Plethora & Plethoric

Plethora (pronounced pleth-er-uh)

(1) Superfluity or excess; an overabundance.

(2) A large quantity or wide array; a great abundance.

(3) In re-modern medicine, , a morbid condition due to excess of red corpuscles in the blood or increase in the quantity of blood (archaic except for historic references); an excess of any of the body’s fluids (archaic).  Medieval apothecaries offered plethora of potions and concoctions to treat “redd face”.

(4) In modern pathology, an excess of Excess of blood in the skin, especially in the face and especially chronically.

1535-1545: From the Medieval Latin plēthōra, from the Ancient Greek plēthṓra or plēthōrē or plēthṓra (fullness; satiety) from plēthein (to be or grow full), from the primitive Indo-European pele (to fill).  The original use of the word was in medicine; later adopted by pre-modern pathology to describe a specific condition.  The modern, figurative meaning (too-muchness, overfullness) was in use by the early eighteenth century.  In figurative use the synonyms include excess, abundance, glut, myriad, surfeit, superfluity & slew while in medical use they’re hyperaemia & hyperperfusion.  The non clinical description of the apothecaries redd face include flushing, blushing, floridity & ruddiness (the condition rosacea (a chronic condition characterized by redness of the face) is treatable but incurable).  Plethoric is the adjective, plethorically the adverb.  Plethora is a noun; the noun plural is plethorae or plethoras.

Lindsay Lohan and her lawyer in court, Los Angeles, December 2011.

Plethoric (pronounced ple-thawr-ik, ple-thor-ik or pleth-uh-rik)

(1) In speech or text, overfull; turgid; inflated; pompous.

(2) By extension, excessive, overabundant, rife; loosely, abundant, varied.

(3) In medicine, a patient suffering from plethora (ruddy in complexion, congested or swollen with blood).

(4) In medicine, of, relating to, or characterized by plethora.

1610–1620: From the Late Latin plethoricus, from the Hellenistic Ancient Greek πληθωρικός (plēthōrikós), from πληθώρα (plēthṓra) (plethora); It deconstructs as plethor(a) +‎ -ic.  The -ic suffix was from the Middle English -ik, from the Old French -ique, from the Latin -icus, from the primitive Indo-European -kos & -ḱos, formed with the i-stem suffix -i- and the adjectival suffix -kos & -ḱos.  The form existed also in the Ancient Greek as -ικός (-ikós), in Sanskrit as -इक (-ika) and the Old Church Slavonic as -ъкъ (-ŭkŭ); A doublet of -y.  In European languages, adding -kos to noun stems carried the meaning "characteristic of, like, typical, pertaining to" while on adjectival stems it acted emphatically; in English it's always been used to form adjectives from nouns with the meaning “of or pertaining to”.  A precise technical use exists in physical chemistry where it's used to denote certain chemical compounds in which a specified chemical element has a higher oxidation number than in the equivalent compound whose name ends in the suffix -ous; (eg sulphuric acid (H₂SO₄) has more oxygen atoms per molecule than sulphurous acid (H₂SO₃).  The use in medicine dates from the fourteenth century while the figurative senses (Excessive, overabundant, rife; loosely, abundant) in rhetoric (and later just about anything) emerged gradually after the seventeenth.  Plethoric is an adjective and plethorically is an adverb.

The apothecaries redd face

From Antiquity, through the medieval period and until as recently as some 200 years ago, it was medical orthodoxy that the plethoric (the primary symptom being a chronic reddishness of the face) was caused by an excess of the humor of yellow bile (xanthe chole).  Humoral (humor a translation of the Ancient Greek χυμός (chymos (literally juice or sap, figuratively flavor)) theory (known also as humorism or humoralism), was a system of medicine from Antiquity which provided a framework and description of the supposed workings of the human body.  It was the standard model for the philosophers and physicians of Ancient Greek and Rome and endured in Western medicine well into the nineteenth century when many of its assumptions about physical illness were disproved by germ theory and the understanding of the role of pathogens in disease.  The overturning of humoral theory was one of the landmarks in the origins of modernity.

