I handed a prescription to a patient last week and she asked me whether she should take it straight away ‘to the apothecary’. I thought at first that she was using the word apothecary as a joke, but she was not. At the age of ninety-seven, she was saying it without any self-consciousness – and presumably without any awareness that dictionaries have defined it as archaic for at least fifty years.
I wondered if I was witnessing the very last time that this word would ever be used in common English parlance. Doctors spend their lives listening to people, so we may be in a better position than almost anyone else to listen out for archaic words that have survived in common speech. Of course, it would be impossible scientifically to record the last usage of any word. Who could ever prove that the word ‘milliner’, or ‘costermonger’, or indeed ‘apothecary’ would never be spoken again?
To chronicle the very first usage of each word in the English language was, in its time, the biggest research project ever undertaken – the nineteenth-century equivalent of the human genome project. A doctor, as it happens, played a large part in this. When James Murray began to compile the Oxford English Dictionary in 1879, he solicited the help of an army of enthusiastic volunteers from around Britain. He asked them to comb the published literature in the English tongue since mediaeval times, and to record examples of the first appearance of every English word, in each of its nuances. One of Murray’s most prolific correspondents, particularly for words beginning with ‘A’ and ‘B’, was William Chester Minor, an American surgeon resident in Berkshire.
Minor had more opportunity – and perhaps more motivation – to go about this task than one might expect from most surgeons. He was a traumatised survivor of the American Civil War and suffered from paranoid schizophrenia. He was also a convicted murderer and an inmate of Broadmoor Hospital. Writing from a comfortable suite of rooms in the hospital (financed from his US army pension), Minor diligently posted his carefully researched examples to Murray in his corrugated iron shed in Mill Hill, just north of London. Over a period of twenty years, he sent in about twelve thousand standardised slips. Murray was to write, ‘So enormous have been Dr Minor’s contributions… that we could easily illustrate the last four centuries from his quotations alone.’ Only in Minor’s later years, when he had cut off his own penis in a fit of post-masturbatory guilt, did his offerings cease altogether. The entire poignant and bizarre story can be read in Simon Winchester’s book, The Surgeon of Crowthorne.
When my elderly patient used the word apothecary, I naturally asked her if she meant that she ought to take her prescription to the ‘chemist’. That was ironic. I too had betrayed my age – because of course these days chemists do not exist either. They are known as pharmacists.
In superficial terms, apothecaries, chemists and pharmacists are all the same. They are all people who make up medicines and sell them. Yet at the same time, we also know that they are quite different creatures. Each title carries a different weight, and a different set of mental associations. Apothecaries became chemists because it sounded more scientific. Chemists then wanted us to call them pharmacists because it sounded more professional. The strategy has worked, and their job status has become enhanced as a result. When you change a word, you also affect the thing it denotes.
Many philosophers nowadays argue that language not only describes reality, it also creates it. The case of apothecaries, chemists and pharmacists is a fairly straightforward example of this process at work. As doctors know, some diseases entirely vanished when we ceased to believe in their names (like neurasthenia), while new names have been conjured into existence to explain the inexplicable (such as irritable bowel syndrome). These examples of the creative power of language are fairly easy to accept, but there are some even bigger challenges to our basic medical assumptions. For example, there are compelling arguments to suggest that even words like ‘asthma’ cover a particular constellation of symptoms, physical signs, treatments and explanatory theories that may evaporate utterly over time. It is not just a question, say the philosophers, of having to hone down our ideas about these conditions, so that they gradually become more accurate. Our whole systems of thought about disease may in fact be no more than a set of self-referential linguistic fabrications. This isn’t something we can ever hope to change as doctors; it is inherent in the nature of language itself.
This idea may seem counter-intuitive, or even absurd. That may be simply because we think in language itself, so we believe uncritically in the reality it generates. In the same way, my patient believed absolutely that she could still take her prescription to an apothecary.