Dictionary of Doubts and Difficulties in English-Portuguese Medical Translation

Fernando A. Navarro

Back in 1999, when I first talked to McGraw-Hill Interamericana about my project for a critical dictionary of English-Spanish medical doubts, I mentioned how useful it would be to publish the dictionary in compact disc format too, because electronic reference resources had already become an essential part of a language professional’s toolkit. However, the publishers decided to put an electronic edition on hold because of the uncontrollable risk of pirated copies, a risk that is still as real today as it was back then. And thus, for far too many years, my dictionary was relegated to being a well-thumbed tome on a bookshelf.

Fourteen years on, I am delighted to be able to offer doctors, specialised translators, scientific writers and translation students this new edition of my dictionary, in an online format at long last. Online access not only offers the well-known benefits of electronic formats (fast searches, cross-referencing, two-way Spanish and English translation, traceability of the full content of every entry, etc.), it also means that the dictionary can be accessed from anywhere with an internet connection, and it becomes a living resource, through an ongoing updating process.

The leap from paper to cloud was so big that I realised that a new name was warranted. For the first two editions, the libro rojo was called Diccionario crítico de dudas inglés-español de medicina (2000 and 2005). For this third edition, I have renamed it Diccionario de dudas y dificultades de traducción del inglés médico (2013). Despite this rechristening, the internal structure of the dictionary has not undergone substantial change: two versions later, the lexicographical design remains largely identical. Proof of this is that the introduction for first-time Cosnautas users (see below), is a simple copy-paste of the original version from the first edition, with very few changes at all. If you are familiar with either of the first two editions of the Diccionario crítico de dudas, you will be able to start using this third edition immediately, without having to learn the meanings of any new symbols or typographical conventions.

You will, however, notice some other changes. For example, before, you looked up terms in alphabetical order and leafed backwards or forwards to locate cross references. Now, simply type a term in the search box and click on the links that take you to the cross references.

You will also notice that colours have been added to indicate headwords, numbered meanings, cross references and comments’ symbols. This has freed up formatting types. Now, the most relevant translations are emphasised in bold, and different degrees of contraindication or error are *encased in asterisks* or marked with a ~~strikethrough~~ effect (in the latter case, following the example of Diccionario de términos médicos [2011] published by the Real Academia Nacional de Medicina).

In this third edition, I have continued my efforts to reduce the dogmatic tone of the dictionary. This is no easy task, because in my pursuit of concision, I have to solve translation dilemmas in a question of lines rather than pages, and this inevitably entails the risk of dogmatism. When my dictionary was still at an embryonic stage, I followed the wise counsel of Ortega y Gasset: “whenever you teach, teach also to question what you teach”. Therefore, I set out my preferred translation solutions, while trying to explain the academic criteria behind them, common usage in medical practice, recommendations from standardised nomenclatures, terminology traditions in the Spanish language, relevant etymological criteria and analogies with similar terms. This strategy has a clear goal: to enable you to make an informed decision - your own decision, not mine - on the most suitable option for a translation, depending on your specific text and personal context. I look on my dictionary, above all, as a medium between two translators, a pointer in the right direction, an informal chat between colleagues. And my comments are written safe in the knowledge that all translators, both new and old, will be using the dictionary in the valuable company of their intelligence and common sense, which are the most powerful work tools of all. I do not seek to convince anyone of anything. With this dictionary, I simply wish to share my knowledge and experience with my medical and translation colleagues, to help them improve professionally and enjoy the legitimate satisfaction of a scientific translation well done.

This electronic version of the Diccionario de dudas y dificultades de traducción del inglés médico is a new, revised, improved and hugely extended edition. I have added thousands of new entries since the second edition, such as acid-fast, add-on therapy, amplatzer, anisakis, annulation, appy, attending, bareback sex, Big Pharma, binge drinking, biogeneric, blunt, breathalyzer, BTC drug, carry over, chaperone, chemical pregnancy, chemonaive, club, concierge medicine, didactic, disease mongering, droptainer, drug-eluting stent, echolocation, ex novo, expanded access, first-hour quintet, forest plot, gamification, ghrelin, grant, grommet, hamstring, high-ceiling diuretics, hot flush, human medicine, junk food, lab-on-a-chip, lap, leakage, locavore, lost to follow-up, luer lock, machine, mindfulness, mourning, multiple, to need, nonvertebral fracture, orthorexia, patch clamp, perfusate, pouch, pregnancy loss, premetabolic syndrome, rare disease, readability, recall, Red Crystal, resurfacing, ritalin, schedule, sexting, sibship, signaling, small molecule, smokeless tobacco, spa, spike, spot, standard drink, statutory, subcentimeter, surrogate mother, system organ class, targeted, tiger mosquito, toddler, tooth numbering, trainee, translational research, transthyretin, to tube-feed, vocational training, wear, webinar, wilderness medicine, workup and yellow flag . I am proud to announce that a large number of these terms are making their very first appearance in a Spanish dictionary; in fact, it will be a first for many of them in international specialist lexicography.