In antiquity it was a concept rather than something with a standardized systemization and there existed competing models with more or fewer components but it’s because the description with four was that endorsed by the Greek physician Hippocrates (circa 460–circa 370 BC) that it became famous in the West and absorbed into medical practice.  The four humors of Hippocratic medicine are black bile (μέλαινα χολή (melaina chole)), yellow bile (ξανθη χολή (xanthe chole)), phlegm (φλέγμα (phlegma)) & blood (αἷμα (haima)), each corresponding with the four temperaments of man and linked also to the four seasons: yellow bile=summer, black bile=autumn, phlegm=winter & blood=spring.  In Hippocratic medicine, to be healthy, the four humors needed to be in balance and this, once achieved, was the state of enkrateia (from the Ancient Greek ἐγκράτεια (eukrasia) (in power), the construct being ἐν (en-) (in-) + κράτος (krátos) (power), a word which appears in the New Testament in the context of virtues (Acts 24:25, Galatians 5:23 & 2 Peter 1:6).  In the King James Version (KJV, 1611), it would be translated as "temperance", a word which went on to assume a life of its own.

Medieval apothecaries treated redness in the face (which may have been rosacea, sunburn, or a variety of internal or skin conditions) using a number of remedies based either on herbal medicine or humoral theory.  Some would to some extent have been have been efficacious, some worthless and some genuinely dangerous.  They included:

Herbal Remedies: (1) Rose water was frequently used both for it cooling and anti-inflammatory properties (applied directly to the skin to soothe redness and irritation), (2) Chamomile (one of medicine’s most ancient calmatives) was applied as a poultice or used in a wash to reduce inflammation and redness, (3) the flesh of the Aloe Vera plant was renowned for its soothing effect and was used to treat various skin conditions, including redness (it’s now recommended also as an alternative to shampoo and conditioner) and (4) cucumber was made into a topical paste and applied directly to the affected skin.

Cooling Agents: Diluted vinegar, often mixed with herbs, was applied to cool the skin and reduce redness. This was believed to balance the body's humors, particularly if the redness was thought to be caused by an excess of heat (choleric humor).

Minerals: (1) In severe or intractable cases (as chronic rosacea tends to be), Ceruse (white lead) was sometimes used to whiten and cover red or blemished skin (a treatment which would be though dangerous by modern standards) and (2) Calamine (a mineral compound) was used to treat skin irritation and reduce redness.  Calamine lotion remains one of the most effective treatments for minor skin irritations.

Humoral Treatments: (1) Until quite recently, it was common for skin redness (especially in the face) to be caused by an imbalance in the body's humors, especially an excess of blood (sanguine humor).  Phlebotomy (bloodletting) was often performed and there were specialists who practiced the trade exclusively (in the USSR (the old Soviet Union) it was still an orthodox treatment as recently as the 1950s, even comrade Stalin (1878-1953; Soviet leader 1924-1953) enjoying some sessions.  (2) Presumably as a result of empirical observation, a patient diet was identified as a contributory factor and the apothecaries followed the practice of the physicians from Antiquity, advising sufferers to eat “cooling foods” like cucumbers, lettuce, and melons, while avoiding “heating foods” such as spicy dishes and red meat.

Spectrum condition: The redness in the face of the honourable Barnaby Joyce (b 1967; thrice (between local difficulties) deputy prime minister of Australia 2016-2022) is used by his colleagues to gauge where his state of mind lies in the adjectival progression of the plethoric (left), the more plethoric (comparative; centre) and the most plethoric (superlative; right).  Mr Joyce’s symptoms (ambitious, leader-like, restless, easily angered) suggest an excess of yellow bile and to counteract this, Hippocrates recommended cold and wet foods such as cucumber or lettuce to bring the humors back into alignment.  Mr Joyce should adopt a cucumber & lettuce diet and it may be a good time for him to try it because he recently announced he'd given up alcohol, the abstinence inspired by a recent "incident" in which he was filmed lying drunk on the footpath (sidewalk) next to a Canberra planter box, conducting a mumbled, expletive-laden conversation with his wife.  He said he's since lost 15 kg (33 lb) and given up smoking (it not known if politicians lie about such claims).  Interestingly, political scientists seem generally to expect the well-publicized event (one of a number featuring Mr Joyce) would probably result in him increasing his margin at the next election (sprawled drunk in a city street making him "authentic" and "relatable").  When interviewed, the once "notorious drunkard" said: "Maybe at some stage I’ll have a beer again, but at the moment, nah".

Phlebotomy

Phlebotomy (pronounced fluh-bot-uh-mee)

(1) The act or practice of opening a vein for letting or drawing blood as a therapeutic or diagnostic measure; the letting of blood and known in historic medicine as "a bleeding".

(2) Any surgical incision into a vein (also known as venipuncture & (less commonly) venesection).  It shouldn’t be confused with a phlebectomy (the surgical removal of a vein).

