Cinderella revisited - The BMJ

Cinderella revisited - The BMJ

What’s in a name? Abstract Objective To examine the references to Cinderella in medical literature. Design Analysis of papers published in the past 5...

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What’s in a name?

Abstract Objective To examine the references to Cinderella in medical literature. Design Analysis of papers published in the past 50 years that mention Cinderella. Results The trend for use of Cinderella as a metaphor in medical publications is increasing exponentially. Five separate themes emerged: neglect, identity, transformation, exhaustion, and the mixed metaphor. Conclusions The medical use of the Cinderella fable is growing in popularity

Department of Family Medicine, Dalhousie University, 5909 Veterans’ Memorial Lane, Halifax, Nova Scotia, Canada B3H 2E2 Stewart M Cameron associate professor of family medicine

12 10 8 6 4 2 0

[email protected] Dal.Ca







BMJ 2005;331:1543–4

Average number of Cinderella articles (represented by pumpkins) published each year

Introduction Cinderella has become a tradition in medical literature. The fictional maiden who becomes a princess has been mentioned by authors with increasing frequency over the past 50 years. A paper by Hazleton and Hickey brought attention to this phenomenon in 2004.1 In a small literature review and analysis, they suggested that it constituted a topic worthy of further study and proposed the term “Cinderology” for the discipline. The preliminary review by Hazleton and Hickey was limited to the theme of neglect. A closer look at the medical literature, however, suggests that it is rich with several distinct metaphors drawn from the Cinderella story.

Methods I carried out a PubMed search on 18 July 2005 for all articles that mentioned Cinderella and analysed the titles for metaphorical themes.

Results I found 163 papers dating from 1954 to June 2005. Two articles came from the 1950s, whereas 69 were published in the past five years. Up to June 12 have been published in 2005. If plotted by the average number published per year, papers citing Cinderella seem to be steadily doubling each decade (figure). Of all the papers, 119 mentioned Cinderella in the title. When I analysed these for themes I found five distinct genres. As noted by Hazleton and Hickey, the fairy tale is invoked most commonly to portray the concept of neglect. It can be used to link neglect with programmes (“An optimistic perspective: Medicaid as Cinderella”w1), specialties (“Obstetrics, Cinderella of medicine”w2), disciplines within a specialty (“Monitored anaesthesia care—a Cinderella of anaesthesiology?”w3), diseases (“Fibromyalgia. The Cinderella of rheumatism”w4), bacteria,w5 w6 and enzymes.w7 w8 w9 Even the humble discharge summary has been portrayed in this way.w10 It would be an oversight, however, to assume that neglect is the only aspect of the fable that is used in modern medical writing. The theme of identity also pervades the Cinderella story. Examples include the titles “More Cinderella than ugly sister”w11 and “Peritoneal dialysis: Cinderella or princess?”w12 Making a positive identification is also a popular Cinderella theme.w13 w14 BMJ VOLUME 331

Average No of papers per year

Stewart M Cameron

24-31 DECEMBER 2005

A third subject is that of transformation. This use alludes to Cinderella’s glorification at the end of her tribulations, as in “Renewed hope for patients with advanced renal cell cancer: Cinderella comes of age.”w15 Similar exaltation has been proposed for female sexual functionw16 and dietary fibre.w17 A subset of this theme is opportunity for recognition. Representative titles include several about “going to the ball.”w18 w19 w20 w21 I also detected a fourth stream, although Cinderella was not cited in the title of the article. She has been exploited as the embodiment of exhaustion. The excessive workload that she bore has moved physiologists to cite Cinderella to describe muscle fatigue from overuse.w22 Lamentably, there are numerous papers in which Cinderella is forced to labour in mixed metaphorical company. She has been required to work with the ugly duckling,w23 the white knight,w24 Achilles’ heel,w25 and Queen Bee.w26 Authors have introduced the scullery maid to Shakespeare on at least two occasions: when the platelet was described as both a Cinderella and “a shrew needing taming”w27 and in “Neurotoxicology: from Cinderella to Cordelia’s secret.”w28 Another writer connected her with Arthurian legend in “Dopamine: from Cinderella to Holy Grail.”w29 Apparently unaware of the profusion of enzyme metaphors, Cinderella was invoked for a prostaglandin dehydrogenase and then forced to endure the indignity of an introduction to “Prince Serendip.”w30 The prevalence of this type of Cinderella use required that it be considered as a fifth category.

