Volume 3, No. 3 
July 1999

Jack Segura




Translation Journal
Medical Translations

The Spanish Language in Medicine

by Jack Segura

Modern medical Spanish is based on a rich heritage of writing and translation that goes back to the early Middle Ages. Translation was the vehicle used for the transfer into Spanish (and into Latin) of scientific and technical knowledge obtained from Hebrew and Arabic texts, which themselves reflected the ancient cultures of India, Persia, Egypt, Mesopotamia (a region in today's Iraq), Greece and Syria.
   Spain had earlier been invaded by the Visigoths, a Germanic tribe that swooped down from the North and conquered the Roman legions gone soft. During their reign (2nd to 7th century A.D.), translation was first attempted from Latin into Visigoth. However, the Visigoths soon chose to abandon their own language in favor of Latin. Now a new form of Latin, known as vulgar Latin, slowly emerged. Born and developed mostly in Rome, vulgar Latin was to give rise to a number of Romance languages, such as Spanish, French, Italian, Portuguese, Catalan and Rumanian. Although the term "Romance" is usually equated with these languages in their modern incarnations, in Spain, at least, Romance was actually a transitional form between vulgar Latin and Castilian Spanish. It should also be noted that classic Latin, despite the spread of its vulgar offspring, continued to be the language of the Christian church, and it ruled the world of literature well into the 17th century. Some of the greatest thinkers and writers of the times—Erasmus, Juan Luis Vives, Francis Bacon, John Milton, Spinoza, Leibnitz, and Newton, among others—wrote in classic Latin.
English and Spanish are emerging as the languages of the third millennium.
The Romance phase of the Spanish language coincided with the invasion of Spain by the Moors (718 A.D.). The Arab invaders brought with them a treasure-trove of medical and scientific knowledge, gleaned from translations done at their Baghdad House of Wisdom (8th and 9th centuries A.D.). While they had no prose literature of their own, only poetry, the Arabs, who had embraced Islam in the 7th century, used the Koran, which itself owed much to translations of the Old and New Testaments, to launch a series of far-reaching translations, interpretations and commentaries of works by Aristotle, Plato, Archimedes, Hippocrates, Euclid and many outstanding philosophers and scientists of ancient Greece. They also translated into Arabic the Septuagint, a version of the Bible originally translated from Hebrew into Greek for the benefit of dispersed Jews, who had forgotten their ancestral language.
   Along with their scientific and technical luggage, the Arabs also brought with them literary tales and fiction from India and Persia gleaned through various intermediary languages and reworked into thoroughly Arabic versions. Among these were the Arabian Nights (Alf-Layhla wa Laylah) and the Fables of Bidpai (Kalila wa-Dimna), which, together with translations of the Bible, were to play a key role in European literary development. An English king, Alfred the Great (849-901), had already decreed the translation into English of all books in Latin that he deemed essential to the education of his subjects. About 384 A.D., an early translation of the Greek Bible into Latin, known as the Vulgate, had been accomplished by St. Jerome, the patron saint of translators. This translation, and subsequent ones based on it, were to be of great help in transforming English into a literary language. The German translation of the Bible by Luther signaled the beginning of modern German. Similarly, Spanish, French and Italian translations appeared.
   While most of these later efforts showed a decided literary bent, two centuries after the arrival of the Moors in Spain, a world-renowned School of Translators was established at Toledo by Archbishop Raimundus (1125-1152), with the stated purpose of mining the treasures of ancient science and technology brought to Spain by the Arabs. Through a process described below, other works, not only those on ancient Asian and Greek medicine, but also on philosophy, astronomy, mathematics, botany, and alchemy, were translated and drawn into the mainstream of European thought. To accomplish this, Raimundus surrounded himself with a core of the best medical, philosophical and legal minds in Europe, including many outstanding Arabs and Jews then living in Spain. Among his contemporaries and collaborators were Abenzoar and Aberroes, two Hispanic-Arab physicians, philosophers and theologians, who became leading authorities on Aristotle and his works; Avicenna, also a physician, philospher, mathematician and author of the Canon, a medical textbook studied and consulted in medical schools up to the 18th century, and of nearly 100 additional books on medicine; and last but not least, Maimonides, a Spanish Jewish philosopher, whose works influenced Albertus Magnus, St. Thomas Aquinas and later, Spinoza.

