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Constitution SIGNIFICANCE OF THE CONSTITUTION IN PATHOLOGY Concept

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Constitution SIGNIFICANCE OF THE CONSTITUTION IN PATHOLOGY Concept Powered By Docstoc
					           SIGNIFICANCE OF THE CONSTITUTION IN PATHOLOGY
                      Concept of Constitution

      Constitution implies the aggregate of all sufficiently
 stable functional and morphological characteristics of an
 organism, which determine the specificity of its reactions to
 external agents and are formed on the basis of heredity and
 acquired properties in interaction with the external environment,
 primarily the social environment in the case of man,
      Great importance was attached to constitutional properties
 even in antiquity, Hippocrates held that the constitution was
 determined by a mixture of body fluids (humoral) and that disease
 resulted from their improper mixture. He distinguished good, bad,
 strong, weak, dry and moist constitutions according to the state
 of the humoral environment and divided people Into sanguine
 (energetic and lively), choleric (impetuous), melancholic
 (reticent and unsociable) and phlegmatic (inert) according to
 temperament,
      Cellular pathology with its anatomic localistic principle
tended to ignore the significance of the organism as a whole in
origination of disease and the very concept of constitution.
Another factor indirectly conductive to this was the development
of bacteriology and the understimulation - characteristic of the
time - of the significance of the host in the etiology and
pathogenesis of diseases. The problem of constitution was only
later subjected to deeper study.
      Today there is no agreement on the essence of constitution
 as yet, There are two diametrically opposed trends in
 understanding constitution.
      Representatives of one trend understand constitution as an
 aggregate of stable and only inherited properties. They hold that
 constitution remains unchanged all through a person's life and is
 the cause of most of the diseases. This view is a result of their
 concept of heredity, according to which nature is invariable, The
 adherents of this trend disregard the role of the environment in
 changing heredity, The definition that "constitution is the
 somatic fate of the organism", which always predetermines the
 origination of disease, ignores the significance of the external
 environment in the formation of man's constitution.
      The representatives of the other tend understand
 constitution as the complex of the organism's properties formed
 in the process of its development in interaction with the
 conditions of its existence. They believe that the organism's
 constitution is not something invariable and fixed either in the
 organism’s individual (ontogenetic) or historical (phylogenetic)
 development, Prolonged influence of external factors leads to the
 appearance of qualitatively new and stable properties which in
 some cases are fixed, in the progeny and determine man's reactions
 to physiologic and pathologic factors. For a correct evaluation
 of the significance of constitution the organism must be viewed
 not as a sum of the properties of its organs, tissues or cells,
 but as a single whole in its inseparable unity with its
 environment, in all its individuality at the moment of its
 affection.
                  Classification of Constitutions
      Many attempts have been made to establish definite types of
 constitutions according to similarities of the various properties
 of t he or gan i sm. Me asu re me nts of th e b ody an d i ts
 par ts (somatometry) were most frequently used as criteria.
 Some observations showed certain types of body build to
 correspond to
certain functional properties.
     Thus one of the widespread classifications of constitutions
(Sigaud) establishes the following four principal types according
to characteristics of body build: 1) respiratory type - long
thorax, acute epigastric angle, long neck, relatively small
abdomen, developed maxillary and frontal sinuses, and
hexagonally-shaped face; 2) muscular type - broad and high
shoulder girdle, developed chest, developed muscles, medium
epigastric angle, and square face; 3) digestive type well
developed lower third of the face, protruding jaw, short neck,
broad chest, and. well developed abdomen and obtuse epigastric
angle; 4) cerebral type - delicate slim physique, large skull,
well developed frontal part of the face, and short limbs.
     In addition to classifications according to body build,
there have been several more attempts to distinguish
constitutions in accordance with the organism's functional
properties, the peculiarities of muscle tone, metabolism,
nutrition or vegetative functions. The constitutions established
by various researchers according to these characteristics usually-
fit into the three following principal types with certain
variations in the different classifications: 1) hyposthenic,
hypotonic and asthenic types (correspond to Sigaud respiratory
and. cerebral types); 2) normosthenic, normotonic and athletic-
types (correspond to the muscular type); 3) hypersthenic,
hyper-tonic and pyknic types (correspond to the digestive type).
     A predisposition to particular diseases was frequently
ascribed without sufficient reason to each of the foregoing
types, for example, a predisposition to respiratory diseases was
ascribed, to people of the respiratory and asthenic types,
metabolic diseases - to people of the digestive or pyknic type.
Some investigators (Kretschmer) ascribed to the types they
distinguished (asthenic, pyknic and athletic) predispositions to
various mental diseases, But this view is erroneous because it is
based on observations of mental patients,
     The basic flaw of these classifications is that they are all
schematic and one-sided. In most cases they are predominantly of
a descriptive character and fail to take into account the
continous interaction of the organism with the external
environment. They do not always permit of determining with
centainty the character of man's possible reaction to a
particular pathogenic agent. Moreover, the constitution of most
people is mixed and does not fit into any definite types; this is
particularly true of women and children.
     It is very important to note that an individual's
constitution may vary with the conditions of this life.
Observations have shown, for example, that the physique of a.
person, who as a child belonged to the hyposthenic or asthenic
type but for a long time did. physical work or systematically wet
in for sports, gradually changes and manifests features
characteristic of a normosthenic or athletic type. This shows the
certain external factors acting over a long period of time may
alter the manifestations of a constitution, its functional and
even morphological characteristics.
     Attempts have also been made to classify constitutions
according to properties of certain systems, for example, the
endocrine glands or vegetative nervous system.
     Types of people were at different times distinguished
according to the properties of endocrine glands, i.e., by an
increase or decrease in certain incretory functions, for example,
hypo- or hyperthyroid constitutions, hypo- and hyperpituitary,
etc. However. there are no reasons to consider the constitution
of an organism exclusively from the standpoint of the functional
characteristics of the endocrine glands because the latter
closely interact with the nervous system.
     Human constitutions were also distinguished according to
peculiarities of the vegetative functions, i.e., with the tone of
either the sympathetic or parasympathetic nervous systems
predominating (sympathicotonic and vagotonic types). But this
classification was likewise based, on a one-sided and erroneous
concept of the self-sufficiency of each division of the
vegetative nervous system and the direct antagonism between them.
     Significance of Types of Higher Nervous Activity in the
Theory of Constitution. The teaching on higher nervous activity
and the role of the cerebral hemispheres in the regulation of all
functions of the organism has made it possible to overcome to
one-sided views of constitution and its significance for
pathology and the clinic and to elaborate a classification of
types of nervous system.
     A type of higher nervous activity is a complex of inborn
traits and. characteristics acquired by the organism in the course
of its individual development under the continuous influences of
the external environment. Each type is characterized, by certain
features of higher .nervous activity such as: 1) strength of the
basic nervous processes - excitation, and inhibition - which
determines the efficiency of the nervous system, 2) balance
between the two processes, and 3) mobility of these processes,
i.e. ready reaction to stimulation and rapid transition from
inhibition to excitation and vice versa. These features ensure
the organism's adjustment to the conditions of its existence,
     Pavlov distinguished weak and strong types of nervous system
in accordance with the strength of the nervous processes
excitation and inhibition. Strong animals are divide into
equilibrated and unequilibrated according to the balance between
the basic nervous processes in the cerebral cortex. The
equilibrated animals are in their turn divided into lively
(mobile) and calm (inert), according to the mobility of the
cortical processes.
     Thus the following principal types of nervous system may be
distinguished according to the manifestations of nervous
activity: 1) weak type characterized by weakness of the
stimulatory and inhibitory process with relative predominance of
inhibition over excitation; 2) strong, equilibrated, mobile type
with equally strongly developed, processes of excitation and
inhibtion, and capable of resisting pathogenic stimuli: 3)
strong, unequilibrated, excitable ("impetuous") type with
excitatory and inhibitory reactions out of proportion to the
stimulation, a type in which both processes are strong but the
process of excitation predominates: 4) calm, phlegmatic type with
a well balanced and somewhat inert nervous system, capable of
great endurance and easily adjusting itself to its environment.
The aforesaid, types correspond to the melancholic, sanguine,
choleric and phlegmatic temperaments. There are also a number of
intermediate typological variants.
     For the clinic the problem of types of nervous system is of
paramount importance because its solution would allow a correct
evaluation of the role of constitution in the pathogenesis of
                                — 4 ~

