INVITATION ARTICLES - Similes in Medicine  By Dr. R. V. Bhatt & Dr. Shirish daftary

Rohit Bhatt
Chief. Dept. Obst. Gynec.
BD Amin General Hospital
Baroda

 

Shirish Daftary
Former Dean. Nowrosjee Wadia Hospital
Parel Mumbai 400 012

 

Similes are used in daily life to compare anything new to popularly known entity. This makes it easy to understand. When we say, ‘It is as cold as ice’, we can appreciate the degree of cold. This is because we know that ice is cold. When we say, ‘As sweet as honey’. We know that honey is sweet. Therefore, the item compared with honey must be as sweet.

 

Similes are also used to simplify expression of words. In clinical medicine there are lot of signs and symptoms. The doctor or the patient find out a similar object to describe their complains or signs. Patients normally like to compare their symptoms to their food. Everyone has seen ‘Rice water’. When stools are compared to ‘Rice water’ in cholera, every one understands what the patient or the doctor wants to convey.

 

Normally, common objects used in simile are related to food, animal/vegetable kingdom, and occupation, commonly played games, environment or romance. More similes are related to food or animals because the patients remember the common food items or animal characters.

 

Food habits of people vary from state to state and from country to country. Therefore, food related similes in one country may not be appreciated in another country because that food item is not used by others. Anchovy sauce may not be available in some countries and so people may not appreciate when you say ‘Anchovy sauce pus in amoebic liver abscess. These are the limitations of using similes. In contrast, chocolates are known all over the world. When we say ‘chocolate colored fluid in ovarian cyst, everyone understands. When patients use similes, it helps the doctor to appreciate what the patient is saying. Use of similes by doctors also simplifies the problem. When Radiologist describes x-ray appearance in vesicular mole as ‘honeycomb appearance, one understands it better. Every clinician understands when radiologist describes ‘Sun Ray appearance’ in osteogenic sarcoma. When we say the woman is suffering from ‘honey moon cystis’ or honey moon pyelitis’, it is easy to appreciate the role of coitus in causing the disease.

 

Similes change with time. New similes appear as new food items or vegetable items are discovered. May be similes related to food and animals have reached a saturation point. Therefore, we have to explore newer technologies to describe signs and symptoms. The newer similes may be related to computer, environment or information technology. We should not be surprised if new similes like ‘zooming’,’ bullets’, ‘formatting’, ‘recycle’ appear in near future.

 

We scanned the literature, asked friends and colleagues to find out various similes in Medicine. We have tried our best to scan the literature. We may have missed some similes.

 

We wish our readers write to use if they can add more similes to our list. Some similes are intentionally repeated under different headings because they are used by more than one discipline

 

Addition to similes is a continuous process. There are no full stops. Newer and Newer similes will appear in future. Our endeavor is to document the existing similes before they are forgotten or go into oblivion. We have classified similes in two groups. Table 1 lists similes related to obstetrics and Gynecology. Tables 2,3,4,5 list similes in all other specialties.

 

Acknowledgement

We thank the colleagues in Bhailal Amin General hospital and many other colleagues for suggesting similes in their specialty

 

Table 1 - Similes in obstetrics and Gynecology

Similes related to food

  • Apple and stalk relationship between urinary bladder and urethra
     in normal woman

  • Barley water fluid in spermatocele

  • Cheesy exudates in tuberculosis

  • Chocolate cyst of the ovary

  • Egg crackling sound in hydrocephalus

  • Peau de orange skin in Ca Breast

  • Grape like sarcoma of cervix

  • Swiss cheese appearance in endometrial hyperplasia

  • Curdy discharge in Monilial infection of  vagina

  • Pear shaped appearance of the uterus

  • Pear and stalk relationship between urinary bladder and urethra in SUI

  • Pear –Unripe pear appearance on cutting the breast cancer

  • Pancake appearance of retro-placental clots in abruptio placentae

 Similes related to animal and vegetable kingdom

  • Breast mouse in fibro-adenoma of breast

  • Cauliflower growth on cervix

  • Fishy smell in Bacterial vaginosis

  • Fishy smell of urine in B.coli infection

  • Flea bitten appearance of vagina in Trichomonad infection

  • Hare lip deformity of the lip

  • Honey-comb appearance on x-ray in Vesicular mole

  • Mickey mouse appearance of fetal head om usg  in anencephaly

  • Mickey mouse sign of umbilical cord on usg (three vessels)

  • Wharton’s jelly-mucoid tissue in umbilical cord

Miscellaneous

  • Accoucheur’s hand

  • Bucket handle tear of cervix

  • Flame shaped hemorrhages on fundoscopy in severe PIH

  • Honey moon cystitis

  • Honey moon Pyelitis

  • Kissing ovaries in endometriosis

  • Retort shaped appearance of hydrosalpinx

  • Snow storm appearance on usg in vesicular mole

  • Uterus Cordiformis (heart shaped)

 

Table 2 - Similes related to Animal Kingdom

  • Breast mouse in fibro-adenoma of breast

  • Buffalo type fat in Cushing’s syndrome

  • Elephantitis in filariasis

  • Fish like mouth in Cushing’s syndrome

  • Flea bitten appearance in sub acute bacterial endocarditis.

