The constitution of man, its role in the development of diseases
Definition of the concept. Classification of constitutional types
The constitution of the person (from Lat. constitutio - property, the state, the device) is a set of genotypic and phenotypic properties and characteristics (morphological, biochemical, psychological, and functional) of the body, the relative stable, prevailing in certain natural and social conditions ensuring its safety features and determining the identity reaction to the stimulus.
Attempts to establish the characteristics features of human according to response types were made in ancient times, among them the most important are the views of Hippocrates, who is the founder of the constitution doctrine. He created the first classification of constitutional types. Hippocrates’ first several types of constitution are good and bad, strong and weak, dry and wet, limp and flexible. However, in the future, not satisfied with these very general criteria, he laid the basis for determining the properties of people's temperament. Temperament (Latin temperamentum - proportionality) is a complex dynamic characteristic of the human mind, including the emotional and general (motor and speech) activity.
Imagining that the body has four major juices: blood (secreted by the heart), phlegm (secreted by the brain), yellow bile (secreted by the liver) and black bile (secreted by the pleen), and the essence of disease is improperly mixture (discrasis) of these four major juices. Hippocrates identified four basic temperaments of people.
Choleric – with predominance of yellow bile; excitable, easily passes into the state of oppression.
Melancholic – with majority of black bile; insecure, unsatisfied.
Sanguine – with majority of blood; good-humored, but not deep.
Phlegmatic – with majority of slime; inert, always calm, even-tempered, "stagnant."
Hippocrates merit is that he "caught in a mass of innumerable variants of human behavior capital features" (I. P. Pavlov). The selection of body types and mental constitution was practical: to establish the type associated with the diagnosis and treatment of patients, because, according to Hippocrates, each type is predisposed to certain diseases. He proposed the principle of people division into types of stature and temperament that relevant to this day.
Later Galen, based on the provisions of Hippocrates, introduced the concept of habitus (Lat. looks, external appearance). According to Galen habitus associated with a predisposition to certain diseases and health depends on the structural features and functions of the body, and on the way of life. Humoral pathology of Hippocrates and Galen was based on the idea of the integrity of the body, the coordinated activity of its parts. For centuries, the doctrine remained almost unchanged.
With the accumulation of evidence about the importance of the human body individual characteristics in the occurrence and progression of disease, a lot of (more than 40) different types of constitution classifications appeared. There were attempts to establish a set of types using morphological or functional characteristics of the organism, which are typical for large groups of people.
One of the classifications based on this principle in medicine and received wide distribution, is the classification of Sigaud (Sigaud, 1914), under which it has been allocated four main body types.
1. Respiratory type. Characterized by the rapid development of the chest in length with sharp epigastric angle, long neck, well-developed maxillary and frontal sinuses, the hexagonal shape of the face (Fig. 2a).
2. Digestive type. Short wide chest with a dull epigastric angle, voluminous belly, well developed lower third of the face, short neck (Fig. 2b).
3. Muscular type. Has a well-developed muscles, broad chest, body balance, high shoulders, square face shape (Fig. 2c).
4. Cerebral type. Large skull with a highly developed frontal part of the face; a thin delicate figure, short limbs, poor muscle development. People of this type are "sources of outstanding personalities" (Fig. 2d).
Sigaud’s classification based on external signs, in greater or lesser development of different systems of the body regardless of its physiological characteristics. Sigaud believed that the constitution of man is influenced by training, mainly in childhood.
German neurologist and psychiatrist E. Kretschmer (Kretsmer, 1888-1964) attempted to establish a link between body types and mental characteristics of a human. External signs of types that he described are similar to the Sigaud’s types:
1. Asthenic (gr. stenos - force). Has a schizoid character (shizotimik) - closed, irritable, cold, affective, autistic, uncommunicative, likes solitude; the mind, the imagination, the cold logic dominate in him; dissociation between affective and intellectual spheres, "seeker of fine forms."
2. Pyknic. Cycloidal character (cyclothymic) - cheerful, good-humored, charming, with a sincere soft-mind, likes to joke, active, easy to converge with people, in the art such people develop empirical direction, in science - popularizers. Feelings are prevailing, characterized by frequent mood swings from boom to fall.
3. Athletic type. Characterized by epileptic character - monotonous, punctual, diligent, melancholic, "meticulous."
Until today, adopted at the clinic is the classification of M. V. Chernorutsky (1884-1957), who developed a method of anthropometric diagnosis of somatotype and terminology; gave a summary of the functional differences between extreme types, using additions of other authors M. V. Chernorutsky identified three types – asthenics, hypersthenics, normosthenics – considering the morphological, biochemical, and functional features of human nature, prone to a particular disease. Distinguished by the Pine index [growth - (body weight + chest circumference)], these basic types of constitutions are morphologically similar to the types of Sigaud and Kretschmer.
It is typical for the astenics to have preferential growth in length, slim and light body built and weakness of their total development. Limbs predominate over relatively short trunk, chest is over the abdomen and longitudinal dimensions dominate over cross over. Small size of the heart, lungs is long and relatively large, short gut, a long mesentery, the low state of the diaphragm. Dissimilation processes predominate. These people are characterized by increased excitability of the nervous system.
