to himself as July 4th, but if I were to write it, I think I'd write "Happy July 4th", since it's in an expression that's addressed to some particular people; not a fact of when something happened, but the name of a day. July 4 might be what I write at the top of a letter, but if I put it in a phrase like that, I think I'd have to write the th in order for it to look like it sounds.

It's OK to wish someone a Happy July 4th (especially if you're trying to save characters on Twitter), but it's still not super-idiomatic American English. The holiday that falls on that day has two official names: Independence Day and the Fourth of July. In wishing people a happy one, it's clearer to use the name of the holiday.

British folk sometimes ask me about the Fourth of July. If Americans write the date as July 4 (and 7/4 when expressing the month as a number), why is the fourth in front of the month in this case?

They probably ask about that one in particular because they don't hear all the other times Americans say the date that way. But we do have and use the option to say other dates that way too.  My Englandiversary is on the 6th of January or January 6th. I could say either, but the 6th of January sounds more formal to me. The formality might just be due to the length of it--and maybe particularly that definite the. The is something of a marker of more formal English.

At this point, a table might be a good idea.


today's date AmE BrE
07/04/2016 yes --
July 4th yes sometimes
July the 4th legal contexts yes
04/07/2016 -- yes
4th July -- yes [but more written]
the 4th July -- yes [but more written]
the 4th of July yes yes


I used the Corpus of Contemporary American English and the British National Corpus to check on these (though I used *th instead of a particular number and June instead of July, because the holiday's name would skew the results)--and that's how I found the "legalness" of [month] the [ordinal] in AmE: all of the examples seemed to be from courtrooms or reporting on legal matters, as in "the evidence will prove that Kato last saw the defendant on the night of June the 12th at 9:35 at the latest".

In general, the table shows that each national dialect wants to do something "extra" if it puts the date on the "other" side of the month from that which it occurs in writing the date numerically. If the date is put after the month in BrE, it needs a the. If it's put before the month in AmE, it needs a the and an of. These extra words are marking these expressions as 'not the default way to express the date' in those countries.

In British English, dates like the 4th June are written much more than they're said. More often the pronounced version has the of in it. Not only does the of help to avoid the ambiguity between 'the fourth day in June' and 'the fourth June in a series', it gives the date a nicer melody: spoken English doesn't like to have two stressed syllables in a row. The of breaks up the stressfest.

How did we end up putting the day on opposite sides of the month? It's one of those where American has the older form. It says July 4, 1776 at the top of the Declaration of Independence because that's how people wrote dates back then. Putting the date before the month came to Britain in the late 19th century, influenced by other European countries. (I'm going to assume "especially France", because British English loves nothing more than a bit of Frenchifying.) 

And why is the holiday the Fourth of July rather than July Fourth? I suspect it has to do with that sense of formality that the longer form conveys and the the.  It's not just some date, it's the date.
(I now have The Twelfth of Never stuck in my head.)

For more on why Americans tend to call the holiday by the date, rather than Independence Day, see this article on Slate.


And I can't leave this post without noting Nigel Farage (UK Independence Party) urging
"let June the 23rd go down in history as our independence day". 

First: note that date after the month. Does June the 23rd sound more formal or ceremonial than the 23rd of June in a BrE context? Would love to hear British thoughts on the relative formality of the ways of saying dates.

Second: Whenever I heard the Leave [the European Union] campaigners claiming that date as "Independence Day", I thought: Is that what all this is about? Are these guys just jealous that they don't have a holiday with a [orig. AmE] kick-ass name like the US has?  I'm asking a bit as a joke, but a part of me thinks that it's not far off the mark.

(The timing of the new Independence Day film, opening in the UK on the day after the EU referendum, meant that lots of people were using the film's poster instead of images of actual people fighting for actual independence in the actual world. It is all rather surreal.)

And third, this table. I haven't been able to find who first put it together and posted it  (if you know, let me know and I'll add a credit)--I've seen it on many friends' Facebook pages.

(The table is from Wikipedia, but I'm not sure who added the question and circulated it.)


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Trying to sound cool & British: bollocks!

We've seen other cases before of Americans trying to use "cool" British words--especially slightly "colo(u)rful" words, and getting it wrong ([more used in BrE] viz. wanker, snog). Here's a lovely example from the New York Daily News (which I saw via Oliver Burkeman):



There's a pile-up of Britishisms here: arse (=AmE ass), Mummy (=AmE Mommy), footy (=AmE soccer--or whatever informal equivalent of soccer there is. Socky?). But the sore thumb sticking out here is bollocks (click link to see its Word of the Year discussion). Yes, bollocks sometimes--sometimes--is an equivalent to AmE bullshit in the sense of 'nonsense, (BrE) rubbish'  But calling bullshit on (something/someone) is an American idiom, and you just can't stick new words (especially new words with not-quite-the-same-feel) into idioms. Kicking the pail is not the same as kicking the bucket; a bird in the hand is not worth two in the shrub, etc.

Who knows, maybe call bollocks on will catch on among the readers of the Daily News, and then we'll have yet another case where borrowing a word from one dialect to another brings a reduction in meaning and a change in usage with it. But I'm betting that British readers are hoping otherwise...


P.S. my arse! or my ass! also qualifies as an idiom, but the two dialects share it, albeit with different forms of the word. (See the link at arse above for more of the arse–ass story.)

P.P.S. Yes, there are a few examples of it on the internets. In those cases, taking the US idiom and replacing 'bullshit' with 'bollocks'. But the facts that (a) Urban Dictionary hasn't noticed it, and (b) two Brits on Twitter pointed it out to me as a bad translation underscore that it's a weird usage. 
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hokey-cokey, hokey-pokey

Thursday's British referendum on EU membership (let's not talk about the result) has given American readers cause to wonder about the hokey-cokey (thanks for pointing this out, Emma). Americans know the song-dance as the hokey-pokey. On referendum day, it was a hashtag on Twitter, with gems like these:





 (Click here for a barbershop referendum hokey-cokey.)


Various sources tell origin stories for the song/dance. It may be based on an old British or Irish children's song/game, but it definitely became popular (as hokey-cokey) in British music hall entertainment in the 1940s. The Hokey Pokey Dance was copyrighted in the US in the 1940s, and recorded in the 1950s as the Hokey Pokey.  And of course there were legal battles.  I'll refer you to Fraser's Phrases on BBC America's Anglophenia for more of the story.

Sometimes it's also known as The Hokey-Tokey. Maybe particularly in New Zealand where Hokey-Pokey is a flavo(u)r of ice cream.

The tune is the same, but the lyrics (and therefore actions) may differ a bit.  I can only tell you about where I grew up in the US and where my child is growing up in the UK, and there might be local variations.

Here's a Hokey Pokey:




And here's a Hokey Cokey:

The differences in these are in line with my experience, that the "knees bent, arms stretched, rah-rah-rah" part is not used in the Hokey-Pokey, but is generally found in the Hokey-Cokey.

Any other good #hokeycokey tweets or jokes to share? Or school dance horror stories? I need some cheering up...
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The book!

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Abbr.

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