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[[File:Atm1 sclerodermia.jpg|left|300px]]

[[File:Atm1 sclerodermia.jpg|left|300px]]

In this chapter we will discuss current medical language. Specifically, we will discuss the study of the relationships between linguistic expressions and the world to which they refer, or which they should describe. The conclusion is that once the vagueness and ambiguity of this form of language (and therefore the negative consequences that all this entails) have been revealed, there is a need to make it more precise and complete. To do this, we want to focus on a more mathematical and rigorous reasoning because, as we will discuss in this chapter, it can be much more effective if it can be manipulated the right way.

In this chapter, we will discuss current medical language. Specifically, we will discuss the study of the relationships between linguistic expressions and the world to which they refer, or which they should describe. The conclusion is that once the vagueness and ambiguity of this form of language (and therefore the negative consequences that all this entails) have been revealed, there is a need to make it more precise and complete. We want to focus on more mathematical and rigorous reasoning because it can be much more effective if we can manipulate it the right way as we will discuss in this chapter.

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==Medical language is an extended natural language==  

==Medical language is an extended natural language==

First of all, we must distinguish between natural languages (English, German, Italian, etc.) and formal languages, such as mathematics. The natural ones emerge naturally in social communities as much as in scientific communities. Simultaneously, the formal languages are artificially built for use in disciplines such as mathematics, logic and computer programming. Formal languages are characterized by ''syntax'' and ''semantics'' with precise rules, while a natural language has a fairly vague syntax known as ''grammar'' and lacks any explicit semantics.  

 

First of all, we must distinguish between natural languages (English, German, Italian, etc.) and formal languages, such as mathematics. The natural ones emerge and evolve naturally in social communities as much as in scientific communities, while the formal languages are artificially built for use in disciplines such as mathematics, logic and computer programming. Formal languages are characterized by ''syntax'' and ''semantics'' with precise rules, while a natural language has a fairly vague syntax known as ''grammar'' and lacks any explicit semantics.  

To keep this study active and engaging, and to avoid it degenerating into a boring treatise on the philosophy of science, let’s consider a very explanatory clinical case. We will deal with it using different languages: [[Logic of classical language|Classical language]], [[Logic of Probabilistic language|Probabilistic language]], [[Logic of Fuzzy language|Fuzzy logic]] and [[Logic of System language|Logic of System]].  

To keep this study active and engaging, and to avoid it degenerating into a boring treatise on the philosophy of science, let’s consider a very explanatory clinical case. We will deal with it using different languages: [[Logic of classical language|Classical language]], [[Logic of Probabilistic language|Probabilistic language]], [[Logic of Fuzzy language|Fuzzy logic]] and [[Logic of System language|Logic of System]].  

===Clinical case and logic of medical language===

===Clinical case and logic of medical language===

Patient Mary Poppins (obviously a fictitious name) was followed and treated for over 10 years by multiple colleagues, including dentists, family doctors, neurologists and dermatologists. The brief history is as follows: the 50-year-old woman first noticed small patches of abnormal pigmentation on the right side of her face at the age of 40. On her admission to a dermatological division, a skin biopsy was performed, and it was consistent with the diagnosis of localized scleroderma of the face, or '''morphoea'''; corticosteroids were prescribed. At the age of 44, she began to have involuntary contractions of the right masseter and temporal muscles; the contractions increased in duration and frequency over the years. The spasmodic contractions were referred to by the patient as both day and night lock. At her first neurological evaluation, dyschromia was less evident, but her face was asymmetrical due to a slight indentation of the right cheek and marked hypertrophy of the masseter and right temporal muscles. The diagnoses were varied, due to the limitation of the medical language as we will see below.    

Patient Mary Poppins (obviously a fictitious name) was followed and treated for over 10 years by multiple colleagues, including dentists, family doctors, neurologists and dermatologists. The brief history is as follows: the 50-year-old woman first noticed small patches of abnormal pigmentation on the right side of her face at the age of 40. On her admission to a dermatological division, a skin biopsy was performed, and it was consistent with the diagnosis of localized scleroderma of the face, or '''morphea'''; corticosteroids were prescribed. At the age of 44, she began to have involuntary contractions of the right masseter and temporal muscles; the contractions increased in duration and frequency over the years. The spasmodic contractions were referred to by the patient as both day and night lock. At her first neurological evaluation, dyschromia was less evident. Still, her face was asymmetrical due to a slight indentation of the right cheek and marked hypertrophy of the masseter and right temporal muscles. The diagnoses were varied, due to the limitation of the medical language as we will see below.    

