Appendix 2 Naming, Nomenclatures, Dictionaries
As a general matter, names are central to identity, and nosological entities are no different from other concepts, individuals and objects in this regard.Footnote 1 Indeed, as part of a doctrinal and professional institution, disease may represent an even more significant instance of the power of naming: the persistence of a concept in nosology and medicine, and its existence as part of a recognized system and network of references, and as a legitimate participant in a course of medical events and human actions, is entirely dependent on nomenclature. In this appendix, I present observations on and examples from the terminology related to phrenitis throughout its history, with the aim of offering an impression rather than an exhaustive survey.
The root phren- (φρεν-) in the Greek world
Nosological discussions of phrenitis in ancient medicine were very sensitive to the problems posed by the etymology from phrēn-phrenes, further qualified by cognates and compounds. The discussion of phrenes in De morbo sacro is perhaps the earliest we have, followed by Plato’s Timaeus, Aristotle’s Parts of Animals, Anonymus Londinensis and Galen (at least twice).Footnote 2 This discussion was felt to be relevant throughout the medieval and early-modern receptions of the disease, in which it was often reported on at length.Footnote 3
Throughout the Greek-speaking and Greek-reading worlds of antiquity, the root φρεν- is synonymous with ‘mind’ in the general sense. Cognates of phrēn/phrenes refer to the sphere of thinking, judging, being of sound mind, wisdom, mental pathology and mental and emotional states. The group includes a number of very common words.
A selection: φρονέω: ‘to think, to be minded’; φρόνημα, -ατος, τό: ‘mind, spirit, thought’; φρόνησις, -εως, ἡ: ‘purpose, intention’; φρονητικός, -ή, -όν: ‘concerned with thought’; φρόνιμος, -ον: ‘in one’s right mind’; φροντίζω: ‘to consider, reflect’; σωφρονέω: ‘to be of sound mind’; σωφρόνημα, -ατος, τό: ‘self-control’; σωφρονίζω: ‘to recall a person to his senses’; σωφροσύνη: ‘soundness of mind, prudence’; σώφρων: ‘of sound mind, prudent’; παραφροσύνη: ‘derangement’; ἀφρονέω: ‘to be silly, act foolishly’; καταφρονέω: ‘look down upon, despise’; δυσφρόνη, ἡ / δυσφροσύνη, ἡ: in pl. ‘anxieties, troubles’; δύσφρων, -ον: ‘sad at heart, sorrowful’. Compounds largely convey damage, disturbance or pathology, for instance: φρενοβλαβέω, φρενοβλαβής, φρενοβλαβεία: ‘to cause damage to the mind’, ‘damaged in mind’, ‘mind-damage’; φρενογηθής: ‘heart-gladdening’, in the magical papyri; φρενοδαλής: ‘ruining the mind’; φρενοδινής: ‘charming the heart’ (Nonn. 1.406); φρενοθελγής: ‘charming the mind’; φρένοθεν: ‘of oneʼs own mind’; φρενόληπτος: ‘possessed, mad’; φρενολυπέομαι: ‘to suffer in the mind’; φρενομανής: ‘distracted, maddened’; φρενομόρως: ‘struck in the mind by calamity’; φρενοπληγής: ‘striking the mind’; φρενοπλήξ: ‘struck in the mind’; φρενόπονος, ‘pain in the soul’; φρενοτέκτων: ‘building with the mind, ingenious’; φρεναπατάω: ‘to deceive someone’s mind’.
The Term phrenitis in the Vocabulary of Ancient Graeco-Roman Medical Texts and Their Tradition
The nomenclature of phrenitis in Greek and Latin sources is fairly limited and consistent:
Greek
φρενῖτις/φρενίτις = phrenitis
φρενιτικός, -ή, -όν = phrenitic
φρενιτιάω = to be phrenitic
φρενιτίζω = to be phrenitic
φρενιτισμός, ὁ = phrenitis, phrenitic attack
ΦΡΗΝΗΣΙΣ (Celsus, hapax) = phrenitis
Classical Latin
ph/frenesis = phrenitis
ph/frenitis = phrenitis
ph/freneticus-ph/freniticus = phrenitic
Medieval, Modern Latin
ch/karabitus = phrenitis
ph/frenesis = phrenitis
ph/frenitis= phrenitis
ph/freneticus = phrenitic
ph/freniticus = phrenitic
ph/frenesia = phrenitis
phrenetiasis = phrenitis
phrenismus = phrenitis
Arabic
farāniṭis = phrenitis
qarānīṭis = phrenitis
sirsām/sarsām/sirsen = phrenitis
birsām/barsām/birsen = phrenitis
ikhtilāṭ = confusion, delirium, phrenitis
Medieval and Modern European Languages: Medical and Lay Uses
The etymological group is used both medically and, hyperbolically, to indicate heightened states, fantasy or general madness of the intense, aggressive, frenetic kind, as well as folly and ethical flaw.
