What's in a word?
Defining soundness

• Definition 2: Soundness
• Soundness means undamaged
• Entropy strikes again
• Problem-oriented healthcare
• Definition 4: A toast
• Defining patient: one who suffers loss of soundness

health 2: Soundness, especially of body or mind;
freedom from disease or abnormality.

The second definition of health stems from its etymology. Health comes from the Indo-European root [kailo-] meaning whole, intact, uninjured. It is the same root from which we get the words whole,* wholesome, hale, heal, holy, and hallow. Health, therefore, is wholeness or soundness. To be sound, in turn, is to be free from defect, decay or damage, to be free from disease or abnormality, to be free of illness.

There are no fewer than four distinct English words sound with clearly different meanings and most likely different etymologies:

1. channel or strait *,
2. undamaged *,
3. to make a noise *,
4. to plumb the depths *.

Health (soundness) means undamaged

It is the second word, of course, that is of significance here. The ancient origin of this word sound is obscure, but it can be traced to the 12th century Old English word gesund and its West Germanic precursor gasundaz. Modern relatives include German gesund and gesundheit (Dutch gezond and gezondheid), healthy and health. The inherent relationship between soundness and health is also found in Latin (Table 4). Three Latin roots stemming from the prehistoric [sol-] (whole) give rise to Latin words that become the English solid, safe, save, salutary and salubrious. The Greek word holos (from which we get holo- and catholic) is derived from the suffixed form [sol-wo] of same prehistoric root.

Entropy strikes again

Health is thus related to soundness or wholeness, but much of our language about healthcare seems quite the opposite. Many health-related words have a positive, wholesome base with a prefix that negates it (Table 5). disease, for example, has the base of ease (comfort) and the prefix dis- meaning not or apart. Still other words, such as malady and illness, have a root that means bad or evil (Table 6). In either case, these words presuppose a state of soundness that subsequently has been injured, damaged or otherwise corrupted.

Soundness (wholeness) describes a low-entropy state, one of perfect (or near perfect) structural order in which the processes of self-organization and self-maintenance are unimpeded. The words from the previous two tables describe the many ways in which this ordered state (of low entropy) may be disturbed, leading to a state of higher entropy.

Strictly speaking, such happenings are irreversible, and soundness, once lost, cannot be completely recovered. (All the king's horses and all the king's men couldn't put Humpty together again.) On the other hand, it is not perfect soundness that must be restored. An organism, by virtue of being self-organizing and self-maintaining, has the capacity to recover much, if not all, of the low-entropy state through the dissipation of energy from other low-entropy sources. Reverse means to turn again; restore means to build again. For any given injury or disease process, what the organism requires is sufficient support from environment for these self-repair processes to function properly. Once these functions are irreveribly lost, permanent disability or death is inevitable.

Problem-oriented healthcare

This leads to a view of healthcare that is disease-oriented in its narrowest aspects and problem-oriented (or difficulty-oriented) in a more general sense. It is not soundness that requires care, but loss of soundness (potential or actual) that requires care. A difficulty is literally anything that is not easy, but this phrase has two different connotations. The first is existential in nature, as in a difficult situation, and the second is cognitive, a difficult problem. The word problem has the same connotations as well: (1) a difficult situation to be resolved and (2) a difficult puzzle to be solved. The etymology of this word includes the Greek prefix pro-, forward, and the Greek base bállein, to throw (as in the English ballistic). Something thrown forward or thrown out can become an obstacle or difficult situation for the patient, or it can become a difficult puzzle for the provider. Perhaps a health problem is also a situation that the patient 'throws in front of' the provider.

Because health involves a living organism (from Definition 1), there are two aspects to every health problem: structural and functional. Any health problem involves a structural defect which threatens the integrity (or soundness) of the organism. The structural defect may be at the molecular level (an abnormal protein, for example) or at the level of an organ (ruptured spleen or fractured bone). It may involve a single structure or multiple related structures (cells, for example). In order to be a health problem, the structural defect must result in a functional deficit of some kind. The functional deficit may lag behind the structural defect temporally, and either deficiency may be unrecognized or unknown at the time that the other becomes apparent.

This is not to say that a problem-oriented view of healthcare focuses only on actual problems. Such a view allows for taking pains to prevent potential problems from occurring as well. Because loss of soundness is irreversible, and the restoration (rebuilding) of soundness is costly, the prevention of health problems as far as possible is a prudent course. To prevent simply means to anticipate, or literally to come before (from Latin venire, to come, also supervene, advent, event). To treat a health problem takes much more effort as reflected in the etymology of this word. Metaphorically, to treat is to drag from the Latin trahere, to draw; to deal with (also treatise). To manage a problem has much the same connotation, to handle, to take care of from Latin manus, hand (also manual, maintain). To handle a problem is to take it in hand (hand). To come before (prevent) is better. :-)

Definition 4: A toast

health 4: A wish for someone's good health,
often expressed as a toast.

Incidentally, a toast to someone's good health is related to wholeness in an offhand way. The English word salute * is a greeting of welcome, goodwill or respect. Originally, however, the salute was a wish for someone's good health spoken in greeting, from the Latin salus, health, and [sol-], whole.

Defining patient

To this point we have talked about healthcare as caring for the soundness of an organism, but the conventional term for the beneficiary of healthcare is patient, a word derived from the Latin patiens, present participle of pati meaning to endure or to suffer. A patient is literally one who suffers. This definition would seem to imply that a person who is not suffering is not a patient and hence not in need of healthcare, but the notion of enduring broadens the perspective somewhat. The verb to suffer has two connotations as well: to feel pain or distress and to endure injury or pain. The word suffer comes from the Latin sub-, under, and ferre, to carry. Literally, then, to suffer means to labor under any burden or hardship, real or imagined, potential or actual.

As one who endures, a patient could also be defined as one who waits (bringing to mind the disconcerting picture of a crowded waiting room). Waiting for care is a passive role. In fact, passive comes from the same Latin root as patient. Beneficiary is itself a passive notion, the beneficiary of care being a relatively passive role and the provider taking the active role in this relationship. Note again, however, that the patient and the provider are not necessarily different individuals, but merely distinct roles. It is possible and often desirable for the patient to assume to the role of provider, at least in part, by caring for his or her own health to the extent possible. Note that enduring suffering may be expanded to included waiting for potential suffering, and that benefiting from care not only implies waiting for relief from suffering, but possibly hoping to avoid suffering as well.