How Translation Was Done at Toledo

The procedure for translating medical, scientific and philosophical treatises, was as follows: A Jew who knew both Hebrew and Arabic first translated orally from these languages into Spanish Romance, the precursor of what later became Castilian Spanish. The Romance version was then translated into Latin by a Christian, to be disseminated throughout Europe. Among the translators who worked at Toledo were Spaniards, Gascons, Frenchmen, Italians, Englishmen and Germans
   The work started by Archbishop Raimundus at Toledo was taken up and improved upon by King Alfonso the Wise (1252-1284), who also surrounded himself with the best minds of his time. King Alfonso was not content with having the great works of antiquity translated into Romance and Latin. He now wanted Romance to be discarded in favor of Castilian Spanish. He promoted the first Spanish (and European) translation of the Kalila wa-Dimna, and himself wrote outstanding treatises on medicine, mathematics, history, law and navigation. In addition, he supervised most of the translations from Arabic that were crafted during his reign. He even created the job of editor (emendador) and exercised it continually to ensure that his translators used "straight" Spanish, not Romance. .

A Tradition Still Alive

As pointed out, the great Hebrew and Arab physicians who worked in Spain were also mathematicians, philosophers, and writers. Modern Spanish and Latin-American doctors share with them this tradition. Indeed, many Spanish-speaking physicians, whether well known or working in near-anonymity, are often frustrated writers. Santiago Ramón y Cajal, a Spanish neuroanatomist who shared the Nobel Prize for Medicine in 1906, wrote beautifully about his discoveries, as well as about ethics and philosophy. One of Spain's greatest novelists of recent times, Pío Baroja, abandoned medicine to devote himself fully to writing. (Baroja was Hemingway's mentor by the latter's own acknowledgment.) Another great physician, Dr. Gregorio Marañón, has written not only on endocrinology, his specialty, but on sexology, the arts, and insanity, and has produced psychobiographies of famous Spanish personalities. A further example of a physician-turned-writer is the Cuban Dr. José Varela Zequeira (1854-1939), who left us a diaphanous and colorful description of Cuban life and politics in the 19th and early 20th centuries, as well as penetrating essays about the human brain and instincts.
   Following Spain's discovery and colonization of the New World in the 15th century, a number of signal achievements were recorded in the fields of medicine, astronomy, mathematics, navigation, botany, and mining technology. In medicine, Miguel Servet discovered the pulmonary circulation; Andrés Laguna first described the ileocecal valve; cinchona (quinine) was discovered by Spaniards in Peru as a remedy for malaria; and Gaspar Casal identified the "illness of the rose", later known as pellagra. It is interesting to note that many of these discoveries were first reported in Spanish and then translated into English and other European languages, only to be retranslated into Spanish in recent times by people who apparently were not aware of the original discoverers.
   The 17th and 18th centuries witnessed the Golden Age of Spanish literature, with figures like Miguel de Cervantes, the author of Don Quixote; the playwright Lope de Vega (often compared to Shakespeare); the satirical writer Quevedo (also a translator); and the poet Góngora.
   In more recent times, there has been a revival of interest in the role of Spanish- speaking physicians and writers. As already mentioned, a Nobel prize went to the Spaniard Santiago Ramón y Cajal for his work on neurons; Nobels were also awarded to the Argentine physiologist Bernardo Houssay (1947), for his biological discoveries, and to the Spanish-born American biochemist Severo Ochoa (1959, co-discoverer of the mechanisms of DNA and RNA). Other famous Spanish-speaking physicians are the Barraquer brothers and Dr. Castroviejo (ophthalmologists) from Spain; the Argentinian Domingo Liotta and René Favaloro, who pioneered heart bypass surgery; and the Mexican Ignacio Chávez, who collaborated with Wiener in his research on cybernetics; as well as the Cuban Carlos Finlay, who laid the groundwork for the discovery of the transmission of yellow fever by a mosquito.
   The purpose of singling out these prestigious names—there are many more we have not mentioned—is to reassure some doubting Spanish translators that their language is not underdeveloped. Spanish-speaking doctors, scientists and writers have never had any difficulty in communicating their findings on any subject, whether it be medical, scientific, technical, theological, philosophical, ethical, or legal.