Middle English frenesye
Old French frenaisie
Italian frenesia, frenetico, frenitico; frenico, farneticare
Spanish frenesí, frenético
French ph/frenesie, ph/freneticque, ph/freniticque
German ph/frenetisch, ph/frenitisch
English ph/frenzy, ph/frensy, ph/frenesy, ph/frenetic, ph/frenitc, ph/franticke,
A Glimpse at Medical Dictionaries
It is instructive to observe what can be seen as an almost exact point of expiration of phrenitis in the nomenclature by considering the genre of ‘medical reference books’: lexica, dictionaries, lists and classifications intended for the medical profession or for medical students.
Medical texts of this kind are a useful source due to the specific quality of the evidence they offer, which has to do not exclusively and not even primarily with the concept and its description, but with its position within a system of reference. A reasonable starting point for the medical vulgate of the seventeenth century might be the 1679 German Lexicon Medicum by Stephanus Blancardus (Steph. Blancardi Lexicon medicum renovatum), where under PHRENITIS we find: ‘Phrenitiasis, seu Phrenesis, est delirium cum febre continue, saepe cum furore et excandescentia (non autem a cerebri inflammatione, quae anticuis placuit) producta. … a φρήν mens, quia mens laborat. German: Große raserei in hitzigen Fieber’. Here phren- is ‘the mind’, and the disease is emphasized as mental, localized in the inflamed brain.
In examples restricted to the Anglo-Saxon world, the 1807 Edinburgh Medical and Physical Dictionary offers a reflection of the important disease taxonomies produced in the eighteenth century, Cullen’s most of all: PHRENITIS (φρενιτις, from φρήν, the mind) is ‘phrenzy or inflammation of the brain; a genus of disease in the class pyrexiae, and other phlegmasiae of Cullen’. The 1826 London Medical and Surgical Dictionary goes more explicitly in the same ‘cephalic’ direction and lists Phrenitis. Phrenesis. Phrenetiasis. Phrenismus. Cephalitis. Sphacelismus. Chephalalgia inflammatoria. By the Arabians Karabitus: ‘phrenzy, or inflammation of the brain’. The 1834 Cyclopaedia of Practical Medicine (London) also offers the lemma PHRENITIS. ‘Brain, inflammation of the’.
By the first decades of the nineteenth century, the inadequacy of the term begins to be felt. Robert Hooper’s Medical Dictionary (London, 1839) intriguingly notes: ‘PHRENITIS. (is, idis, f. φρενιτις, from φρήν, the mind). Phrensy. Inflammation of the brain. A very faulty term [my emphasis]. See Encephalitis.’ Harris’s Dictionary of Medical Terminology (1855) also has ‘PHRENITIS. From φρήν, mind, and itis, inflammation. Inflammation of the brain’, subtly accepting an equation between the two terms. Mayne’s Expository Lexicon (Reference Mayne1860) offers an entry for phrenes, as well as listing phrenesis, phrenetiasis and phrenitis. At Phrenes, we read:
(φρήν, the mind). Anat., Physiol. Ancient term for the praecordia, which was supposed to be the seat of the mind. Fr. syn. praecordie, f. Ger. Syn. Herzgrabe, f. Also for the diaphragm, or, according to some, the two heads of the diaphragm descending into the loins, likewise supposed to be the seat of the mind. Fr. syn. Diaphragme, m. Germ. Syn. Zwerchfell, n.
PHRENITIS, idis, f. is defined:
(φρήν, the mind; terminal -itis). Med. Pathol. A term improperly used [my emphasis] for inflammation of the brain and its membranes; for, strictly it does not express this, but even if allowed, the brain being the seat or organ of the mind, it certainly has no connection with the membranes; phrenzy; a genus of the Ordo Phlegmasiae; Cl. Pyrexiae of Cullen’s nosology. See Encephalitis, Karabitus, Phrenesis, Phrenitiasis, Sibare. Fr. Anal. Phrénite, f. G. Syn. Hirnentzündung.
