Forme fruste

In medicine, a forme fruste (French, “crude, or unfinished, form”; pl., formes frustes) is an atypical or attenuated manifestation of a disease or syndrome, with the implication of incompleteness, partial presence or aborted state. The context is usually one of a well defined clinical or pathological entity, which the case at hand almost — but not quite — fits.

Some critics have asserted that the term forme fruste can be used to project an aura of authority for the clinician while concealing ignorance. An opposite term in medicine, forme pleine — seldom used by English-speaking physicians — means the complete, or full-blown, form of a disease.

Use

According to gastroenterologist William Haubrich:

A patient may exhibit sudden, intense, epigastric pain and a rigid abdomen. He is thought to have a perforated peptic ulcer. But at operation, only a penetrating ulcer is found, sealed off by adhesion to the omentum or anterior abdominal wall. Such a patient is said to have a forme fruste of acute free perforation as a complication of his peptic ulcer disease.

History

The Latin phrase frustra esse means "to be mistaken" or "to be confused". As a technical term in French, the cognate fruste has been used in two related ways. First, as an antiquarian’s term it refers to a coin, medal or ancient stone on which figures and characters can no longer be recognized due to wear. Secondly, it was employed in natural history to denote mollusk shells whose striations, grooves or tips were worn down. By extension, this sense could be applied to sculpture, pottery, or other objects of great antiquity.

It was in this sense of “indistinctness due to wear or through long use” that the great French internist Armand Trousseau (1801–67) first employed the term in connection with an obscured form of Graves' disease, which he described as a “…maladie dite fruste par l’absence du goitre et de l’exophthalmie” (“…disease said to be crude [i.e., indistinct] for its absence of goiter and exophthalmia”)

The sense of the term in medicine has slightly evolved to mean a “not fully developed form of an illness”, rather than simply an obscure form. Sigmund Freud often used the term forme fruste in connection with incomplete or obscured cases of neuroses and psychoses and thus the literature of psychoanalysis is replete with it. (An equivalent term in German is minimalvariante, but Freud used the French version.)

List of "forme fruste" medical syndromes

This list is incomplete; you can help by expanding it.

• "Forme fruste keratoconus", as opposed to "frank" keratoconus
• "Zona fruste", early name for zoster sine herpete (shingles without the rash)
• "Forme fruste mitral regurgitation" Mitral regurgitation due to fibroelastic deficiency with myxomatous changes (as apposed to fully formed degenerative changes seen in Barlow's disease).

See also

• Cryptogenic
• Diagnosis of exclusion