  • Flea bitten appearance in measles

  • Frog hand in Palmer abscess

  • Frog like face in sarcoma of ethymoid bone

  • Hare lip deformity of lip

  • Honey comb appearance in bronchiectasis –Anthrax

  • Leonine face in Leprosy

  • Moth eaten appearance of bone in sarcoma

  • Moth eaten skull in Van Packlinghaussen syndrome

  • Parrot beak appearance of nails in cyanotic heart disease

  • Pigeon breast chest in rickets

  • Rat tail deformity in Ca esophagus

  • Rat tail appearance in Ba.meal in large bowel obstruction

  • Scot terrier appearance in spondylolysthesis

  • Serpentine varicosity in venous obstruction

  • Snail tract ulcers on under surface of tongue in secondary syphilis

  • Spider nevus in vena caval obstruction

  • Toad skin in Vit. A deficiency

  • Worm eaten skull in syphilis

Table 3 - Similes related to food

  • Anchovy sauce pus in liver abscess

  • Bamboo spine in Ankylosing spondilytis

  • Barley water fluid in spermatocele

  • Black current jelly stool in acute intessusception

  • Bread & Butter Pericarditis

  • Cauliflower like growth of tumor

  • Cherry red spot in Berlin edema of optic disc

  • Cherry red lips in diabetes

  • Cherry spots in Tach-Sach’s disease

  • Chickengunia

  • Chocolate colored sputum in Friedlander’s syndrome

  • Cheesy exudates in tuberculosis

  • Coffee ground vomit in Ca. stomach

  • Egg shell crackling in osteoclastoma

  • Egg shell crackling in hydrocephalus

  • Hazelnut tumor in sternomastoid muscle

  • Honey moon cystis

  • Honey moon pyelitis

  • Lemon sign in  spina bifida

  • Hot-cross bun in hydrocephalus

  • Melon seed bodies in tuberculous joints

  • Mulberry Molars

  • Nutmeg liver in chronic liver congestion

  • Oat cell carcinoma

  • Peau de orange skin in Ca breast

  • Pear –Breast cancer cuts like unripe pear

  • Pea soup stool in typhoid fever

  • Port wine urine in black water fever

  • Port wine stain in capillary hemangioma

  • Potato nose in sebaceous cyst

  • Potato tumor of the carotid body

  • Rice water stool in cholera

  • Sago spleen in Amyloidosis

  • Snowman’s heart in anomalous pulm.venous drainage

  • Strawberry gallbladder in cholesterosis

  • Strawberry mark in cavernous hemangioma

  • Sugarcane smell in liver failure

  • Sausage shaped swelling inintessusception

  • Ta cup calcification in plasma cell mastitis

  • Watermelon seeds in compound palmer ganglion

 

Table 4 - Similes related to occupation

  • Athlete’s foot

  • Hammer Toe

  • Housemaid’s knee

  • Kangari cancer in Kashmir

  • Moon face in Cushing’s syndrome

  • Mongoloid face

  • Golfer’s Elbow

  • Policeman’s tip in Erb’s palsy

  • Shoemaker’s chest

  • Singer’s nodule

  • Tennis Elbow

  • Tennis Leg

  • Turban tumor in cylinderoma on head

  • Violinist dinger

  • Weaver’s bottom

  • Writer’s cramp

 

Table 5 - Miscellaneous Similes

  • Bowed legs in childhood rickets

  • Boot shaped heart in felot’s tetrology

  • Buddha position of fetus

  • Clasp knife (penknife) rigidity

  • Clubbed nails in cyanotic heart disease

  • Cotton wool exudates

  • Cotton wool patches in vascular retinopathy

  • Cotton wool appearance in Paget’s disease

  • Dowger’s hump in severe osteoporosis

  • Hilar dance (St.Vitus dance

  • Kissing cancer

  • Kissing spine

  • Leather bottom stomach in Linctus plastica

  • Lead pipe rigidity

  • Magenta tongue in Riboflavin deficiency

  • Moon teeth in congenital syphilis

  • Punched hole appearance in multiple myeloma

  • Rickety Rosary

  • Rocker bottom feet in Edwards syndrome

  • Sabre tibia in congenital syphilis

  • Snowman appearance of heart in Transposition of great vessels

  • Sun Ray appearance of bone on x-ray in osteogenic sarcoma

  • Step ladder appearance on x-ray in Bowel obstruction

  • Tarry stool in G.I.Tract bleed

  • Weeping ulcers

  • Water can perineum (in multiple fistulae)

 

 

 

  
     

 
         
     

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