The extended content is not limited to the addition of new entries or sections, however. I have expanded the comments in many sections that already existed in the second edition of the dictionary. To see what I mean, compare, for example, the sections devoted to the following terms in the second and third editions: aggressive, auditory nerve, bar chart, bay, BC, biologicals, blood alcohol, breath alcohol test, °C, capture, carrier, charge, chart, chikungunya, clavus, clinical pathology, counseling, criminal, -cytic, death, dipping, district nurse, driving while intoxicated, to empower, ex-, finally, foul, height, hematinic, ICH, international normalized ratio, intestinal obstruction, to irradiate, judgment, kinky, local, mg%, -olimus, operator, PD, pulp, pump, to qualify, smart drugs, social worker, to socialize, ST, survival, three Rs, toilet water and veil.

The 15,000 or so cross references in the first edition have now grown to more than 52,000 clickable links embedded in the dictionary, helping you make full use of the dictionary as a whole, while maximising the educational and professional yield of each search. As a result, you will also perceive the internal coherence and uniform criteria that can only be achieved by a single author in projects of this size and characteristics.

And this brings me to the unavoidable issue of geographical variation in the Spanish language. When I published the first edition of the libro rojo, I had never set foot in Latin America; the United States of America was the only part of the New Continent that I knew. It is not surprising, therefore, that the first edition focused heavily on the differences between UK and US English, but as far as the Spanish was concerned, I relied almost exclusively on the medical language used in faculties, hospitals and clinics in Spain. In my opinion, this was one of the biggest oversights in my dictionary, and it was also one that Latin American users repeatedly pointed out.

The second edition marked a clear change in this aspect. It was still obvious that the dictionary had been written in Spain, by an author whose native language was European Spanish, who viewed the Spanish-speaking medical community as a whole. However, peach-flavored tablets were no longer simply tablets with sabor a melocotón, but also sabor a durazno. The animalario now lived side by side with the bioterio; placas de Petri with cajas de Petri; frigorífico with refrigeradora and heladera; datos fiables with datos confiables; biberón with mamadera; hormigón with concreto, and accidentes de tráfico with accidentes de tránsito. The second edition showed that basic language units and their geographical variants are quite compatible, as acknowledged in socorrista and salvavidas, beber and tomar, conducir and manejar, recuento and conteo, inversor and inversionista, mantequilla de cacahuete and manteca de maní.

In the third edition, this greater focus on American variants of Spanish became much more patent. To check this out yourself, take a look at entries such as band-aid, bikini, bleach, booties, brassiere, breast pump, capitation, cartoon, chance, computer, concrete, constipation, contact lens, cost, cream, croissant, cutter, decimal point, dental technician, denture, diesel, donut, dummy, dynamo, earrings, elevator, epidural anesthesia, GDP, grocery, Guinea pig, hair-band, hangover, heel, highchair, hot flush, icon, insulin pen, intensive care unit, jersey, juice, junk food, lemon, lifeguard, lollipop, mammagraphy, marijuana, marker, mask, mat, medical device, mosquito net, notifiable disease, number sign, oxygen tank, pacifier, panties, panty liner, parole, peanut, pertussis, Petri dish, petrol, plaster, prescription, pus, pyjamas, refrigerator, sanitary towel, sauna, -scopy, soya, spectacles, stapler, stethoscope, teether, tin loaf, tongue depressor, traffic, truant, tub, umpteen, unemployment, varicose veins, VAT, white coat and zipper. I trust my Latin American colleagues will notice a considerable difference in this aspect since the first edition.

Three main factors influenced this major change in my approach between the first and third editions: a) from 2001 onwards, I started travelling frequently to different Latin American countries (including five trips to Argentina), and everywhere I went, people asked me to please, oh please, give more weight to regional and national language variants in the second edition; b) the spectacular development of Google with geographical filters in search settings that gave reliable results, and c) e-mail exchanges and forum debates with medical translators and users of my dictionary in different Latin American countries.

Fernando A. Navarro

There is no doubt that in the world of general and specialised dictionaries, translators are spoilt for choice. Considering the sheer number of monolingual, bilingual and multilingual dictionaries, I am sure that many readers will be surprised and somewhat sceptical about the publication of this Diccionario crítico de dudas inglés-español de medicina^†:

“What? Not another dictionary! And what a weird title!“

In the course of this introduction, I hope to convince you that a dictionary of this nature is not only necessary - I can almost hear the critics saying “it fills a gap in the bibliography” - but also that it simply has to have this title. However strange and exotic it initially sounds, the title is certainly not the result of a rash decision or fleeting fancy. Let us dissect the title, word by word.

* This Introduction is a literal copy of the original version published in the first edition, with some very minor changes to adapt to the new typography and format of the third edition.

^† This was the title for the first two editions (Madrid: McGraw·Hill-Interamericana, 2000 and 2005); for this electronic Cosnautas edition (2013), I decided to rename it Diccionario de dudas y dificultades de traducción del inglés médico, which is the title I will use from now on in this introduction.

You will find shelf-fuls of dictionaries of all shapes and sizes in a bookshop. Many of them, and specialised medical ones in particular, are heavy tomes, packed with information, often with over a hundred thousand entries.

