Syndrome

Syndrome (pronounced sin-drohm or sin-druhm)

(1) In pathology and psychiatry, a group of symptoms which together are characteristic of a specific disorder, disease or the like.

(2) A group of related or coincident things, events, actions etc; a predictable, characteristic pattern of behavior, action, etc., that tends to occur under certain circumstances.

1535–1545: From the Medical Latin syndrome (a number of symptoms occurring together), from the Ancient Greek συνδρομή (sundromḗ) (concurrence of symptoms, concourse of people), from σύνδρομος (súndromos) (literally "running together" and often used in the sense of "place where several roads meet"), the construct being συν- (syn-) (with) + δρόμος (drómos) (a running, course), best understood as syn- + dramein + -ē (the feminine noun suffix).  The meaning, beginning in 1540s medical Latin, is thus derived from the Ancient Greek syndromos (place where several roads meet); the psychological sense emerging only in 1955.  In general use, the synonyms include malady, problem, disorder, ailment, sickness, complaint, sign, complex, infirmity, affection, symptoms, diagnostics & prognostics; in medical use, the term syndrome is something also used loosely but in text books or academic use use is more precise.  Syndrome is a noun and syndromic is an adjective; the noun plural is syndromes.

In medicine, a syndrome is a collection of symptoms (some of which clinicians sometimes classify variously as “definitive” & “indicative”) which often manifest simultaneously and characterize a particular abnormality or condition.  The term is commonly used in medicine and psychology and syndromes can either be codified as diagnosable conditions or just part of casual language to describe aspects of the human condition (such as “Paris Hilton Syndrome” or “Lindsay Lohan Syndrome”).  A syndrome describes patterns of observable symptoms but does not of necessity indicate a condition’s cause or causes.  A syndrome does not need to be widespread or even suffered by more than one patient and a single case is all that is required for a syndrome to be defined; the symptoms need only to be specific.  Diagnosing a syndrome typically involves clinicians identifying the common symptoms and ruling out other possible conditions, something often complicated by the variability in severity and presentation among different individuals, many syndromes being classic examples of “spectrum conditions”.  Like any condition, the course of the treatment regime for a syndrome will focus on (1) managing the symptoms and (2) dealing with the underlying causes when known.

COVID-19

Art inspired by the pandemic caused by the COVID-19 syndrome, created by medical professionals: Outsized, Overwhelming Impact of COVID-19 by Lona Mody.

COVID-19 is a syndrome and the name allocated on 11 February 2020 by the World Health Organization (WHO) for the disease caused by the coronavirus SARS-CoV-2.  Although its origin remains most associated with Wuhan in late 2019, it may have been circulating earlier.  An acronym, COVID-19 stands for COronaVIrus Disease-2019 but the original working name for the virus causing the syndrome was 2019 novel coronavirus (2019-nCoV) which the International Committee on Taxonomy of Viruses (ICTV) changed to severe acute respiratory syndrome coronavirus (SARS-CoV-2).  The name is from the standard nomenclature of the discipline, chosen because the virus is a genetic cousin of the coronavirus which caused the SARS syndrome in 2002 (SARS-CoV).  The public tends not to distinguish between virus and syndrome, the popular names being Covid and corona.

Art inspired by the pandemic caused by the COVID-19 syndrome, created by medical professionals: Pipetting the Sample by Ali Al-Nasser.

First discovered in domestic poultry during the 1930s, coronaviruses cause a range of respiratory, gastrointestinal, liver, and neurologic diseases and are common in both humans and animals.  Only seven are known to cause disease in humans, four associated with the common cold; these have the catchy names 229E, OC43, NL63, and HUK1.  The three coronaviruses which cause serious lung infections (related to pneumonia) are SARS-CoV (Severe Acute Respiratory Syndrome) first noted in 2002, MERS-CoV (Middle East Respiratory Syndrome) which emerged in 2012 and SARS-CoV-2 (the COVID-19 pandemic).

Art inspired by the pandemic caused by the COVID-19 syndrome, created by medical professionals: Naturarte by Angela Araujo.

SARS-CoV, MERS-CoV and SARS-CoV-2 are zoonotic, beginning in an animal, transmitting, either directly or via another species, to people.  SARS-CoV-2 appears to be a mutated bat virus; bats host thousands of coronavirues and exist with them mostly in symbiotic harmony and it remains unclear whether the virus passed directly from bat to human or via some other creature.  Interestingly, while the nature of the COVID-19 syndrome hasn’t changed, the SARS-CoV-2 virus has mutated and now circulates in many strains, one tending to emerge as the dominant means of transmission in a given geographical area.  The dominance of the mutated strain happened because the mutation made the virus much more infectious so, in a classic example of Darwinian natural selection, the entity able more efficiently to multiply is the one which becomes dominant.  Despite early speculation, the mutation seems not to account for reductions in the COVID-19 death rate, a phenomenon virologists attribute to improved treatment the “harvesting effect”, meaning the virus first kills those easiest to kill.  There was also the effect of many dying early in the pandemic because health systems were overwhelmed and unable to provide the treatment which would have ensured their survival.  This has been noted in past wars, epidemics, pandemics and localized disasters.

Autobrewery

Autobrewery (pronounced aw-tuh-broor-ee (U) or aw-tuh-broo-uh-ree (non-U))

In the slang of clinical medicine, a clipping of “auto-brewery syndrome”, a condition in which the contents of the sufferer’s stomach ferment, creating alcohol (known also as “gut fermentation syndrome” (GFS), “endogenous ethanol fermentation” (EEF) or the more pleasing “drunkenness disease”).  The standard initialism is ABS).

