Diatheses

DIATHESIS (from Greek diathesis - predisposition), a term under which, theoretically, one should unite states of the organism that predispose it to certain pathological processes. Diatheses themselves are not diseases or morbid states; they merely potentially contain them within themselves. In the presence of diatheses, even physiological irritations cause pathological reactions of the organism, and ordinary life conditions, completely harmless to most people, can lead to diseases. Diatheses are for the most part congenital and hereditary states. The concept of diathesis is inseparable from the concept of constitution and is very close to the concept of constitutional anomalies, under which are meant any deviations exceeding the limits of physiological variations of constitution. Diatheses are hidden internal (endogenous) constitutional anomalies, predominantly of a functional and moreover more general character. Therefore, in principle, it seems entirely possible to recognize diatheses in their latent period by means of various functional tests. Practically, however, diatheses are usually spoken of when a morbid state has already developed on the basis of diathesis, as for example, exudative, uric acid, hemorrhagic and other diatheses. In the vast majority of cases, the terms constitutional anomaly and diathesis are used as synonyms, and this must be recognized as a fact.--The doctrine of diatheses has passed through several stages of its development. Already in the most ancient times Iv (in Hippocrates and Galen) the constitutional moment was considered the most important basis of pathogenesis. Medieval medicine also lived and developed within the circle of ideas about diatheses, but then the concepts of diathesis were too elementary and gradually ceased to satisfy the minds of physicians. During the period of development of the pathological-anatomical cellular direction in medicine and in connection with the development of bacteriology, the concept of diathesis gradually began to recede to the background, to be considered unscientific. But already from the end of the 19th century, there begins a revival of this doctrine, especially thanks to the works of Beneke, Rosenbach, Kraus, and Marcius (Beneke, Rosenbach, Kraus, Mar-tius). This revival of the doctrine proceeded in various fields of medicine, and this was not simply a revival of old views, but results of new ones, built on a scientific basis. This revival is especially indebted to pediatrics, where the doctrine of exudative diathesis, status thymico-lymphaticus, spasmophilia and others was created. The rise of interest in the problem of diathesis in the clinic of internal diseases is noted since the Wiesbaden Congress of 1911, at which His, Bloch, and Pfaundler (His, Bloch, Pfaund-ler) discussed this issue in program reports.--In the literature, many different diatheses, resp. general constitutional anomalies, are described. Of these, the most well-known are: exudative diathesis, lymphatism, arthritism, infantilism, enteroptosis, congenital asthenia. However, upon closer and critical examination of these diatheses, mostly described as isolated and independent morbid states, it is not difficult to see that there are no definite boundaries between them, that their symptomatology largely coincides, and that often different manifestations of the same diathesis, observed at different periods of an individual's life, are described as separate, independent diatheses or anomalies. Thus, one can think that exudative diathesis in childhood, lymphatism in youth, arthritism in maturity, and 'fibrous diathesis' in old age are manifestations of one and the same, essentially unified diathesis. Similarly, infantilism, enteroptosis, and general congenital asthenia of Stiller (Stiller) can be combined into another general diathesis. Diatheses, as indicated above, are inseparable from constitution, and indeed the study of them in connection with constitution leads to the conviction that certain diatheses are characteristic of certain constitutional types of people. Thus, the general diathesis, which includes exudative diathesis, lymphatism and arthritism, is mainly inherent in the hypersthenic type of people, while the diathesis, which to a large extent includes manifestations of infantilism, enteroptosis and asthenia, is mainly inherent to people of an asthenic constitutional type. At the present state of our knowledge about constitution and diatheses, for practical clinical purposes it seems entirely sufficient and expedient to distinguish only two basic diatheses, or general constitutional anomalies, characteristic of two extreme variants of the human type. These will be: 1) Hypersthenic diathesis, or hypersthenic general constitutional anomaly; according to the main diseases developing on its basis, it could also be called arthritic; from a clinical point of view it is very rich and diverse in its manifestations. 2) Asthenic diathesis, or asthenic general constitutional anomaly, having as its basis mainly a special functional sluggishness and weakness of the organism; according to the main disease to which this diathesis predisposes, it can be called pre-tuberculous, while in its clinical manifestations it is relatively uniform and poor.