The clinical scenario can be reduced to the following: the patient expresses in her natural language the psychophysical state that has long afflicted her; the dentist, after having performed a series of tests such as anamnesis, a stratigraphy and a CT scan of the TMJ (Figures 1, 2 and 3), concludes with a diagnosis of ‘Temporomandibular Disorders’, which we call ‘TMDs’<ref>{{cita libro  

The clinical scenario can be reduced to the following: the patient expresses in her natural language the psychophysical state that has long afflicted her; the dentist, after having performed a series of tests such as anamnesis, a stratigraphy and a CT scan of the TMJ (Figures 1, 2 and 3), concludes with a diagnosis of 'Temporomandibular Disorders', which we call 'TMDs'<ref>{{cita libro  

  | autore = Tanaka E

  | autore = Tanaka E

  | autore2 = Detamore MS

  | autore2 = Detamore MS

  | LCCN =  

  | LCCN =  

  | OCLC =  

  | OCLC =  

  }} - Epub 2018 Jun 12.</ref>; the neurologist remains instead on a diagnosis of organic neuromotor pathology of the neuropathic 'Orofacial Pain (_nOP) type, excluding the TMDs component, or does not consider the main cause. In order not to sympathize with either the dentist or the neurologist in this context, we will consider the patient suffering from ‘TMDs/_nOP’; so nobody fights.

  }} - Epub 2018 Jun 12.</ref>; the neurologist remains instead on a diagnosis of organic neuromotor pathology of the 'neuropathic Orofacial Pain' (_nOP) type, excluding the TMDs component, or does not consider the main cause. To not sympathize with either the dentist or the neurologist in this context, we will consider the patient suffering from ‘TMDs/_nOP’; so nobody fights.

 

{{q4|But who will be right?|good question}}

{{q4|But who will be right?|good question}}

We are obviously in front of a series of topics that deserve adequate discussion, because they concern clinical diagnostics.    

We are obviously in front of a series of topics that deserve adequate discussion because they concern clinical diagnostics.    

Unlike the formal languages ​​of mathematics, logic and computer programming (which are artificial systems of signs with precise rules of syntax and semantics), most scientific languages ​​develop as a simple expansion of natural language with a mix of some technical terms. Medical language belongs to this intermediate category. It emerges from natural and everyday language by adding terms such as ‘neuropathic pain’, ‘Temporomandibular Disorders’, ‘demyelination’, ‘allodynia’, etc. This is why it has no specific and semantic syntax beyond the one it takes from natural language. For example, let's consider the term ‘disease’ referring to the patient Mary Poppins: this is a term that indicates the fundamental concept of medicine, the concept of disease at the base of nosology and clinical research and practice. It is expected it to be a well-defined technical term, yet it is still an indefinite term.  

Unlike the formal languages ​​of mathematics, logic and computer programming (which are artificial systems of signs with precise rules of syntax and semantics), most scientific languages ​​develop as a simple expansion of natural language with a mix of some technical terms. The medical language belongs to this intermediate category. It emerges from natural and everyday language by adding terms such as 'neuropathic pain', 'Temporomandibular Disorders', 'demyelination', 'allodynia', etc. It is why it has no specific and semantic syntax beyond the one it takes from natural language. For example, let's consider the term 'disease' referring to the patient Mary Poppins: this is a term that indicates the fundamental concept of medicine, disease at the base of nosology and clinical research and practice. It is expected to be a well-defined technical term, yet it is still an indefinite term.

Nobody knows exactly what it means and, apart from some philosophers of medicine, nobody is interested in its exact meaning. For example, does ‘disease’ concern the subject/patient or the System (as a living organism)? And consequently: can a patient who is not sick in time <math>t_n</math> live together with a system already in a state of structural damage in time <math>t_{i,-1}</math>?

Nobody knows what it means precisely and, apart from some philosophers of medicine, nobody is interested in its exact meaning. For example, does 'disease' concern the subject/patient or the System (as a living organism)? And consequently: can a patient who is not sick in time <math>t_n</math> live together with a system already in a state of structural damage in time <math>t_{i,-1}</math>?