1940s: The construct was auto- (used here as a prefix to mean “reflexive, regarding or to oneself”) + brewery (historically a building or establishment for brewing beer or other malt liquors, especially the building where the brewing is done.  The auto- prefix was a learned borrowing from Ancient Greek αὐτο- (auto-) (self-) (reflexive, regarding or to oneself (and most familiar in forms like autobiography)), from αὐτός (autós) (himself/herself/oneself), from either a construct of (1) the primitive Indo-European hew (again) + to- (that) or (2) the Ancient Greek reflexes of those words, αὖ (aû) (back, again, other) +‎ τόν (tón) (the) and related to Phrygian αυτος (autos), the existence of alternatives suggesting there may have been a common innovation.  Brewery was from the Dutch brouwerij (brewery), the construct being brew +‎ -ery.  Brew was from the Middle English brewen, from the Old English brēowan, from the Proto-West Germanic breuwan, from the Proto-Germanic brewwaną, from the primitive Indo-European bhrewh-.   It was cognate with the Dutch brouwen, the German brauen, the Swedish brygga, the Norwegian Bokmål brygge, the Ancient Greek φρέαρ (phréar) (well), the Latin fervēre (to be hot; to burn; to boil), the Old Irish bruth (violent, boiling heat) and the Sanskrit भुर्वन् (bhurván) (motion of water).  Etymologists suspect brew may be related to English “barley”.  The suffix -ery was from the Middle English -erie, from the Anglo-Norman and Old French -erie, a suffix forming abstract nouns.  The suffix first occurs in loans from the Old French into the Middle English, but became productive in English by the sixteenth century, sometimes as a proper combination of -er with “y” (as in bakery or brewery) but also as a single suffix (such as slavery or machinery).  Auto-brewery syndrome is a noun.

In medicine, a syndrome is a collection of symptoms (some of which clinicians sometimes classify variously as “definitive” & “indicative”) which often manifest simultaneously and characterize a particular abnormality or condition.  The term is commonly used in medicine and psychology and syndromes can either be codified as diagnosable conditions or just part of casual language to describe aspects of the human condition (such as “Paris Hilton Syndrome”).  A syndrome describes patterns of observable symptoms but does not of necessity indicate a condition’s cause or causes.  A syndrome does not need to be widespread or even suffered by more than one patient and a single case is all that is required for a syndrome to be defined; the symptoms need only to be specific.  Diagnosing a syndrome typically involves clinicians identifying the common symptoms and ruling out other possible conditions, something often complicated by the variability in severity and presentation among different individuals, many syndromes being classic examples of “spectrum conditions”.  Like any condition, the course of the treatment regime for a syndrome will focus on (1) managing the symptoms and (2) dealing with the underlying causes when known.

Researchgate’s illustration of the patho-physiological mechanisms of ABS.

Auto-brewery syndrome (known also as “gut fermentation syndrome” (GFS), “endogenous ethanol fermentation” (EEF) or the more pleasing “drunkenness disease”) is a rare and still not widely understood condition, first described in the medical literature during the 1940s.  The condition manifests in patients who exhibit all or some of the symptoms associated with alcohol-induced of intoxication despite not having consumed alcohol.  The early cases highlighted cases where patients had yeast in the gastrointestinal tract, this fermenting carbohydrates (turns sugary and starchy foods) into ethanol, leading to elevated blood alcohol levels.  Because of the rarity of the condition and the effectiveness of treatment regimes, study has been intermittent.

To certain groups (students in university engineering faculties come to mind), auto-brewery syndrome may sound a desirable (time & money saving) condition but for sufferers it can be debilitating and, if untreated, is potentially fatal.  There are legal implications too because those with ABS can appear intoxicated and if breath or blood-tested, can be “over-the-limit for various purposes.  The rarity of presentations (clinicians can in an entire career never see a case) also can mean a patient in somewhere like a hospital’s emergency ward will be assumed to be drunk, their protests of sobriety not believed.  Notably, many of the cases in the literature are those arrested for DUI (driving under influence), one woman in New York found to be have a blood alcohol concentration (BAC) some four times above the legal limit.  She wasn’t charged (despite an elevated BAC while in charge of a vehicle (which included bicycles, horses, donkeys, elephants and such) being an offence of absolute liability) because of the medical evidence.

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

However, a potential legal issue for sufferers is that ABS is also an “accelerant condition” in that one can become very drunk even if one’s consumption of alcohol has been minimal (less than one standard drink).  It would in such circumstances still be possible to mount an ABS-based defense to a charge of intoxication but a defendant’s evidential onus of proof would be higher (and technically often more difficult).  Symptoms and side effects are essentially similar to being drunk or having a hangover and include red or flushed skin, dizziness, disorientation, headache, nausea & vomiting, dehydration, dryness in the mouth, burping or belching, fatigue, problems with memory or concentration and mood changes.  Additionally, ABS can induce or worsen other conditions including chronic fatigue syndrome (CFS or ME) and irritable bowel syndrome (IBS) as well as general issues such as anxiety and depression.  The cause is an excess of yeast (a type of fungus) in the gut, the most common being Candida albicans, Candida glabrata, Torulopsis glabrata, Candida krusei, Candida kefyr and Saccharomyces cerevisiae (brewer’s yeast) and although most have concluded ABS is likely usually to be complication of another disease, imbalance, or infection in the body, the exact mechanism(s) have never been determined.  For other it could be simply a product of their specific genetic mix and both adults and children can be afflicted.  More recent research has revealed that in some cases problems with the liver may cause ABS; this happens when the liver is too slow to process alcohol and even small quantities of alcohol produced by gut yeast can produce symptoms.  An excess of yeast in the body can also be a consequence of the use of certain antibiotics, inadequate nutrition, diabetes and deficiencies in the immune system.

