British English drops the unstressed second syllable to make it sound like med-sin /ˈmɛd.sɪn/.

American English keeps it as a 3-syllable word meh-dee-sin /ˈmɛ.dɪ.sɪn/

In Australia I've only ever heard meh-dee-sin /ˈmɛ.dɪ.sɪn/ except by British ex-pats.

But I think globally every English speaker pronounces all the syllables in "medicinal". Well maybe not the Welsh (I can't find a Welsh pronunciation).

American pronunciation pre-dates a shift in sound of British English in the late-18th and early-to-mid 19th centuries. See Grammarphobia's When did those upper lips stiffen?

This applies to many words like secretary, inventory and accidentally - but reversed for caramel family, chocolate and camera where Americans seem to drop syllables.

I then realised that I've even used the British vs American answer here on accepted answers.

I've just found Why do North Americans pronounce "caramel" as "carmel"? where the accepted answer explains the phenomena well.

But why is there a difference?

Clarification: "Why?" as in, "how come?" or "most plausible". Otherwise the correct answer is "because that's how it is".

  • 3
    "Youglish" is an awesome site that gives you youtube videos based on a word, and it also differentiates between different dialects of English. as for "medicine" if you hear a few dozen videos, you can hear that the pronunciation of "medicine" in UK English may very from schwa , "short I sound" and no sound at all : youglish.com/search/medicine/uk
    – David Haim
    Commented Dec 11, 2017 at 10:07
  • 2
    So the basic premise that the vowel is dropped completely is not accurate. for me it seems like /mɛdsn̩/ is just a lazy way to pronounce the schwa-sound version. (just like in AmE "gon" is a lazy way to pronounce "gonna" or "going to")
    – David Haim
    Commented Dec 11, 2017 at 10:09
  • 2
    I'm sure that I've heard "medissnal" in the UK, and not just from Welsh people. It's a clear pronunciation of the first "i" which is dropped in "medcine" but seems to obliterate the second.
    – BoldBen
    Commented Dec 12, 2017 at 7:26
  • 2
    @paulzag don't feel bad. people tend to downvote questions here for no-apparent reason. maybe they feel superior this way. this is a well written and thoughtful question and we need more of these in this stack exchange.
    – David Haim
    Commented Dec 12, 2017 at 9:02
  • 2
    Tim Post lost his keys again. Hence the downvote.
    – NVZ
    Commented Dec 12, 2017 at 16:02

3 Answers 3


Disyllabic pronunciations of the word "medicine" are quite old, and have in fact at times been considered more proper than trisyllabic pronunciations (I mean "proper" in terms of the concept of "RP" or "Received Pronunciation", as Mick pointed out). It may be relevant that the modern French word, "médecine", is also often pronounced with only two syllables—that's just my speculation, though.

The Oxford English Dictionary (OED) entry for the word records spellings like "medcoyne", "medcyn" and "medsin" that it says occurred as early as Middle English, and includes the following note about the pronunciation:

The disyllabic pronunciation (recognized by Johnson 1755) has existed at least from the 14th cent., as the forms occasionally indicate. N.E.D. (1906) stated that the trisyllabic pronunciation was less common in England, but that in Scotland and in the United States it was apparently the prevailing usage, and that examples of it occur in verse of all periods, from the 14th cent. onwards. N.E.D. also stated that the trisyllabic pronunciation was by many objected to as either pedantic or vulgar. The trisyllabic form still predominates in Scotland and in North America; H. W. Fowler Mod. Eng. Usage (1926) recommends the disyllabic pronunciation, while subsequent editions note the increasing frequency of the trisyllabic pronunciation in England.

In the word "medicinal", the first "i" is always pronounced because it occurs in a stressed syllable, unlike in "medicine". But there is some evidence that in the past, some speakers used an alternative stress pattern for the word "medicinal" that resulted in the first "i" being unstressed and possibly left out. The OED entry for that word says

Johnson gives pronunciations with stress on the penultimate syllable as well as the antepenultimate. Walker adduces a number of authorities in favour of the latter and casts much doubt on the former. A trisyllabic pronunciation, with elision of the second syllable and probably with stress on the first syllable, is attested by 17th- and 18th-cent. spellings such as med'cinal, medcinal.

(You can see Walker's dictionary entry in the scanned copy of his Critical Pronouncing Dictionary (1791) on the Internet Archive.)

As far as I can tell, both pronunciation variants existed already before American English and British English split. The present-day difference doesn't seem to have any clear cause. By the way, the idea that "American pronunciation pre-dates a shift in sound of British English" is an over-simplification: both varieties have changed (although not necessarily by the same amount) from their common ancestor, like how humans and chimpanzees share a common ancestor that is identical to neither of them. (The “common ancestor” of American and British English wasn’t homogeneous.)

  • Brilliant answer! The last paragraph alone is worth being an answer to a better question. I'm waiting 24 hours to see what else shows up, but given the question already has a negative score, it probably won't be seen by anybody else.
    – paulzag
    Commented Dec 12, 2017 at 3:41

As far as medicine is concerned. it may be something to do with RP, since it allows you to pronounce the word without having to move your mouth too much. Indeed, that's the pronunciation that Cambridge gives.

I'm a Brit (from the Midlands), and I use /ˈmɛ.dɪ.sɪn/ (and I don't use RP). I'll have to poll my friends, and see how they pronounce the word. It will probably be something between RP and AmE pronunciations, with the middle syllable present, but reduced as much as possible.

  • 1
    I'm Australian, and I use /ˈmɛ.dɪ.sɪn/, but my partner, also Australian, uses the three syllable version. Australians are said to be very lazy with their pronunciation but my partner has a far broader Australian accent than I do. He thinks my way of saying "medicine" sounds affected.
    – Livrecache
    Commented Dec 11, 2017 at 8:01
  • 3
    @Livrecache year and a half old comment here but /ˈmɛ.dɪ.sɪn/ is the 3 syllable version. I suppose you meant /ˈmɛd.sɪn/ or /ˈmɛd.sn/ ?
    – Some_Guy
    Commented Jun 20, 2019 at 22:57

Sorry, but I have to correct the Authors post. The correct version in the UK is 'Medicine' I'm from the South of England and was educated here, we were taught to pronounce it Medicine. In fact I've never heard anyone pronounce it as med-cine. The only time was when I met a Dutch school teacher on holiday who kept pronouncing med-cine. In fact after further discussion, she couldn't believe it that she had been teaching American English to her students for the last 10 years.

She said she would be raising the subject with her colleges back in Holland. I gave her several correct British words that she thought were true English......Colour/color, apologise/apologize, defence/defense, catalogue/catalog..etc

  • This is interesting, but anecdotal. Can you cite sources that this represents more than a local phenomenon?
    – Davo
    Commented Apr 6, 2021 at 19:32

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