An-Najah National University Faculty of Graduate Studies Terminological Inconsistency in Medical Translation from English into Arabic By Heba Shaji Sa’adeh Yaseen Supervised Dr. Abdel Karim Daragmeh This Thesis is Submitted in Partial Fulfillment of the Requirements For the Master’s Degree in Applied Linguistics & Translation, Faculty of Graduate Studies at An-Najah National University, Nablus, Palestine. 2013 iii This thesis is dedicated to the dearest people in my life, my father, my mother, my sister Abeer, and my two brothers, Ahmad and Khaled for their constant encouragement, support and patience. iv Acknowledgement Gratitude be first to God for enlightening my way through this research. Secondly, this thesis would not have seen the light without the support and efforts of many people. I wish to express my deep gratitude to Dr. Abdel Karim Daragmeh for his guidance, support, and invaluable advice during the course of this study. His encouragement and patience made it possible to go through with this thesis. Deepest gratitude is also due to the members of the supervisory committee, Dr. Nabil Alawi and Prof. Qustandi Shomali without whose assistance, knowledge and valuable comments this study would not have been successful. I would also like to express my deepest gratitude to many people mainly Dr Anas Nabulsi, Dr. Deema Malahmeh, Dr. Mohammed Sa’adeh, and Lowiza Yaseen for their efforts and help during different stages of this thesis. Special thanks are due to my sister Abeer who is a medical student for her invaluable medical assistance. I would like to express my warmest thanks to my mother, and my two brothers for their constant support and patience, and for living with the thesis. Last but not least, the deepest appreciation and gratitude are due to Dr. Shaji, my father, without whose support, patience and guidance as a doctor, I would not have been able to succeed in this thesis. His belief in me indeed gave me the strength to go on with this study. Thank you a million dearest father. v إقرار : أنا الموقع أدناه مقدم الرسالة التي تحمل العنوان Terminological Inconsistency in Medical Translation from English into Arabic باستثناء ما تمت اإلشارة إليه , نتاج جهدي الخاص أقر بأن ما اشتملت عليه هذه الرسالة إنما في أو أي جزء منها لم يقدم من قبل لنيل أية درجة علمية أو بحث , وأن هذه الرسالة ككل, حيثما ورد .علمي أو بحثي لدى أي مؤسسة تعليمية أو بحثية أخرى Declaration The work provided in this thesis, unless otherwise referenced, is the researcher’s own work, and has not been submitted elsewhere for any other degree or qualification. Student’s name: اسم الطالب : Signature: : التوقيع Date: التاريخ : vi Table of Contents No. Content Page Dedication Iii Acknowledgement Iv Declaration V Table of contents Vi List of tables Ix List of appendix X List of abbreviations Xi Abstract Xii Chapter One 1 1.1 Introduction 1 1.2 Statement of the Problem 4 1.3 Purpose of the Study 6 1.4 Significance of the Study 6 1.5 Limitation of the Study 9 1.6 Review of Related Literature 10 1.7 Structure of the Study 16 Chapter Two Features of Medical Language 18 2.1 Introduction 18 2.2 The General Features of English Medical Language 21 2.2.1 Lexical Features 22 2.2.2 Syntactic Features of English Medical Texts 27 2.3 The History of Medical Arabic 29 2.3.1 The Arab Academies and Institutions of Standardization 35 2.3.2 Resources for Medical Arabic 40 vii 2.3.3 Criticisms to the Arabization Efforts 41 2.4 The General Features of Arabic Medical Language 44 2.4.1 Lexical Features 45 2.4.2 Syntactic Features 46 Chapter Three Methodology and Theoretical Frame 49 3.1 Description of Methodology 49 3.1.1 Districts and Respondents 49 3.1.2 The Sample 50 3.1.3 The Sources of Data Collection 51 3.1.4 Data Analysis 57 3.2 Theoretical Frame 58 3.2.1 Approaches to Medical Translation 58 3.2.2 Translation Procedures and Types of Equivalence 61 3.2.3 Terminological Inconsistency 62 Chapter Four Medical Books and DPIs 64 4.1 Introduction 64 4.2 Findings of Interviews with Doctors 64 4.3 Medical Books Structure and Translation Procedures 66 4.4 DPIs Structure and Translation Procedures 70 4.4.1 Findings of Telephone Interviews 74 Chapter Five Types of Terminological Inconsistency in Medical Translation into Arabic 77 5.1 Introduction 77 5.2 Types of Terminological Inconsistency in Medical Translation into Arabic 78 5.2.1 Arabization vs. Descriptive Translation 78 5.2.2 Arabization vs. Transliteration 86 5.2.3 Transliteration vs. Descriptive Translation 93 viii 5.2.4 Transliteration vs. Arabization vs. Descriptive Translation 99 5.2.5 Inconsistency in TL Equivalence 110 5.3 The Usefulness of the UMD 123 5.4 Attitudes of Practicing Doctors toward Medical Translation into Arabic and the Type of Equivalence They Prefer to Use 125 Chapter Six Conclusions and Recommendations 128 6.1 Conclusions 128 6.2 Recommendations 132 References 137 Appendix 146 ب الملخص ix List of Tables No. Table Page (1) An example of medical terminological overlapping 41 (2) descriptive analysis of the sample 50 (3) Terminological inconsistency in relation to arabization vs. descriptive translation 80 (4) Terminological inconsistency in relation to arabization vs. translaitration in medical books and dictionaries 88 (5) Terminological inconsistency in relation to arabization vs. transliteration in DPIs 91 (6) Terminological inconsistency in relation to transliteration vs. descriptive translation in medical books and dictionaries 94 (7) Terminological inconsistency in relation to transliteration vs. descriptive translation in DPIs 97 (8) Terminological inconsistency in relation to arabization vs. transliteration vs. descriptive translation in medical books and dictionaries 101 (9) Terminological inconsistency in relation to arabization vs. transliteration vs. descriptive translation in DPIs 104 (10) Percentages of usability for the three types of equivalence in specialized and non-specialized contexts 106 (11) Inconsistency in TL equivalence (circulated vs. non circulated) 114 (12) Inconsistency in TL equivalence (Non- circulated equivalences) 120 (13) UMD 124 x List of Appendix No. Appendix Page (1) The Questionnaire 146 (2) List of DPIs 152 xi List of abbreviations SL Source Language TL Target Language UMD Unified Medical Dictionary DPI Drug Package Insert xii Terminological Inconsistency in Medical Translation from English into Arabic By Heba Shaji Sa’adeh Yaseen Supervised Dr. Abdul Karim Daragmeh Abstract This study tackles the problem of terminological inconsistency in translating English medical terms into Arabic, which is defined as the lack of consistency in the selection of terms or assigning different translations to the same SL terms throughout a text or across relevant texts. The purpose of the present study is to display how factors of terms usability and circulations, the type of the target audience and the context of translation have an important role in lessening terminological inconsistency to a large extent, and, hence, they should be taken into account when determining which type of equivalence should be used to serve as a translation for a single English medical term. The representative data were collected from seven Arabic and translated medical books, two medical dictionaries of Hitti’s and the Unified Medical Dictionary (UMD) and 35 drug package inserts (DPIs). Such data sources were chosen in an attempt to compare between the most successful type of translational equivalence in specialized vs. non- specialized contexts. Data collection also involved interviews with doctors in which valuable insights about the medical translation process from English into Arabic in general were obtained, and telephone interviews xiii with Palestinian pharmaceutical companies in which a full description of the process of translating DPIs into Arabic was provided. Also, a questionnaire, targeting a sample of 100 Arab doctors in Nablus and Ramallah districts, was developed to measure the circulation of different types of equivalence for English medical terms in both contexts, i.e. communication among doctors and medical staff vs. doctor-patient interaction. The questionnaire also included an open question to give sample population the chance to present their attitudes toward translating medical terms into Arabic. The study has shown that there were five types of terminological inconsistency in relation to the three different types of equivalence, i.e. transliterated, arabized, and descriptive equivalences. It has been also found that the most used type of equivalence in specialized contexts was the transliterated equivalence while descriptive translations reported the highest rate of circulation in non-specialized contexts. Arabization reported low rates of use in both contexts. The study assessed the validity of the fourth and latest edition of UMD and has concluded and emphasized its usefulness as it serves as the closest official Arabic medical resource to everyday medical practices. The study has also concluded that approaches of medical translation into Arabic should not be prescriptive but rather descriptive and complying with the Arabic language structure if terminological inconsistency in medical Arabic is to be overcome. Chapter One 1.1 Introduction “Translation is often regarded as a project for transferring the meaning from one language into another”(Farghal &Shunnaq, 1999: 2). Translation in all its forms has always been used as a means of exchanging ideas in different fields and as a means of communication between different cultures. Medical translation whether for specialized or non-specialized types of audience is one prominent area. Within the field of medical translation fall different types of pharmaceutical and scientific translation that deal with medical topics (Gonzales, 2007: 49). Thus, medical translation is one of the growing areas of translation that includes a number of genres ranging from less specialized forms of health information brochures and drug package inserts (DPIs) to the more specialized forms of medical books and specialized articles in medical journals. The medical translator deals with what is called medical language which differs from everyday language in the specificity of its terminology. Due to the huge achievements and the vast developments the world is witnessing in the scientific fields in general and in the medical branches in particular, hundreds of new words are being coined in this field. Consequently, the need to transfer such achievements into other languages is rather urgent. Moreover, since the English-speaking countries are taking the lead in the medical fields, the major part of the medical jargon is of 2 English origins, or, for the most part, of Greco- Latin origins that has been adopted by and become overtime an inherent part of English language. Consequently, medical English has been translated on an international scale to different languages among which Arabic rises as a good and challenging example. Although Arabic was once the language of medicine, it now struggles to keep up with the frontier of medical sciences through translation, and to that end different institutions have been established throughout the Arab world, most notably the Arab Academies. However, in spite of the immense efforts exerted by the Arab Academies in this field, medical Arabic still suffers from inconsistency, and in some instances, contradictions appear in translating medical terms. This thesis sheds some light on the stages of the development of medical Arabic and the processes of term creation conducted by the Arab Academies. This review is deemed important to lay a theoretical ground for the present investigation. However, the main focus of the present study is on the different translation procedures that are used in translating medical books and drug package inserts (DPIs), and that have resulted in different types of equivalence, the matter that has led to inconsistency in the translators’ lexical choices. Such phenomenon is henceforth called terminological inconsistency. Medical Arabic, making a prominent type of technical Arabic, is thus examined in relation to the following types of equivalence investigated through a comparative analysis in relation to 3 specialized and non-specialized contexts. The three types of equivalence are: 1. Descriptive equivalence 2. Transliterated equivalence 3. Arabized equivalence The terminological inconsistency results from the unjustified alteration between the aforementioned three types of equivalence or among them. Seven prominent medical books, two medical dictionaries, and 35 DIPs have been investigated to serve as two different types of context from which the most problematic terms in relation to inconsistency and context- oriented types of equivalence have been collected. These books are: 1. . 