Discussion Historical perspective The Oxford Companion to Children’s Literature states that the fable of the poor maid who becomes a princess is the most popular fairy tale in modern Western literature.2 It has been the subject of pantomime, opera (La Cenerentola by Rossini in 1817), and over a hundred musicals, plays, novels, and movies. For reasons of popularity alone, Cinderella’s appearance in medical articles might be underThe references for all the Cinderella papers (w1-w34) are on


BMJ: first published as 10.1136/bmj.331.7531.1543 on 22 December 2005. Downloaded from on 15 March 2019 by guest. Protected by copyright.

Cinderella revisited

What’s in a name?


Modern usage Closer analysis suggests that there is more to Cinderella than simple fame. Her story seems to offer medical writers a rich tapestry of metaphors. Their popularity in medical writing may even provide some insight into the attitudes of doctors and others working in health. The transformation topic might be attractive to physicians who have a sense of social responsibility. They feel a need to facilitate the achievement of true potential and to liberate the downtrodden, especially if there is a chance to be called a “champion.”w33 For this reason the prospect of recognition is an attractive one. The focus on exhaustion is easily explainable. Overwork is a day-to-day occurrence in a modern medical life and burn out a constant threat. Moreover, the Cinderella fable combines the themes of overwork with underappreciation. Cinderella is becoming the poster girl for careers in health. The abundance of mixed metaphors is regrettable. It suggests that medical writers need to exercise discretion in their use of poor Cinderella before it is pointed out that the stepsisters may not be the only ones abusing her.

Just wait until a medical author gets hold of you

playing the role of mentor to Cinderella and arranging her makeover. The medical journals are also silent on mousedrawn pumpkin coaches and midnight curfews for debutantes, both important aspects of the fable. There are over one million citations on MedLine that contain the word “rat” but not a single one of these mentions their potential use as coachmen.

Beneath the ashes The profusion of Cinderella themes naturally raises questions about the use of other parts of the story. Premier among them is the fairy godmother, who covertly assists the maid to reach her new status. There are only a few medical articles that cite a fairy godmother, although they sometimes refer to characters in other fables, like Snow White.w34 This is curious as the godmother is such an important part of the fable,

Future research If Cinderology is to rise to the lofty status of an academic discipline, there is a need to answer some questions. A fruitful course of study might be to analyse the discipline-specific use of the metaphor. There are copious references to be sorted through that might provide insights into the psyche of cardiology, dermatology, dentistry, and nursing, all of which are especially fond of exploiting Cinderella in their literature. Interviews with the authors, to fully understand the inspiration she stimulated, might be revealing. This line of study awaits its own champion.


Conclusion Cinderella is still very much alive. Despite some abuse from medical authors, the fabled maid has given birth to an expansive family of metaphors. It may indeed be possible to live happily ever after, if only in health literature.

Some day my metaphor will come


Contributor: SMC is the sole contributor. Funding: None to date, but grants happily accepted. Competing interests: None declared. Ethical approval: Pending the review board’s return from the ball. 1 2

Hazleton L, Hickey C. Cinderology: the Cinderella of academic medicine. Can Med Assoc J 2004;171:1495-6. Carpenter H, Prichard M. The Oxford companion to children’s literature. Oxford: Oxford University Press, 1984:118-20.


24-31 DECEMBER 2005

BMJ: first published as 10.1136/bmj.331.7531.1543 on 22 December 2005. Downloaded from on 15 March 2019 by guest. Protected by copyright.

standable. However, there are only two formal medical conditions named after this character, and they are somewhat obscure. In Cinderella syndrome adopted young women falsely accuse their step-parents of maltreatment.w31 There is also Cinderella dermatosis.w32