In fact, the first thing that novel medical translators notice is the extraordinarily rich vocabulary that a medical text employs. Probably no other specialised field of translation uses so many new words. On every page of every text, there will be half a dozen terms and expressions that even well-educated people will not be familiar with: antiparkinsonian, glomerulonephritis, hepatocystoduodenostomy, hexachlorocyclohexane, keratoconjunctivitis, leukoerythroblastosis, onychotillomania, pneumoencephalography, pyelonephrolithotomy, sphenopalatine, thrombocytoagglutination, uteroenteroanastomosis. However, medical language, and indeed every scientific language, strives to be essentially universal, which is ideal for translators. As we know, many medical terms originate from Latin and Greek, and as the field grows, neologisms are created from classical roots, prefixes and suffixes. This is true of all the main European languages. In the case of the tortuous words quoted above, new medical translators with just a minimum grounding will be able to translate them straight off into Spanish (or other target language), even if they have never heard of them before: antiparkinsoniano, glomerulonefritis, hepatocistoduodenostomía, hexaclorociclohexano, queratoconjuntivitis, leucoeritroblastosis, onicotilomanía, neumoencefalografía, pielonefrolitotomía, esfenopalatino, trombocitoaglutinación and uteroenteroanastomosis. Doctor and translators, in fact, do not need to look up these words in a dictionary. Nobody turns to a bilingual dictionary to translate electrocardiogram. Yet, surprisingly, today’s medical dictionaries are bursting at the seams with such words. They contain tens of thousands of technical terms, which, despite their undeniable apparent complexity, do not ever have to be researched in a dictionary. However, when translators find an English word that entails a tiny challenge, they turn to the same dictionaries and discover that it is not there at all, is incorrectly translated or is missing some of its many possible translations.

To answer this question, simply ask a translator to look at this sentence: Anthrax is an infectious animal disease that is transmitted to veterinarians by contact with animals. Translators will be aware that medical language is largely universal and that much of it stems from Latin and Greek. So, based on this premise, they might well presume that anthrax, in English, translates to ántrax in Spanish, even if they have never heard of these words before and do not know what they mean. Bilingual medical dictionaries will confirm this presumption, when, in fact, the truth is just the opposite. What English-speaking doctors call anthrax, we call carbunco and, vice versa, what they call carbuncle, we call ántrax. Both are infectious diseases that cause skin lesions and they share a similar etymological origin (one comes from the Greek ἄνθραξ, ‘coal’, and the other from the Latin carbunculus, ‘small coal’), but they differ significantly in the causal bacteria (Bacillus anthracis in the case of anthrax and staphylococcus in the case of carbuncle) and also in their treatment and prognosis.

The Diccionario de dudas y dificultades aims to resolve these sorts of paradoxes. Here is the entry for anthrax, which I will use to describe a typical entry structure in this dictionary:

The opening headword is immediately followed by an abbreviation in square brackets to denote the specific field. In the above example, the field is ‘microbiology, parasitology and infectious diseases’ (see the key to these abbreviations). The main body then gives the correct translation and there is a brief comment on the difference between ántrax and carbunco. The symbol ◘ denotes an English sentence that illustrates the use and meaning of the commented word in a wider context. The symbol ● is followed by complex expressions that contain the headword and are misleading or challenging to translate. They appear in alphabetical order. Finally, the symbol ►► precedes comments on the usage of anthrax and its translation. All expressions that contain the headword have their own entry in the dictionary, to make it easier to locate them. Thus, if you search for inhalational anthrax, you will be taken to this entry:

The symbol → denotes a cross reference to the entry for anthrax, and there, the symbol ● will contain the desired expression: inhalational anthrax (carbuncosis pulmonar). The same cross reference symbol → followed by a word in turquoise is also used to show that the translation of a word is explained in a completely different entry. For example, virilizing → masculinization, means that the translation problems inherent to the English word virilizing are commented on in the entry for masculinization.

The doubts to which I refer in the dictionary title are not only those that stem from false friends, which are words that are spelt identically or very similarly in two languages, but have different meanings, such as physic (which is not física, but medicina), plague (not plaga, but peste bubónica), labor (not labor, but parto) and matron (not matrona, but directora de enfermería). Translators also have gnawing doubts about Anglicisms such as rash, odds ratio, immunoblot, piercing, stent, distress and by-pass, because it appears they have no equivalent in Spanish.

Furthermore, in translation, the visual impact of the source text sometimes leads to an expression being used in the target language that is not exactly an error, but sounds unnatural because it simply is not in common usage. Take, for example, a general, non-medical expression: What would you think if you saw information technology or computer science translated as tecnología de la información or ciencia de las computadoras? These translations are not wrong, of course, but the fact is that in Spain, everyone (except Google Translate) uses the term informática, not ciencia de las computadoras. The same also applies to the field of medicine, with expressions such as human milk (leche materna rather than leche humana), weight loss (adelgazamiento rather than pérdida de peso), high blood pressure (hipertensión arterial rather than presión sanguínea alta) and liver cell (hepatocito rather than célula hepática).

