squint, cross-eyed

If you have any interest in the doctor-patient relationship, I very much recommend Dariusz Galasiński's blog. He writes thought-provokingly about various things that he and I have in common: being immigrant linguist patients or linguist immigrant patients or immigrant patient linguists. But probably not patient linguistic immigrants. Anyhow, we're rather different in how we are/do all those things, but I am really enjoying the commonalities and the thought-provocations.

He wrote recently about a term that's always struck me when I've heard it in BrE. Here's a snippet from the relevant blog post, On 'medical language':
...I was asked about ‘the history’ and told about my strabismus. The optometrist (or doctor) responded with something like:
OK, so you had a squint.
I didn’t react the first time, but after a second time, I politely but firmly said I hadn’t – it was strabismus, to which she said, it was one and the same thing. And I somewhat more firmly said it wasn’t and that I would rather she used medical language. She looked at me with a sort of ‘What’s your problem, man?’ look. I so didn’t care.
You see, there is nothing ‘squinty’ about my strabismus. It’s not a squint, it’s not ‘strab’. No, it’s strabismus. For me (and I only speak for myself) when you use colloquial language to refer to my eyes, you make light of all the sh…I had to take when I was a boy....
In AmE, it's said that a person with strabismus is cross-eyed or more rarely that they have a crossed eye. I was told when I was young that cross-eyed means the eye (or eyes) points toward(s) the nose and wall-eyed means it/they point away from the nose. That wasn't the original meaning of wall-eye (no, that was having a very light iris). I imagine that the strabismus meaning came from folk-etymology: the eye is looking at the wall. (Also, there's a fish called a wall-eye and fish generally do look to the side.) But in everyday US usage, cross-eyed seemed to be applied indiscriminately for any off-target eye.

In young children, who were treated with an eye patch, the term lazy eye was used, and though there seems to be a technical difference between that and strabismus, I don't think anyone in my circle was observing the difference. This term seems to be used in both countries.

But I had never heard of squint to refer to strabismus till I came to the UK.

In AmE squint generally means narrowing your eyelids, as you do when the sun's in your eye. This meaning is only a bit more than a century old (three hundred years younger than the strabismus sense). Despite its newness, it's a widespread meaning, which has definitely arrived in the UK. This is what you get if you google "Squint emoji":



The scrunched-eyelid meaning is mostly used as a verb (she squinted in the sun), whereas the  strabismus meaning is mostly used as a noun, following the verb to have: he had a squint.

While US dictionaries have the older meaning (though maybe not listed first), squint does not seem to be used much in the US in this way. There are nine British examples of ha* a squint in the GloWBE corpus, and though it initially looks like there are three "American" examples, one is the narrow-eyed meaning and the other two aren't by Americans.
Why did the strabismus meaning die out in the US? Probably because of the success of the narrowing-your-eyes meaning, connected to the fact that cross-eyed had come along (late 18th c) to do the strabismus job.

Back to Dariusz's post, the tendency of UK medical folk to use colloquialisms--some of which I might classify as 'baby talk' or 'euphemism' is something that's come up here before. (Here's a link to the medicine/disease tag, where related things come up.) It depends on the ailment, but by my tally, the UK does more colloquial terms, the US more medical jargon. Whether BrE medical personnel perceive squint as colloquialism or just "the normal (non-medical) word" for the condition, I don't know.

The point of Dariusz's post (as I read it) is not "people shouldn't use this word", but more "medical personnel shouldn't assume that colloquialisms are the best way to talk to all patients" and "using colloquialisms with some patients may make them feel talked-down-to"—particularly in this case where the patient had used one kind of word and the practitioner had "dumbed-down" the patient's language—that seems dismissive. This is an issue I've had trouble with in dealing with a few UK doctors (and different medical issues) myself--simplifications that are oversimplifications or insistent use of euphemism where I'm using medical terminology.

But I don't want to end on a sour note about UK doctors. (I love the NHS!) American doctors have their own communication problems with patients. A major theme of Dariusz's blog is that doctor-patient/patient-doctor communication should be human-human communication. The problem with that wonderful idea, of course, is that some people on both sides of the pond are trying to make medicine profit-driven. Human relationships hardly stand a chance in those conditions. But let's not stop trying.

[Late addition] A Twitter correspondent offers boss-eyed. Oxford Dictionaries lists it as 'British informal', and the not-updated-since-1933 OED entry lists it as 'dialect slang' and referring to just one eye out of alignment. 


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By the way, I'm happy to report that I have submitted the manuscript for the book that this blog inspired. I will let you know publication details when they are available (you know I will)--but the book won't be out till some point Spring 2018. Yay! And thank you to the (US) National Endowment for the Humanities for making it possible.

112 comments

  1. I enjoyed it very much. I think you're right associating colloquialisms with 'baby talk'.

    Incidentally, I was once spoken to like that by a doctor (ophthalmologist), till she spotted my uni ID card which I 'forgot' to take off. She immediately stopped, just adding in an irritated way something like: Sorry, I shouldn't have bothered. It seems she fully realised that what she was saying could have been taken as patronising.

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    1. My PhD supervisor had a heart attack (or suspected one?) while I was her student (I hope these are not causally connected). She insisted everyone in the hospital call her 'Dr Green', and she recommended that we all do it too if ever in hospital, as the medical staff then explained everything much more specifically.

      Though when I moved to South Africa and tried it, the doctor's receptionist suspiciously asked what kind of doctor I was and refused to ever call me 'Doctor' once she knew I had a PhD and not an MD.

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    2. Earlier today, someone accused me of 'going native' and saying 'in hospital'. I pointed out it was the Twitter character limit. But wait, I just did it again. Old post on that: https://separatedbyacommonlanguage.blogspot.co.uk/2007/04/menopause.html

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    3. When my mother was in the hospital with cancer, my sister managed all the dealings with the staff. She introduced herself as "Dr Arbios" and went by that all through my mother's treatment. Never did my sister feel it necessary to explain that she was a veterinarian.:)

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    4. I have a PhD but always feel a bit of a twat introducing myself as Dr or asking anyone to address me that way. So I never do. But this can get to feel pretty demeaning in a medical setting where the physician is calling me by my first name and I'm expected to call her/him Dr So-and-So. But I have had the same experience as you, Lynne, with medical people refusing to recognize that a PhD is as entitled as an MD to the honorary title of Dr (actually, we had it first, MDs just copied us). How do others with PhDs handle this? -- Lit Doc

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    5. I don't think I have ever been called 'Dr G...' by in a medical context. Still, I have been treated differently. I wrote about the situation which started it all here:
      http://dariuszgalasinski.com/2017/04/10/clinical-genericness/

      Now, I have developed strategies of weaving the fact into a conversation with a medic, it always palpably changes the footing we are on.