disease and would offer a possibility of exerting purposeful
influences on the affected organism.
     Attempts at elaborating a working scheme for classifying
types of nervous system in man in accordance with Pavlov"s
classification principles based on experimental studies of higher-
nervous activity in animals have been repeatedly made. The
problem is extremely complex, however, and these attempts have
not as yet succeeded,
                      Concept of Diathesis
     The concept of constitution is tied in with that of
diathesis, Diathesis usually a morbid state of the organism
characterized by its abnormal reactions to the action of usual
stimuli. The clinic often endeavours to distinguish different
forms of diatheses according to the organism's susceptibility to
certain groups of diseases.
     The following diatheses are thus distinguished: exudative
diathesis with frequent inflammatory reactions and eczematous
eruptions on the skin; neuroarthritic diathesis with sluggish
metabolism, endocrine disturbances and joint affections;
spasmophilic diathesis with increased nervous excitability and
tendency to convulsions; asthenic diathesis with adynamia and
diminished vascular tone; hemorrhagic diathesis with a tendency
to hemorrhages. There are also other forms.
     Certain scientists identify diatheses with hereditary
predispositions for certain diseases. However, such concepts are
ungrounded since various external factors influencing the
organism during intra- and extrauterine life may play a certain
part in the origination of diatheses. The prolonged influences
exerted-on the mother and fetus by infections, intoxications,
altered nutrition, and climatic conditions are particularly
important. It is sometimes possible to diminish or entirely
eliminate the manifestations of diatheses by prophylactic and
therapeutic measures.

				
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posted:3/18/2011
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