English and Spanish: Languages of the Third Millennium

Like many European and Asian languages, Spanish is today somewhat behind the times with respect to the plethora of English terminology being created every day. According to a July 24, 1995 article in US News and World Report, about 25.000 new English words are coined every year, of which 4% make it into the dictionaries. But the catching up with English goes on continually, either by finding adequate Spanish words, borrowing from English, or Hispanizing English terms (sometimes poorly, as reflected in what is known as Spanglish).
   English and Spanish are emerging as the languages of the third millennium. Quantitatively, English is the second most widely spoken language in the world, following Mandarin; Spanish is third, with well over 300 million speakers. It is projected that by the year 2025, Spanish will be spoken in the United States by more than 40 million people, thus ranking the U.S. second (after Mexico and well ahead of Spain) in terms of the number of Spanish speakers.

How English is transferred into Spanish

Some 8.000 books, in addition to stacks of other printed materials, are translated into Spanish every year. Most of these deal with scientific, technical and medical subjects. Some are quite good, while others leave much to be desired, either because they were done under great pressure or because the translators involved were not always up to the task. The challenges facing Spanish translators in the United States are many. Earlier generations of translators were immigrants, not well grounded in their own language, let alone English. Many in the later generations are also immigrants, but tend to be better prepared, with a college or university education, and may even be professionals-doctors, architects, or writers. But a large, peripheral contingent remains of less well prepared people who, upon coming into contact with English, have mistakenly reached the conclusion that because (in their view) anything goes in English, the same should apply to Spanish. Thus, little attention is paid to grammar, syntax, spelling, style, etc. The lack, in English, of any visible authority to rule over propriety—as opposed to the role played in Spanish by the Spanish Academy—has misled them into believing that no such thing as standard English exists. A closer study of the many excellent American dictionaries and grammars, as well as style manuals, would no doubt quickly disabuse them of their views. In the end, a good translator needs to do more than learn the two languages haphazardly; he or she must learn them well and, above all, must love them. Without such love, understanding the peculiarities, similarities and differences between the two languages is next to impossible. Without such love, translation becomes a tedious chore.

The Role of Dictionaries

Bilingual dictionaries, particularly those of scientific and medical genres, can be both a help and a hindrance to the translator. They help up to a point, as far as they go, which is never far enough nowadays; they hinder when they force the professional translator to waste time in fruitless searches. No dictionary can be totally up to date—even those that now appear on the Internet. Many of their terms will have already lost their reason for being, changed or been discarded by the time they are translated into Spanish.
   With regard to bilingual English-Spanish medical dictionaries, many are direct translations from English that frequently do not take into account the actual terminology used in the target language. In other words, they include only American and British entries. Often, the target language uses a different term for a particular item or process, and this, of course, is not reflected in the translated dictionaries. Two cases in point: radioscopia and antibiograma, which appear in monolingual Spanish dictionaries, but not in translated American dictionaries, where mention is made exclusively of their more usual English equivalents: "fluoroscopy"and "antibiotic sensitivity test". This has led many Spanish translators to use the English terminology (fluoroscopia and prueba de sensibilidad a los antibióticos), because they are not aware that commonly used Spanish counterparts exist.
   Again, some American-produced dictionaries do not seem to be aware of the many "false friends" and reversed terms they introduce. In the following examples, the English terms will be given first, then, in parentheses, their meaning, and finally an inequality sign (¹ ) leading to the Spanish false friend, followed by its meaning or an explanation of why it is not equal to the English term: abatement (reduction) ¹ abatimiento (depression); bizarre (strange) ¹ bizarro (courageous, generous); condition (a disease, frequently temporary) ¹ condición (a permanent quality or state); deprivation (lack of something) ¹ deprivación (does not exist in Spanish, privación should be used instead); generic name (non-proprietary name) ¹ nombre genérico, which would properly be applied in Spanish to a drug of the same class or gender, not necessarily a non-proprietary one ( the proper Spanish equivalent is denominación común or no registrada); physiopathologic (relating to both physiology and pathology or disease) ¹ fisiopatológico (more common in Spanish is patofisiológico, with the same meaning but with its components in reverse order); photomicrography (a picture of a microscopic object) ¹ fotomicrografía (the common Spanish equivalent is microfotografía, again having the same meaning but with components reversed); pesticide (kills pests) ¹ pesticida (they both do the same thing, but peste in Spanish has other meanings; use plaguicida instead); renosvascular ¹ renovascular (in Spanish it is more frequent to use vasculorrenal). Thus, if a translator looks for the Spanish term to which he is accustomed in a translated Spanish dictionary, he may not find it.