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    6. Miss Manners (Judith Martin, an American etiquette columnist) wrote in 2007, "In the higher levels of the academic world, it is taken for granted that one has a Ph.D. and considered silly for anyone not in the medical field to use the title of doctor." The whole column as it appeared in the Orlando, Florida, Sentinel, is online at http://articles.sun-sentinel.com/2007-12-26/features/0712210438_1_christmas-card-manners-doctor. Also, the Associated Press stylebook advises journalists not to use the title "doctor" for someone who is not a medical doctor, dentist, or other person with a doctorate in a healthcare profession. It says that it's what ordinary people mean by "doctor."

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    7. My tutor said, "It is enough to be an MA and a gentleman". Expecting to be called Doctor if you are a D.Phil is like retiring from the army and expecting to be called Captain.

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  2. A BrEng speaker writes...
    I know wall-eyed as one blue & one brown eye, especially in dogs (usually Border Collies). I have known this term for well over 50 years. I have also seen a sub-breed of Border Collie called a Blue Merle (common-ish in Camarthenshire in Wales) with one brown eye & one eye half & half blue & brown described as wall-eyed by the farmer who owned him. I've seen a wall-eyed pony too.
    Also boss-eyed is sometimes used for a squint (regarded as not very polite).

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    1. AmE speaker who has acquired heterochromia here. Huh, I would never have expected 'wall-eyed' to refer to heterochromia. Though I have heard 'odd-eyed'!

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  3. In Scotland, it usually describes something that is not straight.

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  4. To me (British), squint is just the ordinary word for strabismus, and it doesn't have any talking-down or strongly informal connotations. (Cross-eyed and boss-eyed are a different matter - rather offensive, I think.)

    I knew the meaning of squint long before I knew the meaning of strabismus. In fact, I had to look up the latter in the dictionary when I encountered "venerean strabismus" in a novel by Anthony Burgess.

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    1. A common-sense contribution.
      (A "squint" in a church is a sideways gap in the masonry enabling the priest at a side altar to keep an eye on what is happening at the high altar.)

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  5. If anyone's curious about the technical difference between "lazy eye" and "strabismus" that Lynne mentions, it's that a lazy eye (the proper term for the condition is ambliopia, by the way) decides to shut down for all intents and purposes when the dominant eye is open. It is literally lazy because it only works when it's the only one around to do the work.

    The patch she mentions is to trick the lazy eye into becoming the dominant eye, but it doesn't always work, especially if it's not caught early enough. In this case, the sight in the lazy eye deteriorates pretty quickly (at least for me) into legal blindness. But again, if I had to keep my dominant eye covered for an extended period, I could get around with my lazy eye with few problems. I wouldn't be able to read, but otherwise be fine.

    Tying back to the subject of the post, I'd love to refer to my condition as "lazy eye" since it's so apt, but everyone I've talked to assumes that I mean "cross-eyed", so I have to use the proper medical term.

    PS: for some strange reason, the lazy seems to always be on the same side as the dominant hand (at least in the cases of the people I've met). Don't know what that's about.

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  6. I once overheard a colleague who had previously been a nurse teaching a class of medics preparing for a Medical English exam. She was telling them that they would need to know terms patients actually used —the most memorable being water works.

    If there's a stylistic speech difference between a professional and an educated foreigner, it's no big deal: communication isn't greatly impaired. But if a professional uses terms that a native speaker patient doesn't understand, or terms that make them feel inadequate, the communication failure can have serious consequences.

    Strabismus is a term that nobody uses here. I would feel quite annoyed if a professional used it to me without immediately explaining it. Squint is not a colloquial substitute here — it's the neutral term that everybody understands/

    In any case, it was wise of the professional to substitute the everyday term to make sure that the patient had used the technical term correctly.

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    1. I agree. While I appreciate the general point that it is important not to talk down to patients (which is not synonymous with using colloquial language and can be done equally easily through using scientific terms) in this case I think it's a dialect difference that happens to have particular meaning for one patient due to his personal medical history. But for the vast majority of patients that a UK doctor sees, squint would not be a patronising colloquialism, it would be the correct and immediately comprehensible medical term.

      Likewise, when the common term is "heart attack", the doctor does not come across as engaging more respectfully with the patient by saying "myocardial infarction", but as being deliberately obscure. And saying "Your baby has a non-serious rhinovirus" is not superior to "Your baby has a slight cold".

      /nineveh_uk @LJ

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    2. Just to make it clear - I did not think I was being talked down to. I just wanted medical language.

      Having said this, your point about 'heart attack' is very well made. And I wish, I had a good response to it.

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  7. Dariusz wrote

    She looked at me with a sort of ‘What’s your problem, man?’

    Well yes. Not only was he telling her how to do her job, but he was telling her a 'fact' about her language which isn't a fact at all. Squint and strabismus are one and the same thing.

    The explanation

    You see, there is nothing ‘squinty’ about my strabismus.

    is totally incomprehensible to my British ears.

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    1. Except that there is a difference. One is a medical term, the other is not. In the same way, 'Please leave' is the same as 'Get the f...out', except one is polite and the other is not.

      I think it's worth reminding ourselves that there are no perfect synonyms. So 'squint' and 'strabismus' refer to the same phenomenon, but do it differently.

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    2. Let's distinguish words from things. You recall

      she said it was one and the same thing

      which it incontrovertibly is.

      There is a difference in the words, which normally wouldn't matter, but caused havoc in this instance.

      • Without any such intention, she gave the impression of talking down to you.

      * Without any such intention, you gave the impression of criticising her professionalism.

      This was all very unfortunate, but not nearly as unfortunate as when doctors use terms that patients don't understand — or just half-understand — but are too anxious or too intimidated to ask for the precise meaning.