The diaphragmatic interpretation and the ancient mental view of the phrenes are retained, while the ‘actual’ disease is interpreted as entirely encephalic. Reference FowlerFowler’s 1875 Medical Vocabulary (London) treats ‘phrenetic’ and other cognate terms as all indicating something ‘that affect the mental faculties’. In particular, ‘phrenetic’ means ‘applied adj. and subs. to a person subject to strong, or violent, sallies of imagination or excitement, which in some measure pervert the judgement and cause the person to act as if partially mad’. Phrenitis is ‘inflammation of the brain, or of its membranes’.
Significantly, the 1888 New Sydenham Society’s Lexicon of Medicine and the Allied Sciences (Reference Power and SedgwickPower and Sedqwick 1881–92) now has only the English ‘frenzy’. The entry reads: ‘FRENZY: (Mid. E. Frenesye; Old F. Frenaisie; L. Phrenensis; Gr. φρένησις for φρενῖτις, inflammation of the brain. F. Frenesie; I. Frenezia; S. Frenesi; G. Wahnsinn, Raserei). Madness, delirium, great agitation of the mind’. Mayne’s Medical Vocabulary (London, 1889) offers the brief: ‘PHRENITIS. (φρήν, the mind …) Pathol. Inflammation of the brain; phrenzy’. Reference QuainQuain’s 1890 A Dictionary of Medicine also treats the term as anachronistic: ‘PHRENITIS. (φρήν, the mind) – An obsolete term, [my emphasis] formerly associated with all forms of acute inflammations of the brain or its meninges, but especially the latter’. The 1892 Dictionary of Terms Used in Medicine by Richard Dennis Hoblyn (London) begins:
PHRENES: (plural of φρήν, the mind). The diaphragm; so called because the Ancients supposed it to be the seat of the mind. Hence the terms: 1. Phrenic (a designation of the internal respiratory nerve, which goes to the diaphragm 2. Phrenitica Diseases affecting mental faculties, the first Order of the class Neurotica of Good. Also Medicines which affect the mental faculties, as narcotics, inebriants, & c. 3. Phrenitis. Phrensy; inflammation of the brain. A term under which have been confounded arachnoïtis and encephalitis. It constitutes the third genus of the order phlegmasiae of Cullen. φρενῖτις is strictly a fem. Adjective, and requires the addition of νόσος to complete its meaning.
The 1899 edition of Mayne’s Medical Vocabulary (London) also inserts a notice of the anachronistic character of the term:
Phrenitis: (an inflammation of the brain which causes madness; from φρήν, φρένες, the seat of the mental faculties.) A term improperly used [my emphasis] for inflammation of the brain and its membranes. Phrensy; a Genus of the Order Phlegmasiae, Class Pyrexiae of Cullen’s nosology.
The dictionary quotes a variety of subtypes, bringing to full light the development of the disease into a syndrome or set of clusters of signs related to derangement, odd behaviour and ‘nervousness’ with disparate causes: ‘Phrenitis Calentura (A term for Sunstroke), Phrenitis latrans (Hydrophobia). Phrenitis Potatorum (Delirium tremens). Phrenitis verminosa (A form of phrenitis formerly supposed to be due to the presence of a “worm” in the brain)’. The spelling Phrensy is also used here: ‘Phrensy: (Phrenesis) The same as Frenzy; also used in the same sense as phrenitis’.
At the turn of the twentieth century, in The American Illustrated Medical Dictionary (Reference CattelCattel 1910), Phrenitis is simply ‘delirium of frenzy’, with what had once been a disease now completely transformed into the syndrome or the symptom. In the 1925 and 1932 editions, as phrenitis progresses towards ‘archaeological’ status, the reference to the Greek diaphragmatic origin returns with ‘1. Delirium or phrenzy 2. Inflammation of the diaphragm’. The 1910 Lippincott’s New Medical Dictionary (Philadelphia and London) also refers to both the Greek medical construct and the modern, medical frenzy and inflammation of the brain. It is thus evident that by the middle of the twentieth century the label phrenitis and its etymological implications were still recognized and included. In Skinner’s The Origin of Medical Terms (Reference Skinner1949), only the adjective phrenic is included, with cultural-historical discussion:
In Homer the use of φρήν is for the parts about the heart, even the heart itself. Later it was restricted to the parts between the heart and the liver, thus the abdominal diaphragm. As this area was generally considered the seat of the emotions, and was also very properly considered to have some association with speaking, the term φρήν came to have the metaphorical significance of soul or mind, a sort of affective centre. Thus the word frenzy, which is derived from φρήν, originally had the significance of an emotional disturbance but became identified more and more with mental disturbance. The importance of the diaphragm was further enhanced by the knowledge that wounds of the diaphragm were generally fatal.