An engineering student, studying.

Although doctors tend to disapprove of “Dr Google” and other forms of self-diagnosis, a defensibly scientific approach for those who suspect they may suffer ABS is (1) abstain from the consumption of alcohol for 24 hours, (2) on an empty stomach eat some food high in carbohydrates and (3) after an hour use a home-breathalyzer to record one’s BAC.  Record the findings and repeat the test several times with different levels of carbohydrate consumption.  Such a test obviously is a challenge for engineering students, few of who abstain from alcohol for 24 hours but it can be done.  If a pattern emerges of an elevated BAC without any preceding consumption of alcohol, take the findings to a physician and seek a diagnosis and treatment.  Treatments can be as simple as reducing the consumption of carbohydrates or the use of antifungal medications.

Proxy

Proxy (pronounced prok-see)

(1) The agency, function, or power of a person authorized to act as the deputy or substitute for another.

(2) The person so authorized; substitute; agent.

(3) An authorization, usually in writing, empowering another person to vote or act for the signer, as at a meeting of stockholders.

(4) An ally or confederate who can be relied upon to speak or act in one's behalf.

(5) In computing, short for proxy server.

(6) In computing, as proxy server, an interface for a service, especially for one that is remote, resource-intensive, or otherwise difficult to use directly; technically a proxy server is a piece of software but in casual use the term is often applied also to the hardware on which it’s run.

(7) In the administration of the courts of canon law, the written appointment of a proctor in suits in the ecclesiastical courts.

(8) In science, a measurement of one physical quantity that is used as an indicator of the value of another.

(9) In munitions, a slang term for a proximity device (a mine, torpedo, missile etc) which explodes when in proximity to the target, rather than having to make physical contact.

(10)In geopolitics, as proxy war, a conflict between two or more state or non-state actors conducted on behalf of or with extensive support from other parties not directly participating in the hostilities except as “advisors”

(11) In psychiatry, as Munchausen syndrome by proxy (MSbP), a mental disorder in which a factitious disorder imposed on another for the purpose of gain the attention of medical professionals.  Now technically known as 

1400–1450: From the late Middle English prokesye, proccy & procusie (agency of one who acts instead of another, office or authority of a substitute; letter of power of attorney), a contraction of the Anglo-French procuracie and the Anglo-Norman procuracy & procuration, from the Medieval Latin procuratia, from the Latin prōcūrō (I manage, administer) & prōcūrātiō (a caring for, management) from procurare (manage).  The present participle was proxying, the simple past and past participle proxied and the noun plural proxies.

The meaning "person who is deputed to represent or act for another" is from 1610s whereas of things, "that which takes the place of something else" dates from the 1630s.  The practice of proxy voting has a long history but the term appears first to have been used Rhode Island in 1664 although then it described voters sending written ballots rather than attending the election, as opposed to would now be thought a “true” proxy system, as had be used in the assembly elections of 1647.  Proxy wars date from antiquity but the term seems first to have been used in 1955, during the high Cold War.  In computing, following the proxy server, there exists a whole ecosystem of related products & protocols including caching proxy, closed proxy, complexity-hiding proxy, dynamic proxy, firewall proxy, forward proxy, open proxy, protection proxy, remote proxy, smart-reference proxy, surrogate proxy, synchronization proxy etc.  In just about any field, there seem to be proxy somethings, including proxy statement, proxy indicator, proxy measurement, proxy abuse, proxy battle, proxy bullying, proxy card, proxy marriage, proxy murder, proxy pattern, proxy voting etc.

Munchausen syndrome by proxy (MSbP)

Although the American Psychiatric Association (APA) insist the condition has been re-named factitious disorder in another (FDIA), most still prefer the more poetic Munchausen syndrome by proxy (MSbP).  It also once was called factitious disorder imposed on another FDOA) or factitious disorder by proxy (FDP) but most agree MSbP is best.  Its primary characteristic is the production or feigning of physical or psychological symptoms in another person (usually a young child or sometimes but the proxy subject can be an adult or even an animal) under the care of the person with the disorder. The symptoms are problems which are inexplicable, persistent or resistant to interventions that, based on clinical experience, would have worked, after adequate evaluation and treatment attempts.  MSbP is a variation of Munchausen syndrome (which the APA list as factitious disorder (FD)), a mental disorder in which those affected feign (or sometimes even induce) disease, illness, injury, abuse, or psychological trauma to draw attention, sympathy, or reassurance to themselves.  The name is from the fictional character Baron Munchausen from the 1785 novel Baron Munchausen's Narrative of his Marvellous Travels and Campaigns in Russia, by German author Rudolf Erich Raspe (1736-1794), a collection of extraordinary stories, based (loosely) on the tales told by the real-life Baron Hieronymus Karl Friedrich, Freiherr von Münchhausen (1720-1797).  The real baron was prone to quite some exaggeration in the tales of his travels but never went as far as Herr Raspe who included in his volume the eighteenth century baron flying to the moon.

Factitious disorder (FD) is an umbrella category including a range of mental disturbances in which patients intentionally act physically or mentally ill without obvious benefits.  The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR (2000)) distinguished FD from malingering, which was defined as faking illness when the individual has a clear motive (typically to avoid work, benefit financially or evade legal difficulties).  FD used to be known as "hospital addiction", "pathomimia" or "polysurgical addiction" and variant names for individuals with FD included "hospital vagrants", "hospital hoboes", "peregrinating patients", "problem patients" and "professional patients".