How can the translator keep up?

Ideally, to keep up with his or her native language, today's translator must not only read on a continuing basis—literature, newspapers, magazines—but must also listen to radio, watch TV, surf the Internet, and visit one's country of origin as often as possible. Whether we like it or not, the media have become the modern models and teachers of language for a large portion of the population, sometimes with dire results, as in the case of Spanglish.
   What is one to do when faced with a new term that does not appear in any dictionary or reference source? My practice, for many years, has been to give the new term an appropriate Spanish equivalent, or even invent one, by drawing from similar terminology lurking in memory or from books and dictionaries in other Romance languages. This is followed by the English term in parentheses, so that there will be no possibility of misconstruing the source term; the Spanish term is then used throughout the translation. In this manner, one can communicate clearly and immediately what the original word conveys, and if other people do not care for the term offered, they can always create a new one. Either the one offered or theirs may prevail. More likely, the final arbiter, often capricious, will be usage by people in their own countries. In the meantime, the translator has succeeded in fulfilling an immediate need in an unequivocal fashion. I was greatly surprised, in researching this article, to find that King Alfonso the Wise, back in the 13th Century, used precisely this same method in translating unknown medical and scientific terms from Arabic, Hebrew and Greek. As mentioned, he also instituted the function of editor, and I cannot emphasize enough the need we all have of being competently edited.

What a medical translator needs to know

At the basic level, the medical translator—into any language—will gain immeasurably if, in addition to a thorough knowledge of the target language and more than a superficial understanding of the source language, he/she also possesses a good dose of writing ability and, of course, of general knowledge. This is particularly true when the target language is Spanish, which, as we have seen, has a long tradition of medical writing and writers. But in addition to writing, a considerable advantage can also be drawn from being a good researcher and reporter, for this will allow writing and translating on subjects about which the translator's knowledge is limited. A good researcher and reporter can take any subject, analyze it carefully, and explain it cogently to the reader. Extensive reading and analysis of texts in particular languages will go a long way toward facilitating the translation task.
   In addition, the medical translator will have to make use of scientific and medical dictionaries, keeping in mind their limitations, which have already been pointed out herein. Often, it is necessary to purchase additional dictionaries on a particular field, so as to complement their coverage. In a way, medicine is easier to write about or translate than other scientific and technical subjects, because much of its terminology is based on Latin and Greek words, prefixes and suffixes. This is particularly true of Romance languages, but less so of English, which frequently uses colloquial terms (gut, bowel movement, lung infection, lifespan) rather than their Latin- or Greek- based equivalents (intestine, defecation, pulmonary infection, longevity). Also, as we have seen above, it is not unusual to come across numerous semantic pitfalls. Aside from terminology, a great deal of specific English usage in medical and surgical procedures requires a parallel knowledge of usage in the target language. Hence, the need for constant reading and searching for terminology and common expressions in the target language.
   There is one other aid I have found to be invaluable. At times, we translators like to complain that there are no reliable sources of information about certain medical procedures or terminology in the target language.. This is obviously specious. Often what I cannot find in Spanish can be found in French or Italian—or even Portuguese—all of them Romance languages whose thought patterns and inventive processes are similar. For instance, my basic reference dictionary for medicine is Gladstone's English-French, which hardly ever fails me (although it is becoming a little long in the tooth), pointing the way to how I can say what needs to be said in Spanish. Earlier I had found that French and Italian dictionaries were also excellent guides for translating English technical words like push-pull (en contrafase), flip-flop (circuito biestable, basculador), scanning (tomografía, imaginología, exploración), throughput (rendimiento neto). In the case of scanner, the Spanish Academy has already hispanisized it to escáner, though only with reference to the original medical CT scanners. Usage in Spain has now expanded the meaning of escáner to encompass other than medical applications, including the scanners used in supermarkets to read bar code (also known as lectores ópticos—optical readers).