1350–1400: From the earlier flebotomye & phlebothomy, from the Middle French flebotomie, from the thirteenth century Old French flebothomie, (phlébotomie the Modern French) from the Late & Medieval Latin phlebotomia, from the Ancient Greek φλεβοτόμος (phlebotómos) (a lancet used to open a vein), the construct being φλέψ (phléps) (genitive phlebos) (vein), of uncertain origin + tomē (a cutting), from the primitive Indo-European root tem- (to cut).  The form replaced the Middle English fleobotomie.  The noun phlebotomist (one who practices phlebotomy, a blood-letter) is documented only as late as the 1650s but may have been in use earlier and operated in conjunction with the verb phlebotomize.  The earlier noun and verb in English (in use by the early fifteenth century) were fleobotomier & fleobotomien.  The Latin noun phlebotomus (genitive phlebotomī) (a lancet or fleam (the instruments used for blood-letting)) was from the Ancient Greek φλεβότομος (phlebótomos) (opening veins), the construct being φλέψ (phléps) (blood vessel) +‎ τέμνω (témnō) (to cut) +‎ -ος (-os) (the adjectival suffix).  The alternative spelling was flebotomus.  The noun fleam (sharp instrument for opening veins in bloodletting (and this in the pre-anesthetic age)) was from the late Old English, from Old French flieme (flamme in Modern French), from the Medieval Latin fletoma, from the Late Latin flebotomus, from Greek φλεβοτόμος (phlebotómos) (a lancet used to open a vein).  The doublet was phlebotome and in barracks slang, a fleam was a sword or dagger.  Phlebotomy & Phlebotomist are nouns, phlebotomize is a verb and phlebotomic & phlebotomical are adjectives; the noun plural is phlebotomies.

Phlebotomy describes the process of making a puncture in a vein cannula for the purpose of drawing blood.  In modern medicine the preferred term is venipuncture (used also for therapy) although the title phlebotomist continues to be used for those who specialize in the task.  One of the most frequently performed procedures in clinical practice, it’s commonly undertaken also by doctors, nurses and other medical staff.  Although the origins of phlebotomy lie in the ancient tradition of blood letting, it’s now most associated with (1) the taking of blood samples for testing by pathologists and (2) those carried out as “therapeutic phlebotomies” as part of the treatment regimen for certain disorders of the blood.  The inner elbow is the most often used site but in therapeutic medicine or in cases where the veins in the arms are not suitable, other locations can be used.

Bleeding the foot (circa 1840), oil on canvas following Honoré Daumier (1808-1879).

It’s an urban myth the Hippocratic Oath includes the clause: “First, do no harm” but by any reading that is a theme of the document and while the Greek physician Hippocrates of Kos (circa 460-circa 375 BC) wouldn’t have been the first in his field to regard illness as something to be treated as a natural phenomenon rather than something supernatural, he’s remembered because of his document.  His doctrine was one which took a long time to prevail (indeed there are pockets where still it does not), holding that treatment of ailments needed to be based on science (“evidence-based” the current phrase) rather than devotion or appeals to the gods.  His influence thus endures but one of his most famous theories which persisted for decades resulted in much lost blood for no known benefit and an unknown number of deaths.  Drawing from the notion of earlier philosophers that the basis of the universe was air, earth, water & fire, the theory was that there were four “humors” which had to be maintained in perfect balance to ensure health in body & mind, the four being flegmat (phlegm), sanguin (blood), coleric (yellow bile) & melanc (black bile) which were the source of the four personality types, the phlegmatic, the sanguine, the choleric & the melancholic.  Had Hippocrates and his successors left the humors in the realm of the speculative, it would now be thought some amusing fragment from Antiquity but unfortunately surgical intervention was designed to ensure balance was maintained and the mechanism of choice was bloodletting to “remove excess liquids”.

George Washington in his last illness, attended by Doctors Craik and Brown (circa 1800) engraving by unknown artist, Collection of The New-York Historical Society.

Apparently, bloodletting was practiced by the ancient Egyptians some 3000 years ago and it’s not impossible it was among the medical (or even religious) practices of older cultures and From there it’s known to have spread to the Middle East, Rome, Greece and West & South Asia, physicians and others spilling blood in the quest to heal and the evidence suggests it was advocated for just about any symptom.  The very idea probably sounds medieval but in the West that really was the nature of so much medicine until the nineteenth century and even well into the twentieth, there were still some reasonably orthodox physicians advocating its efficacy.  Still, in fairness to Hippocrates, he was a pioneer in what would now be called “holistic health management” which involved taking exercise, eating a balanced diet and involving the mind in art & literature.  He was an influencer in his time.  All the humors were of course good but only in balance so there could be too much of a good thing.  When there was too much, what was in excess had to go and apart from bloodletting, there was purging, catharsis & diuresis, none of which sound like fun.  Bloodletting however was the one which really caught on and was for centuries a fixture in the surgeon’s bag.