The syndrome has a long tradition.  The English physician Hector Gavin (1815-1855) in 1843 published On Feigned and Factitious Diseases in which he documented, drawing mostly from the records of soldiers and seamen, the means used to simulate or produce symptoms and the best techniques a clinician could use to of uncover impostors.  Two thousand-odd years earlier, the noted Roma physician Aelius Galenus (Galen, 129-216 AD) wrote of six cases in his journals and from then to the present, the medical literature is littered with examples but modern, systematic study didn’t really begin until 1961 when British endocrinologist and haematologist Richard Asher (1912-1969) published a paper.  It had been Dr Asher who, in 1951, had coined the term Munchausen syndrome to describe a chronic subtype of FD and his work is worth reading even by the medically untrained and otherwise uninterested, such is the vivid quality of the writing and the seductive use of language.  It was in these years that the condition began more fully to be understood as distinct from malingering and the term Munchausen syndrome most appropriately refers to the subset of patients who have a chronic variant of FD with predominantly physical signs and symptoms.  In practice, however, many still use the term Munchausen syndrome interchangeably with FD.  The American Psychiatric Association first classified Munchausen syndrome in the third edition of the DSM (DSM-III 1980) so, historically, the condition was under-diagnosed and the current view is these patients feign illness or injury not to achieve a clear benefit, such as financial gain, but rather to gain the sympathy and special attention often given to people who are truly ill.  There is often a willingness to undergo painful or even risky tests and operations in order to obtain this attention.  Munchausen syndrome is considered a mental illness but can just as helpfully be thought a symptom because it is associated with severe emotional difficulties.

The term Munchausen syndrome by proxy was in 1977 coined by British pediatrician Roy Meadow.  Meadow became famous also for the rule he published in his 1977 book The ABC of Child Abuse, which stated that in a single family, "one sudden infant death is a tragedy, two is suspicious and three is murder, until proved otherwise", this coming to be known as "Meadow's Law" and influential among UK social workers and child protection agencies.  His framing of the rule reflected his dogmatism and his reputation suffered as a consequence of his being struck from the British Medical Register by the General Medical Council (GMC) because of the erroneous and misleading evidence he provided in several trials which resulted in wrongful convictions although GMC’s ruling was overturned on appeal, on what might be described as public policy grounds.  Dr Meadow subsequently voluntarily relinquished his registration, thereby ensuring he could not be compelled to appear before the GMC regarding any previous professional conduct.

MSbP however survived the controversy.  Those with FD tend to be women aged 20-40 years and employed in medical fields such as nursing or other discipline where those employed enjoy familiarity with medical technology while those with chronic FD (Munchausen syndrome) are predominately unmarried, white, middle-aged men estranged from their families.  Perpetrators of Munchausen syndrome by proxy are typically mothers who induce illness in their young children although the conduct by fathers or others is not unknown.  The causes of FD, whether physical or psychiatric, are difficult to determine because affected patients are often lost to follow-up when they leave the hospital.  Magnetic resonance imaging (MRI) has been used and abnormalities in the brain structure of some patients with chronic FD have been detected but this does no more than suggest the possibility there may be some biological or genetic factors in the disorder shouldn’t be excluded.  The results of EEG (electroencephalography) studies are usually reported as non-specific and the suggestions for the causes of these disorders cast a wide net including (1) traumatic events and numerous hospitalizations during childhood, (2) FD allows patients to feel in control as they never did in childhood, (3) a coping mechanism, learned and reinforced in childhood and, intriguingly, (4). The “care-eliciting behaviors” theory, a process of unconscious identification with an important person, who genuinely has the pathology the patient is feigning.

Many authors have also underscored the co-occurrence of some pathological personality traits or disorders such as (5) identity disturbance, (6) unstable interpersonal relationships and (7), recurrent suicidal or self-mutilating behaviors which are similar to those encountered in borderline personality disorder.  Also noted have been instances of deceitfulness, lack of remorse, reckless disregard for safety of self, repeated failure to sustain constant work behavior and the failure to conform to social norms but these are common features not only of FD but of many antisocial personality disorders.  There is little agreement or evidence as to what causes Munchausen syndrome or Munchausen syndrome by proxy. Some theories suggest that the patient (or caregiver) may have experienced just about any of the conditions or experiences suffered by those with a variety of mental disorders and there seems to be no one thing or subset either exclusive or predictive.

In the DSM-5 (2013), the FD conditions were placed in the category Somatic Symptom and Related Disorders and the most precise definitional clauses were added, FD assigned to individuals who falsify illness in themselves or in another person, without any obvious gain  This combination of intentional falsification and lack of any obvious gain sets factitious disorder apart from similar conditions, such as somatic symptom disorder (where someone seeks excessive attention for genuine concerns) and malingering (where an individual falsifies symptoms for personal gain).  The condition is noted as both to diagnose and treat and, being rare (1% of individuals in hospital present with criteria matching the disorder), but the prevalence of factitious disorder throughout the general population is unknown.  Diagnosis of factitious disorder often requires a number of investigatory steps in order to accurately identify the condition without wrongful accusation, and treatment options can be both limited and difficult to administer if the individual refuses to admit the deception.  There are four primary criteria for diagnosing factitious disorder:

(1) Intentional induction or falsification of physical or psychological signs or symptoms.

(2) The individual presents themselves as ill, impaired or injured to others.

(3) The deceptive behavior persists even in the absence of external incentives or rewards.

(4) Another mental disorder does not better explain the behavior.

Factitious disorder may be diagnosed as either a single episode or as recurrent episodes (two or more instances of illness falsification and/or induction of injury) and Factitious disorder in another (formerly known as previously called Munchausen syndrome by proxy) may be broadly diagnosed using essentially the same four criteria as:

(1) Intentional induction or falsification of physical or psychological signs or symptoms in another person.

(2) The individual presents another individual (the victim) as ill, impaired or injured to others.