Paying Back One's Dues

As one matures in the profession and looks back at what has modestly been achieved, it becomes clear that it is time to return some of the gifts received to the new generations of translators. With this in mind, I agreed to teach a translation course on Life Sciences—a fancy name for what used to be known as Natural Sciences or, more commonly, Biology—at New York University. This was an opportunity to put into teaching practice all—or much—of what I had learned in my translating experience. I was fortunate to be afforded a free hand in developing the syllabus for the 12-week course, given twice a year. Only the overall framework of the course was preordained. I began the course by telling my students that it was not enough to learn what a particular part of the body is called. It is necessary also to know its structure, its function, and how doctors look at it and refer to it in their daily conversations, papers and reports. My students were already translators, some quite advanced in years and experience, who now wanted to be able to translate medical subjects. I taught them a little basic biology, enough to refresh their memories of what they had learned in school or else to become acquainted with the rudiments of this science. Every time an English term was mentioned, it was accompanied by its Spanish equivalent and vice versa.
   In addition to the core subjects of cells, tissues, organs, and systems, we delved into the various types of microscopes that are used to see cells and their components, as well as other diagnostic tools—like computed tomography (CT), magnetic resonance imaging (MRI), positron-emission tomography (PET), and single-photon emission computed tomography (SPECT). Medical translation, while deeply involved with anatomy and function, also deals in a major way with diseased, malfunctioning and nonfunctioning body components. This led the course directly into treatment—particularly drug treatment, the major type of therapy today, besides surgery. We studied the nature of the various types of drugs available, how they are investigated, approved, labeled, and marketed, all of them matters the medical translator will have to deal with in his or her daily work. An outline of the course follows, for anyone interested in one way to approach the teaching of this subject. It is what I call the in-context method of teaching translation.

In-Context Medical Translation

Subjects Discussed:

  1. The structure of cells, tissues, organs and body systems, including cell components or organelles, types of tissues, main body systems (nervous, muscular, cardiovascular, digestive, etc.).
  2. How all these elements and parts function and interrelate. The underlying processes at the atomic and molecular levels; biochemical reactions (bonds and valences), metabolism, cell respiration, glycolysis, the Krebs cycle, hydrogen and electron transport, oxidation and reduction, the power-supplying role of ATP; salts, acids and bases, hydrolysis, buffers, body gases.
  3. Abnormal structure, from the genetic and environmental aspects—all the way from cell division to mutations, excessive or insufficient chromosomes, abnormal DNA sequences, bad RNA transcription, all potentially leading to malformations and disease.
  4. Having detailed the structural and functional basics and problems, the course moved on to therapy, concentrating on drug treatment. Basic pharmacology—pharmacokinetics and pharmacodynamics—was reviewed, and how drugs are administered (orally, by various types of injections, and even by pulmonary absorption of gases). The importance of drug absorption, bioavailability (how much of the drug reaches the target tissue) and biotransformation (how drugs give rise to metabolites, some of them quite dangerous). Then, there is the end process of drug excretion—renal (urinary), biliary (fecal), sweating, saliva, and tears.
  5. In medical translation, the most frequent materials to be handled are medical articles and papers, package inserts, investigational new drug applications (IND's) and new drug applications (NDA's). Samples of these were reviewed in class. IND's are necessary before a drug company is allowed to experiment with a new drug intended for market. NDA's are required before clinical tests start. Experimental testing usually starts with the selection of a particular chemical molecule, among many, that holds some promise as a therapeutic agent. At this stage, the drug mostly should show some efficacy and safety (lack of toxicity). To find out, these types of studies are conducted in laboratory animals. With successful completion of the experimental tests, clinical testing can begin, with the FDA's permission. Clinical tests are conducted on selected human volunteers under highly controlled conditions, and are promptly terminated if any strong toxicity, not found in the experimental animals, emerges during these tests. In addition to drug action, the effects on different populations (older patients, younger patients, male or female, children) may be studied. Tests are usually done first on a small number of patients, then on wider groups, and finally on large samples involving hundreds or thousands of participants. Tests may be either single- or double-blind randomized or open studies, and their results are evaluated by means of statistical analysis, in which the placebo effect, patient's compliance, tolerance, cross-tolerance with other drugs, and additional factors are taken into account. Finally, in some countries, Government regulations require a drug company to continue to monitor efficacy and safety, particularly the latter, after the drug has reached the market, since the toxicity of some drugs does not become apparent until they have been used in millions of human beings.
  6. As a drug progresses through experimental and clinical tests to approval and launching, it acquires different names and labels that are important to the manufacturer, the FDA and the translator. While under investigation, the drug usually has a chemical and a structural name, the nature of which is sometime hidden from rival eyes by the use of an in-house code name. All drugs under testing or already approved also have a generic or non-proprietary name (like, say, nifedipine), the use of which is recommended for all medical communications. If the manufacturer has been successful in patenting the drug, he may then use a proprietary name or registered trade name, such a Procardia or Adalat in the case of nifedipine. Before a drug is approved for marketing, the FDA will require the manufacturer to use only approved labeling, which sets the tone for the claims he is allowed to make in his literature, package inserts, labels, etc. Again, these intricate aspects were discussed during the course, inasmuch as they impinge on the requirements of translation, and equivalent terms were given.
  7. On a very practical level, no medical translation course can be complete without dealing with the interactions between patient and physician and between patient and hospital, including emergency situations and procedures, admission, physical examination, history, therapy, discharge and follow-up. This aspect, in itself, requires a considerable amount of time and terminology, which we broke down into sections, each given at the very beginning of each teaching session.
  8. Supporting subjects and materials, such as statistics, correct and incorrect grammar and terminology, samples of medical publications, how and where to obtain medical information (books, magazines, journals, databases), frequent quizzes on subject understanding and on appropriate terminology, as well as mid-term and final examinations were included as part of the curriculum.

