Peterson presents compelling examples of the meaning and the constructions of medical slang in Rio de Janeiro, and describes the new meanings physicians create for (and communicate about) their health care system through their use of medical slang. But he makes unconvincing attempts to differentiate his study from others (particularly a study by Gordon in California), and sometimes moves too quickly between descriptions of metaphor, slang, jargon, proverbs, puns, and jokes. This is at once a pleasing and problematic paper, especially for a medical anthropologist with little formal sociolinguistic training.

Peterson contrasts substitutive, comparative, and interactive explanations of metaphor, and makes a convincing case for the utility of the third category. He presents only a sketch of the Brazilian health system crisis, but he makes appropriate and convincing references to a context of horror and moral challenge, and the development and use of medical slang to manifest and confront (or worsen) that context. On the other hand, his attempts to compare his study with one from California on hospital jokes (Gordon, 1983) are less convincing. He contrasts his broader with Gordon's narrower focus, though it is not clear that Gordon sought to represent anything other than one specific type of joke. He also critiques Gordon's attention to rapport among professionals and distance from patients, preferring instead his own attention to the creation of meaning. But while Peterson does attend to meaning, he also posits a mechanism of social critique that links a context of horror to the creation and use of puns by doctors. So is it that Peterson dislikes Gordon's lack of attention to meaning, or is it that Gordon employs a different functional model? Or both? Peterson later explains that he pays most attention to the third of his three themes (medical specialty, patients, health care services) because this is an area more relevant to the crisis. He chooses his own examples for what, as much as how, they communicate. Finally, Peterson writes that Gordon draws "curious conclusions." This critique seems to me to rest largely on a misrepresentation of the word 'claim,' as equivalent to the verb 'to demand' rather than the also acceptable 'to require' (contrary to Peterson's conclusion, in this latter sense comatose patients can readily claim attention).

But underneath this I am confused about the role of this critique in the article itself: without defending Gordon I wondered why Peterson chose to make these sometimes forced comparisons rather than letting his work 'speak for itself?' Is Gordon the only available representative of a substitutive view of medical metaphors? I would have liked to have read fewer critiques of Gordon, and more extensive analysis, for example, of the similarity in imagery between the emasculation of the medical staff (expressed through the term esculhambina) and the emasculation of patients (expressed through the term poliesculhambado).

I regret that Peterson sometimes uses language to distance rather than inform the reader. What, for example, is the reader to make of this sentence: "Medical slang is thus essentially connotative, to the extent that the significant element is the use of the linguistic register per se?" Is this the same as saying, 'Medical slang basically helps to convey new meanings, based on its use of words already in circulation?' And why use terms like chiasmas, catachresis, and paronomastic transformation or paronomastic interaction without defining them? These are disconcerting parts of an article that pays such close attention to words themselves.

While the opening is at once forceful and playful, I am sorry that Peterson does not follow through with his promise "to return to questions raised by the clavicle...". The conclusion invoking metaphors of keys and fumes might have been more powerful had it reinforced more specifically the links between ethical challenge, daily practice, and physicians' puns.

Despite these criticisms, it is still a pleasure to see (well, to read) this attention paid to what (and how) we mean. Peterson offers many ideas for additional work on the topic, in Brazil and elsewhere.