(3) The deceptive behavior persists even in the absence of external incentives or rewards.

(4) Another mental disorder does not better explain the behavior.

As with factitious disorder, factitious disorder in another may be diagnosed as either a single episode or as recurrent episodes (two or more instances of illness falsification and/or induction of injury). With factitious disorder in another, the victim may be assigned an abuse diagnosis as a result of the perpetrator’s behavior or actions.

Asperger

Asperger (pronounced a-spuh-guh or a-spr-gr)

(1) In neo-paganism and modern witchcraft, a ceremonial bundle of herbs or a perforated object used to sprinkle water (in spells as “witches water”), usually at the commencement of a ritual.

(2) In neurology, as Asperger's syndrome (less commonly Asperger syndrome), an autism-related developmental disorder characterised by sustained impairment in social interaction and non-verbal communication and by repetitive behaviour as well as restricted interests and routines.  The condition was named after Austrian pediatrician Hans Asperger (1906–1980).

Pre-1300: The surname Asperger was of German origin and was toponymic (derived from a geographical location or feature).  The town of Asperg lies in what is now the district of Ludwigsburg, Baden-Württemberg, in south-west Germany and in German, appending the suffix “-er” can denote being “from a place”, Asperger thus deconstructs as “someone from Asperg” and in modern use would suggest ancestral ties to the town of Asperg or a similar-sounding locality.  Etymologically, Asperg may be derived from older Germanic or Latin roots, possibly meaning “rough hill” or “stony mountain” (the Latin asper meaning “rough” and the German berg meaning “mountain or hill”.  The term “Asperger’s syndrome” was in 1976 coined by English psychiatrist Lorna Wing (1928–2014), acknowledging the work of Austrian pediatrician Hans Asperger (1906–1980).  Dr Wing was instrumental in the creation of the National Autistic Society, a charity which has operated since 1962.  Asperger is a noun (capitalized if in any context used as a proper noun).  Aspergerian & Aspergic are nouns; the noun plural forms being Aspergers, Aspergerians & Aspergics.  In the literature, Aspergerian & Aspergic (of, related to, or having qualities similar to those of Asperger's syndrome (adjective) & (2) someone with Asperger's syndrome (noun)) appear both to have been used.  In general use “Asperger's” was the accepted ellipsis of Asperger's syndrome while the derogratory slang forms included Aspie, autie, aspie, sperg, sperglord & assburger, now all regarded as offensive in the same way “retard” is now proscribed.

The noun asperges described a sprinkling ritual of the Catholic Church, the name was applied also to an antiphon intoned or sung during the ceremony.  It was from the Late Latin asperges, noun use of second-person singular future indicative of aspergere (to scatter, strew upon, sprinkle), the construct being ad (to, towards, at) + spargere (to sprinkle).  The use in Church Latin was a learned borrowing from Latin aspergō (to scatter or strew something or someone; to splash over; to spot, stain, sully, asperse; besmirch; (figuratively) to bestow, bequeath something to, set apart for) the construct being ad- +‎ spargō (strew, scatter; sprinkle; moisten).  The origin lay in the phrase Asperges me, Domine, hyssopo et mundabor (Thou shalt sprinkle me, O Lord, with hyssop, and I shall be cleansed), from the 51^st Psalm (in the Vulgate), sung during the rite of sprinkling a congregation with holy water.  Hyssop (any of a number of aromatic bushy herbs) was from the Latin hȳsōpum, from the Ancient Greek ὕσσωπος (hússōpos), of Semitic origin and the idea was would be cleansed of one’s sins.  In the Old English the loan-translation of the Latin aspergere was onstregdan.

The three most recent popes demonstrate their aspergillum (also spelled aspergill) technique while performing the sprinkling rite.  In the more elaborate rituals, it's often used in conjunction with a container called an aspersorium (holy water bucket).  Benedict XVI (1927–2022; pope 2005-2013, pope emeritus 2013-2022, left), Francis (1936-2025; pope 2013-2025, centre) and Leo XIV (b 1955; pope since 2025, right).

In the Christian liturgy, an aspergillum was used to sprinkle holy water and the borrowing, adaptation and re-purposing of ceremonies, feasts days and such from paganism widely was practiced by the early Church.  In the Bible (notably chapter 14 in the Old Testament’s Book of Leviticus) there are descriptions of purification rituals involving the use of cedar wood, hyssop, and scarlet wool to create an instrument for sprinkling blood or water and historians sometimes cite this as “proto-aspergillum”.  While it seems the earliest known use on English of “aspergillum” dates from 1649, the documentary evidence is clear the practice in the Christian liturgy was ancient and common since at least the tenth century.  Exactly when the ritualistic practice began isn’t known but because water is so obviously something used “to cleanse”, it’s likely it has been a part of religious rituals for millennia before Christianity.

Asperger ceremonial herb bundle.

The use of the “asperger” in neo-paganism & witchcraft was a continuation of the concept and well documented in the remarkably prolific literature (some book shops have dedicated sections) devoted to modern witchcraft and the construction of the objects (a bundle of fresh herbs or a perforated object for sprinkling water) is a lineal descendent of the aspergillum of the Medieval church and that makes sense, both institutions devoted to the process of cleansing although the targets may have differed.  According to Ancient Pathways Witchcraft (which sounds an authoritative source), although it’s the fluid which does the cleansing, the asperger is significant because it symbolizes “the transformative and cleansing properties of water…”, rinsing away “…spiritual debris that might interfere with the sanctity of rituals.”  In both neo-paganism and witchcraft, the herbs used may vary and while, pragmatically, sometimes this was dictated by seasonal or geographical availability, priests and witches would also choose the composition based on some “unique essences” being better suited to “enhance the sacred water's effectiveness”.  Nor were herbs always used for, as in the rituals of the church, “an asperger might be a metal or wooden rod designed with perforations or an attached mesh”, something like a “small brush or a dedicated holy water sprinkler akin to those seen in Christian liturgy.”  Again, it was the sprinkling of the water which was the critical element in the process, the devices really delivery systems which, regardless of form, existed to transform simple water into “a divine medium of purity and transformation.”  That said, their history of use did vest them with tradition, especially when certain herbs were central to a spell.