Another problem, leading on from the above paragraph, is the complexity of polysemic words in English. Since many such words have a similar equivalent in Spanish, translators use the same translation time and time again, without realising that while it may absolutely correct for one particular meaning, it is actually wrong in all the other cases. For example, knife may mean cuchillo, but in the operating theatre it usually means bisturí. Worse still, words such as abuse and examination can have very different meanings indeed: child abuse (malos tratos a menores), spousal abuse (violencia conyugal), alcohol abuse (alcoholismo), heroin abuser (heroinómano), self-abuse (automutilación, autolesión or masturbación, depending on the context); clinical examination (exploración física), fundus examination (oftalmoscopia), pelvic examination (tacto vaginal), postmortem examination (necropsia, autopsia), ultrasound examination (ecografía). In these cases, the dictionary displays the different meanings in a single entry using a turquoise numbered list, as follows:

In this example, again, you will see that the simplistic translation of annular ligament (ligamento anular), which is found in most medical dictionaries, may be very convenient to use, but medical translators will be short-changed with this solution alone.

Here, I would like to clarify that the concept of ‘doubt’ in this dictionary does not coincide with its meaning in non-specialised language. With this dictionary I cannot hope to solve all the doubts that medical translators will encounter during the course of their work. When faced with an English medical text, translators may well not know the meaning of a huge number of words. However, I do not believe that these words pose a major danger because their obvious difficulty will call for further research in specialised dictionaries and reference books to clarify their meaning. The biggest danger lies in the English words or expressions that are apparently easy to translate, especially when they can be translated literally, because this often leads to incorrect, unclear, problematic or deficient translations in Spanish. Those are the doubts that will be commented on in this dictionary.

As a professional translator, I have had my fill of simplistic, dogmatic dictionaries. Adding yet another to the list is far from my intention. From the very beginning, I knew that my dictionary had be a critical, reasoned one.

The last thing I want is to prohibit people from using words such as controlar, test, escáner, Western blot or baipás. Instead, I would like to offer more suitable or preferable ways of translating these and other Anglicisms, while commenting on the main problems of translating apparently simply words and expressions, such as acute abdomen, adrenaline, athlete’s foot, clinics, growth hormone, hay fever and sleeping disease.

And it is not my intention to flag certain expressions such as enfermedad cardíaca as incorrect. I simply want to make translators aware that what Spanish-speaking doctors usually call cardiopatía, is called heart disease by their British or American counterparts (and only very rarely, if ever, cardiopathy).

I am one of those medical language geeks who believe that it would be useful for all scientific translators to know that the official name for neuraminidase is exo-α-sialidase, that Spanish doctors use peroné when referring to the international anatomical term fibula, that the common laboratory animal, Macacus rhesus, is now officially called Macaca mulatta,that European blastomycosis no longer exists in the modern blastomycosis nomenclature, and that the Spanish INN carbamazepina should actually be spelt carbamacepina, following the Spanish rule of using c before e. The ultimate decision regarding which translation to use depends in each case on the source genre, the target audience and, of course, the translator’s own criteria. But what I do find illogical in most of today’s medical dictionaries, is to find glucose translated as glucosa and dextrose as dextrosa, without mentioning that they are exact synonyms: two different names for the same carbohydrate.

That is why you will find many entries in this dictionary are accompanied by a critical comment on common usage in medical practice, basic spelling rules in Spanish, official terminology recommended in standardised nomenclatures and by the main international organisations, and also the need for precision and clarity that should characterise all scientific language.

For almost half a century, English has been the indisputable global language of medicine. I feel I could almost skip this section of the introduction because it is so obvious that nowadays, a medical translator absolutely has to understand English. Not only is English the source language of most translations; it is also the lingua franca of the main text books and cutting-edge journals in every field of medicine. In other words, medical translators who do not understand English may well find it impossible to solve doubts that arise when translating a medical text in French, German or any other modern language.

And this, of course, will be in addition to the multitude of doubts and misleading or challenging words that they will have to decipher when translating a medical text from French or German. However, I thought it was particularly urgent to publish, at long last, the dictionary of English-Spanish doubts that medical translators had been clamouring for for years, without which I can now hardly imagine translating effectively.

Since I am referring to medical translators as the natural beneficiaries of this dictionary, I would like to point out that my definition of this professional function is all-embracing. Translation is not included in a medical student’s training, and few doctors have become medical translators, as I have. However, most Spanish and Latin American doctors have done many informal translations during their training and later on in their career. It is an undeniable fact that the majority of today’s medical publications in Spanish are the outcome of texts that were originally written in English. Not only am I referring to medical text books edited in Spanish-speaking countries, a quarter of which are translations of foreign works. I am also particularly referring to the fact that more than 80% of the references of articles published in specialised Spanish medical journals are in English. We should acknowledge, therefore, that in countries like ours, where science plays a supporting role to the main English-speaking actors, every medical author also has to be a translator to a great extent. And, in my opinion, it is not too far-fetched to think that in a few years’ time - as was the case one generation ago with the history of medicine - medical translation and writing might be duly recognised as medical specialties in their own right.

I would also like to answer another question that I am sure many of you will be asking by now:

“OK, an English-Spanish dictionary, but which flavours of English and Spanish?”

Here, as with many aspects of this dictionary, my choice was largely determined by my personal circumstances. As a medical translator with broad experience working with multinational pharmaceutical companies and international organisations, I am only too familiar with having to tackle words that have different meanings, depending on which side of the Atlantic they hail from.

As you probably know, the word billion means a million million in England, but only a thousand million in the United States; pants are underpants for an English lord, but long trousers for a Californian; a gallon is equal to 4.55 litres in Britain, but only 3.79 liters [sic] in America; public school is a state school in the United States, but a private school in England; MD is a doctoral qualification in Oxford, but a bachelor degree in Harvard; and a US Surgeon General is the chief medical officer of the public health service, while his English namesake is the most senior medical officer of the Armed Forces.

