• My mom writes me about health care grammar …

    In retirement, my mom volunteers her time teaching English as a second language.

    My student and I discussed (briefly) the inconsistent use of articles before the names of diseases/ailments/injuries:

    a cold, a broken arm, a headache
    the flu, the measles, the mumps
    cancer, pneumonia, pleurisy, shingles

    What’s the reason?  Maybe temporary, easily curable diseases/ailments/injuries get an “a,” the ones that land you in bed for a few days get “the,” and the killers get neither.  Or symptoms may get “a” (a sore throat) and the actual disease earns some more powerful linguistic designation.  Or anything in the plural (swollen glands, clogged arteries) gets no article.

    But I’m sure that there are many variations (a heart attack, for example).  Since you’re in the health care biz, maybe you know.

    No, I don’t know. Do you?


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    • The indefinite articles look like to be members of a class of similar ailments. I.e., you don’t get “the cold” you get one of the class of illnesses known as “colds”. Same with headaches.. lots of things can cause a headache. Maybe broken arm is similar.. there are lots of things that we call “broken arm”.

      We now know there are lots of flus, but did we know that when it got its name? There’s only one measles and mumps, right?

      I don’t have an explanation for the non-articles. It does seem like they are more serious. Maybe they were personified at one point (like Death) and so we are left with a remnant of a proper name?

    • Purely speculative reactions: a lot of this is fluid – it’s possible to refer to “a cancer,” for instance. “The” seems most associated with archaic terms, or at least long-familiar conditions (the flu, the clap); also perhaps used for recognizable sets of symptoms, whereas “a” can be used more effectively with a single nonspecific symptom (e.g. a fever)? And this may be a product of the particular examples you selected, but it seems like technical terms (more than common terms) tend toward no-article constructions.

    • My girlfriend suggests that it’s because you are referring to a specific virus. THE Influenza virus, or THE rubeola virus. The others aren’t referring to something specific.

    • I have the feeling that we say “a cold, a broken arm, a headache” because these are recurring ailments. We can get a cold today, and another cold in a month. This explanation feels pretty accurate to me, fwiw.

      I don’t know why some diseases get “the”, but I observe that all your examples are diseases that have been epidemic. Perhaps, if there is a widespread concern with a particular disease, it merits the definite article? This could then be passed down to periods in which the disease is no longer epidemic. This explanation is only a guess.

    • The English say “going to hospital” while an American will say “going to the hospital.” I once asked an Englishman. He said, when you go to sleep, you don’t say “going to the bed,” it’s just “going to bed”.

      I suspect that the crazy rules about articles are just idioms with no rational justification.

    • This is total speculation, but my guess is that it has to do with the introduction of different terms at various times across history, with vastly different understandings of disease across centuries. Additionally, some terms came in at different stages of linguistic history, while many are probably borrowed from other languages, and some diseases were widespread enough to gain vernacular terms while others grew out out of the professional healthcare sphere.

    • The answer is that “cancer, pneumonia, pleurisy, shingles” are all collective nouns, which do not have definite quantities. For example, we use the term “cancer” to refer collectively to all the cancerous cells and tumors in a given patient, so it doesn’t make any sense to imply a quantity by using an article.

      The difference between “a” and “the” just has to do with quantities. The former refers to a generic example of the reference group, while “the” refers to the only example of the reference group. Thus, if you are eating one of many cookies that were baked, you are eating “a cookie” while if you eat the only one that was baked, you are eating “the cookie.”

      As for why some words are collective and others aren’t, a big part of the reason seems to simply be the way in which the word entered the language. Derivation of new words tends to be very slow, and this results in fewer collective nouns from being formed–over time their definition comes to be associated with an explicit, discrete quantity. However, morphological words–where we borrow and combine old words to form new ones–tend to produce more collective nouns as these words have not come to be associated with an explicit quantity.

      Things like flu, cold, and measles, all describe things that we’ve known about for a very long time, and for which we’ve derived words very gradually over time, and hence refined the definition to refer to a particular quantity. On the other hand, our modern understanding of cancer is quite new, and the though the word we use for it, “cancer” is quite old, it has come to mean something quite different from what it originally did, or even what it meant relatively recently (in linguistic time)–to the romans, cancer meant “a crab,” and as recently as old english cancer meant just a skin sore. It now means something very different, referring to a concept for which standardized quantification has not yet entered the mainstream parlance.