Debridement: The History & Word Source of a Common Medical Procedure

increase your vocabulary including your knowledge of medical words and why they mean what they mean

 At the Wording Desk

Bill Casselman

Debridement is not ─ as one naïf guessed ─ removing a new wife from a house.

Debridement is one of various medical procedures to remove dead or heavily contaminated tissue inside a still living person, for example, to excise necrotic tissue from a wound. Today, medical students, grand but brief rounds shall consist of the history of two medical terms: decubitus ulcer and debridement.

The term entered medical English in 1842 from French as débridement and was first pronounced after the French fashion (day-breed-uh-meñ), thus making clear the word had nothing to do with brides. But imprecision and unclarity always win; thus some years later, by the time of the word’s advent and acceptance among American doctors, any notion of a “frog” pronunciation was abandoned and the plain, American, corn-flakes pronunciation took over (duh-BRIDE-ment).

In French, its prime meaning (as early as the 13th century) was loosening the reins or the bridal of a horse. Indeed the Proto-Germanic etymon *brigdilaz also gave us English bridle from Old High German brīdil ‘rein.’ Compare cognates like French bretelle ‘strap, suspenders,’ Spanish brida and Italian briglia.

The word is the noun from the verb débrider meaning ‘to remove the bridle from a horse or other beast of burden.’ A special sense developed in French surgery (first printed mention in French in 1721 CE), namely, ‘to remove material preventing healing of the wound, for example, to cut away necrotic tissue (bridles of dead flesh) preventing the outflow of pus, to excise lacerated tissue or adhesions that are blocking the drainage of a wound.’ Débrider can also be used to mean ‘to lance a boil or an abscess.’ Why would one want to cut away necrotic tissue? Because it is a hotbed of nutrients for bacteria to grow in and prevent speedy wound healing.

Five commonly used methods of debriding dead tissue are listed below:

(1) Autolytic (literally ‘self-loosening’) debridement employs wet dressings to promote autolysis with the body's own enzymes and white blood cells. Slow and painless, autolysis works best in patients with strong immune systems.

(2) Living maggots are introduced into the wound to eat the dead tissue and therefore clean the wound of excess bacteria. This method is too vivid for most Western patients but it is still legal. In fact, a new, specially bred variety of flesh-eating maggot has been developed in a laboratory and is touted as a very efficient and cheap means of wound cleansing in localities not near a large hospital.

(3) Enzymatic debridement introduces enzymes to remove necrotic tissue.

(4) Mechanical debridement is the use of debriding dressings, whirlpool, or ultrasound for sloughing off dead tissue in a stable wound.

(5) Surgical debridement is the fastest method, as it allows a surgeon to excise quickly dead tissue.

Decubitus Ulcer
A bedsore. Latin decubitus = Latin prefix de- ‘down’ + cubitus ‘lying in bed.’ Ulcer is also from Latin ulcus ‘a runny sore, an ulcer’ akin to Greek elkos ‘a sore.’

An ulcer is a limited lesion of the skin or mucous membranes that line many organs and body parts, an open sore with dead tissue due to infection, inflammation, or malignancy.

 A decubitus ulcer, sometimes called a pressure ulcer, is a bedsore, an ulceration of tissue lacking blood supply because blood vessels are pressed against bones, common in immobile, elderly, bed-ridden patients. Bedsore sites include elbow, hip, buttocks and shoulder.

A patient or relatives may ask medical personnel to assess the risk of developing bedsores. It is predictable using the Braden Scale for Predicting Pressure Ulcer Risk. The scale consists of six risk factors: cognitive-perceptual, immobility, inactivity, moisture, nutrition and friction/shear.

A Fertile Etymon!
The Latin etymon cub- (participial stem of Latin verb cubare ‘to lie down, to recline’ and its compound verbs ending in –cumbere with a letter /m/ infixed for ease of pronunciation in the compound words) gives rise to dozens of words in modern English, two of which are familiar.
One of the older terms is that Biblical measurement, a cubit, traditionally the length of a man’s arm from elbow to fingertip. Cubitum in Latin means ‘the elbow.’ Why elbow? It’s a skeletal support one uses to lie down cubare and perhaps prop oneself up while lying on one side. Perhaps you are doing your lying down in a cubicle. Latin cubiculum first meant ‘a little bed’ then expanded its sense to signify a cubicle or little bedroom.
Well, those are grand rounds for today. Perhaps it was not so grand? Mayhap petit rounds? Nevertheless, I must now seek an interval of repose in my private cubiculum. The deft wafture of vernal zephyrs across my brow, facilitated by Aïda, my fan maiden, will, I feel certain, restore me to ancestral vigor. At the same time, such breezelets may freshen the stale corridors of stately Casselman Manor.

Bill Casselman
April 10, 2016
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