Blood self-letting: Lindsay Lohan as Carrie from the eponymous film, Halloween party, Foxwoods Resort & Casino, Connecticut, October 2013.

Actually, as the profession evolved, the surgeons emerged from the barber shops where they would pull teeth too.  The formal discipline of the physician did evolve but they restricted themselves to providing the diagnosis and writing scripts from which the apothecary would mix his potions and pills, some of which proved more lethal than bloodletting.  The bloodletting technique involved draining blood from a large vein or artery (the most productive soon found to be the median cubital at the elbow) but if a certain part of the body was identified as being out-of-balance, there would be the cut.  The mechanisms to induce blood loss included cupping, leeching & scarification and with the leeches, they were actually onto something, the thirsty creatures still used today in aspects of wound repair and infection control, able often to achieve better results more quickly than any other method.  Leeches have demonstrated extraordinary success in handing the restoration of blood flow after microsurgery and reimplantation and works because the little parasites generate substances like fibrinase, vasodilators, anticoagulants & hyaluronidase, releasing them into the would area where they assist the healing process by providing an unrestricted blood flow.  Of course the leeches don't always effect a cure.   When in 1953 doctors were summoned to examine a barely conscious comrade Stalin (1878-1953; Soviet leader 1924-1953), after their tests they diagnosed a haemorrhagic stroke involving the left middle cerebral artery.  In an attempt to lower his blood pressure, two separate applications of eight leeches each were applied over 48 hours but it was to no avail.  Had he lived he might have had the leeches shot but they probably lived to be of further service.

A Surgeon Letting Blood from a Woman's Arm, and a Physician Examining a Urine-flask (in some descriptions named Barber-Surgeon Bleeding a Patient), eighteenth century oil on canvas, attributed to school of Jan Josef Horemans (Flemish; 1682-1752); Previously attributed to Richard Brakenburg (Dutch; 1650-1702); Previously attributed to the Flemish School,

Scarification was a scraping of the skin and if the circumstances demanded more, leeches could be added.  Cupping used dome-shaped cups placed on the skin to create blisters through suction and once in place, suction was achieved through the application of heat.  However it was done it could be a messy, bloody business and in the twelfth century the Church banned the practice, calling it “abhorrent” and that had the effect of depriving priests and monks of a nice, regular source of income which wasn’t popular.  However, especially in remote villages far from the bishop’s gaze, the friars continued to wield their blades and harvest their leeches, the business of bloodletting now underground.  In the big towns and cities though the barbers added bloodletting to their business model and it’s tempting to wonder whether package deals were offered, bundling a blooding with a tooth pulling or a haircut & shave.  From here it was a short step to getting into the amputations, a not uncommon feature of life before there were antibiotics and to advertise their services, the barber-surgeons would hang out white rags smeared in places with blood, the origin of the red and white striped poles some barbers still display.  To this day the distinctions between surgeons and physicians remains and in England the Royal College of Physicians (the RCP, a kind of trade union) was founded by royal charter in 1518.  By the fourteenth century there were already demarcation disputes between the barber surgeons and the increasingly gentrified surgeons and a number of competing guilds and colleges were created, sometimes merging, sometimes breaking into factions until 1800 when the Royal College of Surgeons (RCS) was brought into existence.  It's said there was a time when fellows of the RCP & RCS, when speaking of each-other, would only ever make reference to "the other college", the name of the institution never passing their lips. 

Bloodletting tools: Late eighteenth century brass and iron “5-fingered” fleam.

Unfortunately, while doubtlessly lobbying to ensure the fees of their members remained high, the colleges did little to advance science and the byword among the population remained: “One thing's for sure: if illness didn't kill you, doctors would”.  It was the researchers of the nineteenth century, who first suggested and then proved germ theory, who sounded the death knell for most bloodletting, what was visible through their microscopes rendering the paradigm of the four humors obsolete.  By the twentieth century it was but a superstition.

Sanpaku

Sanpaku (pronounced san-pach-ew)

The presence of visible white space (sclera) above or below the iris of the human eye.

Pre 1800s: A borrowing from the Japanese 三白 (sanpaku) (three whites) or 三白眼 (sanpaku gan) (three-white eyes).  Sanpaku is a noun and sanpakuish is an adjective; the noun plural is sanpakus.