    After about five years of teaching the course, I decided to withdraw because two other projects required my time and attention: an English-Spanish/Spanish-English pocket dictionary for a Spanish publisher and, as a member of the American Academy of the Spanish Language and chairman of its Translation Commission, editing a quarterly bulletin called Glosas, a publication that seeks to clarify all types of obscure points on usage and grammar. It is intended particularly for people who use the Spanish language in public forums—schools, universities, radio, TV, and so on. In addition, the bulletin includes a few pages on Spanish terms culled from the official dictionary of the Spanish Academy, to which we have added English equivalents, in order to make them useful both for Spanish- and English-speaking translators. These are modern or special terms selected for their timelessness and need. Because it also includes medical terms, Glosas is a helpful resource for medical translators. It is almost axiomatic that many people consult a dictionary only when they need to find a term, but otherwise often remain oblivious to the specific content of dictionaries, and as a result miss a lot of new words. Glosas also has a section on new English terms (medical, computer, technical) and suggested Spanish equivalents. Another, very successful section, deals with "false friends"—words that are spelled the same, or almost the same, in Spanish and English but have different meanings (we have dealt with a few herein). Finally, it includes a list of expressions with the prepositions they normally require. This is very important, because the use of prepositions is perhaps what most distinguishes one language from another, and what allows one to pinpoint right away if a person is really fluent in a language or is still trying to conquer its fine points.

A word in closing

Finally, some reflections engendered by all these years as a practicing translator. When I started, translation was relatively easier than it is today. People learned by doing and by seeing how others did it. There were no schools that taught one how to translate. The pace, too, was different.. One would do a translation, put it in the mail, wait until payment arrived, and then forget it until tax time. Today, one is less of a translator and more of a communicator, who needs to handle not only a telephone, a fax, a computer, but also forever-changing software, floppies, e-mail, the World-Wide Web, and so on. A newly revived science of linguistics has emerged in recent years, no doubt spurred by the perceived need to develop automatic translation by computers. First, it is necessary for linguists to determine how languages are structured, what their common features and differences are, and where and how possible solutions are to be found. Though great strides have been made in gaining a better understanding of what makes languages tick, with parsers and other tools being added to the linguist's armamentarium, the fact remains that automatic translation is still a long way from solving the basic problems of translation, and its usefulness is mostly confined to a narrow field—repetitive, predefined, and search jobs. It is so far of little help to the average translator, whom it would presumably replace. Computer-aided translation, on the other hand, seems to be catching on, providing translators with tools to simplify and codify their tasks. In the end, I believe, the human translator will always need to intervene. Any other solution requires that language be adapted to the machine, not the machine to language.


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