The age-old use of food comparisons to describe the smells and appearances of disease should be given a resurgence in the medical literature, a pathologist has said, using a journal article to list examples – from a “fish mouth” appearance of heart valves to a smell of rotten eggs in burps.

The paper – written by Dr. Ritu Lakhtakia, a pathologist from Sultan Qaboos University in Muscat, Oman – is published in the journal Medical Humanities.

Food descriptors may reflect a basic human need for survival, one of the reasons Dr. Lakhtakia suggests for their widespread but vanishing use, and doctors “must have strong stomachs” for all they confront. Or, she wonders, do doctors turn to these comparisons because of the meals they are forced to take on the job?

But, adds Dr. Lakhtakia:

It is a wonder that, in the midst of the smells and sights of human affliction, a physician has the stomach to think of food at all.”

Her account chronicles some of the “innumerable allusions to raw and cooked items of food that can reinforce, through imaginative imagery, audiovisual and olfactory understanding of diseases.”

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The infection with the yeast candida has a curd-like or cottage cheese appearance. “For me, it changed forever the delights of the cheese counter at the delicatessen.”

These may “stimulate epicurean enlightenment in medical students” but look away now if you are queasy. The autopsy appearance of a blood clot, for example, resembles “chicken fat” – because the effect of gravity to settle the red blood cells turns the “gelatinous” substance “yellowish”.

Perhaps offering a more comforting image are the descriptions listed in the paper for tumors that protrude into the cavities of hollow organs such as the gut. They can be differentiated by how they look: either the “smooth dome-shaped elevation of a mushroom or the more irregular and frond-like protrusion of cauliflower florets.”

The infection with the yeast candida has a curd-like or cottage cheese appearance. “For me, it changed forever the delights of the cheese counter at the delicatessen.”

Calling up images of food can provide useful indications of size, too. The size of a tumor can be related to increasingly larger foodstuffs:

  • Peanut
  • Walnut
  • Lemon or orange.

Talking of fruit, the list includes apples, pears, currants, grapes, cherries, strawberries, and watermelons.

For the cherries, it is their color used for reference, but once you know that for the benign skin growths dubbed cherry red spots or cherry angioma, you can refer to them as Campbell de Morgan spots, in recognition of a 19th century surgeon.

Dr. Lakhtakia says there is a nutmeg comparison to be made in the appearance of congested blood vessels contrasting with the paler liver:

Today, I never fail to carry a nutmeg to demonstrate the dark and light contrast in my lectures on liver disease.”

A note for producers of TV medical dramas: the color of vomited blood (from hematemesis) is usually that of ground coffee, owing to the stomach’s acidic action on the bloody contents.

The coffee bean is also cited by Dr. Lakhtakia for the reference to a groove in the center of a Brenner tumor of the ovary.

The many “audacious and colorful references” to food in medical descriptions “can be attributed in equal measure to the imagination of the author and his or her own or regional food preferences.”

In her concluding remarks, Dr. Lakhtakia says these preferences explain the dominance of European delicacies, with American foods being a more recent addition to the lexicon, “with a smattering of more Eastern delights thrown in.”

Wherever and however they originated, she champions their use in medical training: “Whatever the genesis, these time-honored allusions have been, and will continue to be, a lively learning inducement for generations of budding physicians.”