Sanpaku (三白) (three whites) & Sanpaku gan (三白眼) (three-white eyes) are Japanese terms from traditional Chinese & Japanese medicine and they describe the “condition” in which the white of the eye is visible either above or below the iris when looking straight ahead.  Although the word was popularized by Japanese educator and nutritionist Nyoichi “George” Ohsawa (1893–1966) when he published the book You Are All Sanpaku in 1965, the idea had existed in Oriental medicine probably for centuries although it’s impossible accurately to determine its origin.  It was mentioned in the diaries of at least one nineteenth century US Navy physician but attracted no interest in the West until the release of hsawa san’s book.  In Western medicine the phenomenon is described as “lower scleral show” or “inferior scleral show”, terms which are merely descriptive because (1) it’s something thought within the range of normality, (2) in indicative of no other mental or physical states and thus (3) is not considered a medical condition requiring treatment, the state either genetic or induced by aging, trauma or clinical and aesthetic dermatology procedures.  In short, the medicalization of sanpaku is thought a superstition thus, predictably, on social media ,“sanpaku eyes” seems to have a cult following.

In You Are All Sanpaku, Ohsawa san described Sanpaku as a condition which indicated physical and mental imbalances and discussed its significance in relation to diet and overall well-being.  Historically, sanpaku is believed to have entered oriental medicine from the Japanese practice of “face-reading” and those with eyes observed thus were considered ill-fated and destined for a life filled with misfortune, culminating often with an early demise.  It gained a following on social media by the usual means: celebrity association.  Diana, Princess of Wales, President John Kennedy & Marilyn Munroe, all of whom died young, were all sanpakus and as Ohsawa san warned in You Are All Sanpaku: the eyes indicate someone's fate, signifying imminent danger or an “early and tragic end.”

Early and tragic ends: John Kennedy (JFK, 1917–1963, left), Diana, Princess of Wales (1961-1997, centre) and Marilyn Monroe (1926–1962, right)

The original basis of “face reading” isn’t known but as a diagnostic tool it focused on the matter of “balance”, something important also to the physicians of Antiquity who identified the “four humors”: flegmat (phlegm), sanguin (blood), coleric (yellow bile) & melanc (black bile) which were the causative against of the four personality types, the phlegmatic, the sanguine, the choleric & the melancholic.  In the East, signs of sanpaku meant a man’s whole system (physical, physiological and spiritual) was out of balance, something caused by sins committed against the order of the universe, accounting for his sickness, unhappiness or insanity.  Ohsawa san noted that in the West such folk had come to be called “accident prone” and they were the ones who should take note of the warning from sanpaku, nature’s tap on the shoulder.  A practical author of self-help texts, Ohsawa san recommended sanpaku eyes should be treated with a macrobiotic diet, focusing on brown rice and soybeans, something on which he had real expertise as the founder of the macrobiotic diet.

By their sanpaku you shall know them: Adolf Hitler (1889-1945, left), crooked Hillary Clinton (b 1947, centre) and Charles Manson (1934-2017, right).

Interestingly, the beliefs about sanpaku are culturally variable although universally it’s held the condition determines one's fate.  In the Japanese tradition those consequences are ill fate and misfortune while the Chinese associate sanpaku with good luck and wealth and this divergence has interested cultural anthropologists who study the symbolism and mythologies of different societies.  The tradition divides the eyes into yin sanpaku and yang sanpaku, the roots of this the ancient Chinese concept of yin and yang, representing the duality of opposing yet complementary forces in the universe.  Yin and Yang are fundamental concepts in Chinese philosophy and represent complementary and interconnected aspects of the universe. Yin is associated with qualities such as darkness, femininity, passivity, and coldness, while Yang is associated with light, masculinity, activity, and warmth. They’re seen as opposing forces that are in a constant state of dynamic balance and they exist within all phenomena, including human physiology, nature and society.  In this they differ from the (wholly un-related) concept in particle physics of matter and anti-matter.  Matter is the familiar stuff which is much of the physical universe (particles such as protons, neutrons, and electrons) while anti-matter consists of particles with the same mass as their matter counterparts but carrying an opposite charges.  When matter and anti-matter particles come into contact, they can annihilate each other, releasing energy.  Ying and Yang, mutually dependent, live in peaceful co-existence.

