This week, after a long day at EWMA-DEWU 2026 in Bremen, I had dinner with my dear friend, the renowned biomechanist Prof. Sicco Bus from Amsterdam. Sicco and I have been colleagues, co-authors (NEJM, JAMA, and a long string of others), and co-conspirators for the better part of two decades. We share a fascination with at least two things: classification systems, and language. These usually feel like two interests, but really they are one — both are attempts to slice up the world cleanly enough to act on it.
Somewhere between courses, the word wound came up, and Sicco said it the way a Dutchman would: wond. Same word, different mouth. And I sat with that for a moment — because here we were, two people who spend our professional lives talking about wounds and ulcers, and we had never quite reckoned with the fact that those are two different words for the same hole in the body. Why?
What follows is the dinner conversation, written down.
Two words, one hole
Wound is Anglo-Saxon. Old English wund, Proto-Germanic *wundo, from a Proto-Indo-European root *wen- meaning to beat, to strike. It was already in the mouths of the people who farmed Wessex when Alfred was king. Sicco’s wond is the same word — the cousin that survived in Dutch almost unchanged since both languages were Germanic dialects in the same forest. German Wunde, Old Norse und, Gothic wunds — all the same family.
Ulcer is the latecomer. From Latin ulcus, ulceris, from Greek helkos, entering English through Old French in the 14th–15th century, on the back of scholarly Latin medicine. Critically, helkos in the Hippocratic corpus already meant something specific: not any old gash, but a sore that persists, that suppurates, that fails to behave. When Galen elaborated this in De methodo medendi, he distinguished traumatic disruption — a fresh injury — from ulcus, the lesion that has settled in. Ulcer arrived in English already pre-loaded with chronicity.
Why English keeps two
This split is the same fault line that runs through cow/beef, pig/pork, sheep/mutton. The Norman Conquest layered French-Latinate vocabulary on top of the Germanic substrate, and the Renaissance dropped a third stratum of Greco-Latin clinical learning on top of that. The native word stayed at the bedside. The borrowed word migrated into the chart.
The pattern is everywhere in the body. Skin is what you can touch; cutaneous is what the dermatologist names. Bone is what you can break; osseous is what shows up in the orthopedist’s note. Cut is what you describe to your friend; incision is what gets written in the operative report. And the hole you bring to the clinic — that is a wound in the morning and an ulcer by afternoon, depending on whether it is healing.
Event vs. state
But the wound/ulcer pair does something more than just stratify by register. It divides the conceptual territory.
A wound is an event. There was a thing that happened. A disruption from outside. A moment of breach. It is process-oriented, often acute, with an implied trajectory toward closure. Vulnus, its Latin cousin, gives us “vulnerable” — the capacity to be hurt.
An ulcer is a state. A defect that persists, often arising from intrinsic failure — vascular, neuropathic, pressure, venous, malignant — rather than external trauma. It is condition-oriented, almost always chronic, and the name itself is a diagnosis, not a description.
This is why diabetic foot ulcer is the right term and diabetic foot wound would feel slightly off. The DFU encodes the pathophysiology of failure. The chronicity is doing semantic work. A pressure ulcer that arises de novo, without trauma, was never a wound at all in the everyday sense. It is an ulcer from the moment we name it — because the name is a diagnosis.
At the bedside, the words trade places
You can watch this happen in real time. A surgical wound that does not close becomes a wound dehiscence, then a chronic wound, and at some threshold of time and behavior we start calling it an ulcer. The language tracks the failure of healing as it happens. Vulnus and ulcus mark out the same anatomical territory; they project entirely different temporal and causal narratives onto it.
Why this should matter to us
Sicco and I came back to the same thought as the dishes were cleared: classification is never neutral. The names we use carry whole theories of disease tucked inside them. When we say ulcer, we are not just describing a hole in the skin; we are silently committing to a story about what is happening underneath — about why this wound is no longer behaving like a wound. That story shapes who gets seen, who gets imaged, who gets vascularized, who gets offloaded, who gets followed after closure into the long, fragile thing we have learned to call remission rather than cure.
And here is the part that delights me. In medieval and early modern humoral medicine, ulcus carried not just chronicity but a specific theory of the body — the suppurating sore was the body expelling corrupt humors. The ulcer was, in some sense, purposive. A drain rather than just damage. Some of that survives, oddly, in our modern preoccupation with whether to debride, drain, or let it breathe. The word remembers what the theory has forgotten.
Two inheritances
When we use both words, we deploy two inheritances at once: the Germanic one that names the event of being hurt, and the Greco-Latin one that names the failure of being healed.
Two words. One hole. Whole etymology.
Met dank aan Sicco — for the company, the cognate, and the conversation. We have always done our best work somewhere between classification and language, and this dinner was no exception.
#DiabeticFoot #DFU #Wound #Ulcer #Etymology #Language #LimbPreservation #WoundHealing #ClassificationMatters #Bremen #EWMA #DEWU2026
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