New Results

Naming of human diseases on the wrong side of history

Zhiwen Hu
doi: https://doi.org/10.1101/2021.05.01.442270

Abstract

Background In the medical sphere, understanding naming conventions strengthen the integrity and quality of naming human diseases remains nominal rather than substantial yet. Some strongly-held but flawed names like German measles frequently appear in scientific literature.

Objective This study examines whether some stereotypes of diseases like German measles are at the cost of social impacts. As an exemplificative case, we also offer a heuristic approach to determine a pithy synonym instead of German measles.

Methods In the global online news coverage experiments, we examined the compiled global online news volumes and emotional tones on German measles, Middle Eastern Respiratory Syndrome, Spanish flu, Hong Kong flu, and Huntington’s disease in the past two years. The results demonstrate 65 multilingual textual and visual narratives via GDELT’s machine translation and neural network image recognition. In the historiographical survey, we prototypically scrutinize the lexical dynamics and pathological differentials of German measles and common synonyms by leveraging the capacity of the Google Books Ngram Corpus.

Results The results of the global online news coverage experiments show that the public informed the long-standing but flawed names like German measles with extremely negative tones in textual and visual narratives. Furthermore, the findings of the historiographical study indicate that many synonyms of German measles did not survive, while German measles has been on the wrong side of history, and rubella has taken the dominant place since 1994.

Conclusions This study first orchestrates rich metadata to unveil that the nosological evolution of German measles is on the wrong side of history. The survey strongly indicates that some stereotypes of diseases like German measles have always come at the cost of sociocultural impacts, whatever their seemingly harmless origins. To mitigate such impacts, rubella should exclusively become the common usage rather than German Measles in scientific perspective.

Introduction

Background

Terminology is the crystallization of human scientific and technological knowledge in natural language. In medical sphere, appropriate names deliberately invented for the designation of human diseases with pathological characteristics. However, less aligned emphasis has been placed on the medical nomenclature of human diseases. In the same week, the idiomatic usage of German measles in the leading journals Nature and Science implies that some strongly-held but flawed names may brand discrimination and stoke panic [1–3]. In the 19th century, the name rubella was proposed as a substitute for German Rötheln, then the epidemic neologism German measles was accepted gradually [4–13]. Arguably, the looming worry is that such usages might reignite the torch of discrimination and fuel the current infodemic unconsciously [14–18].

Study Objectives

Based on extensive literature review, this study aims to punctuate heuristic introspection of naming practices for human diseases and address the following research issues:

  • Are the idiomatic usages like German measles at the cost of negative impacts?

  • What are the diachronic discourses of German measles and common synonyms? What can we learn from the lexical dynamics of German measles?

  • Should we hash out the inappropriate names like German Measles?

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [19], we orchestrated rich metadata available to unveil the scientific paradigms via the following experiments:

Global online news coverage experiments

In the experiments, we aim to unveil the scientific paradigms of the diachronic discourse and emotional tone. Here, the metadata analysis aims to demonstrate the emotional polarity of the public in the context of global online news on German measles, Middle Eastern Respiratory Syndrome, Spanish flu, Hong Kong flu and Huntington’s disease over time, respectively.

Firstly, the curated codebook was designed by three main principles we established before [20]. According to the codebook, the search formulas in the survey are as following:

  1. German measles: (“German measles” OR “German Measles”) AND PublicationDate>=5/27/2019 AND PublicationDate<=5/27/2021

  2. Middle Eastern Respiratory Syndrome: (“Middle Eastern respiratory syndrome” OR “Middle Eastern Respiratory Syndrome”) AND PublicationDate>=5/27/2019 AND PublicationDate<=5/27/2021

  3. Spanish flu: (“Spanish flu” OR “Spanish Flu” OR “Spanish influenza” OR “Spanish Influenza”) AND PublicationDate>=5/27/2019 AND PublicationDate<=5/27/2021