In Japanese face reading, yang sanpaku eyes (white part visible above the iris) reveal a person's dark and sinister nature, the eyes indicating the unstable mental state suffered by individuals exhibiting uncontrollable aggression, such as psychopathic murderers or serial killers.  Yin Sanpaku Eyes (white part visible below the iris) signify a different physical or mental imbalance, one caused by the abuse of drugs, alcohol, and sugar which disrupt the body's equilibrium.  Sanpaku eyes are far from rare, half of the population estimated to have sanpaku eyes, with at least 0.25-millimeter space between the iris and the upper and lower eyelids while some 20% show a separation with 1 millimeter or more.  However, the more celebrated of the species, those with a gap of 2 millimeters or more are fewer than 1% of the total.  Although discouraged by all in the profession except the odd, entrepreneurial cosmetic surgeon, treatment options are available to “correct” scleral show and the most effect treatment is aesthetic plastic surgery, specifically the procedure called blepharoplasty, which can correct the appearance of the eyes.  The construct of blepharoplasty was blepharo- +‎ -plasty.  Blepharo- was from the New Latin, from the Ancient Greek βλέφαρον (blépharon) (eyelid; a feature resembling an eyelid) and -plasty was from the Ancient Greek πλαστός (plastós) (molded, formed) which now has the special meaning in medicine meaning "repair, restoration or re-shaping of part of the body with a surgical procedure".

The Mean Girls demonstrate the range:  Rachel McAdams (b 1978, far left) & Lindsay Lohan (b 1986, centre-left) are in the half of the population who are either not sanpakus or the effect is imperceptible.  Lacey Chabert (b 1982, centre-right) is in the 20% of the population with a separation around 1mm while Amanda Seyfried (b 1985, far right) is a one-percenter who displays up to 2mm depending on her expression.

That humans even have white scleras has interested linguistic anthropologists, evolutionary biologists and other researchers and some have offered the Cooperative Eye Hypothesis which suggest the distinctive appearance evolved as a mechanism with which to enhance non-verbal communication.  According to this hypothesis, the high visibility of the iris & pupil against the white background allows an interlocutor more easily to track eye movements, helping individuals to understand where others are looking during interactions.  Observational studies revealed the way humans and other great apes move their heads and eyes in different ways, humans relying more on eye movements than head movements to see where someone else is looking.  Apes, without the white component in their eyes, tend more to move the whole head.  Not all support the cooperative eye hypothesis but it’s an interesting approach to understanding the evolutionary significance of the human eye's appearance and the sophistication of communication is certainly a noted difference between humans and apes.

Mean Girls (2004) four-way phone call: Eye-rolls (top right) don't count.  A sanpaku is defined only by separation maintained when looking straight ahead.

Melancholia

Melancholia (pronounced mel-uhn-koh-lee-uh or mel-uhn-kohl-yuh)

(1) A mental condition characterized by great depression of spirits and gloomy forebodings, apathy, and withdrawal.

(2) In clinical psychiatry, endogenous depression (and a former name for depression).

1685-1695: From the Late Latin melancholia, from the Ancient Greek medical term μελαγχολία (melankholía) (blackness of the bile), from μέλας (mélas), the construct being μελαν- (melan-) (black, dark, murky) + χολή (kholḗ) (bile).  In English it originally meant "mental condition characterized by great depression, sluggishness, and aversion to mental action" and over the years many synonyms emerged: discontent, pain, distress, agony, desolation, despondency, discomfort, grief, suffering, despair, torment, affliction, woe, anguish, sadness, depression, unhappiness, abjection, dreariness, dolefulness et al.

The noun melancholiac (person afflicted with melancholy, one who is affected with mental gloom) dates in the medical literature from 1819 though earlier in the same vein were melancholian (1630s), melancholist (1590s) & (most numerously) melancholic (1580s).  The adjective melancholic then was still defined as "containing black bile" reflecting the continued influence of the medical tests from antiquity, this construction from the Late Latin melancholicus, from the Greek melankholikos (choleric), from melankholia (sadness (literally "(excess of) black bile")).  To describe the habitually gloomy souls thought afflicted with melancholia, use began in 1789 (apparently unrelated to anything else happening at the time).  It replaced both the mid-fourteenth century adjective melancholian and survived (for a while), melancholiac which enjoyed a brief vogue during the mid-1800s.  The early fourteenth century noun melancholy (mental disorder characterized by sullenness, gloom, irritability, and propensity to causeless and violent anger) was from the Old French melancolie & malencolie (black bile; ill disposition, anger, annoyance), again borrowed from the Late Latin, source also of the Spanish melancolia, the Italian melancolia, the German Melancholie and the Danish melankoli.  The Old French variant malencolie (which existed also in Middle English) was formed by a false association with mal (sickness).