2. 3. 4. . .األساسيات في تشريح اإلنسان .5 لطبيةدليل المصطلحات ا .6 . 7. 4 Upon examining the above mentioned sources, the researcher presents a simple outline for the structure of medical books and DPIs that are translated into Arabic. Also, the translation procedures followed in translating such materials into Arabic are discussed. More importantly, five main types of terminological inconsistency have been identified in relation to the three main types of translational equivalence: 1. Arabized vs. Descriptive equivalence; 2. Arabized vs. Transliterated equivalence; 3. Transliterated vs. Descriptive equivalence; 4. Arabized vs. Transliterated vs. Descriptive equivalence; 5. And inconsistency in Target Language Equivalence. The present study attempts to find out which type of equivalence is more widely used or alternatively accepted to be used as a first step to cease terminological inconsistency. This in turn helps in achieving the ultimate goal of officially recognizing Arabic as the medium of instruction in medical colleges in the pan-Arab area. 1.2 Statement of the Problem Fishback has argued that translating medicine is regarded as “the most universal and oldest field of scientific translation because of the homogenous ubiquity of the human body” (as cited in Pilegaard, 1997: 160). Medical translation as a branch of technical translation needs to enjoy a high degree of consistency in transferring the source text to the target 5 language. For various reasons, medical Arabic nowadays suffers from terminological inconsistency, the matter that frustrates attempts aimed at making Arabic language the official medium of instruction in medical colleges throughout the Arab world. Having different types of equivalence and different medical Arabic terms for the same foreign English medical term might seem inevitable due to different factors. For example, having different source languages (English and French) from which medical Arabic seeks the largest portion of its corpora, different bodies of translation that work individually, and multiple codified lexical resources are considered among major causes of multiplicity of terms that is reflected in terminological inconsistency. However, terminological inconsistency results mainly from the absence of clear-cut criteria upon which translators should make their choices when conducting translation in genuine contexts of use as in medical books and DPIs as opposed to the abstract context-free realm of dictionaries. Thus, important criteria of circulation and usability of terms are not considered in medical translation into Arabic to a large extent. Also, the communicative function of medical translation has been consequently neglected, and this is further evidenced in the fact that the type of the target audience and its level of professionalism and education usually go unheeded in the translation process. 6 1.3 Purpose of the study The present study is expected to answer the following questions as the main goals of this thesis. 1. What is the structure of Arabic medical books and DPIs from a translational point of view? 2. What are the translation procedures that are followed in translating medical books and DPIs into Arabic? 3. What type of translational equivalence is mostly used in specialized and non-specialized medical contexts? 4. To what extent can usability and circulation of a translational equivalence in relation to the context of use and the type of the target audience help in solving the problem of terminological inconsistency? 5. What are the doctors’ attitudes and views on the medical translation into Arabic in general? 6. To what extent can Arabic medical dictionaries, particularly UMD, serve to build a sufficient corpus of Medical Arabic? 1.4 Significance of the Study The significance of this study can be described in a two-folded sense. To the best of the researcher’s knowledge, there is a paucity of research on translation of medical terms from English into Arabic, and the literature on medical translation into Arabic in general is meager indeed. The 7 significance of the present study evolves first from its attempt to identify the most recognized type of translational equivalence in medical Arabic in both specialized and non- specialized contexts as a first step toward achieving terminological consistency. Vasconcellos (as cited in Roger, 2008: 104) has pointed out that good technical writing is manifested in high degrees of consistency in the selection of terms. This feature usually contributes to the superiority of machine translation over human translation. The second point of significance of this study lies in the fact that though this study adopts a descriptive methodology, it follows a problem-solving approach in addressing medical translation into Arabic. In fact, the meager studies that have addressed medical translation into Arabic have been by and large dedicated to describing the obstacles facing translators and the weaknesses in the process of medical translation into Arabic in general, offering theoretical solutions or alternatively offering practical solutions selectively rather than quantitatively. This study, however, is based on a quantitative sample and provides tangible solutions and practical suggestions for translators to mind during the translation process. (Newmark 1979: 1407) has argued that “the heart of medical translation problem, as far as terminology alone is concerned”, is “ the search for contemporary forward-looking usage”. He has also stressed the point that for the entire highly specialized language area of medical terminology, the translator should seek the recognized equivalent. 8 In an attempt to obtain a preliminary insight into the topic of this study, a pilot study was conducted in which 75 medical terms which are translated inconsistently in medical books, DPIs, or in both, were selected. The terms were then distributed to 20 doctors that were chosen randomly to get their feedback on whether the selected terms are all used in practical medicine and are familiar to doctors rather than being mere bookish terms. Doctors were asked to choose the type of equivalence they would use in specialized contexts when they communicate with other doctors and medical students and the type of equivalence they would use in the non- specialized context of doctor-patient interaction. The results entailed excluding five terms on the basis of extremely infrequent occurrences in everyday medicine. The results also indicated a systematic pattern of using transliteration and descriptive translation over arabization. Based on the findings of the pilot study, the researcher’s observations indicate that terminological inconsistency in its large part can be solved if significant factors of circulation, context of use, and the type of the target audience are taken into account during the translation process. Moreover, doctors explained that Arabic language is not used on a regular basis among medical staff while it is heavily used with patients. Also, responding doctors reported zero usability for some translations, while other translations were approved almost unanimously. In an attempt to solve the terminological inconsistency that has exhausted medical Arabic, inconsistent translation of medical terms need to be studied to 9 come up with reasonably well defined criteria of choosing one translation over another. 1.5 Limitations of the Study The findings and conclusions of this study should be limited to the scope of the present study to a number of limitations. 1. Although the medical terms investigated in this study are collected from anatomical and pharmacological books, the selection process has been relatively random from a medical point of view. In other words, the selected terms cannot be fully categorized under anatomy, pharmacology, pathology, or any other medical area. Rather, terms have been selected and categorized under different types of equivalence from a translational point of view. Thus, generalizations cannot be made in accordance with medical considerations. 2. The number of responding doctors who have received their medical education or training in Arabic has been low as only few Palestinians could easily pursue their medical education in countries where Arabic serves as the means of medical education such as Syria. 3. Although the number 100 is deemed statistically adequate to present systematic patterns of terminological use, a larger number would have yielded more valuable insights into the study. 4. The sample of the study is general and random. In other words, variables of respondents’ specialty, gender, years of experience, or exact place of 10 work were not considered in the scope of the present study since previous studies have shown that such variables did not show any significant relationships with doctors’ attitudes toward medical translation into Arabic in general. 5. The study focuses on Ramallah and Nablus districts only. 6. The study focuses on terms only; structure and stylistics are not considered. 1.6 Review of Related Literature The literature on medicine in general is abundant. There is hardly any culture without medical literature. Medical translation is one of the most active types of professional translation (Montalt, 2011). This can be a prior to the universality of the subject and the necessity of passing knowledge from one nation to another. However, medical translation has not received the due attention in the scope of translation studies, and it is only recently that serious attempts to contribute some valuable insights into medical translation have taken place (82-83). Similarly, the literature on medical translation into Arabic is yet to be fully built, and it has been an issue of debate by many researchers, too. As medical Arabic is not used on a large scale, it continues to interest those who are solely concerned with Arabic language for the sake of the language in the absence of its circulation in the Arab community. However, there are a number of leading studies upon which the present study can build its basis. For instance, Sieny (1985) discussed the process of terminology production, co-ordination and 11 dissemination and outlined the problems facing the process of arabizing scientific terminology in general. He explained that there are many official and unofficial agencies involved in producing Arabic scientific terminology, the matter that leads to the common problem of multiplicity of terms. The author further explained that attempts were made to face this phenomenon through the establishment of agencies of standardization and coordination. He concluded that in practice though, lack of coordination and unification still seems to make the prominent feature of such attempts.