  4. Hong Kong flu: (“Hong Kong flu” OR “Hong Kong Flu” OR “Hong Kong influenza” OR “Hong Kong Influenza”) AND PublicationDate>=5/27/2019 AND PublicationDate<=5/27/2021

  5. Huntington’s disease: (“Huntington’s disease” OR “Huntington’s chorea” OR “huntington’s disease” OR “huntington’s chorea” OR “Huntington Disease” OR “Huntington disease” OR “Huntington chorea” OR “huntington disease” OR “huntington chorea”) AND PublicationDate>=5/27/2019 AND PublicationDate<=5/27/2021

Secondly, based on the curated codebook, the metadata of compiled global online news coverage and emotional tone retrieved through the open project GDELT Summary between May 2019 and May 2021, including the textual and visual narratives of different queries in 65 multilingual online news [21,22]. Finally, by leveraging the capacity of GDELT’s machine translate and neural network image recognition [22], the instant news portfolio in Figure 1 summarizes the textual and visual narratives of different queries in 65 multilingual online news.

Figure 1.
Figure 1. Diachronic discourse and emotional tone of stigmatizing names in the past two years through GDELT Summary.

The global instant news portfolio summarizes the textual and visual narratives of different queries in 65 multilingual online news: A, German measles; B, Middle Eastern Respiratory Syndrome; C, Spanish flu; D, Hong Kong flu; and E, Huntington’s disease. The upper panels display the percent of all global online news coverage over time. The lower panels show the average emotional tone of all news coverage from extremely negative to extremely positive. The temporal resolution of sampling is 15 minutes per day.

Historiographical study

The Google Books Ngram Corpus (GBNC) is a unique linguistic landscape that benefits from centuries of development of rich grammatical and lexical resources as well as its cultural context [23]. It contains n-grams from approximately 8 million books, or 6% of all books published in English, Hebrew, French, German, Spanish, Russian, Italian, and Chinese. The GBNC covers data logs from 1500 to 2019. A unigram (1-gram) is a string of characters uninterrupted by a space, and an n-gram (n consecutive words) is a sequence of a 1-gram, such as morbilli (1-gram), rubeola (1-gram), rubella (1-gram), Rötheln (1-gram), and German measles (2-grams). In this study, by retrieving the use frequency of a specific lexicon in historical development, we first obtain a glimpse of the nature of historical evolution in Figure 2.

Figure 2.
Figure 2. Historiographical study.

Google Books Ngram Corpus (GBNC) facsimiles the diachronic discourse of morbilli (English corpus), rubeola (English corpus), rubella (English corpus), Rötheln (German corpus), and German measles (English corpus) from 1719 to 2019. Based on the pragmatic frequency of these synonyms, rubella has tended to dominate in literature since 1994.

Then, as we continue to stockpile seminal patterns in Figure 2, some have argued that correlation is threatening to unseat causation as the bedrock of scientific storytelling before. We must punctuate heuristic cautions of wrestling with information from retrospective sources, cross-validation, and the reassembly of the whole story. Finally, we provide compelling arguments to the extent of understanding the underneath nature of lexical dynamics and pathological differentials based on authentic materials and critical examination.

Results

Marginal cost of contextualizing stigma

May 8, 2021 marks 6 years since the first naming conventions of new human infectious diseases announced by the World Health Organization (WHO)[24]. In recent years, we have witnessed many outbreaks of human diseases, with proper names given by stakeholders. Sometimes, diseases are initially given interim names or common names by stakeholders outside of the scientific sphere. The proper name is officially ratified by the International Classification of Diseases (ICD) of WHO. Even so, each round of naming practice is not always successful, such as Ebola, Rift Valley Fever, Athlete’s foot, Chagas disease, Marburg disease, Legionnaire’ disease, Creutzfeldt-Jakob disease, swine flu, monkey pox, bird flu, etc [24–26]. Of them, Middle Eastern Respiratory Syndrome (MERS) [27], Spanish flu (1918-1919)[28,29], Hong Kong flu (1968-1969)[30–32] and Huntington’s disease [33–36] were frequently accused of unintentional social impacts.