Moving on: Avoiding loneliness is recommended as a way of staving off feelings of melancholia.  Lindsay Lohan in spoof eHarmony dating advertisement, posted after splitting from former special friend Samantha Ronson, 2009.

The physicians from Antiquity attributed mental depression to unnatural or excess "black bile," a secretion of the spleen and one of the body's four "humors," which help form and nourish the body unless altered or present in excessive amounts. The word also was used in Middle English to mean "sorrow, gloom" (brought on by unrequited love, disappointment etc).  In antiquity it was a concept rather than something with a standardized systemization and there existed competing models with more or fewer components but it’s because the description with four was that endorsed by the Greek physician Hippocrates (circa 460–circa 370 BC) that it became famous in the West and absorbed into medical practice.  The four humors of Hippocratic medicine were (1) black bile (μέλαινα χολή (melaina chole)), (2) yellow bile (ξανθη χολή (xanthe chole)), (3) phlegm (φλέγμα (phlegma)) & (4) blood (αἷμα (haima)), each corresponding with the four temperaments of man and linked also to the four seasons: yellow Bile=summer, black bile=autumn, phlegm=winter & blood=spring.  Since antiquity, doctors and scholars wrote both theoretical and clinical works, the words melancholia and melancholy used interchangeably until the nineteenth century when the former came to refer to a pathological condition, the latter to a temperament.  Depression was derived from the Latin verb deprimere (to press down) and from the fourteenth century, "to depress" meant to subjugate or to bring down in spirits and by 1665 was applied to someone having "a great depression of spirit", Dr Johnson (Samuel Johnson, 1709-1784) using the word in a similar sense in 1753.  Later, the term came into use in physiology and economics.

What was for over two-thousand years known as melancholia came gradually to be called depression, a reclassification formalized in the mid-twentieth century when mental illness was subject to codification.  The first edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM (1952)) included depressive reaction and the DSM-II (1968) added depressive neurosis, defined as an excessive reaction to internal conflict or an identifiable event, and also included a depressive type of manic-depressive psychosis within the category of Major Affective Disorders.  The term Major Depressive Disorder was introduced by a group of US clinicians in the mid-1970s and was incorporated into the DSM-III (1980).  Interestingly, the ancient idea of melancholia survives in modern medical literature in the notion of the melancholic subtype but, from the 1950s, the newly codified definitions of depression were widely accepted (although not without some dissent) and the nomenclature, with enhancements, continued in the DSM-IV (1994) and DSM-5 (2013)

Lululeika Ravn Liep (b 1998), 2015: An aesthetic of melancholia.

The cult of cultural and literary melancholia arose in England in the sixteenth and seventeenth centuries.  It had the curious effect of transforming the notion of melancholia from a dreadful affliction to an indispensable adjunct of the artistic spirit; the persona of the troubled genius began here.  The phenomenon spread to Europe, best known in the German Sturm und Drang (literally "storm and drive" but more accurately translated as "storm and stress") movement (1760s-1780s) exemplified by the works of Goethe (Johann von Goethe, 1749–1832) and is an identifiable thread in the romantic movement of the nineteenth century.

Choleric

Choleric (pronounced kol-er-ik or kuh-ler-ik)

(1) Extremely irritable or easily angered; irascible; bad-tempered.

(2) A person with a choleric temperament.

(3) A person suffering from the infectious disease cholera (rare).

1300–1350: From the Middle English colrik & colerik (bilious of temperament or complexion), from the Old French colerique, from the Medieval Latin colericus (bilious), from the Classical Latin cholericus, from the Ancient Greek cholerikós or kholerikós, from the Greek kholera (a type of disease characterized by diarrhea, supposedly caused by bile), from khole (gall, bile) and so-called for its color, related to khloazein (to be green) & khlōros (pale green, greenish-yellow), from the primitive Indo-European root ghel- (to shine), with derivatives denoting "green, yellow," and thus "bile, gall”.  The meaning "easily angered, hot-tempered" is from 1580s (based on the then-current medical orthodoxy of the supposed effect of excess choler) and the synonyms include wrathful, testy, impatient, touchy, bilious, irascible and peevish.  The more literal use "of or pertaining to cholera" dates only from 1834.  Choleric is a noun & adjective, cholerically & cholericly are adverbs and cholericness is a noun; the noun plural is cholerics.

Many have choleric moments; there are good days and bad days.