(155-159) Halloush (2000) outlined the extent to which arabized medical terms in the field of general surgery were acceptable and used as a means of medical communication among doctors in Jordan. The author elaborated on term planning through which terms are created for any language. She stated that there was a poor acceptability of arabized terms among Arab doctors regardless of their degree of specialty, gender, and center of work. She concluded by recommending a revision of the arabization process and, if necessary, replacing it by a more efficient one. Also, she emphasized the necessity of standardization as a prerequisite of acceptability of arabized terms.(p.54). Another pioneer study was conducted by Nassar (2002) in which the author investigated the problem of lexical and non-lexical meaning loss in medical translation between English and Arabic. He explained through individual illustrative examples collected from drug leaflets and one 12 medical journal that the loss in lexical meaning results from problems of mislexicalization, lack of standardization, and even lexical over standardization. Non-lexical loss in meaning, on the other hand, emanated from grammatical loss in meaning represented in the random placement of syntactic entities in sentences and structural ambiguity and from textual loss resulted, for example, from differences in punctuation and paragraphing. The author concluded that meaning loss is either intrinsic, i.e. related to inherent mismatches between English and Arabic as two different languages, or extrinsic, i.e. related to factors of domination of English over Arabic in educational institutions which would debar the latter from development, familiarity and circulation. The author recommended the establishment of a highly specialized committee versed in medicine and language to follow on new medical terms. He also recommended that Arab medical specialists have easy access to medical Arabic to ensure circulation for translated medical materials, and that Arabs should conduct more contrastive research studies about the experience of other languages of the Far East that have succeeded in expressing sciences in native languages to benefit from them.(91-93). Romani (n.d.) scrutinized the contemporary status of medical Arabic through a comprehensive review of the stages of medical Arabic starting from classical scientific medicine to contemporary western-style medicine. He explained that there is a need to build a representative corpus of Arabic medical texts. The author commented that although Arabic medical 13 dictionaries exist indeed, such dictionaries do not contribute a large benefit to the contemporary medicine as they do not agree in their lexical choices and are normalized by the guidelines of the academies rather than by actual use (p.95) . He concluded by highlighting the necessity of including in the representative medical Arabic corpora contemporary medical texts such as patient information leaflets, excerpts from medical textbooks used in Arab countries such as Syria and also websites of hospitals and medical centers in Arabic countries, where it is possible to find terms that are linguistically closer to everyday practice.(p.103). An equally significant study touching upon problems of inconsistency in Arabic technical terminology was also conducted by Seiny (1987). The author attributed the confusion in Arabic technical terminology to both linguistic and administrative factors. The linguistic factors include: the rich nature of Arabic language which would result in a large number of synonyms for the same concept; the different procedures in coining Arabic technical terms such as finding a term from Arabic scientific heritage, or translating foreign terms using different translation procedures; and the existence of two source languages, English and French. The administrative factors include the absence of an official terminological body and the slow progress of official agencies in producing Arabic term for thousands of new concepts(169-171). Listing the terminology agencies that are at work, he concluded that the efforts of such agencies can be 14 culminated by success only if high levels of cooperation, coordination, and systematic dissemination are achieved. By the same token, problems of terminological inconsistency have been reported to exhaust other nations in their attempts to accommodate the increasingly rapid English sciences into native languages. Quah (1999) studied the standardization and modernization of Malay language in spelling patterns and scientific terminology focusing the attention on the English affixes. He explained that the means to achieve standardization involved accepting international terms of Greco- Latin origins to make it easier for readers to read foreign languages, and that the use of such Greco- Latin terms would mean the universality in these terms with other languages. Modernization of the language on the other hand, meant adopting a variety of translation methods such as using existing words, borrowing form English and foreign languages, translating concepts with Malay words that carry the same idea, coining terms and reviving archaic words to serve as equivalents for foreign terms(606-607). However, he clarified that standardization of scientific terminology still makes the most difficult problem, and that without linguistic procedures, many standardized terms are not possibly achieved. He concluded that what causes rigidity in language growth is the infrequent updates of terminology lists and guidelines. In 1997, Haddad studied translation of medical terms into Arabic and examined the low acceptability of arabized terms among medical students 15 in Jordan. The writer further explained that most of the translated medical terms are odd and unfamiliar as translators depend on Arabic dictionaries which also include many alternatives for a single term while transliterated terms seem more adequate. However, she concluded that due to the unfamiliarity of translated terms and the unnatural use of transliteration, descriptive translation should be put in use. The author also recommended standardizing medical terms as a necessary procedure in medical books(50- 52). A more related study that addressed the reasons of inconsistency of terms in Arabic technical translation was conducted by Al-Quran (2011). The author explored constraints on technical Arabic that have led to introducing different types of equivalence ranging from single-word arabizations- whether through free standing words or composites (naht), to paraphrases, and loans. The fact that most of the arabized terms were unfamiliar led to the alternative use of paraphrases. Yet, issues of lack of economy and precision disapproved the usability of paraphrases in favor of loan words and transliterations which were in turn rejected by Arab purists on the grounds that they were of non-Arabic origins. He concluded that “ What is needed, instead, is a joint effort by the linguists to coordinate their efforts across the Arab world to reduce the extent of confusion and chaos in the use of the Arabic terms used as equivalent for their foreign counterparts” (p.449). He also added that the profusion of synonyms characterizes the chaotic coining of terms which in turn leads to terminological inconsistencies. He concluded that the individual trends especially in coining foreign technical and scientific terms should cease, as 16 precision in meaning is more valuable than meeting mere linguistic considerations. Reviewing the findings and recommendations of previous studies, the researcher intends to add new insights into an already existing problem of having many equivalents for the same foreign term yet form a completely novel point of view. All of the previous studies have recommended standardization as a step toward the development of the language. Yet, standardization can not be achieved unless the problem of terminological inconsistency is first solved. In other words, the present study investigates the usability of such many equivalences as a criterion for consistency and consequently standardization. It attempts to solve the terminological inconsistency by utilizing the extra linguistic factors of the context of use and the type of the target audience. 1.7 Structure of the Study Chapter two incorporates a detailed review of the different features of the medical language. Lexical and syntactic features of English and Arabic medical languages are explained. Chapter three describes the methodology adopted in the present study. It also lays the theoretical frame of the study by exploring the approaches of medical translation and including basic definitions of key concepts like equivalence, types of equivalence and terminological inconsistency. Chapter four describes medical books and DPIs structure and translation procedures. 17 Chapter five incorporates the findings and results of this study. It scrutinizes the type of equivalence that should be used in specialized vs. non- specialized contexts and assesses the validity of the Unified Medical Dictionary (UMD). Finally, chapter six presents a summary of the results and recommendations. 18 Chapter Two Features of Medical Language 2.1 Introduction Herget and Alegre (2009) have explained that medical language belongs to the languages for special purposes which differ from everyday language in the specificity of their terminology, and the fact that they are usually used in communication between professionals and in specialized contexts. These languages for special purposes are part of the language system and can be classified in different ways. However, since these languages are in constant development and overlap with everyday language to some extent, such classification appears to be difficult. (Haddad 1997: 9-10) has defined medical language more specifically as a subcategory of the language of science which is characterized by the use of the present tenses, abbreviations and compounds. Precision and objectivity are highly valued in the language of science. Another related classification of medical language is made by (Newmark 1988: 151- 153) who has described medical language as a subcategory of technical language. Technical language is in general distinguished from other varieties of language by terminology. Moreover, the style of technical language is usually non- emotive, and free from connotations and sound effects if the text is to be well written. Technical language, especially in the case of English language, is characterized by the use of passives, impersonality, empty verbs, third persons, and nominalizations. In terms of medical vocabulary, 19 Newmark (1988: 153) suggests three levels of technical language as follows: “1. Academic: This includes transferred Latin and Greek words associated with academic papers, e.g. 'phlegmasia alba dolens' 2. Professional: Formal terms that are used by experts, e.g. 'epedemic parotitis', 'tetanus'. 3. Popular: Layman vocabulary, which may include familiar alternative terms, e.g., 'chicken pox'.” Loning proposes a more comprehensive typology which differentiates four main levels according to the degree of specialization among the communicating partners and the aim of the text in medical contexts: 1. Professional - professional (doctor - doctor). At this level the aim is to transfer specialized knowledge in the style of scientific texts as in summary reports. 2. Professional - semi-professional (doctor - medical student/health personnel). At this level the aim is to transfer basic knowledge in an instructional style as in handbooks and course books. 20 3. Professional - non-professional (doctor - patient). At this level the aim is to educate non professionals as in writings on patient education and instruction. 