In the 1951 Medical Dictionary by Newman Dorland (Philadelphia and London), phrenitis is defined as ‘1. Inflammation of the brain 2. Delirium or frenzy 3. Inflammation of the diaphragm’. In Wain’s 1958 American historical dictionary The Story behind the Word, only ‘Frenzy’ is found, and there is no mention of phrenitis: ‘Τhis term designating a violent mania is a corruption of the older spelling of this word which was “phrensy”. This is derived from the Latin and the Greek word “phrenesis” meaning madness or delirium, and in turn comes from the Greek word “phren” or mind.’ Wakeley’s Faber Medical Dictionary (1962) lists:
phrenesis (G[reek], inflammation of the brain) ‘delirium, insanity’; phrenetic (G[reek] Phren, midriff) ‘maniacal’; phrenic ‘(G[reek] phren, midriff). 1. Relating to the diaphragm … 2. relating to the mind’; and phrenitis, ‘(G[reek] phren, midriff or mind) 1. Inflammation of the brain. 2. Inflammation of the diaphragm 3. Delirium.
Black’s Medical Dictionary, from 1981, represents yet another development, including ‘phrenic nerve’ (for the one ‘which chiefly supplies the diaphragm’) and ‘phrenology’ as an ‘old term’ for physiognomic approaches to the relationship between head-shape and character, but not ‘phrenitis’.
It is significant that phrenology – by then, much more factually absurd – is included, but not phrenitis, a testament to the still recent validity of the latter. The 1981 Psychiatric Dictionary by Robert J. Campbell mentions various terms in phren-, and under phrenitis explains that ‘This term was used by Hippocrates for inflammation of the brain’, which was precisely not the case, as we have seen. The 1986 Oxford Companion to Medicine likewise avoids phrenitis, but again accepts ‘phrenology’, defining this as a ‘pseudoscience’; the reality of phrenitis seems confirmed as both still too close to be dismissed as archaeology and too distant scientifically to be treated as medically valid. The Radcliffe European Medical Dictionary (1991) includes only the adjective ‘frenico (Italian, ‘diaframmatico, mentale’) = phrenic (English) = diaphragmatisch, Zwerchfell- (German), frénico (Spanish), psychique (French)’. Stedman’s Medical Dictionary (1995) also offers ‘phrenic’: ‘1. Diaphragmatic 2. Of the mind’ and ‘phrenology’ as ‘obsolete doctrine’, but not phrenitis, while the 2006 Mosby’s Dictionary has the adjective ‘phrenetic’ for ‘frenzied, delirious, maniac’, and phren- again referring to ‘1. Diaphragm 2. The mind’. But we find no phrenitis here. Discomfort with the label and its bulky history is also visible, finally, in the 1999 A Dictionary of the History of Medicine, which keeps phrenitis somewhat distant, describing it as ‘Ancient Greek term for disease of the mind’, while offering a longer section on ‘phrenology’.
This partial, episodic and patently patchy survey shows that sometime towards the middle of the nineteenth century the term phrenitis became (or began to become) obsolete and non-viable in official medicine. But the adjectives associated with it and its general ‘mental’ and ‘diaphragmatic’ meanings were remembered, as were its connections with the brain, more or less precisely traced back to various authors of the ancient past. The concreteness and clinical appeal of the term were still felt well into the nineteenth century, when several dictionaries consider it passé but its copyright had not yet expired, so to speak: while phrenology can be comfortably placed in the Museum of the History of Medicine, phrenitis cannot yet be handled so cavalierly. As far as phren- is concerned, the root’s meanings ‘mind’, ‘diaphragm’ and ‘brain’ are still felt, and more or less in this order of importance. Today, however, the vast majority of doctors and general readers ignore what phrenitis once was.
1 I discuss some of these issues in Reference ThumigerThumiger (2013); Reference Thumiger and SingerThumiger and Singer (2018a) 1–6. See also the studies in Reference SteinertSteinert (2020). On naming and new diseases, see Chapter 1, and Reference HarrisHarris (2022).
2 See pp. 13, 17, 34 n. 33, 43, 44, 52–53, 103–09. above.
3 See above, pp. 235–38, 249, 253, 278–80, 319.
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