It is typical for hypersthenics to be of the increased width, the massiveness, good nutritional state; they have relatively long body and short legs, the relative abundance of the abdomen over the chest, and the transverse dimensions over the longitudinal. They are characterized by a relatively large heart, located transversely in the high standing aperture wide aorta, lungs are short and of relatively small size, bulky stomach, intestines are long. Hypersthenics (picnics) are sociable, lively, practical. The processes of assimilation dominates, the sex and adrenal glands are usually elevated, these people have a relatively higher level of blood pressure.
The normostenics - (athletic type people) are energetic, self-confident.
Another approach to the classification of constitutions is based on the functional state of individual systems. So, Eppinger and Hess (1910), based on the provisions of the antagonism of the sympathetic and parasympathetic nervous systems, divided all people into vagotonics and sympathicotonics.
The theory of vagotonia and sympathicotonia was based on the misconception about the absolute opposite physiological significance of sympathetic and parasympathetic nervous systems.
AABogomolets (1881-1946) believed the connective tissue, which is the active mesenchyme to be the main in the body. "Active mesenchyme - he wrote - is the root of life." According to the state of the connective tissue he singled out four types of constitution: asthenic - dominated by thin, delicate connective tissue, fibrous (predominant dense, fibrous connective tissue), pasty (prevalence of loose connective tissue), lipomatous (excessive development of fat tissue). AABogomolets paid attention to the important role of the endocrine and autonomic nervous systems in the formation of the constitution.
IP Pavlov’s (1849-1936) teaching about the types of higher nervous activity significantly influenced the development of ideas about the Constitution. IP Pavlov believed that first of all the typological features of the nervous system should be considered in defining the constitutional the properties of the body. These features manifest itself in particular responses of the body. He created a classification of the types of higher nervous activity in animals and humans, which was built on the basic properties of the nervous processes (excitation and inhibition), i.e. their strength, balance and mobility. IP Pavlov referred his classification to the classification of temperament developed by Hippocrates, but IP Pavlov put it on a scientific basis.
4 types corresponding to the temperaments singled out by Hippocrates were identified:
- Strong, balanced, flexible (sanguine);
- Strong, balanced, inert (phlegmatic);
- Strong, unbalanced (choleric);
- Light (melancholic).
Three additional types for a human were defined based on the ratio of the first and second signaling systems: type "artist" - with the primary development of the first signal system; the type of "thinker" - dominated the second system; - synthetic, analytical, and "medium". IP Pavlov defined the term type as the basic properties of complex neural processes, complex congenital features and changes that have been acquired in the course of individual development under the constant influence of the environment, ie the result of effects of the unconditioned and conditioned stimuli on the organism, it is not only the genotype, but the phenotype as well.
WH Sheldon (Sheldon, 1940) believed that the features of the basic constitutional types are related to the primary development of one of the three germ layers - external (ectomorph), medium (mesomorphs), internal (endomorph). Accordingly, the selected types: ectomorphic, mesomorphic, endomorph. WH Sheldon proposed a method of typing a constitution based on somatoskopii, anthropometry, providing a quantitative assessment of habitus individual scoring taking into account three photos with different projections. The objectivity of this method differed it favorably from the pre-existing ones and therefore allowed it to receive international recognition.
At the same time, there were absolutely ridiculous classifications, in particular, characterizing female reactivity. So pyknic type - "the type of the past" (Mates), the type of Venus (Walker), Rubens type (Goldueyd) type, similar to the type of athletic male intersexual - "the type of the future" - a woman - a man with a rational behavior, and the demand for equality in all respects (Mates), a type of Minerva (Walker), the type of Botticelli (Goldueyd). Intermediate type is described as "the type of Diana" (Walker), also known as "antique" type (Goldueyd).
The description of the "type of the past" (Mates) is given as an example: "... is characterized by friendliness, attractive, fast and exact soft movements, rapid onset of affect which easily turns to the main cheerful mood. Women of this type are not vindictive, bear many children, are faithful, devoted wife, not jealous, and are able to wait quietly for their unfaithful husbands to return back to them full of remorse".
This way a huge variety of classifications of constitutional types was suggested. Some of them, such as the Hippocratic covered and summarized huge century-old experience of observation, a number of them were purely speculative, far removed from reality, characterized by an arbitrary choice of the driving member, and therefore having lost their significance.
Giving a general description of the classification, it should be noted that separate "pure" types of constitutions are particularly difficult (yet they are unlikely to exist) to single out. Features of different constitutional types are usually found combined in a man. The drawback of most classifications is the fact that they do not include intermediate (mixed) types, to which the majority of people belong. At the same time, the allocation of constitutional types, defining features of reactive properties of the body, is of great importance for clinical practice, and may reflect a predisposition to certain diseases. In this regard the ideas about the anomalies and pathology Constitution are crucial, as they reveal a predisposition to abnormal reactions to normal in intensity and nature of exposure events(diathesis, idiosyncrasies).