      Miscommunications like this are recognised in Britain as frequent — and potentially dangerous. Fro our point of view, your expert acted admirably in making sure that you were using this outlandish term — which few British speakers would know and hardly any would use — in the precise sense used by experts.

      And I repeat: the adjective squinty means nothing to me. Of course, I can guess that it means 'characteristic of a squint' but then you seem to expect me to understand that you have squint with none of a squint's characteristics.

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    3. Yes, I agree. This is probably what's so interesting. She was making sure I understand, I was making sure I feel comfortable. As it happened, these two communicative goals were at odds with each other.

      I also agree that in a different context, it would not have mattered.

      Still, the situation does raise an important point about clinical communication. As any communication it is contextual, but here sensitivity to context is way more important than, say, in a pub. Which is, of course, obvious, yet, I'm not certain all healthcare profs remember it.

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    4. "...there are no perfect synonyms..."
      Gorse, furze and whin.

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    5. I use gorse and furze as an example of the slipperiness of synonyms in one of my books. Yes, they refer to the same plant, but meaning is more than reference. In the wild (of English) furze and gorse, at least (I have never come across 'whin' in anything but discussions of synonymy) are used in different contexts. E.g. around where I live there are many placenames with 'furze', none with 'gorse', but people mostly seem to refer to the plant as 'gorse'.

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    6. My husband, who is from Northern Ireland, has always called it "whin", and had never heard it called "gorse" until he met me. I, conversely, had never heard it called anything other than "gorse".... didn't even realise that "Furze" referred to anything (despite having lived, briefly, in a house known as "Furzeholme")

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  8. Indeed. I remember an embarrassing situation back when I did not yet know that contusions meant 'bruises', and I asked a doctor if I had contusions. Of course I did — she could see them as well as I could.

    I am both wall-eyed and amblyopic, but my amblyopia is not progressive: the affected eye is 20/200, but is not getting worse as I get older. Glasses correct it. I had an operation in my 40s to correct the wall-eye: I was quite surprised to learn that they would partially cut (thus weakening) the muscles in both eyes. After a few weeks of balance problems when my eyes didn't agree with my inner ears (I found myself leaning over to the right while sitting), I am now wall-eyed only if I am not wearing my glasses.

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  9. So, British people, to us, ‘squint’ means the narrowing of one’s eyes; for example the way your eyes clench up and nearly close when you face a bright light.
    Since you don’t use ‘squint’ for that, what do you call such a narrowing of the eyes?

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    1. The verb to squint means that as well. So in the right context a squint can be understood to mean 'a narrowing of the eyes'. But with no obvious context to deny it, the default interpretation of a squint is that German-sounding medical jargon strabismus.

      If an oculist says So you had a squint? it could have only one meaning.

      I'm not joking. The use of ‑ismus where English would use ‑ism is typical of German — even if German isn't actually the source of strabismus. A British humorist of the last century who called himself Beachcomber specialised in silly names for ridiculous invented characters. One of them was Doctor Strabismus of Utrecht, whom God preserve.

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    2. Margaret, we should have read Lynne's post more carefully. She actually explained that your American sense of squint is a recent invention first recorded at the beginning of the last century 'three hundred years younger than the British sense.

      Looking at the OED I see

      • Actually it's three and a half centuries younger for the noun, though the verb is recorded from 1879.

      • More seriously, and more surprisingly, it's only last September that this sense made it into the dictionary. Well, not actually into the dictionary but as a draft for eventual inclusion.

      And I've thought of what we say for the American sense; we say screw your eyes. For the verb, that is. I'm not sure anyone would say a screwing of the eyes, though. A screw of the eyes? I don't think so.

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    3. To me (British), the default meaning of "squint" would be the narrowing of the eyes. When I was growing up, "cross-eyed" would refer to the other meaning but this may be taken as offensive today. I've only ever come across the other meaning of "squint" on eye tests.

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    4. In UKEnglish I would say squinting in the sunlight to refer to a narrowing of the eyes

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    5. I would say I "screwed up my eyes".

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  10. Speaking as an ophthalmologist (NZ-retired), I don't recall ever using the term strabismus when talking with a patient, because it would have been considered incomprehensible jargon/gobbledegook. 'Cross-eyed' and 'squint' were standard expressions commonly understood to mean misaligned eyes - along with 'crooked (two syllables) eyes' - although squint could also mean partial closure/narrowing of the eyelids, and medical students needed to be aware of the potential for confusion when assessing a patient's medical history.

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  11. (AusE perspective here)

    What I don't understand is why any dialect of English would need a colloquial word for this concept at all, unless it's the legacy of a peculiarly British plague. I can't say I've really noticed this condition in anyone I've ever met, so what occasion would the average British person have to learn and use the term?

    I first came across it in Terry Pratchett's "Jingo":

    'Hammerhead? Stinks of fish all the time. And she's got a squint.'
    'She's got her own business, though. Does wonderful chowder, too.'
    'And a squint.'
    'Not exactly a squint, Nobby.'
    'Yes, but you know what I mean.'
    Angua had to admit that she did. Verity had the /opposite/ of a squint. Both eyes appeared to be endeavouring to see the adjacent ear.


    I once raised this in a discussion group, but responses weren't particularly illuminating. People were, however, clear that the "narrowing eyelids" sense is the primary sense in BrE too, just as it is for the rest of us. (Obligatory note: limited sample space.)

    "Cross-eyed" usually refers to a voluntary action (as in "to go cross-eyed"), so I suppose "permanently cross-eyed" would be my translation.

    On colloquial anatomical terms, I've been weirded out in the past by BrE speakers' casual use of "navel", which to me is markedly formal. "Belly button" is neutral, and "tummy button" is the infantile choice.

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    1. But squint is not a colloquial word. It's the standard unmarked term — in British English, that is.

      The term strabismus was a learned invention to express a concept that already existed. The earliest two quotations in the OED are from a translated dictionary and an encyclopaedia:

      1684 tr. S. Blankaart Physical Dict . 269 Strabismus , Squinting, is occasioned by the Relaxation, Contraction, Distorsion, too great Length, or too great Shortness of the Muscles which move the Eye.