You will also be aware of spelling differences between British and American English. In general, translators need not worry that doctors in London write tumour and haematology, while their colleagues in New York use tumor and hematology. These trivialities rarely matter when you are translating into Spanish. But sometimes they do. A British anaesthetist, for example, has the same training as his or her Spanish counterpart (in other words, they are doctors specialised in anaesthesia), while an American anesthetist is a professional individual, but not a qualified doctor, who is registered to administer anaesthesia to patients. (A US doctor specialised in anaesthesia would be called an anesthesiologist.)

These and other differences in meanings between American (and usually Canadian) English and British English (which is also used in many other countries in the world) are included in this dictionary, preceded by their respective abbreviations [US] and [GB].

However, with regard to Spanish differences on either side of the Atlantic, in the first edition of this dictionary, I used just the opposite approach. Since I was born and bred in Spain, and undertook my medical training at the University of Salamanca and at the Marqués de Valdecilla Hospital in Santander, it was logical for my dictionary to weigh heavily towards the medical language used in Spanish faculties, hospitals and clinics, scientific journals and text books. Thirteen years later, my personal knowledge of the geographical variants of Spanish has increased exponentially, and, as a result, I have paid much more attention to this aspect in this edition of Diccionario de dudas y dificultades, as explained in more detail at the end of the “Preface to the third edition“ (see above).

While it is perfectly reasonable for a reader to ask this question, in my opinion it is unnecessary to do so. As a medical specialist by training and a medical translator by career, it would have been quite illogical for me to write a dictionary on heraldry, beekeeping, plumbing or Etruscan art (with all due respect, of course, for the experts in these fields).

Unfortunately, writing a medical dictionary is not that simple, because it has to include a host of common but misleading words found in medical texts that do not strictly belong to the medical sphere. Examples of such words are actual (real), American (estadounidense), library (biblioteca), vegetables (verduras) and November (noviembre), which medical translators will find time and time again in their texts. And, for the same reason, you will find thousands of entries that do not belong to the field of medicine itself but to many other similar or complementary sciences, such as pharmacy, chemistry, biostatistics, zoology, botany, genetics, molecular biology, history of medicine, bibliology, law, etc.

Some readers may think that, in that case, it would have been more correct to call this dictionary a “biomedical dictionary”, a “dictionary of health sciences” or similar fashionable title. I deliberately chose not to. When you become familiar with this dictionary, you will realise - I hope - that one of its flagship features is its condemnation of unnecessary or deliberately misconstrued euphemisms. I do not agree with the advertising tactics of pharmaceutical companies, which have stopped using ‘medicine’ (replacing it with ‘health’ to avoid any negative connotation with illness or pain) and ‘chemistry’ (to avoid any subconscious association with carcinogenic E numbers or pollution). Nor do I like the process by which big pharma, later followed by the rest of the international medical community, has gradually replaced ‘toxicity’ - a term that was used to denote a medicinal product’s ability to produce toxic effects, initially coming up with ‘tolerability’, a word with less negative connotations, and finally arriving at ‘safety’, a word with a clearly positive ring to it.

Personally, as a doctor, I have often consulted dictionaries on botany, biochemistry, genetics or pharmacy to expand my knowledge. Therefore, I hope that my colleagues in other fields will welcome a new medical dictionary, in the broadest sense of the term. I have every confidence that this medical English dictionary will be exceptionally useful, not only for doctors and medical students, but also for biologists, pharmacists, chemists and, above all, specialised translators and scientific writers.

In Spanish, unlike in English, grammatical gender is a vital syntactic function that expresses agreement among nouns, adjectives, some pronouns, articles and certain participles used as adjectives. Grammatical gender poses major challenges for lexicographers, particularly with regard to nouns that name persons.

In a bilingual dictionary, it is fairly easy to denote the grammatical gender of inanimate nouns, since most objects have a single form and explicit gender: biopsia, for example, is always feminine; quirófano is always masculine. In a bilingual dictionary, it is therefore easy to state that "biopsy is biopsia" and "operation room is quirófano".

However, in the case of nouns that name persons, most have a double gender form in Spanish (e.g., el cardiólogo and la cardióloga, el bioquímico and la bioquímica) or they are invariant with an implicit gender (e.g., el dentista and la dentista, el psiquiatra and la psiquiatra). Very few nouns that are invariant with explicit gender can be used for both biological sexes without changing the grammatical gender. This is true of masculine (e.g., bebé, cadáver, personaje, ser) and feminine nouns alike (e.g., criatura, familia, gente, persona, víctima).

Nouns naming persons that undergo gender-related changes are a major problem for bilingual dictionaries. Some dictionaries opt to use an inclusive masculine form. This strategy is very common in general spoken language when referring to a person whose sex is not yet known (e.g., "espero que en este hospital haya un ginecólogo de guardia"). These dictionaries state, for example, that "neurologist is neurólogo", running the risk that their strategy may be misinterpreted as gender bias against women. Other dictionaries, on the other hand, prefer to expand the double forms and state that "neurologist is neurólogo o neuróloga" or they opt for a double abbreviated form, "neurologist is neurólogo/-ga".