''The term languishes without any semantics as if it were irrelevant or gratuitous and its derivatives share the same semantic obscurity with it.''<ref>{{cita libro

''The term languishes without any semantics as if it were irrelevant or gratuitous and its derivatives share the same semantic obscurity with it.''<ref>{{cita libro

}}.</ref>

}}.</ref>

*In short, is the patient Mary Poppins sick, or is the chewing system damaged?

** In short, is the patient Mary Poppins sick, or is the chewing System damaged?

*Is it rather a ‘System’ disease considering the masticatory system in its entirety consisting of subsets such as receptors, peripheral and central nervous tissue, maxillary bones, teeth, tongue, skin, etc.,?

** Is it instead a 'System' disease considering the masticatory System in its entirety consisting of subsets such as receptors, peripheral and central nervous tissue, maxillary bones, teeth, tongue, skin, etc.,?

*Or is it an ‘organ’ disease involving in this specific case the temporomandibular joint (TMJ)?

** Or is it an 'organ' disease involving in this specific case the temporomandibular joint (TMJ)? These brief notes demonstrate how natural language's inaccuracies and peculiarities enter medicine through its syntactic and semantically underdeveloped form. We should deal with some of these peculiarities with concrete clinical examples.

<center>'''Clinical approach'''

<center>'''Clinical approach'''

==What does a medical term mean==

==What does a medical term mean==

Let us ask ourselves what ''meaning'' means. The Cambridge Dictionary says that "''The meaning of something is what it expresses or represents''"<ref>[https://dictionary.cambridge.org/dictionary/english/meaning Cambridge Dictionary online]</ref>. As simple as it may seem, the notion of ‘meaning’ is rather generic and vague; there is still no commonly accepted answer to the question 'what does "meaning" mean?' Controversial theories of meaning have been advanced, and each has its own advantages and shortcomings<ref>{{cita libro  

Let us ask ourselves what ''meaning'' means. The Cambridge Dictionary says that "''The meaning of something is what it expresses or represents''"<ref>[https://dictionary.cambridge.org/dictionary/english/meaning Cambridge Dictionary online]</ref>.As simple as it may seem, the notion of 'meaning' is rather generic and vague; there is still no commonly accepted answer to the question 'what does "meaning" mean?' Controversial theories of meaning have been advanced, and each has its advantages and shortcomings<ref>{{cita libro  

  | autore = Blouw P

  | autore = Blouw P

  | autore2 = Eliasmith C

  | autore2 = Eliasmith C

  | LCCN =  

  | LCCN =  

  | OCLC =  

  | OCLC =  

  }}</ref>.

  }}</ref>.  

 

Traditionally, a term is displayed as a linguistic label meaning an object in a world, be it concrete or abstract. The term is thought to stand in the language as a representative for that object, e.g. ‘apple’ for the famous fruit. This term ‘apple’ will have the same meaning for the American child, the European adult or the Chinese elder, while the meaning ‘_nOP’ will have a meaning for the neurologist, one for the dentist and certainly its own meaning for the unfortunate Mary Poppins.      

Such expressions do not derive their meaning from representing something in the world out there, but how they relate to other terms within one’s world or context.

The meaning of ''pain'' for Mary Poppins is in relation to what it can mean to her, to her conscience, and not in reference to the external world: actually, asking the patient to attribute a numerical value to his pain, say from 0 to 10, makes no sense, has no meaning, because there isn't any internal normalizing reference to one’s world or context. The same is true for the neurologist who will give a meaning to the term ‘pain in the right half face’ solely in his/her own context based on synapses, axons, ion channels, action potentials, neuropeptides etc. The dentist will do the same, based on his/her context that consists mainly of teeth, temporomandibular joint, masticatory muscles, occlusion etc. Concepts should not be neglected when it comes to ‘'''differential diagnosis'''’, because they could be a source of clinical errors. For this reason, we should reflect on the modern philosophy of ‘Meaning’, which began with Gottlob Frege<ref>[[:wikipedia:Gottlob_Frege|Wikipedia entry]]</ref>, as a compound of "extension" and "intention" of a term that obviously expresses a concept.