      1771 Encycl. Brit. III. 155/1 A Strabismus, commonly called squinting.

      That first use is translated from Dutch — which apparently shares the German predilection for the -ismus suffix.

      As for navel it's been English for ever. It was clearly the term for the thing long before English existed, as seen from cognates in all related 'Germanic' languages. The earliest use discovered in the OED is to translate Latin umbilicus for Anglo-Saxon readers.

      To me navel is the unmarked term. I might expect the same sort of person who uses strabismus to use similarly marked umbilicus.

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    2. Umbilicus: Or possible omphalos.

      This reminds me that The Independent newspaper once ran a profile of format US president Jimmy Carter and claimed he'd attended the US Navel College.

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    3. You can be involuntarily cross-eyed.

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  12. I'd never heard "strabismus" before this post. (BrE, large vocabulary in general)

    Chad, that makes sense, as the right hand is controlled by the left brain and vice versa. Assuming the "wires cross" in the neck, your weaker eye and your dominant hand would be controlled by the same brain hemisphere.

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  13. Lynne, before I dominate this discussion with my comments: Thank you very much for writing about this. Also thank you to all who commented. It's a great discussion, raising all sorts of issues about medical language and its presence in the society.

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    1. Thanks, Dariusz! I'm so glad you're finding it helpful, as I was a little worried about appropriating your discussion!

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  14. A bit of a tangent, but I've done a fair amount of Spanish interpreting for US doctors with Mexican or Central American patients--most often undocumented workers with very limited English and often with little formal education.

    Medical professionals tend to do what they regard as simplification of their language when they talk to these patients. Whether it's a response to the language barrier or the difference in SES or a combination of the two, the result is that they use shorter words and more colloquial expressions.

    In fact, their patients are much more likely to understand medical terms, because Spanish is a Romance language with its roots in Latin. So a stroke or heart attack is an 'infarto', a lung is a 'pulmón', a kidney is a 'riñón,' the spine is the 'columna vertebral,' anything to do with the heart is 'cardíaco', etc.

    This is often a very hard sell with doctors, in whom the habit of colloquializing their language when speaking to low-SES patients is very ingrained.

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    1. The doctors are not necessarily "colloguializing their language"; they may just be using the ordinary terms that people are familiar with, and not necessarily "low-SES" (I am having to guess what that means).

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    2. SE is socio-economic, and I think the 2nd S is probably stratum.

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  15. I recall wondering about the word squint when I read Murder in Mesopotamia when young.

    See:
    ‘It was yesterday afternoon,’ I said. ‘He’d been cross-questioning me about the man with a squint who was looking in at the window that day. He asked me just where he’d stood on the path and then he said he was going out to have a look round. He said in detective stories the criminal always dropped a convenient clue.’

    ‘Damned if any of my criminals ever do,’ said Captain Maitland. ‘So that’s what he was after, was it? By Jove, I wonder if he did find anything. A bit of a coincidence if both he and Miss Johnson discovered a clue to the identity of the murderer at practically the same time.’

    He added irritably, ‘Man with a squint? Man with a squint? There’s more in this tale of that fellow with a squint than meets the eye. I don’t know why the devil my fellows can’t lay hold of him!’

    ‘Probably because he hasn’t got a squint,’ said Poirot quietly.

    ‘Do you mean he faked it? Didn’t know you could fake an actual squint.’

    Poirot merely said: ‘A squint can be a very useful thing.’

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    1. Do you mean he faked it? Didn’t know you could fake an actual squint.’

      Huh? Is there a kid on the planet who hasn't experienced the joy of squinting -- or, since until now 'd no idea that "squinting" could have this meaning, going cross-eyed?

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  16. InE perspective: "strabismus" was unknown to me until I looked it up in the dictionary when an AmE doctor used the term in front of me. "Squint" is normal and not "colloquial" or "talking down". It's the equivalent of saying "loose motion" instead of "diarrhoea", or "heart attack" instead of "myocardial infarction".

    As David Crosbie mentions elsethread, your point that doctors mustn't use patronising language is well taken, but this one would be a bad example in InE.

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    1. "Loose motion"—never heard of that either. In the US we might say "loose bowels", though I think that's generally less loose than diarrhea.

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    2. "There’s more in this tale of that fellow with a squint than meets the eye."
      I wonder if the brilliance of that sentence was intentional.

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  17. Then again, it can work like this: you go to the doctor because your arm is sore, and he declares you have a medical condition with a long name and writes a prescription. The long word turns out to be Greek for "sore arm". (This is not a real example).

    There is an Irish (I think it was) stand-up who has some shtick about how his mother used to tell him he had a "special eye".

    @David: We say "screw up your eyes", don't we?

    Not sure what, if anything, it adds to this discussion, but British progressive rock band Jethro Tull had a song on their Aqualung album called Cross-Eyed Mary.

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    1. In AmE "screw up your eyes" means you damaged them, somehow. (or abused them)

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  18. @David

    "We say 'screw up...'"

    ... as in "screwed-up eyes and screwed-down hair-do" in David Bowie's Ziggy Stardust.

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  19. I suspect this all stems from a realisation in the not-so-distant past that there was a problem with Medical English. The idiom had acquired two functions:

    1 As scientific terminology it provided terms which were (potentially, at least) more specific and informative than existing lay terms, and which could be indefinitely augmented as medical knowledge expanded

    2 As a jargon it allowed doctors and other medics to communicate with each other to the exclusion of lay eavesdroppers, including patients. This exclusivity amplified the already superior status of doctors. Worse, doctors could employ it to bamboozle patients when they didn't really know what the the trouble was.

    This barrier to communication was unfair on patients, so we tried to democratise affairs on either side of the Atlantic.

    • In America you decided to educate lay people to understand (and use) jargon.

    • In Britain, we decided to encourage doctors to use ordinary language.

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  20. I grew up with a medical background (my mother was matron of a geriatric hospital) and am familar with strabismus but wouldn't expect it to be generally known.
    Anecdote: When my young daughter was seen by a nurse on a visit to Surrey, I was flabbergasted to be asked whether she had a 'wee problem'. Before it hit me that she meant 'urinary', I thought for a moment she was mocking my Scottish accent!