Dr Hans Asperger at work, Children's Clinic, University of Vienna, circa 1935.

The term “Asperger’s syndrome” first appeared in a paper by English psychiatrist Lorna Wing (1928–2014) although use seems not to have entered the medical mainstream until 1981.  Dr Wing (who in 1962 was one of the founders of the charitable organization the National Autistic Society) named it after Austrian pediatrician Hans Asperger (1906–1980) who first described the condition in 1944, calling it autistischen psychopathen (autistic psychopathy).  Dr Wing was instrumental in the creation of the National Autistic Society, a charity which has operated since 1962.  The German autistischen was an inflection of autistisch (autistic), the construct being Autist (autistic) +‎ -isch (an adjectival suffix).

Dementia Praecox, oder Gruppe der Schizophrenien (1911) by Eugen Bleuler.

The English word autism was from the German Autismus, used in 1913 by Swiss psychiatrist and eugenicist Eugen Bleuler (1857-1939), the first known instance dating from 1907 and attributed by Swiss psychiatrist & psychotherapist Carl Jung (1875-1961) as an alternative to his earlier “auto-erotism” although in his book Dementia Praecox, oder Gruppe der Schizophrenien (Precocious Dementia, or Group of Schizophrenias, 1911) Bleuler differentiated the terms.  The construct of the word was the Ancient Greek αὐτός (autos) (self) + -ισμός (-ismós) (a suffix used to form abstract nouns of action, state or condition equivalent to “-ism”).  Being a time of rapid advances in the relatively new discipline of psychiatry, it was a time also of linguistic innovation, Dr Bleuler in a Berlin lecture in 1908 using the term “schizophrenia”, something he’d been using in Switzerland for a year to replace “dementia praecox”, coined by German psychiatrist Emil Kraepelin's (1856-1926).  What Dr Bleuler in 1913 meant by “autistic” was very different from the modern understanding in that to him it was a symptom of schizophrenia, not an identifiably separate condition.  In the UK, the profession picked this up and it was used to describe “a tendency to turn inward and become absorbed in one's own mental and emotional life, often at the expense of connection to the external world” while “autistic thinking” referred to those who were “self-absorbed, fantasy-driven, and detached from reality; thinking patterns, commonly seen in those suffering schizophrenia.”

Looking Up was the monthly newsletter of the International Autism Association and in Volume 4, Number 4 (2006), it was reported Lindsay Lohan’s car had blocked the drop-off point for Smashbox Cares, a charity devoted to teaching surfing to autistic youngsters.  Arriving at the designated spot at Malibu’s Carbon Beach, the volunteers were delayed in their attempt to disembark their charges, something of significance because routine and predictability is important to autistic people.  To make up for it, Ms Lohan staged an impromptu three hour beach party for the children, appearing as a bikini-clad DJ.  Apparently, it was enjoyed by all.

Autistic Disturbances of Affective Contact (1943) by Leo Kanner.

The modern sense of “autistic” began to emerge in the 1940s, among the first to contribute the Austrian-American psychiatrist Leo Kanner (1894–1981) who in 1943 published a paper using the phrase “early infantile autism” to describe a distinct syndrome (which now would be understood as autism spectrum disorder).  The following year, in Vienna, Dr Asperger wrote (seemingly influenced by earlier work in Russia) of his observational studies of children, listing the behaviors he associated with the disorder and unlike some working in the field during the 1940s, Dr Asperger wasn’t wholly pessimistic about his young patients, writing in Autistic Psychopathy in Childhood (1944): “The example of autism shows particularly well how even abnormal personalities can be capable of development and adjustment. Possibilities of social integration which one would never have dreamt of may arise in the course of development.”  Many of the documents associated with Dr Asperger’s work were lost (or possibly taken to the Soviet Union) in the chaotic last weeks of World War II (1939-1945) and it wasn’t until Dr Wing in the 1970s reviewed some material from the archives that his contributions began to be appreciated although not until 1992 did “Asperger’s Syndrome” became a standard diagnosis.

DSM IV (1994).  Not all in the profession approved of the reclassification of Asperger’s syndrome under the broader Autism Spectrum Disorder, believing it reduced the depth of diagnostic evaluation, flattened complexity and was disconnected from clinical reality.  There was also regret about structural changes, DSM-5 eliminating the multiaxial system (Axes I–V), which some clinicians found useful for organizing information about the patient, especially Axis II (personality disorders) and Axis V (Global Assessment of Functioning).

Asperger’s Syndrome first appeared in the American Psychiatric Association's (APA) classification system when it was added to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 1994) and the utility for clinicians was it created a sub-group of patients with autism but without a learning disability (ie characterized by deficits in social interaction and restricted interests, in the absence of significant language delay or cognitive impairment), something with obvious implications for treatment.  In the DSM-5 (2013), Autism Spectrum Disorder (ASD) was re-defined as a broader category which combined Asperger syndrome, Autistic Disorder & PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified) into a single ASD diagnosis, the editors explaining the change as a reflection of an enhanced understanding of the condition, the emphasis now on it being something with varying degrees of severity and presentation rather than distinct types.

