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While never explained in the original series, the name "stuck" when (in the 2009 movie) McCoy mentions at his introduction to Kirk that his ex-wife "...took the whole damn planet in the divorce. All I got left is my bones".

In the original series it comes from an old 19th century nickname for battlefield doctors, "Old Sawbones" this name originated during the american civil war when amputations were common in battlefield hospitals.

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