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  21. I think a point that may be being missed here in some of the "doctor's shouldn't use medical language" comments is that it was the patient who had used it first, and then the doctor kind of rejected the patient's use of the medical word. "Doctors should adjust to their patient's language" doesn't just go in the direction of colloquializing, it can also go in the direction of medicalizing.

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    1. I don't believe the doctor 'rejected' the medical word. I suggested that she was checking that Dariusz was using it correctly — to which Dariusz responded

      Yes, I agree. This is probably what's so interesting. She was making sure I understand, I was making sure I feel comfortable. As it happened, these two communicative goals were at odds with each other.

      And I really think you should drop the idea of 'colloquializing' in this particular context. In British English, squint is very much the neutral term. You'd have a point, though, with 'a wee problem' or 'tummy trouble' or 'water works' or 'a bit of a dicky heart'.

      Yes, in an ideal world doctor and patient should attempt to negotiate appropriate terms. But before that, they must be sure that the term — whether technical or lay — is being used unambiguously and precisely, to the comprehension of both parties.

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  22. I'm NZE living in the UK. I'd only ever heard the AmE usage of squint until I moved to the UK. I still think of it as wrong when I hear someone describe being crossed-eyed as a squint!

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    1. Just to clarify, we don't say someone is a squint, but has one. There is an adjective, squint-eyed, to describe the person, but afaik no noun.

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  23. I had thought that the meaning of "screw up the eyes" (or just "screw the eyes" in Scotland, @David?) was perfectly normal British English, something I've used all my life, but looking in my old Chambers, it was not apparently considered such by the editors in 1988, being entirely absent. Also, I note it says there that "boss-eyed" derives from the (slang/dialect) sense of boss meaning "a mistake", as in a boss-shot (bungled shot), so it's not surprising that is felt to be derogatory.

    There are numerous jokes about doctor-patient miscommunication, such as the one [please don't read on if you are offended by "coarse" language] about the simple man who was prescribed suppositories for severe constipation with the instruction: "You don't swallow these; you put them in your back passage. Use one a day and come back in a week's time". When the man comes back, he is asked if he has "moved yet?" and says he hasn't. The doctor ups the dose and tells him to come back the following week, again. Same story that time. On his third visit, the man is asked "Have you moved, yet?", and replies "Oh, yes, Doctor. We had to: the house was full of shit".

    Another one involving suppositories has the punchline, "For all the good they did, I might as well have stuck them up my arse!"

    (Suppositories are not prescribed so much in the UK as in many other countries, I believe).

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    1. The OED records screw up rather than simple screw and associates it with mouth as well — if not more so:

      14.b.to screw up: to contract the surrounding parts of (the mouth, eyes).


      1743 H. Fielding Journey from this World i. ii, in Misc. II. 16 But that female Spirit screwing up her Mouth, answered, she wondered at the Curiosity of some People.

      1853 Dickens Bleak House xvi. 159 Jo screws up his mouth into a whistle.

      1883 F. M. Crawford Dr. Claudius ii, Mr. Barker screwed up his eyes and put out his jaw.

      The up may have been dropped historically for the same reason as why I decided the other day not to write screw up — which has it's own, rather unfortunate, default meaning.

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    2. Screw up in the sense of "mess up" is a simple substitution of screw for the stronger (more taboo) synonym "fuck", isn't it? I think this sense of screw probably did come from the US. When I was in my mid-teens (late 1960's), if you looked (even glanced) at a skinhead (a species of ruffian extant at that time, for those unfamiliar), he was likely to come up eyeball-to-eyeball with you and menacingly ask "Are you screwing [ie looking/staring/squinting at] me, mate?" -- obviously a behaviour connected with male dominance. I don't remember ever thinking that was humourously synonymous with "Are you having sex with me?", so I wonder if the latter sense arrived later than that? (Perhaps the OED can help with that question, David?). Or maybe it was just too scary to chime humourously...

      Of course, in Britain at least, you can say the same thing with "balls up" (more as a noun than a verb in that case, I think) or "cock up", which is probably(?) still the most widespread version (and not at all taboo, I don't think, though a little slangy, perhaps). I wonder if those have any currency at all in the US?

      Finally, there's also the colourful "make a pig's ear of" something, which is apparently (per phrases.org) a mid-C20th coinage based on the proverb "You can't make a silk purse from a pig's ear".

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    3. Regarding screwing up the eyes (squinting in the once-only-Am sense) or mouth, I don't remember hearing "screw up the mouth" before (is that the same as "puckering" it?), but it's semantically almost identical with "screw up a piece of paper", isn't it? ie, make it smaller (narrower in the case of eyes), with creases.

      Did Clint Eastwood squint in America, as that sounds wrong. I'd say "he narrowed his eyes" or perhaps "screwed [them] up"

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    4. Did Clint Eastwood "squint" in America, I meant.

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    5. Hmm... maybe it's just me, after all, though. Presumably Columbo (Peter Falk) didn't "squint" (or have one)?

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    6. He often squinted, but also his eyes weren't quite straight. ;)

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    7. Actually, I've just checked it out, and Falk had a false eye, so I'm not sure how his look would be described in any dialect. Not strabismus, anyway, I assume (IANAD).

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    8. @Zouk Delors
      "Of course, in Britain at least, you can say the same thing with "balls up" (more as a noun than a verb in that case, I think) or "cock up", which is probably(?) still the most widespread version (and not at all taboo, I don't think, though a little slangy, perhaps). I wonder if those have any currency at all in the US?

      "Finally, there's also the colourful 'make a pig's ear of' something, which is apparently (per phrases.org) a mid-C20th coinage based on the proverb 'You can't make a silk purse from a pig's ear'."

      I think I would expect any of those phrases to be understood in the US (because of British media imports), but I would not expect any to be spontaneously generated by an American.

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    9. I wasn't familiar with the Dr Strabismus quote, which I find is from J.B.Morton, aka Beachcomber of the Daily Express, and is in full: "Dr. Strabismus (Whom God Preserve) of Utrecht is carrying out research work with a view to crossing salmon with mosquitoes. He says it will mean a bite every time for fishermen."

      Coincidentally, he also once wrote: "One disadvantage of being a hog is that at any moment some blundering fool may try to make a silk purse out of your wife's ear."