4. Non-professional - non-professional (journalist - reader). At this level the aim is to turn problems public in the style of popular science texts as in articles, and magazines of general interest (as cited in Herget & Alegre, 2009). Loning's typology is more detailed and therefore serves as a basis for classifications included in this thesis since the arching aim of this thesis is to compare the different translation procedures used in translating medical texts in different contexts for different types of audience. Bearing in mind that the present study investigates medical books and DPIs, its main focus will be on the second and third levels of Loning's typology. However, in the case of medical Arabic, and because it is not used frequently among doctors as it will be explained later, Arabic medical books target not only the semi-professional audience of medical students but also the professional doctors who in some cases need to learn about medical Arabic, e.g. when writing Arabic medical reports. This is evidenced in the fact that the prefaces of some of the books investigated for this study indicate the usability of such books to both medical students and doctors equally. Consequently, the differentiation between the two levels of professionalism (professional, semi-professional) is deemed unimportant 21 for the present study, and thus they are merged together to be studied in the sense of professional versus non-professional contexts. The next few sections present an overview of some of the main features of medical English and Arabic at the level of vocabulary and syntax. Medicine, as many other fields, has its own specific language, and the most obvious feature of medical language is medical jargon (Krulj, Prodanovic & Trbojevic, 2011: 170). Hence, this thesis focuses mainly on the translation of medical jargon -in the different contexts of medical books, and drug package inserts- as it makes the most prominent feature that distinguishes medical language not only as being a specialized language as opposed to the general language, but also as being different from other types of specialized categories of the language of science. 2.2 The General Features of English Medical Language It is well known that English is the leading language of medical sciences. To doctors, communication in English has been indispensable throughout the history of medicine (Krulj et al., 2011: 170). Thus, it is hard to fully understand the nature of medical language without having some access to the features of English medical language. Sections 2.2.1, 2.2.3, 2.4.1, and 2.4.2 describe such characteristic features of English medical language and the characteristic features of Arabic medical language to gain some insight into the nature of the two languages concerned in the present inquiry. 22 2.2.1 Lexical Features Medical English distinguishes itself by the massive use of pure medical words (Yan, 201: 235). English medical terminology can be divided into the following subcategories. 1. Greco-Latin terms As long as English medical terminology is concerned, the first thing that comes to mind is the terms of Greco-Latin origins as they comprise the substantial part of the overall lexical body of medical knowledge. Medical English is rich with morphologically complex words which are made up of Latin or Greek roots and affixes. Haddad (1997: 5-6) has classified the medical term groups in relation to Greco-Latin origins as follows: 1.Words using a prefix and a free root: Prefix Root Example Pre mature premature 2.Words using a root and a suffix: Root Suffix Example Bronch -itis Bronchitis 3.Words made up of two roots (compound words): Root Root Example Head ache Headache 4.Words using combining forms: Combining forms are made up of a combining vowel plus the root (Chabner, 2009: 3). For example, the word “Hemat/o/logy” is made up of 23 the root “hema” and the suffix “logy” with a combining vowel “o” that English Language has introduced to mark the different parts of the compound words (2009: 2). 5.Words using bound roots only: Prefix Suffix Example An- - emia Anemia 6.Words using a prefix, a root, and a suffix: Prefix Root Suffix Example Peri- card -it is pericarditis Such words are called neo-classical compounds, and they are present in different areas of medical vocabulary including anatomy, diseases, and procedures (Deleger, Namer & Zweigenbaume, 2009: 48). Latin is the language of choice for anatomical nomenclature, whereas Greek is the language of choice for pathology (Albin, 1999). For example, there are two roots -Latin and Greek- for the word kidney and are used in different senses. The Latin root is REN- which is used with the suffix AL- to make up the anatomical word “pertaining to kidney”. The Greek root is NEPHR- which describes an abnormal condition “Nephritis” or a procedure “Nephrectomy” where an inflammation of the kidney, and a surgical removal of the kidney are denoted respectively (Chabner, 2009: 14). The meaning of a compound is often compositional in the sense that it is a combination –at least partially- of the meaning of its constituent parts. One interesting aspect of English medical Greco-Latin terms is that they 24 are transparent in that a medical student can identify the meaning of a word even though s/he has not encountered it before by simply recognizing the meaning of the roots, suffixes and prefixes of which that word is composed. For example, a long word such as “gastr/o/enter/o/logy” can be understood quite easily as the study of intestines and stomach, when it is divided up to gastr (a root means 'stomach'), enter (a root means 'intestines'), and logy (a suffix means 'study of'). Medical English either purely borrows Greco-Latin terms without any alternations as in phlegmasia alba dolens (a disease related to deep vein thrombosis), fascia (a sheet of connective tissue covering or binding together body structures) or, adapt them hence making them overtime an integral part of English language such as “pericardium” instead of the Greco-Latin "perikardion” which according to Merriam Webster online medical dictionary, refers to “ the conical sac of serous membrane that encloses the heart and the roots of the great blood vessels of vertebrates”. 2. Collocations: "A collocation consists of two or more words used in normal association with one another in a given language together to form one word group- for example "benign" and "malignant" collocate with “tumour” (Newmark, 1979:1406). 3. Abbreviations and Acronyms: Kasprowicz (2010) has defined abbreviations as shortened forms of words or phrases that are spelled variously according to the rules of different languages, e.g. MRI (Magnetic Resonance Image), CPR (Cardiopulmonary resuscitation),…etc. Acronyms on the other hand, are words created from a sequence of one to several 25 capitalized initial letters or syllables. The most vivid example of acronyms is AIDS (Acquired Immune Deficiency Syndrome). Other examples are REM (Rapid Eye Movement), SIDS (Sudden Infant Death Syndrome),..etc. Medical English employs a great deal of abbreviations and acronyms. The popularity of such shortened forms in medical language is due to the historical tradition of the language of medicine, and the economy in space and time they provide (Kasprowicz , 2010). Newmark (1979: 1405) has interestingly argued that one of the distinguishing lexical features of medical language is “the universal craze for creating acronyms (not just to seek fame, but often because the writer is too lazy to repeat a multi noun-compound)”. 4. Eponyms: “A law, theory, theorem, hypothesis, principle, rule, formula, equation, disease, etc. named after a person is called an eponym" (Kalyane & Kadam, 2002: 172). There are numerous eponyms in medical English e.g. Achilles tendon, Crohn disease, Cushing syndrome,..etc. Eponyms are used because they are a simpler way of describing complicated syndromes, procedures or diseases. There are also interesting trends in the spelling of eponyms. The traditional spelling pattern entailed that these terms be formed as possessives, indicating in somehow that the disease or procedure belonged the individual who was first to discover it, e.g. Crohn’s disease. Nonetheless, spelling patterns have changed over the past few decades. There has been a tendency to omit the apostrophe - 26 Crohns disease- and, more recently, to eliminate the possessive altogether – Crohn disease- (Hall, 2006: 1134). 5. Neologisms: Neologisms can be defined as "newly coined lexical units or existing lexical units that acquire a new sense" (Newmark, 1988:140). As a consequence of the rapid development in medical fields and the largely increasing number of pharmacological discoveries, neologisms are constantly created. In medical English, neologisms are present mainly in the names of drugs which are being invented for the treatment of different diseases. Names of organisms, enzymes are just few examples of medical neologisms. 6. Blends: Blends are the new words that are formed from parts of other words. The blending process means joining the first part of a word with the final part of another word to eventually create one word (Farghal, 2000: 45). One example of medical English blends is the word “caplet” which is taken from the two words “capsule” and “tablet” to refer to some kind of bills that is between capsules and tablets. 7. LGP Terms vs. LSP Terms: Within the field of English medicine, two types of language are differentiated by terminologists in relation to terms as LGP- language for general purposes-and LSP- Language for special purposes. LGP terms are everyday words that are accessible to all, and no special medical knowledge is needed to understand them, e.g. chest, kidney failure, stroke,…etc. LSP bound terms, on the other hand, are the technical 27 specialized terms that are not readily accessible to non-professionals. Terms as thorax, renal failure, cerebrovascular accident are the corresponding technical terms for the above mentioned LGP terms respectively (Wiseman, 2000). 2.2.2 Syntactic Features of English Medical Texts At the sentence level, medical English is structurally complex. Medical English shares many features with the language of science in general. These features are as follows: 1. Reduced Relative Clauses: Relative clauses are usually reduced in medical English as in the example below: "This phenomenon can be explained by the description of special pathways in the artial wall, having a structure consisting of a mixture of Purkinje fibers and ordinary cardiac muscle cells" 1 , instead of " which has, that consists of…” 2. Prolonged Strings of Successive Adjectives: One prominent feature of medical English is the use of more than one adjective simultaneously for defining or describing one entity. Examples are: left anterior descending (interventricular) coronary artery, fourth posterior sacral foramen, etc. 2 1 Examples are taken from انجليزي –سنل علم التشريح السريري الصدر والظهر عربي p. 147. 2 Examples are taken from pp.185, 248. 28 3. The Use of the Present Tense: The use of the present tense is an obvious feature of medical English as well as in the language of science (Haddad, 1997:9). Examples are many including: each intercostal nerve enters…, cardiac muscle consists of..,etc. 4. Complex Structure: Medical English employs many structures that, although they might not be so much problematic to English doctors, on some occasions, they form an obstacle to medical practitioners whose first language is not English despite their impressive command of medical English. This observation, made by an Arab doctor, depends for its validity on specific examples as: “…the greater petrosal nerve. This nerve joins the deep petrosal nerve as it passes through the foramen lacerum to form the nerve which passes anteriorly through this canal to the pterygoplalatine fossa 3 ”. It is not structurally clear whether the anaphora “it” refers to “the greater petrosal nerve” or to ”the deep petrosal nerve”. 