Naming conventions are not merely for naming diseases but for the vitality of science and the promotion of social progress [26,37–39]. Evidently, as shown in Figure 1, the results of the global online news coverage experiments show that the global news outlets (in 65 languages) enjoy long-standing but flawed naming conventions with extremely negative tones, such as German measles, Middle Eastern Respiratory Syndrome, Spanish flu, and Huntington’s disease. This new finding suggests that some stereotypes of diseases confounded the generally accepted paradigm at the cost of unintentional social impacts [16,24,38].

Admittedly, understanding how naming conventions strengthen the integrity and quality of naming practices with the original mission remains nominal rather than substantial yet. In the COVID-19 infodemic, multifarious monikers have become explicit consideration in the COVID-19 paper tsunami, and the global profusion of tangled hashtags has found its ways in daily communication. Just as the remarks of the editorial of Nature, “As well as naming the illness, the WHO was implicitly sending a reminder to those who had erroneously been associating the virus with Wuhan and with China in their news coverage — including Nature. That we did so was an error on our part, for which we take responsibility and apologize.”[40] Unfortunately, many more stigmatized names somewhat aggravate the collective perceptual biases and contribute to recent backlash against Asians and diaspora [41,42]. Thus, scientists must verse themselves in naming conventions rather than feeding the trolls of racism.

Nosological evolution of German measles and counterparts

Framed within the historical coevolution of scientific contexts, understanding the nosological continuity of diseases remains limit [43–47]. As a case in point, the pathological associations between German measles and common synonyms (e.g., morbilli, rubeola, rubella, Rötheln, etc.) are in the fog of confusion, although the debate has been going on over a century and a half earlier [4,48–52]. These diachronic discourses and lexical dynamics also remain unclear [1,4,53–56].

Nowadays, the Google Books Ngram Corpus (GBNC) is a unique linguistic landscape that benefits from centuries of development of rich grammatical and lexical resources as well as its cultural context [23,57,58]. It contains n-grams from approximately 8 million books, or 6% of all books published in English, Hebrew, French, German, Spanish, Russian, Italian, and Chinese from 1500 to 2019. Arguably, the lexicographical and historiographical study promises to articulate the ins and outs of scientific storytelling by leveraging the capacity of these rich-metadata corpuses. As shown in Figure 2, many miscellaneous disease names (e.g., morbilli, morbilli scarlatinosi, rötheln, feuermasern, scarlatina morbillosa, rubeola notha, rosalia idiopathica, bastard measles or scarlatina, hybrid measles or scarlatina, etc.) have sunk back into a merited oblivion in the ups and downs of history, while German measles has gone astray, and rubella deserves to take the dominant place in scientific perspective.

The nosology of German measles and similar diseases is still far from being generally recognized, as well as their pathological differentials [59,60]. Measles is an old English disease name that classical nosologists have vainly attempted to replace by such synonyms as morbilli and rubeola [61]. The English term measles was introduced by Dr. John of Gaddesden as an equivalent of the Latin term morbilli around the 14th century [47,62,63]. But such designation was generally criticized for “a product of semantic and nosographic confusion.”[64] The term rubeola originally borrowed from the Latin word rubeus (meaning reddish) in Avicenna of Bagdad’s writings, is thought to have been used for the first time as a translation of the term measles [63,65,66]. Indeed, the great majority of scientists recognize German measles to be an independent disease.

According to the Oxford English Dictionary Online (OED Online), the earliest known references to German measles date back as far as 1856 (Table 1). Therefore, it is generally believed that the epidemic entity German measles was accepted growly after 1856 [4,67,68]. In fact, the earliest usages could be stemmed back to about 1814 (Table 2).

View this table:
Table 1.

The earliest print appearance of German measles and its synonyms according to OED Online.

View this table:
Table 2.

Historiographical origins of German measles and common synonyms.