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  24. A couple of things:

    * When my son was born, he spent 6 weeks in the neonatal ICU. I had the good fortune that my sister had trained several of the NICU nurses, including my son's primary care provider. As a result, I was able to get doctors to be responsive when I asked questions, including using real medical terminology that allowed me to understand what was really happening.

    * I normally use the technical generic names of drugs when speaking to doctors, in part because it results in fewer misunderstandings (there's a difference between pseudoephedrine HCl and phenylephrine, though both are varieties of "Sudafed" in the US), but in part because I've found that it causes doctors to treat me more as a professional than as a bug pinned to a board. (Several have asked me whether I was a doctor; in fact I'm a technical writer, so the jargon comes easier for me than for most.)

    I am absolutely of the opinion that a competent medical professional (like, as it turns out, a competent technical writer) should be able to notice the register used by his/her patients and adjust accordingly.

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  25. In the UK, my 93-year-old mother's doctor once referred to her as"a bit wooly"

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  26. Cross-eyed brings back many painful memories of eyepatches, surgery (removal of the eye and cutting the muscles behind it), tachistoscopes, etc. AmE "squint" has nothing to do with cross-eyed/strabismus/ambliopia. Find it weird, in fact. You squint when someone shines a light in your eyes, or the sun hits them suddenly, and that's about it.

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    1. "...that's about it."
      Not so! "Squint" for many people, including me, indicates, at least sometimes, a sideways, or faulty alignment of the eyes.

      Delete
  27. I appreciate the difficulties noted in the original post - my parents are a pharmacist and a nurse, so I was raised in a medically rich environment. I am more likely to use clinical terms and appreciate being spoken to in the same way. However, I had a trip to the doctor where they inspected something on my back, spent the next 15 minutes talking about it in clinical terms (while I was wondering how I got herpes, much less on my BACK) until they handed me an information sheet and I burst out with "OH, SHINGLES. Why didn't you just SAY THAT?" So, neither solution is perfect.

    Regarding squint - AmE, Midwest, if I were speaking to a doctor who said "you have a squint", I would likely look at them blankly and say "no, I don't" or "well, it's bright in here" depending on whether I had narrowed my eyes. Cross-eyed/strabismus wouldn't even cross my mind. Another (very) colloquial use of squint is toward science "geeks" - as they have (stereotypically) permanently narrowed eyes (US squint) from looking through a microscope or at a computer screen all the time.

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  28. 34-year-old British-English speaker from the South-East here – this post is the first time I’ve ever heard of anyone using the term ‘a squint’ to refer to someone with crossed eyes. For me, squinting is only available in the ‘narrowed eyes’ sense – presumably I must’ve seen the term ‘a squint’ in print before, but I’d’ve assumed it was a reference to ‘permanently narrowed eyes’ or something. ‘Crossed eyes’ is the usual unmarked term in my idiolect.

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  30. I grew up in Britain (born mid-1970s), and to me "squint" has only ever had the meaning of "narrow the eyes". My everyday term for strabismus would be "cross-eyed".

    Looking at other comments, it looks as if there may have been a generational shift in the BrE everyday meaning of "squint".

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    1. I wa born in the UK in mid 50's and I agree with you. Maybe it's a regional thing?

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    2. Maybe. I grew up in the Midlands.

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    3. Perhaps "a squint" is the condition, and the verb "to squint" means either to screw up your eyes or look in a cross-eyed fashion?

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    4. @LBS:

      Possibly for some people, but not for me. "Squint" whether noun or verb, has only ever been associated in my mind with narrowing the eyes.

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  31. I (BrE, Southern, mid-60s) would squint at the sun, but I'd also refer to someone as having a squint. I don't think the term "strabismus" is a part of my active vocabulary.

    And I'm sure I'm not the first one to remember the story of the child who was given a teddy bear and decided to call it "Gladly", because it had a squint, and in church that Sunday they had sung "Gladly my cross-eyed bear"!

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    1. [Haha! I've heard it before, but thanks for renewing the mirth, Annabel. I once worked for a company that had a software product call MICROSS (pron. mai'cros). The long-suffering head of technical support, a practising Christian, used to say "We all have our cross to bear, and I have MICROSS"]

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  32. I have just received a copy of a paper in the British-based journal 'Brain' - hence directed at scientists and medics, in which a patient is described thus: 'at 8 months, muscular hypotonia, squint and nystagmus were documented'. I did have to look up nystagmus, but the other terms are perfectly comprehensible to a biochemist!
    The authors were neurologists and geneticists from Germany and the Netherlands, presumably using the house style of the Oxford University Press.

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  33. Br-Eng speaker, fairly educated in my late 60s. Like many others on this thread, I've never heard the word 'strabismus' used, apart from in the context of 'Dr Strabismus, whom God preserve, of Utrecht'. If an optician told me I had strabismus, it would mean nothing to me. I'd also prefer not to be spoken to with medical phrases I don't understand.

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  34. I (BrE) also have what Chad Walters above tells me is officially called ambliopia but I have always called a Lazy Eye and would not have known or understood the term ambliopia or indeed strabismus. (And yes, my lazy eye is the right one and I am right-handed).
    I squint (vb) into birght light but a person might have a squint (n). (O.T. but it is interesting that in a lot of the examples quoted, having a squint is indicative of shiftyness/being the baddie.)
    And I had heard of 'Dr Strabismus, whom God preserve, of Utrecht' but only in a very old collection of comic writing called "A Book of Nonsense".

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  35. Interesting discussion, as always. I'd definitely fit into the British pattern of using 'squint' and recognising 'boss-eyed', though I'd find that a little rude to use myself. 'Cross-eyed' would only be for the temporary and deliberate action of 'going cross-eyed'. Never heard of strabismus, but I don't know anyone with it particularly well.

    In Scotland 'squint' can also be an adjective meaning 'not straight'/'at an angle'. It's one of those words that I and many other Scots grow up believing to be standard English, until we venture south of the border and are confronted by a row of blank faces.

    Having had this reaction from a group of English friends after saying the pub we were in got some of its charm from the lovely old squint windows, I asked what they'd say. 'Skew-whiff' and 'off-kilter' were all they could come up with - surely there's a simpler term?

