Diathesis (Greek - diathesis - predisposition) is extreme border with abnormal variants types of the constitution (constitutional anomalies). Currently, scientist distinguish three main types of diathesis as objectively existing marginal types of reactivity:
· exudative catarrhal diathesis, characterized by increased irritability of the skin and mucous membranes, tendency to eczematous onset of the skin, itchy blisters, hives, allergic reactions of immediate type, increased risk of anaphylactic reactions, hyper-ergic course of inflammation, the risk of asthma development, Quincke's edema (angioedema), false croup, tendency to atopic allergy.
· neuro-arthritic diathesis is a condition characterized by increased excitability, lability of the neuro-vegetative regulation, strong unstable excitable type of higher nervous activity, high intensity of purine metabolism and elevated levels of uric acid in the blood, a tendency to increased levels of oxalic acid in blood and urine tests, periodic increases in the levels of ketone bodies, prone to dyskinesia of the gastrointestinal tract, high risk of urolitiazisa, holelitiazisa, diabetes, migraine, neuralgia, arthritis, atherosclerosis, gout, chronic renal failure. These symptoms are related in large part to the accumulation of urate in the body, as well as with the kofein –like affect of uric acid on the nervous and muscular tissue, which acts a kind of chronic effects "endogenous doping". Carriers of this diathesis often exhibit extraordinary intelligence.
· limfatiko-hypoplastic diathesis (status thymico-lymphaticus) is characterized by hyperplasia of the thymico-lymphatic apparatus and hypoplastic adrenal chromaffin tissue, thyroid, reproductive organs, heart, aorta, smooth bodies, reduced ability to adapt, low stress tolerance, easy development the exhaustion phase under stressful reactions which is due to reduced functionality of the adrenal glands. Marked thymomegaly, enlarged tonsils, lymph nodes, follicular language spleen adenoids, lymphocytosis, neutropenia. A serious complication of this diathesis is sudden infant death syndrome (SVSD) - «morsthymica» - collapse with severe respiratory and cardiac activity occurring during vigorous procedures, severe irritations, narcosis or sleep that occurs most often in the first two years of life. Low socio-economic status of parents, smoking and substance abuse in mothers contribute to SVSD. Existing theories of the pathogenesis of this condition (mechanical, stress, immune, tissue hypoxia, etc.) are not generally accepted. Most researchers interpret as SVSD syndrome of multy- aetiology with the necessity to take into consideration the value of status thymico-lymphaticus.
All forms of diathesis are characterized by recurrent manifestation of certain symptoms that appear and disappear now and again, which is described as the hidden or latent phase of diathesis. Latent phase can turn into the frank one under the influence of exogenous and endogenous factors.
Clinical onset of diathesis is caused by the interaction of the body and external stimuli. In the absence of exogenous stimulus diathesis does not appear and in the favorable environmental conditions can disappear completely. Environmental conditions can provoke or hinder its manifestation. Diagnosing of diathesis latent enables to mitigate or inhibit its manifestation by changing appropriate external conditions.
On the interpretation of the term "Constitution"
In the 20th century there were two extreme points of view on the term "constitution". One view is to underestimate the value of etiologies in the development of disease as having a secondary role, and being only a trigger mechanism. Everything which was not clear in the pathogen, everything that could not be explained in terms of etiology, was assigned to the constitutional characteristics of the organism. Thus was born the constitutionalism, a theory which overestimates the role of the Constitution in the course of a disease and ignores the causal factor. In this case, the very notion of a "constitution" shrouded mystical veil. From this perspective, human constitution is self-sufficient, independent on the environment, and is not subject to change. It manifests itself with fatal inevitability in the type of a man, and in his features, as well as in the origin and development of disease. The Constitution, therefore, identified with the genotype (genotype direction). One of the most prominent representatives of this school, the founder of constitutionalism Tandler (1869-1936) wrote: "The Constitution is a somatic fate of the body." Proponents of this trend were trying to prove the superiority of certain races and nations, and the existing supposedly inferior others in terms of typology of constitutional features.
Thus, an Italian psychiatrist and criminologist, Lombroso (1835-1909) the founder of the anthropological trends in criminal law argued that society has a special type of "criminal individuals" burdened by "dangerous state" and their very nature intended to commit a crime. Lombroso's criminal man has special physiological "stigmata" (issued by the facial angle, square face, a hardened villain, etc.). He recommended on the basis of these "stigmata" to use drastic measures of "social protection" (the death penalty, life imprisonment, perpetual reference to the uninhabited islands) without waiting for a "criminal man" to commit an offense. The harm of such ideas is quite obvious.
This view gave way to the most reactionary conclusions for the practice of medicine, and for the life of the society. For example, alcoholism, syphilis, drug addiction and other diseases attributed only hereditary germs of a man, the existence of the dominant race was recognized, as well as fatal "immoral constitutions," "constitution crime" and so forth, It lead to neolombrozians - racism. The Nazis used this theory to justify their terrorist regime for the extermination of ethnic minorities, sterilization and castration of men, not pleasing to fascism.
The second view is an overvalue of the role of the environment, the notion that the constitutional features are subject to arbitrary change, and that environmental factors and living conditions play the leading role in the formation of the constitution.
Modern medical science considers the Constitution to be the basic biological characteristics of the whole organism, caused by heredity (genotype) and the long intense influence of the environment.
The concept of the Constitution comprises not only inherited but also acquired during the individual life properties. Constitution depends on the conditions of human existence and, if the latter are repeated from generation to generation in the almost unchanged form, constitutional structure of man is repeated as well. But as soon as these conditions change the constitution of a man stars changing. The environment is a prerequisite for the manifestation of hereditary traits, but at the same time it can contribute to the formation of new traits of constitutional significance. Body built rights, its reactivity and resistance can change under the influence of infections, intoxication, exposure, and working and living conditions, the environment and other social factors.
Exaggerated role of the constitution in the development of the disease limits the goals of medicine and public health. But this does not in any way mean that constitutional characteristics of the organism are subject to arbitrarily change.