The meaning of ''pain'' for Mary Poppins is concerning what it can mean to her, to her conscience, and not about the external world: actually, asking the patient to attribute a numerical value to his pain, say from 0 to 10, makes no sense, has no meaning, because there isn't any internal normalizing reference to one's world or context. The same is true for the neurologist who will give sense to the term 'pain in the right half face' solely in his/her context based on synapses, axons, ion channels, action potentials, neuropeptides etc. The dentist will do the same, based on his/her context consisting mainly of teeth, temporomandibular joint, masticatory muscles, occlusion etc. Concepts should not be neglected when it comes to ''''differential diagnosis'''<nowiki/>', because they could be sources of clinical errors. For this reason, we should reflect on the modern philosophy of 'Meaning', which began with Gottlob Frege<ref>[[:wikipedia:Gottlob_Frege|Wikipedia entry]]</ref>, as a compound of "extension" and "intention" of a term that expresses a concept.

The concept has its '''extension''' (it includes all beings that have the same quality) and ‘understanding’ (complex of qualities referred to the concept). For example, the concept ''pain'' refers to many human beings, but it is more generic (great extension, but little understanding); and if we consider the pain in patients who receive, for example, dental implants, in patients with ongoing inflammatory dental pulpitis and in patients with neuropathic pain (atypical odontalgia)<ref>{{cita libro  

The concept has its '''extension''' (it includes all beings with the same quality) and 'understanding' (a complex of markers referred to the idea). For example, the concept of ''pain'' refers to many human beings, but it is more generic (great extension, but little understanding). If we consider the pain in patients who receive, for example, dental implants, in patients with ongoing inflammatory dental pulpitis and patients with neuropathic pain (atypical odontalgia)<ref>{{cita libro  

  | autore = Porporatti AL

  | autore = Porporatti AL

  | autore2 = Bonjardim LR

  | autore2 = Bonjardim LR

  }}</ref> we'll have:

  }}</ref> we'll have:

#Increases in the mechanical perception threshold and in the sensory perception threshold related to the activation of C fibres.

## Increases in the mechanical perception threshold and the sensory perception threshold related to C fibres' activation.

#Somatosensory abnormalities such as allodynia, reduced mechanical perception and impaired pain modulation in patients with atypical odontalgia.

## Somatosensory abnormalities such as allodynia, reduced mechanical perception and impaired pain modulation in patients with atypical odontalgia.

#No somatosensory alteration after implant insertion although patients report mild pain in the treated region.

## No somatosensory alteration after implant insertion, although patients report mild pain in the treated region.

On ‘pain’ in general we can say that it has a wide extension and minimal understanding, but if we consider the type of pain mentioned above, for example in patients who receive dental implants, in patients with ongoing inflammatory dental pulpitis and in patients with neuropathic pain (atypical odontalgia), it becomes evident that the greater the understanding is, the smaller the extension.  

On ‘pain’ in general we can say that it has a wide extension and minimal understanding, but if we consider the type of pain mentioned above, for example in patients who receive dental implants, in patients with ongoing inflammatory dental pulpitis and in patients with neuropathic pain (atypical odontalgia), it becomes evident that the greater the understanding is, the smaller the extension.  

The '''intension''' of a concept, on the other hand, is a set of aspects that distinguish it from the others. These are the characteristics that differentiate the generic term of "pain", which by articulating the intension of a concept automatically reduces its extension. Obviously, though, various generality scales can descend from a concept depending on which aspect of its intension is articulated. That is why we could conceptually distinguish pain in the TMJ from neuropathic pain.

The '''intension''' of a concept, on the other hand, is a set of aspects that distinguish it from the others. These are the characteristics that differentiate the generic term of "pain", which by articulating the intension of a concept automatically reduces its extension. Obviously, though, various generality scales can descend from a concept depending on which aspect of its intension is articulated. That is why we could conceptually distinguish pain in the TMJ from neuropathic pain.

We can conveniently say, therefore, that the meaning of a term with respect to a particular language is an ordered couple, consisting of extension and intension, in a world that we will now call ‘context’.  

We can conveniently say, therefore, that the meaning of a term with respect to a particular language is an ordered couple, consisting of extension and intension, in a world that we will now call ‘context’.