    Does anyone know if this 'squint' is related to either of the eye-related squints? And does it appear in other dialects?

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    1. Whaddayamean, "squint" as in "not straight" is not standard (British) English? Really? (Scot, but have lived in England a lot of my life. Had never noticed that one. Maybe it is just not a word I have used much myself.)

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    2. Chambers dictionary doesn't give that meaning as Scottish only. In fact, the first definition of "squint" is adv. obliquely. Interestingly, it doesn't seem to give the meaning of screwing up ones eyes against the light. It possibly comes from the Dutch schuinte, meaning slope, slant.

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    3. The OED etymology is more detailed:

      • The earliest evident use of a word in English is an adverb — but the adverb is asquint.

      • The only known cognate is indeed Dutch schuinte. This makes it likely that we borrowed the word from Dutch and added an English prefix a‑, but it's also possible that there was an English word that was lost.

      Asquint was used from the thirteenth century, but the shorter word squint is more recent — earliest quotes in the OED from the turn of the seventeenth century.

      • The ADJECTIVE squint is recorded from 1597. At first it denoted a 'sideways look' — often implying envy or malice. Nearly all the later uses relate to eyes or vision. From the eighteenth century it's recorded in the 'not straight ' sense with words like cut, motion and quoin (in its naval sense). The don't quote squint window, but it seems to have be an actual architectural term — leading to a sense of the NOUN (see below).

      • The COMPOUND squint-eye seems to have been used in the way that we now say beady eye. Earliest recorded use 1625.

      • The VERB squint is first recorded in 1610 as meaning 'give a sideways glance' and in 1611 with the medical meaning. The 'screw your eyes up' meaning is very recent — not even noticed by the OED until recently and even now only in a DRAFT ADDITION from last September. Once they decided to look, they found a use from 1879 for 'screw up your eyes to focus' and one from 1900 for 'screw up your eyes to protect them'.

      • The NOUN squint is record from about 1652 referring to a permanent sideways look — possibly but not always a medical strabismus. A later sense (from 1673) is a 'sidelong glance'. A century and a half later it's recorded as denoting a particular sort of squint window in a church. use from For the DRAFT ADDITIONS, they discovered a 1909 use of a squint against a glare. And can even later 1967 squint against the dust.

      • The ADVERB squint was a rare substitute for asquint.

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  36. The church in my parents' village has a window known as the "lepers' Squint". Legend has it that it was where the local lepers could gather to hear Mass without infecting others. There was certainly a local leper colony, apparently, and a path from there to the (12th century, replacing an earlier Norman building) church known as the "Lepers' Walk".

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  37. Interesting discussions. I didn't see any mention of the expression "Have a squint at this", which is rather dated but still well understood (in Ireland anyway!) to mean "have a quick look at this". My guess this follows the look sideways derivation.

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    1. Dated or not, I think Have a squint at this would be understood anywhere that squint can mean 'glance'.

      Without a TARGET expression such s at this, there's an ambiguity to

      have a squint

      compounded by the multiple ambiguity of have.

      Squint, as we've seen implies that the eyes do one of the following

      • make an involuntary gesture
      • make a controlled gesture
      • are uncontrollably and steadily directed
      • are controllably and steadily directed

      Among the many meaning of have, the relevant ones here are

      • 'indulge in' — as have a bath, have a fag
      • 'be characterised by' — as 'have a limp, have a roving eye'

      So

      • 'indulge in a voluntary gesture of the eyes at this'
      have a squint at this

      •'was characterised from childhood by an uncontrolled and steadily directed gaze'
      had a squint from childhood

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  38. On medical/colloquial language: as a wild generalisation, I'm struck by how often American contributors to sundry internet messageboards I visit delve into the technical details of various medical issues, the specific results of specific tests and so on. In part this may be something to do with (and let's not get too far into this) how medical care is organised in our two countries, with people in the US seemingly feeling they have to or ought to do a lot of running around between different sorts of doctor and service, where we're brought up to rely on the GP as the default option. But in part it seems to be a collision/collusion between the remains of an old "de haut en bas" attitude to doctor/patient relationships, and a great push to counter-act against that precisely by consciously looking for what would be considered patients' ways of talking about medical problems, in a culture that's prone to euphemisms and indirect allusion anyway - they have special courses on it. It's a source of many a joke, of course - trying to discuss constipation with a lady who's obviously using all the euphemisms:
    "And do you take anything when this.. you know...."
    "Well, I take my knitting"

    Or there's the habit of mouthing rather than speaking potentially embarrassing words, which adds another layer of complication.

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    1. "the habit of mouthing rather than speaking potentially embarrassing words"

      This habit, mostly displayed, I think, by ladies of a certain age, was regularly parodied by Les Dawson and Roy Barraclough in drag as the characters Cissie and Ada:

      "Dawson explained that this mouthing of words (or "mee-mawing") was a habit of Lancashire millworkers trying to communicate over the tremendous racket of the looms, and then resorted to in daily life for indelicate subjects." (Wikipedia)

      One unforgettable such sketch goes like (something like) this:

      "Did you hear Madge died?"
      "No-o-o! What of?"
      "It was the big C that took her" [meaning cancer, of course]
      (Beat)
      "What, she drowned?"

      In an echo of this blog's subject matter, this pun was recently reworked by David Mitchell in the R4 comedy panel game The Unbelievable Truth as (something like): "Her Majesty stated that we [Brits and Americans] are divided by an enormous sea. A spokesman later clarified that she was referring to the Atlantic Ocean, not Donald Trump"

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  39. I think you have a very good point, Autolycus, one which I hadn't thought of.

    It's often said — half seriously — that the NHS (National health Service) is Britain's closest approximation to a national religion. Whatever the current flaws and difficulties, we cling to an idealised picture of how it's supposed to be. What you've brought out is that this image of the NHS affects the way we communicate with doctors.

    US readers may not be aware that — aside from accidents and the emergencies — we access the service though a gatekeeper: a GP (general practitioner) on whose list we are registered. Actually, the gatekeeper nowadays is more likely to be a group of doctors working together and sharing the list (a so-called practice), but the principle remains that we have a long-term relationship with one, or not many more, service provider. And that doctor or practice is not usually our choice, but what the system makes easy. This means a practice which is local and has room on the list for you.