These two alternatives for solving Spanish gender variance work quite well in monolingual dictionaries (where they are used as isolated headwords) and in simple bilingual dictionaries (where direct equivalents are usually given in the form of one- or two-word entries). However, in complex bilingual dictionaries that provide a range of compound expressions, these strategies become cumbersome and confusing. For example, a good surgeon becomes un buen cirujano, una buena cirujana (not to mention un/a buen/a cirujano/na!). Even more long-winded and convoluted are explanatory sentences with nouns, adjectives and articles that all express gender agreement. A sentence such as "Además del médico adjunto y el auxiliar administrativo, solamente pueden estar presentes el paciente ingresado y un amigo íntimo o un familiar cercano" should reflect all its variants: "Además de la médica adjunta y el auxiliar administrativo, solamente pueden estar presentes la paciente ingresada y un amigo íntimo o una familiar cercana", "Además del médico adjunto y la auxiliar administrativa, solamente pueden estar presentes el paciente ingresado y una amiga íntima o un familiar cercano", "Además de la médica adjunta y la auxiliar administrativa, solamente pueden estar presentes la paciente ingresada y un amigo o amiga íntimos o una familiar cercana" and scores of other possibilities that the Spanish language contemplates. Instead of increasing the reader's understanding, these strategies actually further confuse the issue. Worse still would be a double expanded option ("Además del médico adjunto o la médica adjunta y el auxiliar administrativo o la auxiliar administrativa, solamente pueden estar presentes el paciente ingresado o la paciente ingresada y un amigo íntimo o una amiga íntima o un familiar cercano o una familiar cercana") or a double abbreviated option ("Además del/de la médico/ca adjunto/ta y el/la auxiliar administrativo/-va, solamente pueden estar presentes el/la paciente ingresado/-da y un/a amigo/-ga íntimo/-ma o un/a familiar cercano/-na").

The options for nouns that name persons also apply to all English adjectives for persons and things, but with an even greater degree of complexity. This is because adjectives have gender and number in Spanish, but not in English. An adjective such as white, for example, would be blanca in white skirt (falda blanca), but blancos in white trousers (pantalones blancos). So, in an exhaustive bilingual dictionary, it would no longer suffice to say that white means blanco, as is usually the case, but white means blanco, blanca, blancos or blancas or, in the abbreviated form, white means blanco(s)/-ca(s). Again, this is extremely cumbersome and confusing, which is just what a dictionary seeks to avoid.

Therefore, the time-old practice in the history of lexicography is to tend towards simplicity and clarity over exhaustiveness. Everyone who regularly uses a monolingual dictionary will know, for example, that bisturíes has to be searched for as bisturí, because it does not have its own entry. Likewise, soy, eras, fue, seremos and serían have to be searched for as ser; librito as libro; dificilísimo as difícil, and so on and so forth.

I have never heard anyone suggest that searching for different verb forms using the infinitive shows bias against past, present, future or imperative conjugations. And no one contends that finding Spanish plurals only by searching for singulars implies a number bias that might empower the individualistic nature of our modern capitalist society against the plurality and sense of community that is defended by the social revolution of Christianity or anarchy. Everyone readily understands that these are mere conventions of usage, designed to simplify dictionary searches, with an eminently practical purpose. So it should not be hard to interpret grammatical gender conventions the same way, as simple grammatical conventions designed for practicality.

In the Dictionary of doubts and difficulties in English medical translation, I have sought to avoid the long-windedness of expanding each and every Spanish grammatical gender variant of an English term or phrase. I have therefore opted to apply the following conventions:

1. For headwords and compound expressions (denoted by the symbol ●), and in the main body of the articles, I have given the Spanish equivalent in an inclusive or generic single gender form. In line with general Spanish usage, the inclusive gender is usually masculine, except for a few cases in which the inclusive feminine form is used in general speech to represent both grammatical genders. Therefore, the equivalent terms rheumatologist (reumatólogo) and obstetric nurse (comadrona), should be interpreted in the standard, underlying sense of rheumatologist (reumatólogo or reumatóloga, depending on the context) and obstetric nurse (comadrona or comadrón, depending on the context), respectively.

2. In the case of example sentences (denoted by the symbol ◘), however, I have used the inclusive masculine form only (or, more rarely, the inclusive feminine form) when the example refers to a group of men and women or a person of indeterminate or unknown sex. In all other cases, I have tried to alternate examples in which an English noun has a standard, underlying Spanish masculine equivalent with others that have a feminine one, so that the reader is constantly aware that the transformation from English to Spanish involves an inherent grammatical gender decision. Therefore, with words such as child and doctor, the reader will encounter example sentences such as My child is badly injured (mi hijo está gravemente herido) and The doctor ordered complete rest (la médica le prescribió reposo absoluto) together with other examples such as She was often ill as a child (de pequeña se ponía enferma con frecuencia) and The doctor put the patient out for surgery (el médico anestesió a la paciente para la intervención quirúrgica).

Notwithstanding the above, for some entries where I feel it would be useful for the reader to have access to more detailed comments, I have discussed specific problems encountered when translating English - a language with almost no traces of grammatical gender - to Spanish, where this feature is ever present. Take, for example, the first comments on usage (denoted by the symbol ►►) in the entry for Dr. or the comment on meaning usage (denoted by the symbol ►) in meaning one, sub-meaning a), in the entry for nurse.