It was an excess of the humor of yellow bile (xanthe chole) which made one choleric.  Humoral (humor a translation of the Ancient Greek χυμός (chymos (literally juice or sap, figuratively flavor)) theory (known also as humorism or humoralism), was a system of medicine from antiquity which provided a framework and description of the supposed workings of the human body.  It was the standard model for the philosophers and physicians of Ancient Greek and Rome and endured in Western medicine well into the nineteenth century when many of its assumptions about physical illness were disproved by germ theory and the understanding of the role of pathogens in disease.  The overturning of humoral theory was one of the landmarks in the origins of modernity.

In antiquity it was a concept rather than something with a standardized systemization and there existed competing models with more or fewer components but it’s because the description with four was that endorsed by the Greek physician Hippocrates (circa 460–circa 370 BC) that it became famous in the West and absorbed into medical practice.  The four humors of Hippocratic medicine are black bile (μέλαινα χολή (melaina chole)), yellow bile (ξανθη χολή (xanthe chole)), phlegm (φλέγμα (phlegma)) & blood (αἷμα (haima)), each corresponding with the four temperaments of man and linked also to the four seasons: yellow bile=summer, black bile=autumn, phlegm=winter & blood=spring.  In Hippocratic medicine, to be healthy, the four humors needed to be in balance and this, once achieved, was the state of enkrateia (from the Ancient Greek ἐγκράτεια (eukrasia) (in power), the construct being ἐν (en-) (in-) + κράτος (krátos) (power), a word which appears in the New Testament in the context of virtues (Acts 24:25, Galatians 5:23 & 2 Peter 1:6).  In the King James Version (KJV, 1611), it would be translated as "temperance", a word which went on to assume a life of its own.

Spectrum condition: The redness in the face of Barnaby Joyce (b 1967; thrice deputy prime minister of Australia 2016-2021) is used by his colleagues to gauge where his state of mind lies in the adjectival progression of the choleric (left), the more choleric (comparative; centre) and the most choleric (superlative; right).  Mr Joyce’s symptoms (ambitious, leader-like, restless, easily angered) suggest an excess of yellow bile and to counteract this, Hippocrates recommended cold and wet foods such as cucumber or lettuce to bring the humors back into alignment.  Mr Joyce should adopt a cucumber & lettuce diet.

Inflammable & Flammable

Inflammable (pronounced in-flam-uh-buhl)

(1) Easily set on fire; combustible; incendiary, combustible, inflammable, burnable, ignitable (recommended only for figurative use).

(2) Easily aroused or excited, as to passion or anger; irascible; fiery; volatile, choleric.

1595–1605: From the Medieval Latin inflammābilis, the construct being the Classical Latin inflammā(re) (to set on fire) + -bilis (from the Proto-Italic -ðlis, from the primitive Indo-European i-stem form -dhli- of -dhlom (instrumental suffix).  Akin to –bulum, the suffix -bilis is added to a verb to form an adjectival noun of relationship to that verb (indicating a capacity or worth of being acted upon).  Construct of the Classical Latin inflammare (to set on fire) is -in (in, on) + flamma (flame).

Flammable (pronounced flam-uh-buhl)

Easily set on fire; combustible; incendiary, combustible, inflammable, burnable, ignitable

1805–1815: From the Classical Latin flammā(re) (to set on fire) + -ble (the Latin suffix forming adjectives and means “capable or worthy of”).

Need for standardization

Flammable and inflammable mean the same thing.  English, a mongrel vacuum-cleaner of a language, has many anomalies born of the haphazard adoption of words from other tongues but the interchangeability of flammable and inflammable is unfortunate because of the use in signs to warn people of potentially fatal danger.

In- is often used as a prefix with adjectives and nouns to indicate the opposite of the word it precedes (eg inaction, indecisive, inexpensive etc).  Given that, it’s reasonable to assume inflammable is the opposite of flammable and that objects and substances should be so-labeled.  The reason for the potentially deadly duplication is historic.  Inflammable actually pre-dates flammable, the word derived from the Latin verb inflammare (to set on fire), this verb also the origin of the modern meaning “to swell or to provoke angry feelings”, hence the link between setting something on fire and rousing strong feelings in someone.  So, at a time when Latin was more influential, inflammable made sense.  However, as the pull of Latin receded, words with in- (as a negative prefix) became a bigger part of the lexicon and the confusion was created.  By the early nineteenth century, flammable had become common usage, and by the twentieth was widespread.  The modern convention is to use flammable literally (to refer to things which catch fire) and inflammable figuratively (to describe the arousal of passions, the swelling of tissue etc.  Surprisingly, the rules applying to warning signs have yet to adopt this standardization.

Using flammable and inflammable to mean the same thing is confusing.  The preferred wording is flammable and non-flammable.  Borrowing from semiotics, danger should be indicated with red, safety with green.