The term German Measles was established as a separate disease in 1814, and official recognition by the International Congress of Medicine in 1881. Shortly before 1768, for more learned occasions, Rötheln and morbilli seem more decidedly to mark a distinct disease, than any other yet proposed [4,56]. French physician Sauvages de Lacroix, who established the first methodical nosology for disease classification in 1763 [80,81], first applied the term rubeola to what had been previously termed morbilli in 1768 [56]. And while almost immediately after him, the German physicians, Selle, Orlow, and Ziegler, clearly laid down the distinctive marks between rubeola and morbilli. On April 4, 1814, Dr. George Maton read a paper entitled “Some Account of a Rash Liable to be Mistaken for Scarlatina” at the Royal College of Physicians in London [75–77], which results in the names rubella or German measles as a substitute for Rötheln [4,53]. Then, the epidemic term German measles was accepted gradually as a synonym of rubella. German measles, Rötheln or rubeola per se, was officially ratified as a distinct disease at the 7th International Medical Congress, London, August 2 to 9, 1881 [55,82–89]. A quarter-century later, the term German Measles has ultimately become the common usage, but being on the wrong side of history.

Rubella has been “discovered—and named—multiple times” in the past centuries [90]. In modern literature, rubella has become a de facto synonym for German Measles after 1944 [4–13]. In 1740, the English name rubella is derived from Latin rubellus reddish, and the first clinical description of rubella was first described by German chemist and physician Friedrich Hoffmann, the author of Fundamenta Medicinae [78,79]. Then, rubella was considered by Dr. Maton to be mere variant of measles or scarlet fever in 1814 [75,76,91]. Half a century later, English surgeon Henry Veale suggested the need to name the discrete disease, and formally proposed the name rubella as a substitute for Rötheln in 1866 [67]. As a major human infectious disease, rubella must have emerged only in the past 11,000 years for which some close relative may still exist among animals [1,59]. Indeed, consistent with the historiographical results (Fig. 2), rubella had been considered of “minor importance among the common communicable diseases” until 1940 [92]. Following the rubella epidemic of 1940, the occurrence of congenital rubella syndrome (CRS) first recognized by Norman McAlister Gregg in 1941 [93,94]. As of 2018, 81 countries were verified as having eliminated rubella via routine vaccination, and even today rubella remains endemic in other countries [95].

To quell confusion and avoid stigma, we should hash out the inappropriate name German Measles. In fact, some pioneers advocated the discarding of the offensive name German Measles before [60,96,97], as the remarks, “it [rubella] is perhaps the best that has been used”[60] and “a better name for which [German Measles] is rubella.”[97]

Discussion

Conclusion

Long-standing but flawed names of human diseases are still going viral in both the scientific community and news outlets at the cost of social impacts, whatever their seemingly harmless origins. Following by the best practices of WHO, curated names of human diseases should be scientifically pithy and socially acceptable, with the faith of minimizing marginal impacts on nations, economies, and people. Lexicographical and historiographical study could bridge the gaps in understanding the natural history and finally penetrate to the essence of human diseases’ nosology. Heuristic introspection would help us to determine pithy synonyms instead of offensive names. Arguably, as an exemplificative case, it is reasonable that rubella should become an exclusive usage rather than German Measles with the same clinical manifestations and equivalent semantics in scientific perspective.

Acknowledgements

We hereby desire to express indebtedness to anonymous reviewers for their valuable and constructive comments. This study was partially supported by the National Natural Science Foundation of China under Grant U1936208 and Zhejiang Provincial Natural Science Foundation of China under Grant LZ21F020004.

Footnotes

Abbreviations

COVID-19
Coronavirus Disease 2019
GBNC
Google Books Ngram Corpus
GDELT
Global Data on Events, Location and Tone
ICD
International Classification of Diseases
MERS
Middle Eastern Respiratory Syndrome
OED Online
Oxford English Dictionary Online
WHO
World Health Organization

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Posted June 04, 2021.
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Naming of human diseases on the wrong side of history
Zhiwen Hu
bioRxiv 2021.05.01.442270; doi: https://doi.org/10.1101/2021.05.01.442270
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