When on the eve of the pandemic at the end of 2019 I received an invitation from Fernando Navarro to create a Brazilian edition of his famous Libro rojo, I knew immediately it would be a herculean, though very necessary, task.

Herculean it would be, in terms of the quality, the size, and the nature of the task that I had been given. He did not want a translation of his dictionary, but rather a derivative work, a Brazilian edition of his dictionary.

Naturally, I was flattered, and I accepted the challenge.

After all, like Navarro, I have had double training as a translator, the owner of a small medical translation business since 1996, and as a doctor, with a specialization in infectious and parasitic diseases, and ample experience in clinical research and emergency medicine, all of which made me sufficiently qualified.

The closeness between our two Romance languages often made me embarrassed by our English "colonization". The Hispanic fidelity to our Romance language roots, so very useful in medical vocabulary of Graeco-Latin origin, was what allowed me to choose the options that seemed more appropriate in my task, like, for example, deoxyribonucleic acid, which is ADN in Portuguese, and ribonucleic acid, which is ARN, instead of DNA and RNA, respectively, just like all its derivatives (e.g. messenger ARN = ARNm). The terms for viruses and the diseases they cause, as well as their acronyms, are translated into Portuguese in cases where they are already listed in the Orthographic Vocabulary of the Portuguese Language (VOLP in Spanish or Portuguese) or the main Brazilian dictionaries. The same occurs with foreign words: when they are accepted as the norm, they are rightly shown in italics, such as the frequently used term abstract. All spellings are consistent with the VOLP.

The guiding principle of translation is to offer information in a certain language from another language to monolingual readers and listeners. Therefore, it makes no sense at all the import words, false friends and syntactic and semantic structures from the original language and insert them in the target language. This is a pitfall many bilingual writers who are not translators fall into.

Navarro reveals to us each and every one of these traps in the universe of medical translation with clarity and concision, offering the best options for translation and explaining the erroneous alternatives already accepted by use. The idea is not to create new dogmas, but to accompany the natural movement of the language without allowing it to be destroyed, something that already happens in so many other places. The tone is therefore that of a conversation among friends in a living room, speaking of a subject that interests us.

Indeed, it certainly does interest us!

This is the first medical translation dictionary in Portuguese.

There are of course many old medical dictionaries conceived by erudite doctors and intended for their fellow physicians–true lexicographic, etymological and vernacular delights. They are extremely valuable for the culture of medicine, but for the translator they are esoteric. Some small dictionaries, some of them bilingual, have already been published by translators, though not by a single author.

There are also contemporary medical dictionaries in other languages, and while they have an undeniable value for the medical translator and the medical student, having been translated by several translators, they are quite heterogenous in terms of vocabulary and terminology.

Our dictionary is different because it was made by medical doctors and translators for medical doctors and translators. Furthermore, it is a dictionary of doubts and difficulties in medical translation, making it even more unusual. The Brazilian edition of the original English-to-Spanish version has been developed by a Brazilian doctor and medical translator who has always worked in Brazil.

In my view, this provides us with a differentiating factor when it comes to instrumental resources for medical and scientific writing in English and Portuguese, allowing for greater excellence in our areas of knowledge in both languages.

It was not by chance that the launch of the Dicionário de dúvidas e dificuldades da tradução médica do inglês para o português was entrusted to the Brazilian Association of Translators and Interpreters (ABRATES) with the support of the National Union of Translators (SINTRA), to whom I extend my deepest thanks by way of their presidents, Giovanna Lester and Ana Beatriz Caldeira Ferreira Braga Dinucci, respectively.

It would not be possible to finish this prologue without mentioning the most revolutionary aspect of this dictionary: it is alive. Yes, it is alive and pulsating, evolving and interactive. Being exclusively digital, all entries have at the foot of the page a contact form to communicate doubts, suggestions, comments, proposals for terms, data on regionalisms and other speaking styles from variants of Portuguese, critiques, corrections, and more. I respond to all messages with the decision either taken (e.g., a small punctuation error already corrected on the screen) or soon to be taken (e.g., whether to include in a future edition and when). The names of all the people who collaborate in this way are permanently listed in the acknowledgements of each edition.

Finally, please be sure to read the forward in the Spanish editions. In it, Navarro explains in detail how to use the dictionary, what each symbol means, its history, different lexicographical options, and all other essential information to ensure that the dictionary may be used easily and skilfully.

I hope you enjoy it!

Dedication

To Dominique Perrot, for all and everything.

First, to the beloved daughters that life has given me together with their loved ones, Anaik and Tato, Laís and Jaime, and my grandson Oliver, and to the loved ones that good fortune brought me later: my daughter Ana Paula Keila and my granddaughter, her daughter Mila, and to my grandson Tomás, with whom I share my life and who always keep my heart warm.

To my very dear teacher and friend, Dr. Jacqueline Anita de Menezes, who introduced me to medical translation, instructing me and accompanying me along the way, and with whom I learned and continue to learn the many aspects of the job.

To all my patients, who taught me the practice of medicine and trusted me, allowing me the privilege of taking care of their health, and opening the doors to their personal lives, something that has always made me feel honoured as a professional and a human being.

