Nauseated/nauseous

I am often told that a patient is nauseous, only to find that he or she is actually nauseated, not nauseous at all, or at least not what I mean by nauseous.

The word nausea comes from the Greek nausia or nautia, which originally meant seasickness (Greek naus = ship). In Latin nauseare meant to make sick; nauseated (from the supine form nauseatum) therefore means made to feel sick (verb transitive) or feeling sick (adjective).

Now the suffixosus in Latin meant full of or rich in. And, although nauseosus could have meant feeling sick or nauseated, it was actually used to mean causing nausea. When nauseous came into English from the Latin it first meant likely to feel sick (that is, squeamish) or fastidious, but that meaning rapidly became obsolete. At the same time nauseous was used in its original Latin sense of causing nausea, and therefore smelling or tasting unpleasant and (figuratively) loathsome or disgusting. And that meaning persisted until about the middle of the 20th century.

However, Webster's Third International Dictionary (1961) gave two different meanings of nauseous: 1. Affected with or inclined to nausea: nauseated. 2. Causing or such as might be expected to cause nausea: sickening, loathsome, disgusting. This distinction was not made in Webster's second (Webster's New International Dictionary), so presumably the new meaning arose at some time between 1913 and 1961.

The distinction between nauseous and nauseated was not discussed by Fowler in his Modern English Usage (1926), nor by Ernest Gowers in his revision of Fowler (1965), but it was discussed in Bob Burchfield's revision (1996; see also BMJ 2000;320: 35710657334), in which he distinguished between British English and American English usages. According to Burchfield, in British English nauseated means feeling sick and nauseous means disgusting, but in American English nauseous has tended to replace nauseated, while nauseating has replaced nauseous.

On the other hand, some US sources have condemned the failure to observe the original distinction between nauseous and nauseated. For example, Wilson Follett, in his Modern American Usage (1966), wrote: “When we have two adjectives, nauseous and nauseated, it should be clear that the first applies to the substance that causes the state named in the second. To call oneself nauseous, except in self-depreciation, is to ignore the point of view of the word.” And Strunk and White in The Elements of Style (3rd edition, 1979) wrote: “Do not say `I feel nauseous', unless you are sure you have that effect on others.”

Nevertheless, by 1989 Webster's Dictionary of English Usage had gathered a large amount of evidence of the widespread use of nauseous to mean nauseated: “Any handbook that tells you that nauseous cannot mean `nauseated' is out of touch with the contemporary [US] language.”

Searching PubMed for examples of nauseous and nauseated in the titles and abstracts of bioscience publications, I have found only seven instances of nauseous in UK publications, compared with 51 worldwide, and 97 instances of nauseated worldwide. In one paper both were used: “The procedure had no significant effect on cardiovascular variables in control subjects or in subjects who were exposed to vestibular stimulation but who were not nauseated by it. Those subjects who felt nauseous showed a tachycardia and forearm vasodilatation” (Cardiovascular Research 1982;16: 610-2). This example is interesting in that it shows the use of nauseated in the verbal sense and nauseous, meaning nauseated, in the adjectival.

But I still think that, although several of my patients are or become nauseated, sometimes because of drugs that I give them, very few of them are really nauseous.