    [These lists are crucial to the working of the system. GPs are not employed by the NHS but are paid on the basis of the list of potential NHS-users they have contacted to serve.]

    So, we're service users, not consumers. Yes, some people are able to choose one practice over others. And yes, we have a right to a second opinion. But these are the exceptions.

    One linguistic consequence is that the core of our conversation with doctors is with someone that we've known for some time. Insofar as we understand each other, it's the result of learning to understand each other's vocabulary. There's no call in principle for precise technical terminology — although it's an option if doctor and patient prefer.

    The way we converse with GPs tends to affect the way we communicate with the specialist doctors, surgeons, clinicians that we may be referred to. We bring to the conversations the terms we have previously used with our familiar GP. This stranger will often try to use the language that we're familiar with. Problems arise when the specialist starts explaining conditions that have not been named to us before. There are many anecdotes of patients failing to take in what they're told. It's a double whammy — strange new terms uttered by a stranger. And a triple whammy if the patient fells pressured and anxious. When all this comes together, some patients fail to take in the doctor's explanations of the terms he/she uses. These communication failures may be a minority, but they constitute a potential problem that doctors are trained to avoid.

    PS
    I wrote, but somehow failed to post a reply to Doug Sundseth about the use of generic names for drugs. My GPs (and, I believe, most NHS GPs) try to speak of generic drugs, because the prescribe generic drugs because (in Scotland at least) they are paid for in full by the NHS and not at all by the patient. So I, like no doubt many other patients, try to use generic names if I know them.

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    1. AmE here. The system you describe in paragraphs 3 and 4 sounds quite a bit like the system I have. My doctor is a Family Practice doctor (GP was previously used in the US, but I don't think anyone would be called a GP now) in a practice chosen from a local list provided through my health insurance. I have a long-term relationship with her, but it began because she has a contract with my insurance company, is local, and had room for me as a patient. She is the gatekeeper for other medical services I might need. Unless I misunderstood your post, it sounds like the biggest difference between our services is who has the contract with the doctor to provide medical care?

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  40. In the UK "squint" is a medical term and the one most doctors in the UK would use when talking to another professional. Using the word "strabismus" when talking to a patient would widely be regarded as poor communication and use of jargon. When I used to teach and assess medical students, I would have been surprised if they used "strabismus" and discouraged Its use.

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    1. But it was the patient who used strabismus. Surely it is good communication to accommodate to the patient's vocabulary.

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    2. Yes, she accommodated by checking that he was using strabismus in the same way that she might use it.

      The fact that patients sometimes use abstruse medical terminology doesn't always mean that they understand it.


      Other things being equal, doctor and patient would have ended up with mutually satisfactory vocabulary. Unfortunately, Dariusz derailed the negotiation that might have been by claiming that a squint was different from a strabismus.

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    1. There's medical, and then there's medical. :)

      But I still think there is a fault in the communication here. The patient (who is not British) started out with one term, and the doctor shifted it. It gives the feeling 'that word you used, that's not a word I'm allowing you'.

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    2. In the original quote, the objection was that the doctor or optometrist was not using medical language. The point I am making is that "squint" is medical language in the UK and not talking down to the patient. It is one and the same thing to doctors in the UK. I think it is likely that the professional did not perceive that using this term would be objectionable to someone not from the UK. In other words they simply would not take in the point that was being made. I think it is unreasonable to expect them to guess this. Perhaps if the patient had explained they would have been quite happy to use "strabismus". Maybe you could further clarify doctors in in the USA would always use "strabismus"and would always be understood.

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  42. I don't understand your comment "There's medical, and then there's medical. :)". The term "squint" is the medical term in common use in the UK. See, for instance, NICE guidance -https://cks.nice.org.uk/squint-in-children#!scenario. This is a document intended for professionals.
    There is no "shift". It is much more likely the professional involved did not perceive the point being made. For them the two terms are synonymous and they are unlikely to understand that someone is going to interpret their comment that "they are one and the same" as giving the feeling 'that word you used, that's not a word I'm allowing you".

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    1. My smiley comment was intended to communicate: Latin terms feel 'more medical' than English ones to some people.

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    2. Only if they're aware of both terms.

      What Wheatie and I are saying is that the word strabismus is so extraordinarily abstruse to British speakers — even including British doctors — that you just can't extrapolate.

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  43. To me, too, the word 'strabismus' brings to mind the Beachcomber character (I remember Spike Milligan in a TV series based on Beachcomber's writings many years ago). I did know it meant a squint, but would never use it in ordinary conversation.

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  44. While reading about wellerisms on Wikipedia, I came across this line spoken by the character, Sam Weller (from Charles Dickens' The Pickwick Papers, 1836), that they're named after:

    "There; now we look compact and comfortable, as the father said ven he cut his little boy's head off, to cure him o' squintin'."

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  45. I have had a squint since birth and it has always been called that. I'm British. Squint is a standard term to use with patients, because it is understandable, not too colloquial, not too medical and inoffensive. I only learned strabismus is the official name as an adult. Cross eyed is too colloquial for a doctor and quite offensive now.

    Lazy eye refers to a different condition, amblyopia. But it is used with patients and is not offensive or too colloquial.

    The verb to squint is also widely understood and more used that screw up, which means get something wrong.

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  46. Count me among those who had never heard the unnecessary word 'strabisimus' before reading this post.
    Americans need to understand that (not just in the doctor's surgery, but anywhere at all) the use of obscure latinate words for commonplace concepts instantly sets off an ear-splitting alarm audible to all British people:
    [i]"Charlatan! charlatan! charlatan!"[/i]

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    1. Brits need to understand that they're inconsistent about this. :) Plenty of British use of classical words where AmE would use English. E.g. labrynthitis v inner ear infection. Covered that back here: https://separatedbyacommonlanguage.blogspot.co.uk/2016/07/infections-and-itises.html

      (Also, do note that the person who introduced the word strabisimus into the conversation was not American.)

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  47. As I understand it, there are three words for squint in British English: squint, strabismus and heterophoria. Squint is the word that most people in Britain understand, and strabismus and heterophoria are used only by professionals.

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AmE = American English
BrE = British English
OED = Oxford English Dictionary (online)