And last but not least, to Fernando Navarro–thank you for giving me the enormous gift of bringing the Libro rojo to my language, my country and my life with your infinite kindness and warmth. To the inestimable and always friendly and helpful José Antonio de la Riva Fort, thank you for your unconditional support, unbeatable willingness and bright smile. Your companionship on this trip made it all possible and very enjoyable. And to Constanza Cervino, whose gentleness, professionalism, collaboration, persistence, commitment with the Brazilian edition and untiring dedication made all the difference.

Acknowledgements for version 1.02

On 9 April, Medscape Português began publishing weekly unpublished texts from the Dictionary of Doubts and Translation Difficulties from Medical English to Portuguese or DDD, even before its launching on May 14^th, 2022. My sincere appreciation for their support and encouragement.

I would also like to place on record my appreciation for the support provided by Abrates (Brazilian Association of Translators and Interpreters), Sintra (National Union of Translators and Interpreters), and HighFive, company responsible for the brilliant simultaneous interpretation of the event, with the support of Tradusa - Meetings - Courses - Workshops, for having carried out the launching of the Dictionary of doubts and difficulties of translation from medical English to Portuguese on May 14^th, 2022. In addition, Abrates made available for 30 days a recording of the release on its YouTube channel, an additional reason for gratitude. My thanks to Giovanna Lester, Eleonora Nascimento of Alcântara Barros, Bruno Murtinho and Reinaldo Rocha, and Cátia Santana, respectively, as well as to Damiana Rosa, and to the interpreters coordinated by Norma Medina: the Spanish and Portuguese interpreters Meg Batalha and Enrique Julio Romera, and sign language interpreters Karoline Andrade, Suzana Souza and Marlon Soares.

I would also like to thank the director of Cosnautas, Dr. José Antonio de la Riva Fort, and Constanza Cervino for being part of the launch table and presenting the different aspects involved in the difficult task of transforming the unique Libro Rojo into a Brazilian edition apt to respond to the needs of the Portuguese-speaking public.

And, of course, to Dr. Fernando A. Navarro, author of the original Libro Rojo, of which the Brazilian edition is a derivative work, my most sincere and deep gratitude for entrusting me with the task of making accessible to Brazil and to all Portuguese-speakers medical translators throughout the world the inestimable worth of his work.

Contributors to version 1.12

Debora Blanco

Contributors to version 1.11

Mirtes Pinheiro

Contributors to version 1.06

Ana Elisa Igel, Ana Maciel, Ana Maria Barreiros, Anthonio João, Carolina Ribeiro, Cátia Santana, Claudia Corbusier, Claudia Dornelles, Christiane Karydakis, Daniel Fernandes, Dawn Taylor, Ester Dodo, Estevam Sampaio Rebouças, Giovana Lester, Jacqueline Anita de Menezes, Joana Bernardes dos Santos, Joaquim Bezerra, Júlio César Leites Rodriguez, Karine Souto, Kathleen Goldsmith Killing, Kelly Elizeu, Lavinia Gondim, Leonardo Faria , Luiz Sérgio de Oliveira, Marcos Henrique Martins, Maria Aparecida Amim de Carvalho, Maria Dolores Wanderley, Maria Helena Almeida Pereira, Miriã Carper, Mateus Baldi, Mirtes Pinheiro, Monica Carneiro, Norma Medina, Patrícia Gimenez Camargo, Rached Cavalcanti, Rhuan Contardi, Sofia Pulici, Sonia M Joventino, Talita Domiciano, Talitha Bittencourt Austin, Thaiane Assumpcao, Vera Lucia de Godoy Bueno Larsson, Vinicius Carvalho, Virginia Lovisolo

Contributors to version 1.05

Alan Dalles, Beatriz Araujo do Rosário, Debora Branco, Jacqueline Anita de Menezes, Laura Bocco, Marcia Gouveia, Marisol Mandarino, Nilo Sérgio Loja da Silva, Paulo César Hoffman Dorna, Ricardo Bertoni, Talita Domiciano

Contributors to version 1.04

Bruno de Carvalho, Carlos Garrido Rodrigues, Laís Volp, Marcelo de Oliveira Lima

Contributors to version 1.03

Ana Paula Keila Vicente Vieira, José Ernando Souza Filho, Kenny Hernandez, Laura Bocco, Marcelo Lima

Contributors to version 1.02

Gisele Klein, Elionai Paes, Cátia Santana, Bernardo Schubsky, Leoleli Schwartz, Ana Paula Keila Vicente Vieira y Laís Volp

Contributors to version 1.01

Americo Grilo, Ana Paula Keila Vicente Vieira, Chadwick Wenga, Claudia Yanomine, Constanza Cervino, Cristina de Amorim Machado, Fabio Santana, Juan Manuel Igea, Kenny Hernandez, Laís Volp, Luiz Carlos Fraga, Marisol Mandarino

DDD

Preface to the fourth edition (2022)

Introduction (2000)

Why yet another dictionary?

Why a dictionary of doubts?

Why a critical dictionary?

Why an English-Spanish dictionary?

Why a medical dictionary?

Conventions on grammatical gender

Preface to the first Brazilian edition by Dr. Carla Vorsatz

Acknowledgments

Bibliography

DDD