5. Prepositional Phrases: Prepositions and prepositional phrases play a significant role in the professional medical language in English. The preposition “of” has the highest frequency compared with other prepositions, though this finding cannot be generalized as a universal rule (Krulj et al, 201: 173; 175). 3 Examples are taken from Clinically Oriented Anatomy, Sixth Edition, p.952. 29 6. Progressive Stripping of Compound Nouns: In special-language texts in general such progressive sequences are frequently occurring (Rogers, 1997: 220). Medical English is abundant with the use of multi- noun compounds (Newmark, 1979: 1406). An exemplification is as follows: “Disease Control measure” instead of “measures for the control of diseases 4 ”. Having identified the features of medical English, the researcher shall present the features of medical Arabic. However, since English speaking countries in the modern times are taking the lead in medical sciences, medical Arabic, in an attempt to keep up with the frontier of medical sciences, has been largely casted in translational moulds, as it will be explained later, making the task of identifying its original features not quite easy. Hence, it would be greatly insightful to first shed the light on the stages medical Arabic has gone through, that have led ultimately to the establishment of the Arab academies. 2.3 The History of Medical Arabic Arabic medicine and pharmacology reached their peak during the Islamic era, more specifically during the Umayyad and Abbasside periods, when movements of translation into Arabic flourished, followed by a period of Arabic contributions. The history of Arabic medicine extended 4 Examples are due to Haddad, 1997, p. 10. 30 from the eighth century when Arab intellectualists started to appear and multiple sciences began to emerge eastward. This beacon of sciences remained there until the beginning of the thirteenth century (Najjar, 2012: 587). While the Middle Ages were an era of darkness for Europe, for Arabs, they were an era enlightened by a renaissance of scientific study which preserved for the world much of the medical knowledge of the Greeks and ancient Semites and added on it by contributing with much of what had been unknown in medical science (Wakim, 1944: 96). The history of Arabic medicine can be divided into three main stages; the age of translation, the age of Arabic original contribution, and the age of decline and transmission to Europe (Sa’di, 1958: 208-218). The next few pages present an outline for the three stages. It also sheds the light on the aftermath establishment of Arab academies and their role in developing medical Arabic. 1. The Age of Translation (A.D. 750-850) Medical Arabic flourished by means of translating Greek and Latin medicine. Haddad (1997, 29:30) has explained that such translation movements began in the Islamic era during the Umayyad period. Translation was further developed during the Abbasside era as Abbasside Caliphs had great interest in science and knowledge. They encouraged doctors and scientists in general and offered them incentives in return of their efforts in translating Greek sciences. For example, Caliph al Mamoun 31 used to pay translators of Greek and Hippocratic works the weight of their translations in gold (Najjar, 2010: 588). The most prominent translator who had translated the whole Galenic corpus was Hunain bin Ishak (Romani, n.d.: 100). His widespread popularity stems from the fact that, until Hunain’s time, Arabic scientific knowledge was meager in content and lacked terminology which makes the most essential characteristic feature of scientific knowledge and communication. Hunain was in a position to develop Arabic terminology for practically every branch of knowledge (Sa’di, 1958:208). As for Arabic pharmacology in particular, Pormann PE (2011) has pointed out that the evolution of pharmacological writing in Arabic started in late eighth century in which technical terms were developed by means of transliterations until mid-ninth century in which many standard Arabic translations for Greek words were established. It is worth noting here that medical Arabic at that time and along the middle ages, followed two methods in its translations. Haddad (1997: 32- 33) has explained that the first one was Yunnan bin Batriq's method in which he looked at every Greek word and tried to find a corresponding Arabic word, then he would continue translating in a linear fashion until he finished what he was arabizing. This method was deemed ineffective somehow as there is no one to one correspondence between Greek and Arabic as well as due to the fact that the two languages have quite different structures. 32 The second method of translation was that of Hunain bin Ishak in which he translated sentence by sentence rather than word by word. He translated sentences into corresponding sentences in terms of meaning regardless of whether or not they were equal at the word level. This translation method was deemed better as it evaded the shortcomings of the previous method of translation. Thus, Arabic scholars preserved the scientific heritage of other nations through their translations, and this fact highlights the importance of translation in building civilizations and in bridging civilizational gaps. Following this stage comes a more fundamental stage characterized by the commence of originally Arabic medical writings alongside continuing the translation from classical languages into Arabic. 2. The Age of Arabic Contribution (900-1100 A.D.) Following the age of translation, the Arabs began to build on and develop classic sciences, and they relied upon their own resources and scientific discoveries. This stage of Arabic-Islamic medicine was characterized by the production of what are defined as medical encyclopedias due to their comprehensive content. The most eminent medical figures were Al-Razi, Ibn Sina, and Ibn Al-Haitham (1958, p.208). Together with Al-Magusi, they were considered "the most important protagonists in the process of 'vivification of medical sciences'" (Romani, n.d: 101). Najjar (2010: 587) has also described this idea by quoting Osler 33 as :“The Arab scholars had used the Greek candles for their lamps, but they rapidly became a huge Flambeaus that gives its light to all world”. Some of the Western scholars see the contributions of the doctors of the Arabic and Islamic world as simple keepers of Greek science to the scholars of the Renaissance. However, this is a pejorative point of view that conceals the tremendous contribution of Arab doctors to medical sciences. As Najjar (2010:289) has argued, it was Ibn al-Nafis who first described the pulmonary circulation. This discovery refuted the thousand-year old theory of Galen that had suggested invisible pores in the intraventricular septum. The Arab achievements in this stage have largely laid the basis for Western medicine to flourish afterwards. 3.The Age of Decline and Transmission to Europe (1100-1400 A.D.) The study of science started to die up in the East in the beginning of the twelfth century, hence marking the end of the Eastern intellectual era and at the same time drawing the beginning line of scientific growth in the West. By the end of the thirteenth century, sciences had transmitted to Europe. As the Arab civilization had expanded and reached Spain, western students came in contact with the Arabic scientific heritage. For example, a man named Gerard of Crimona, learned Arabic and translated 92 books into Latin (Haddad, 1997: 31). Similar efforts granted the rest of Europe a wide access to the Arab rich civilization, ultimately paving the way toward further studies and discoveries which characterized the Renaissance era in 34 the Western world. This at the same time resulted in a period of scientific recession in the Arab world, where medical Arabic has occupied a back seat compared with the Western medical languages. Nonetheless, in the nineteenth century, movements to revitalize scientific terminology started throughout the Arab world not through original Arabic contributions to medical sciences, but by means of translation once again. Translation of medicine started over in Muhammad Ali’s reign (Al-Zarkan, 1998). Schools of translation then started to appear in Syria, Iraq and other spots of the Arab world. The translations were merely from French into Arabic. However, when the American University of Beirut was set up, sciences from English started to slash their way into the Arab world through translation (Haddad, 1997: 32). Since that time, Arabic language that was once a means of civilizations bridging and a source language from which other languages sought credible mounts of translation, has now become a target language that struggles to keep up with everyday updating foreign sciences. One step toward achieving approximation to the western advanced medical sciences is the establishment of institutions accountable for translating western medical publications and, in many cases, creating new Arabic medical terms to correspond to the constantly emerging English medical terms. These institutions are represented by the Arab academies which began to emerge after the first world war (Al-Zarkan, 1998). 35 2.3.1 The Arab Academies and Institutions of Standardization 1. The Arab Academies According to a July 24, 1995 article in the US News and World Report, almost 25.000 new English words are coined every year, of which only 4% make it into the dictionaries (Segura, 1999). Consequently, Arabic for science in general is today somewhat behind the times with respect to the plethora of English terminology being created every day. The Arab academies were institutions established to serve Arabic Language, preserve it, and make it adequate for accommodating all the requirements of science and arts to fit more the needs of contemporary life. Al-Zarkan (1998) has thoroughly studied the Arab academies and their efforts in this field, and to him, the present review is accredited. There are four Arab academies that have been mainly at work in Syria, Iraq, Jordan, and Egypt. The first Arab Academy was established in Syria in 1919, followed by the Arab Academy in Egypt in 1932, the Iraqi Scientific Academy in 1947, and finally the Arab Academy in Jordan which was founded in 1976. At the beginning, especially in the Syrian and Egyptian Academies, no due heed was paid to technical terms in spite of their importance and necessity in the world of rapid discoveries and invention. This in fact hindered medical Arabic to some extent. However, these Academies eventually took the initiative in introducing thousands of Arabic technical terms, and they opened the door toward further advances in this field. The 36 methodologies all the Arab Academies have followed in translating medical terms in particular have been similar to a large extent. The Arab Academy in Damascus, despite its small contributions, derives its importance from being the first step toward reviving Arabic technical terminology. But the Academy does not have any specific procedures in arabizing terminology, according to its previous president Dr. Husni Sabah, a professor of Medicine (Sieny, 1985: 155). Hence, the work of this Academy was based on the efforts of its individual members (Al-Zarkan, 1998). As a result of such individual works, medical Arabic terms suffered from multiplicity, thus creating a substantial degree of confusion among translators. However, since the Arab Academy in Cairo has contributed the most to the process of translating and coining of Arabic technical terms, the researcher finds it suffice to present its methodology to stand for all other Arab academies in their efforts to develop medical Arabic. 