However, although after 2013 the term no longer appeared in the DSM, it has remained in popular use, the British military historian Sir Antony Beevor (b 1946) in Ardennes 1944 (2015, an account of the so-called "Battle of the Bulge") speculating of Field Marshal Bernard Montgomery (First Viscount Montgomery of Alamein, 1887–1976) that "one might almost wonder whether [he] suffered from what today would be called high-functioning Asperger syndrome."  The eleventh release of the World Health Organization’s (WHO) International Classification of Diseases (ICD) (ICD-11) aligned with the DSM-5 and regards what once would have been diagnosed as Asperger’s Syndrome to be deemed a relatively mild manifestation of ASD.  The diagnostic criteria for ASD focus on deficits in social communication and interaction, as well as repetitive behaviors and interests.  Although no longer current, the DSM IV’s criteria for Asperger's Disorder remain of interest because while the label is no longer used, clinicians need still to distinguish those in the spectrum suffering some degree of learning disability and those not so affected:

DSM-IV diagnostic criteria for Asperger’s Disorder (299.80).

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.

(2) failure to develop peer relationships appropriate to developmental level.

(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (eg by a lack of showing, bringing, or pointing out objects of interest to other people).

(4) lack of social or emotional reciprocity.

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.

(2) apparently inflexible adherence to specific, non-functional routines or rituals.

(3) stereotyped and repetitive motor mannerisms (eg hand or finger flapping or twisting, or complex whole-body movements).

(4) persistent preoccupation with parts of objects.

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning

D. There is no clinically significant general delay in language (eg single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

The term in the twenty-first century became controversial after revelations of some of Dr Asperger's activities during the Third Reich (Austria annexed by Germany in 1938) which included his clinic in Vienna sending selected children to be victims of Aktion T4 (a mass-murder programme of involuntary euthanasia targeting those with disabilities), an operation which ran at times in parallel with the programmes designed to exterminate the Jews, Gypsies, homosexuals and others.  While there is no surviving documentary evidence directly linking Dr Asperger to the selection process which decided which children were to be killed, researchers have concluded the records suggest his construction of what came later to be called “Asperger’s syndrome” was actually that very process with an academic gloss.  Because those Dr Asperger so categorized were the autistic children without learning difficulties, they were thus deemed capable of being “cured” and thus spared from the T4’s lists, unlike the “uneducable” who would never be able to be made into useful German citizens.  While the surviving material makes clear Dr Asperger was at least a “fellow traveller” with the Nazi regime, in professional, artistic and academic circles there was nothing unusual or even necessarily sinister about that because in a totalitarian state, people have few other choices if they wish to avoid unpleasantness.  However, it does appear Dr Asperger may have been unusually co-operative with the regime and his pre-1945 publication record suggests sympathy with at least some aspects of the Nazis’ racial theories and eugenics.

Valetudinarian

Valetudinarian (pronounced val-i-tood-n-air-ee-uhn or val-i-tyood-n-air-ee-uhn)

(1) An individual in chronically poor health; sickly; an invalid.

(2) An individual who believes themselves in chronically poor health.

(3) An individual obsessively or excessively concerned about their health or ailments; a hypochondriac.

(4) Of, relating to, or characterized by invalidism.

1695-1705: A learned borrowing from the Latin valētūdinārius, from valētūdō (state of health (good, bad or indifferent) (from valeō (to be strong) or valēre), the construct being valēre (be strong (from the primitive Indo-European root wal- (to be strong)) + -tudo (the abstract noun suffix).  The construct of valetudinarian was the now obsolete valetudinar(y) (Sickly, infirm) + -ian.  The suffix -ian was a euphonic variant of –an & -n, from the Middle English -an, (regularly -ain, -ein & -en), from the Old French –ain & -ein (or before i, -en), the Modern French forms being –ain & -en (feminine -aine, -enne), from the Latin -iānus (the alternative forms were -ānus, -ēnus, -īnus & -ūnus), which formed adjectives of belonging or origin from a noun, being -nus (cognate with the Ancient Greek -νος (-nos)), preceded by a vowel, from the primitive Indo-European -nós.  It was cognate with the English -en.  Valetudinarian & valetudinary are nouns & adjectives and valetudinarianism & valetudinariness are nouns; the noun plural is valetudinarians.

The form valetudinarian (one who is constantly concerned with his own ailments) was in use by 1703 and developed from the adjective valetudinary, documented as early as the 1580s and is an example of the profligate ways of English being nothing new, hypochondriac (as both a noun & adjective) first noted in the 1570s, developed from the earlier noun hypochondria which was in use as early as the 1550s.  Like hypochondriacs, the valetudinarian is on a spectrum, the comparative “more valetudinarian”, the superlative “most valetudinarian”).  Hypochondria was from the Late Latin, from the Ancient Greek, the neuter plural of Greek ὑποχονδριακός (hupokhondriakós (pertaining to the upper abdomen which, in the medical orthodoxy of Antiquity, was the supposed seat of the condition of melancholy).  The construct of the anatomical area the ὑποχόνδριος (hupokhóndrios) (the region between the ribs and navel) was ὑπό (hupó) (below) + χόνδρος (khóndros) (cartilage).  One very modern derived form was the portmanteau noun cyberchondriac, the construct being cyber- (the prefix here used as a clipping of cyberspace thus denoting the Internet, or computers generally) +‎ (hypo)chondriac.  First documented in 1997, a cyberchondriac belongs to a subset of hypochondriacs who research their medical condition(s) (real, imagined and, more controversially, desired) using the internet, thus the popular label “Dr Google”.

Lindsay Lohan in hospital bed in I Know Who Killed Me (2007).