1.2 The Methodology of the Arab Academy in Egypt This Arab Academy has followed the traditional methods of coining terms through transliteration, blending, derivation, and arabization. Its methodology can be summarized as follows: In case there are Arabic equivalences for the scientific foreign terms, the Arab Academy pursues the following steps: 1. Reviving equivalent terms from ancient Arabic books. 37 2. Creating Arabic dictionaries in which these old Arabic terms are included. 3. Preferring old terms over new ones unless the new ones are common. 4. Avoiding multiplicity in reference in that each term refers to one meaning only. Moreover, in case the terms are new and have no equivalence in old Arabic books, “ the Cairo Academy has very sophisticated procedures in processing new terms beginning from subject specialties through to the annual ‘General Conference’, when the new terms are given the blessings of the Academy” (Sieny, 1985: 156). Al-Zarkan (1998) specifies these procedures as follows: 1. Asking the experts to provide thorough explanations of the new terms. 2. The terms are then discussed by committees within the Academy, and the equivalent terms are reviewed by the council of the Academy. 3. If the council approves the terms, they are spread in the scientific fields by sending lists of the latest coined terms to educational institutions . In an attempt to stay updated with the latest sciences and scientific terms, the Arab Academy asks educational institutions to send to it lists of the newly used terms and their foreign equivalents, and discusses the possibility of including them in Arabic dictionaries. Should the terms be approved, the Arab Academy recommends the use of such terms. Furthermore, the Arab Academy would also include the terms that have 38 been used in other Arab countries. This, once again, has led to lack of standardization of the scientific terms among Arab countries. Like other Arab academies, the Egyptian Arab Academy looks at transliteration as the last resort. In other words, it tends to transliterate terms if and only if finding an equivalence of purely Arabic origins is out of question. Thus, it tends to transliterate, for example, proper names and names of chemical elements like Oxygen, Hydrogen,..etc. However, transliteration is not arbitrary but is rather rule governed as it should follow certain rules in transferring foreign letters into Arabic ones. For example, the pronunciation of such transliterated terms should comply with the Arabic rules. Furthermore, the Academy allows for the use of foreign words as they are when necessity calls for that, though it does not define what that necessity is or to what extent foreign words can be used in Arabic. Moreover, it does not recommend translating a term with a phrase or with more than one synonymous term. It stipulates that the Arabic term be clear and precise in its meaning. Finally, the Egyptian Arab Academy seeks to avoid strange terms, though it does not deny the use of some rare terms that seem quite sound. In conclusion, it can be noticed that the Arab academies, despite their relative differences, have all agreed upon similar methodology in their attempts to deal with the scientific terms. They all called for reviving the 39 old Arabic terms as a first step rather than the tendency to hastily create new ones or even transliterate the foreign terms (Al-Zarkan, 1998). In relation to medical terms in particular, it can be said that both the Egyptian Arab Academy and the medical school at the Syrian University are the most active groups in enriching medical Arabic. 2. Other Institutions Along with the Arab academies, there are also other institutions that are concerned with translating and arabizing scientific terminology. Sieny (1985:156) has listed them: 1. ALECSO’s Bureau of the Coordination of arabization in the Arab world. The Bureau is largely involved in the coinage of new terminology in addition to its main role as a coordination agency. 2. The Institute for Studies and Research for arabization. 3. The Kuwait Research Institute. 4. The Arab Development Institute in Tripoli and Beirut. Thus, many bodies have been concerned with the production of Arabic technical terms in general and medical terms in particular. Consequently, the need for establishing medical dictionaries to include the thousands of the arabized, newly coined, or transliterated terms to serve as translational equivalents to the increasing numbers of foreign medical terms is extremely urgent. The next section presents the most common resources for medical Arabic. 40 2.3.2 Resources for medical Arabic As mentioned earlier, contemporary medical Arabic is heavily dependent on translating English medicine; therefore the need for credible translation references is urgent. According to Romani (n.d.: 95), there are two standard dictionaries and two internet-based resources that count as main references for Arabic medical terminology. The first dictionary is the Unified Medical Dictionary or UMD. It is issued and sponsored by the Regional Office for the Eastern Mediterranean of the World Health Organization, and it is thus considered of an official status. The second dictionary is the Arabic Dictionary by Yusuf Hitti. Although it is of a lesser official status compared with UMD, it is considered a rich reference for medical practice in the Middle East. Additionally, the two internet-based resources are Arabic Wikipedia and the Arabic medical website, Altibbi.com. The latter is more reliable given the fact that it is a very well managed website, and it includes extended descriptions that make it as a sort of an online Arabic medical encyclopedia. Arabic Wikipedia, on the other hand, includes contributions that are made in an anonymous way without a strong standard of reference. However, Arabic Wikipedia derives its importance from being perhaps the closest reference possible to the current medical and linguistic practice. 41 2.3.3 Criticisms to the Arabization Efforts Despite the immense efforts the Arab academies have paid in the field of medical terminology, they could not manage to unify and spread the approved medical terms throughout the Arab world (Al-Zarkan, 1998). Arabic medical terms suffer heavily from multiplicity in reference. Additionally, some of these different translations of the same English medical term are contradictory in meaning. This idea is best illustrated by the example below. Table (1) An example of medical terminological overlapping The English medical term UMD translation Hitti’s translation Epiphysis (p. epiphyses) المشاش: ج"المشاشة" مشاشة, كردوس Diaphysis ساق أو عمد العظم,مشاش جدل As it can be seen from the example above, there is some overlap between the translation of the two most credible Arabic dictionaries, the UMD and Hitti. The word “ المشاش “ is used by the UMD to refer to the plural form of epiphysis– where “ج” stands for “جمع”- and at the same time, it is used by Hitti to refer to a different part of the bone i.e. the diaphysis. “Epiphysis” refers to “ the end of a long bone” while “ Diaphysis” refers to “the shaft of a long bone”. Moreover, Arabic medical dictionaries include words that are odd and unfamiliar (Haddad, 1997: 7). Another weak point is the inconsistency 42 of the lexical choices they make. This idea is expressed by Romani (n.d.: 95) as follows: “one could think that contemporary technical medical lexicon is already covered by dictionaries and other reference works: in fact it is not so. Although contemporary medical dictionaries do indeed exist, they tend – as in other sectors of contemporary Arabian lexicography – to normalize terminology according to [the] guidelines of language academies rather than on common medical terminological praxis. Moreover, as it is customary in Arabic lexicography, medical dictionaries often do not agree in their lexical choices.” Consequently, translators tend to make different lexical choices and use different equivalences for a single foreign medical term leading ultimately to terminological inconsistency. By the same token, Haddad (1997: 36) argues that medical terms are usually translated by resorting to medical dictionaries to find equivalent terms. Having found such terms, Arab linguists approve them as a formal translation without due consideration to clarity, familiarity, and precision. Yet another weak point attached to Arabic medical dictionaries – most probably Hitti rather than UMD- is the fact that different terms with different conceptual references may be translated by one term only leading to what is called lexical overstandarization which refers to the total or 43 partial equation of two or more different SL terms with one TL correspondent (Nassar, 2002: 50). For example the term “aponeurosis” is defined by Merriam Webster Online medical Dictionary as “any of the broad flat sheets of dense fibrous collagenous connective tissues that cover, invest, and form the terminations and attachments of various muscles” and the term “peritoneum” refers to “the smooth transparent serous membrane that lines the cavity of the abdomen of a mammal, is folded inward over the abdominal and pelvic viscera, and consists of an outer layer closely adherent to the walls of the abdomen and an inner layer that folds to invest the viscera”. However, they are translated respectively by Hitti’s dictionary (1982) as “الصفاق”, and “الصفاق,البريتون”. Thus, the word “الصفاق” is used to refer to both aponeurosis and peritoneum. Furthermore, looking through any medical dictionary, one can find that at least two different meanings are provided for the same word. The English term is translated differently in different English- Arabic dictionaries; thus the translator feels confused about which term to use. Moreover, the lack of standardization among Arabic medical dictionaries leads medical books translators to use different terms for the same concept which confuses students of medicine and affects their readiness toward studying medicine in Arabic. For example, the medical term “groin” is translated by the UMD as “أربية” and as both “ ,أربية by Hitti’s dictionary. The term was translated in the book of ”المغبن as “المغبن” (p.142) while the same term is translated as "أربية" in the book of :التشريح ووظائف األعضاء .(p.447) مقرر التعليم الذاتي 44 Thus, different Arabic words for the same English term are used in the translation of two medical books which aim to serve the needs of medical students whose first language is Arabic. Moreover, Al-Zarkan (1998) has pointed out that weak coordination between the Arab academies has resulted in such multiplicity of terms. Furthermore, the fact that Arab academies are colored with local characteristics make their terminology not valid to be equally used in different parts of the Arab world. As a final note, it can be noticed that having different kinds of resources for medical Arabic and having different bodies of translation and standardization with low coordination among each other have caused medical Arabic to suffer from multiplicity in reference, overstandarization, and a lack of standardization. All of this, together with the superficial interest in issues of circulation and usability of translational equivalences have all resulted in terminological inconsistency. 2.4 The General Features of Arabic Medical Language It can be said so far that the largest portion of the currently available Arabic medical corpora is of the contemporary western-style medicine as Romani (n.d.) would call it. Arabic medical texts are similar in many aspects to their English counterparts. Nonetheless, because of the different linguistic structures of the two languages, the two registers differ considerably. It is indeed a must to say that this thesis could not find 45 adequate resources that would provide a frame for what could characterize medical Arabic . However, based on multiple readings of both originally Arabic medical writings and medical works translated into Arabic, the researcher lists the following lexical and syntactic features that can be said to characterize modern medical Arabic. 2.4.1 Lexical Features Arabic medical texts generally have the following lexical features: 1. Blends: The process of blending is common in Arabic language in general and is known as “naht”. Medical Arabic, like medical English, makes use of blends as in: "الغدد الفوكلوية ” for “الغدد الفوق كلوية”, and الشريان تحترقوي" ” for “ الشريان is used as a translation of the English ”حبسولة“ Also, the blend .”تحت الترقوي blend “Caplet”. It is taken from the two words “حبة” and “كبسولة”. Nonetheless, there is a tendency toward discouraging the use of blends in Arabic medical writings as stated by the UMD, edition four. 2. Neologisms: Due to the immense number of emerging brand drugs, chemical elements and acids, and active ingredients, the use of neologisms has shown to be an inherent characteristic of medical Arabic. Examples are باراسيتامول,ألوباربيتون ,سبازمين for Paracetamol, Allobabitone, and Spasmin (brand drugs), respectively. 46 3. Eponyms: it is very common to find eponyms throughout Arabic medical writings. Examples, among many, are كسر , كسر غاليازي, كسر مونتيغيا كسر سميث, نتكسر بي, كوليس 5 for Monteggia’s fracture, Galezzi’s fracture, Colles’ fracture, Bennett’s fracture, and Smith’s fracture respectively. 2.4.2 Syntactic Features The syntactic features of Arabic medical language are the following: 1. Present Tense: Medical Arabic shares with medical English the use of the present tense as in: This flat fibrocartilaginous disc lies within… يتوضع هذا القرص الغضروفي المسطح 6 2. Prolonged Strings of Successive Adjectives: Medical Arabic is crammed with successive adjectives. This phenomenon stems from two facts. First, in corresponding to the very use of prolonged strings of successive adjectives in medical English, medical Arabic tends to employ the same strategy. Secondly, the use of successive adjectives in medical Arabic is closely related to the heavy dependence of medical English on compound words which are made up of combining different forms and affixes. Due to the absence of such word formation techniques in Arabic language in general, medical Arabic compensates for this absence by the 5 Examples are taken from انجليزي–سنل علم التشريح السريري الطرف العلوي والسفلي عربي , pp. 161-162. 6 Examples are taken from انجليزي–سنل علم التشريح السريري الطرف العلوي والسفلي عربي , p. 45. 47 use of successive adjectives when translating the so many medical English terms that are of Greco-Latin origins. Thus, it is safe to say that this feature is even more commonly used in medical Arabic than in medical English. An example on the first case is: fourth posterior sacral foramen الثقبة العجزية الخلفية الرابعة 7 Examples on the second case are: Inferior tibiofibular joint المفصل الظنبوبي الشظوي السفلي 8 Sternocleidomastoid muscle 9 العضلة القصية الترقوية الخشائية 3. Prepositional Phrases: Medical Arabic prefers the use of prepositional phrases over compound structure as stated in the UMD, fourth edition. For example, الطبقة الحبيبة للبشرة is preferred over “ طبقة البشرة الحبيبة ”, and “ الرأس “ is preferred over ”األمامي للعضلة ذات الرأسين رأسين األماميرأس العضلة ذات ال ”. Prepositional phrases are also used as an equivalent to English adverbials of place as in: Medially إلى األنسي Laterally: إلى الوحشي Posteriorly: إلى الخلف anteriorly: إلى األمام 7 Examples are taken from انجليزي–سنل علم التشريح السريري الصدر والظهر عربي p.248. 8 Examples are taken from انجليزي–سنل علم التشريح السريري الصدر والظهر عربي p.66. 9 Examples are taken from انجليزي–سنل علم التشريح السريري الطرف العلوي والسفلي عربي , p. 173. 48 4. Negative Particle Definition: Another technique that medical Arabic commenced to use in an attempt to grasp the meaning of certain prefixes is defining the negative particle “ ال”. For example: “ 10 البنى الالإرادية مثل ,”الشبكة الهيولية الباطنة الالحبيبية بالقل 11 " ”,” أما فعاليات الجزء الالودي ”. The use of “ال” with singular nouns has become customary in medical Arabic as stated in the UMD. 10 Examples are taken from األساسيات في تشريح اإلنسان, p.24 11 Examples are taken from انجليزي –سنل علم التشريح السريري الصدر والظهر عربي , p.41. 49 Chapter Three Methodology and Theoretical Frame This chapter presents a full description of the study methodology. It also lays the theoretical frame upon which the present study is based as it introduces the approaches to medical translation and defines the notion of equivalence in the sense used in this study. Moreover, a description of the most common three types of translational equivalence in Arabic medical texts along with a definition of terminological inconsistency are also presented. 3.1 Description of Methodology The first part of this chapter highlights the methods and procedures used to collect the amount and type of data deemed necessary to conduct a reliable study and come up with representative results. It defines the sources of data, and the districts covered in this study, and provides the significant details about the study respondents. The instrument of data collection is shortly described, too. 3.1.1 Districts and respondents As this study is concerned with the translation of medical terms into Arabic for the purpose of finding out the most successful and circulated Arabic medical equivalence among doctors on one hand, and between doctors and their patients on the other hand, Arab doctors working at 50 governmental or private hospitals or in private clinics are targeted in this study. The study covers both Nablus and Ramallah districts to provide a quantitatively comprehensive sample. 3.1.2 The sample The present study is based on a sample consisting of a total of 100 Arab doctors. The sample size is deemed adequate to present systematic patterns of terminological use, and it is also convenient for calculations. Furthermore, in order to investigate whether or not the relevant variable of the language in which the respondents have received their medical education could affect the results of this study, the study participants were asked to provide the information shown in table (2) Table (2) Descriptive analysis of the sample Variable Number Percentage 1. District Nablus Ramallah 80 20 80% 20% Total 100 100% 2. The language of medical education English Non-English 63 37 63% 37% Total 100 100% 51 The sample included 80 doctors working in Nablus and 20 in Ramallah districts. The number of responding doctors who have received their medical education in English was 63 while the remaining 37 obtained their medical degrees in other languages including mainly Russian, German, Latin, French, Italian, and Arabic. The sample is representative in that it included doctors who have received their medical education in a variety of the most prominent languages of medicine. The number of doctors who have received their medical education in English is higher given the fact that Palestinian universities use English as the official medium of instruction especially in medical faculties. Also, most of Palestinian students who are granted scholarships to pursue their studies abroad, usually go to European countries, mainly Russia, or to North African countries such as Morocco or Algeria, where French rules as a language of medicine. 3.1.3 The Sources of Data Collection 1. Medical Books, Medical Arabic Dictionaries and Drug Package Inserts (DPIs) In order to measure the terminological inconsistency in medical Arabic, seven medical books were investigated to extract the most problematic and inconsistent term translations. These books are: 1. 2. 3. 52 The above three books are a translation of Snell Clinical Anatomy. مقرر التعليم الذاتي -التشريح ووظائف األعضاء .4 . It is a translation of Anatomy and Physiology : A Self-Instructional Course” by Cambridge Communication Limited. .األساسيات في تشريح اإلنسان .5 .دليل المصطلحات الطبية .6 7. The first six medical books discuss anatomy while the seventh covers pharmacology. The first four anatomical books are translated from English. The remaining two anatomical books are originally written in Arabic. Yet, they are included within the scope of medical translation because, despite being original Arabic writings, they both include English medical terms along with their Arabic translations and list the UMD as a reference. And since this study is concerned with inconsistency at the level of terms only rather than at structural or stylistic levels, these books are deemed essential to provide an entrance for modern Arabic medical terminology and its relation with the source language of medical English. They also stand as important indicators for the degree of circulation of certain translations. The three books of Snell clinical Anatomy, and Lippincott’s pharmacology are translated by Al-Mualaqua (المعلقة) in Damascus, while the book Anatomy and Physiology : A Self-Instructional Course is translated by King Saud University. The two Arabic medical 53 books are written by doctors in Jordan. The two medical dictionaries are Hitti’s and the Unified Medical Dictionary (UMD). Moreover, data were also extracted from 35 DPIs that were collected from local pharmacies and private clinics. The selection of the sources of data was neither fully random, nor purely subjective. The above mentioned books were chosen as they are issued in the different Arab countries of Syria, Jordan, and Kingdom of Saudi Arabia, and they are made available for students in Palestine, and thus cover the efforts of different bodies in the pan-Arab area. Also, this study is concerned with assessing inconsistency in translation not only among medical books on one hand and among DIPs for patients on another, but also between the two different contexts of medical books and DIPs as they target different audience. Thus, anatomical and pharmacological books were investigated, so that the odds for the same medical term to occur in both contexts were relatively high. Furthermore the two medical dictionaries –Hitti’s and the UMD- are the most popular and the most used dictionaries when medical books are being written in or translated into Arabic. This argument is verified in the fact that six out of the seven mentioned books list the UMD as one main reference. The selection of DPIs on the other hand was also semi random. It aimed at detecting the problematic words from a pure translational point of view. The selected DPIs indicated a variety of drugs distributed by the 54 leading Arab pharmaceutical companies in Palestine including Jerusalem Pharmaceuticals Company, Birzeit Pharmaceutical Company, Pharmacare PLC, and Beit-Jala Pharmaceutical Company along with foreign distributing pharmaceutical companies. The largest portion of the selected DPIs are translated by the aforementioned Arab pharmaceutical companies themselves. Also, some DPIs are translated and issued by the Council of Arab Ministers of Health and other foreign pharmaceutical companies. The selection process of DPIs was mainly based on three criteria: 1. All DPIs include Arabic translation along with the English content. 2. They address patients, and thus, they are translated into Arabic. As it shall be indicated later, DPIs addressing doctors and specialized institutions are usually not translated. This claim is true in Palestine at least. 