The most extreme (or skillful) of the valetudinarians & hypochondriacs often seek to spend as much time as possible admitted to hospital ignoring the warning of Evelyn Waugh (1903-1966) that “…the greatest danger to one in hospital is being murdered by the doctors.”, a phenomenon thought statistically under-recorded because the legal system is complicit in allowing an extraordinary definitional largess in the matter of “medical misadventure”.  “Medical misadventure” is a deliciously vague term which began as a way to add a scientific gloss to “act of God” but it has come to appear with such frequency in tort cases and coronial inquests that some doctors claim it now conveys the very implication of “responsibility” to profession originally concocted the phrase to avoid.  Some have suggested it be replaced with “death while under medical care” but the way the linguistic treadmill works means that this too would come similarly to be vested with the same hint of guilt.

The baron surprising gunners by arriving on a cannonball, an illustration from a nineteenth century edition of The Adventures of Baron Munchausen by Rudolf Erich Raspe.

At the margins, it can be hard to tell where hypochondria end and Munchausen syndrome begins.  Munchausen syndrome (also known as factitious disorder (FD)) is a rare type of mental disorder in which a person fakes illness, either by lying about their symptoms or using some trick or technique to make themselves appear unwell.  There are cases in the literature where the conditions have overlapped, patients, convinced they are suffering some ailment despite the contrary opinion of physicians, inducing the requisite symptoms by some means in order to be admitted to hospital.  There, they assume they’ll be more closely examined and their elusive conditioned diagnosed.

That, like hypochondria, can be understood as an aspect of the human condition but what is truly mysterious is what the American Psychiatric Association (APA) insist has been re-named factitious disorder in another (FDIA): Munchausen syndrome by proxy (MSbP).  It also once was called factitious disorder imposed on another FDOA) or factitious disorder by proxy (FDP) but most agree MSbP is best.  Its primary characteristic is the production or feigning of physical or psychological symptoms in another person (usually a young child or but the proxy subject can be an adult or even an animal) under the care of the person with the disorder. The symptoms are problems which are inexplicable, persistent or resistant to interventions which, based on clinical experience, would have worked, after adequate evaluation and treatment attempts.  MSbP is a variation of Munchausen syndrome (which the APA lists as factitious disorder (FD)), a mental disorder in which those affected feign (or sometimes even induce) disease, illness, injury, abuse, or psychological trauma to draw attention, sympathy, or reassurance to themselves.  The name is from the fictional character Baron Munchausen from the 1785 novel Baron Munchausen's Narrative of his Marvellous Travels and Campaigns in Russia, by German author Rudolf Erich Raspe (1736-1794), a collection of extraordinary stories, based (loosely) on the tales told by the real-life Baron Hieronymus Karl Friedrich, Freiherr von Münchhausen (1720-1797).  The real baron was prone to quite some exaggeration in the tales of his travels but never went as far as Herr Raspe who included in his volume the eighteenth century baron flying to the moon.

So valetudinarian & hypochondriac are synonyms as use of the former evolved in English, losing the specific senses enjoyed in antiquity and that one became popular and one fell into obscurity is the way the language develops.  While it can be argued it might have been useful had the valetudinarian retained the sense “an individual in chronically poor health; sickly; an invalid”, there’s hardly a lack of words and phrases to describe that.  Although hypochondria & hypochondriac remain common in popular use (whereas valetudinarian and the related forms are used only by historians or as a literary device), in the lexicon of medicine & psychiatry they endured (officially) only until the early twenty-first century.  Hypochondria (historically known as hypochondriasis) did appear in the earlier editions of the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM), last used in the DSM-IV-TR (Text Revision, 2000) when Hypochondriasis listed as a somatoform (having no physical or organic cause) disorder but when the fifth edition (DSM-5) was released in 2013, the terms were replaced with two classifications said better to capture the range of symptoms associated with the condition:

Somatic Symptom Disorder (SSD): SSDs are characterized by one or more somatic (physical) symptoms that are distressing or result in significant disruption of daily life, causing the patient excessive numbers of troubling thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns.

Illness Anxiety Disorder (IAD): IADs are characterized by a preoccupation with having or acquiring a serious illness.  Individuals with IAD have minimal or no somatic symptoms but exhibit a high level of anxiety about health and frequently engage in excessive health-related behaviors which can include seemingly contradictory behavior patterns such as repeatedly & obsessively checking their bodies for symptoms of illness or exhibit maladaptive avoidance, the most common of which is not attending medical consultations.

The tenth edition of the World Health Organization’s (WHO) International Classification of Diseases (ICD-10, 1990) classified hypochondriasis as a mental and behavioral disorder (substantively unchanged in ICD-11, 2018) but the trend in recent decades has been for the DSM & ICD to align so there may in the future be changes to either.

Trends of use 1800-2019: Hypochondriac & Valetudinarian.

Impressionistically, the decline in use of valetudinarian is unsurprising and the twenty-first century resurgence probably reflects nothing more than proliferation of on-line dictionaries, etymology sites and lists of bizarre, archaic & unusual words.  Just as impressionistically, it seems remarkable hypochondriac appears more frequently to have appeared in print in throughout the nineteenth century than today.

Because of the way Google harvests data for their ngrams, they’re not literally a tracking of the use of a word in society but can be usefully indicative of certain trends, (although one is never quite sure which trend(s)), especially over decades.  As a record of actual aggregate use, ngrams are not wholly reliable because: (1) the sub-set of texts Google uses is slanted towards the scientific & academic and (2) the technical limitations imposed by the use of OCR (optical character recognition) when handling older texts of sometime dubious legibility (a process AI should improve).  Where numbers bounce around, this may reflect either: (1) peaks and troughs in use for some reason or (2) some quirk in the data harvested.