3. They are available in drug stores and private clinics and are usually inserted with drugs yielded to patients in local pharmacies. 2. Interviews with Doctors As this study is aimed at discovering the most acceptable type of equivalence on the basis of use and the contexts of use, short interviews have been conducted with experienced doctors who provided some insightful guidelines about Arabic medical terms, the credible Arabic medical dictionaries, and the general mechanism they adopt in dealing with specialized and non-specialized participants. 55 3. Telephone Interviews Bearing in mind that this study is concerned with translating medical terms for patients in DPIs, the researcher conducted telephone interviews with the aforementioned most prominent pharmaceutical companies in Palestine. The aim was to build a suffice understanding of which translation methods are used in translating DPIs, on what basis the translations are done, who the translators are, what expertise they have in the field, and to what extent the non- specialized patient is given attention throughout the translation process. 4. The Questionnaire In an attempt to reach a reliably representative corpus of data, a comprehensive and well designed questionnaire was created for this study. After conducting a pilot study, a stage in which the questionnaire was updated, revised and finalized upon the consultation of Dr. Anas Nablusi 12 , a seven-page questionnaire was developed. The questionnaire included 70 medical terms found problematic in relation to terminological inconsistency. The questionnaire consisted of four sections. The first section included background information about the respondents, which was deemed to be relevant to the scope of this study. Such information touched upon the respondent’s district of work as well as the language in which the respondent received his/ her medical education. The second section 12 An orthopedist at Rafidia hospital 56 included 60 medical terms along with the different translations into Arabic. It is worth mentioning here that the terms, though randomly chosen, fell more or less under the headings of anatomy and pharmacology given the fact that the books investigated in the present study were of anatomical and pharmacological nature. Each medical term had at least two translations and some terms had three translations. Such translations were documented in accordance with the aforementioned dictionaries for the most part except for a few translations that the researcher could not find in Arabic dictionaries but yet reported occurrence in DIPs. In this section, the respondents were required to choose the Arabic equivalence that they use when they exchange specialized Arabic medical talks with doctors, medical students, and any other figures specialized in the medical field. As mentioned earlier, the three different types of equivalence of arabization, transliteration, and descriptive translation were provided from among which respondents could make their choices. Moreover, the questionnaire included an extra column to give respondents the chance to suggest their own translation of the included medical terms in case none of the present types of equivalence or translations was in common use. The third section is more or less the same as the second one, only that it was aimed at identifying the type of equivalence to be used when doctors are involved in medical interactions with ordinary uninformed patients. It contained 26 terms that were found inconstantly translated in DPIs. Although the total number of terms investigated in this questionnaire 57 seems to be 66 terms, the real number of different terms is 70 as 16 terms were identical in the second and third sections of the questionnaire. The fourth section contained an open question so the respondents could present their attitudes toward the process of translating medical terminology into Arabic in general. 3.1.4 Data Analysis The 100 copies of the developed questionnaire were collected, and data were extracted and classified in relation to terminological inconsistency in the light of the three prominent types of translational equivalence. True percentages representing the rate of use were assigned to the different translations of each medical term on its own. Afterwards, the percentages of use for a specific type of equivalence were added up to figure out the final percentage of use for each type in comparison with one another in both specialized and non-specialized contexts. The next step involved identifying the total percentage of use for each type of equivalence in general, and they were ordered descendingly in the two contexts. This procedure was followed in all the types of terminological inconsistency that included alteration between different types of equivalence. Finally, the percentage of terms whose translations were found to either match or diverge from the lexical entries included in the UMD was also calculated to gain some insight into the usability of the UMD as a body of reference for medical Arabic. 58 3.2 Theoretical Frame 3.2.1 Approaches to Medical Translation Pilegaard (1997) has explained that most of the current international medical literature adopts a sociolinguistic approach to medical language, i.e. describing it in terms of speakers and communicative situations, and that “the communicative purpose of medical language is to provide unambiguous and nonsynonymous language by means of terminologies in order to express relevant concepts, especially in the expert-to-expert tenor” (159-160). Hence, what must be heeded in medical writing necessitates reasonably the same application on the translated copy. Medical translation, being a branch of specialized translation, follows the same patterns as any other type of technical translation. For instance, the translator of medicine should be adequately informed about the subject matter and should keep the maximum degree of accuracy. Also, medical texts are crammed with medical terminology that need to be translated heedfully. Some allegedly argue that translating technical terms can be easily handled by virtually consulting a bilingual or multilingual dictionary. Although accuracy can be maintained, using the right equivalence in the right context cannot always be granted. Newmark (1979: 1406) has pointed out that using such dictionaries can never be enough to reach the sought equivalence as they often contain many synonyms that are out of context. From a translational point of view, equivalence is a very common concept in translation studies. Many researchers have attempted to define equivalence in translation. 59 However, for the purpose of the present inquiry, the present study employs the definition by Catford which presents equivalence as being “the basis on which source language (SL) textual material is replaced by target language (TL) textual material” (as cited in Hatim, 2001:14). As far as the word level is concerned, Hatim (2001: 29) has illustrated that a quantitative approach to the scheme of equivalence relations can be a adopted especially in domains of terminology and technical translation. Hatim presents Kate’s typology of a quantitative approach toward the concept of equivalence relations as follows: “1. One-to-one equivalence, where there is a single expression in the TL for a single SL expression 4 One-to-many equivalence, where more than one TL expression is available for a single SL expression 5 One-to-part-of-one equivalence, when a TL expression that covers part of a concept is designated by a single SL expression. 6 Nil equivalence, when no TL expression exists for an SL expression.” The translation of English medical terms into Arabic is an obvious case of one-to-many equivalence. The fact that all English medical terms investigated in this study have established Arabic equivalences eliminates the case of nil equivalence. However, having three different types of equivalence- arabized, descriptive, transliterated- lies in the fact that translating English technical terms into Arabic in general suffers from the absence of one-to-one equivalence. Roger (2008: 103) has quoted Catford: 60 “In a text of any length, some specific SL [source language] items are almost certain to occur several times. At each occurrence there will be a specific TL [target language] textual equivalent.” Roger has explained that if a term A in the source text is always translated as term A' in the target text, this indicates a one-to-one equivalence of A and A' which can be represented without trouble in a bilingual dictionary. However, a probability of less than one entails variation in the lexical choices made by the translator in the target text for term A, and hence, a lack of consistency. The case of one-to-part-of-one equivalence is manifested in medical translation into Arabic if taken from a medical point of view. For example, the English term “ataxia” is translated consistently as “ترنح”. However, Nassar (2002: 36) denotes that this English term is defined as a “defective muscular coordination manifested when voluntary movements are attempted” while the Arabic term of “ترنح” refers only to lack of balance in walking and excludes other voluntary motions of different organs of the body such as the head, the hand, etc. However, as long as terminological inconsistency is involved, medical Arabic seems to relate to medical English through one-to-many equivalence relations. 61 3. 2.2 Translation Procedures and Types of Equivalence In translating medical English terms into Arabic whether in books or in DPIs, three main translation procedures, that lead to three different types of equivalence, are predominantly used as follows: 1. Arabization: According to Saydai, arabization in the East Arab countries means a lexical expansion that involves the rendering of new terms from existing roots and translation of foreign terms (as cited in Haloush, 2002: 21). For example the medical term “cataract” is arabized as .”الساد“ 2. Borrowing: “ To take a word or expression straight from another language. It can be pure (without any change), e.g., to use the English word lobby in a Spanish text, or it can be naturalized (to fit the spelling rules in the TL)” (Molina, & Albir, 2002: 510). Naturalized borrowing is also called transliteration, and it is this latter naming that shall be used throughout this research. For example “cataract” is transliterated as .”الكاتاراكت“ 3. Description: “To replace a term or expression with a description of its form or/and function” (2002: 510). For example the same medical term of “cataract” is translated descriptively as “إعتام عدسة العين”, or “ماء بيضاء”. It is worth mentioning here that descriptive translation also includes the translation of one-word terms that are made up of prefixes and suffixes- into two-or-more-word Arabic terms. This is especially true in the case of Arabic which lacks the use of prefixes and suffixes in forming equivalents, 62 a technique of word formation that is used heavily in English. For example, the one-word term “pheochromocytoma” which is made up of (pheo=dusky), (chromo=color), (cyt=cell),(oma=tumor) is translated descriptively into Arabic as “ورم القواتم”. Moreover, descriptive translation involves one-word equivalents that are seen to describe the form or the function of the original term. To illustrate, the term “edema” has been arabized as “وذمة” or described as “االستسقاء”. While “وذمة” is used specifically to stand for the term “edema” which means “ an excessive accumulation of serous fluid in connective tissue or in a serous cavity” (Merriam Webster online medical dictionary), the word “ االستسقاء" is used to refer to any excess accumulation of fluid as in “H