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Art. III. – 1. Treatise on the physiological and moral Manage
ment of Infancy. By ANDREW COMBE, M. D., with Notes and a Supplementary Chapter, by John Bell, M. D. Philadelphia: 1840. Carey and Hart.
2. Lectures on the Theory and Practice of Physic. By WILLIAM
STOKES, M. D. Philadelphia: 1840. Haswell, Barrington, and Haswell.
The doctrine of temperaments, at this time recalled to our mind by the reading of the admirable works just cited, has been the subject of acute and minute discussion since the time of Galen, who first directed the attention to constitutional differences. He considered that the human system was principally operated upon by four humors, tempered by four elements. The humors were blood, bile, phlegm, and the atrabilious, or black bile. The elements, of course, were fire, air, earth, and water. A warm and moist temperament he attributed to the blood, this he called sanguineous. A warm and dry temperament, was bilious; a cold and moist one, was pituitous; and a cold and dry temperament, was melancholic.
A classification so positive and curious could not fail to arrest the attention of all those who took an interest in physiological research; and philosophers, as they proceeded in the inquiry, generally accommodated their speculations to the doctrine. But, prone as we are to novelty, and strong as is the disposition to substitute our own theories for those which are already in favor, no one, thus far, has been able to change the arrangement made so long ago. It has been borne out by repeated observation, even in our changeful times, enlightened on all matters relating to health and organization, and we cannot but feel great respect for the author of so valuable a suggestion as constitutional differences, particularly when we reflect that the era of Galen was adverse to philosophical certainty.
But though the classification may be correct enough for common purposes, and in fact, is adopted, with little variation, by all writers on human physiology, yet, the doctrine of assimilation, which it involves, is found to be very defective. Of late, the curious discussion of red and white tissues, in
itself of vital importance, as well as some new and startling facts in pathological anatomy, will place the doctrine of temperaments in a different light. We may now hope for results more philosophical and satisfactory, and if we differ in our classification it will be owing to the vast accumulation of new matter which the union of scientific talents has produced.
Let us see how the temperaments are defined by external indicia:
First. The sanguineous temperament, where the blood is supposed to be abundant, and the pulse quick and strong, is seen in persons of a full habit, soft skin, ruddy complexion, blue eyes, red or auburn hair, large veins, and vivid sensations.
Second. The melancholic, or atrabilarious temperament, is supposed to belong to a firmer and thinner frame than the sanguineous; there is a darker complexion, black hair, slow pulse, the nervous system not excitable, and the disposition grave and meditative.
Third. The choleric, or bilious temperament, is between the two preceding; the hair is black, and generally prone to curl, the complexion swarthy and ruddy, the skin rough, hairy, and thick, and the pulse strong and full.
Fourth. The phlegmatic, or lymphatic, or pituitous temperament; the hair is light, the skin thin and soft, the complexion fair, sometimes pale and sallow, the pulse rather slow, and the mental, as well as physical faculties and organs, generally sluggish.
Fifth. The nervous temperament; a thin, feeble frame, generally pale complexion, dark hair, thin skin, quick, and a somewhat irregular pulse, and generally acute intellect.
Now there are individual cases recorded by every historian, wherein the above classification and explanation hold good to a tittle. These cases belong to marked and stantly referred to by every writer on temperaments. The choleric, or bilious temperament, is ascribed to every hero or remarkable person, for it is said to belong to men of action, men who are ambitious and love to keep before the eye
of the world. It is the delight of all writers on this subject to exhibit their bilious characters in full length. Themistocles is a great favorite with some writers, he being, for them, a fine illustration of the bilious temperament. sented as a person of unerring judgment, and of undaunted spirit in the cause of truth and liberty. Great stress is laid
He is repre
upon bis ever-memorable remark, of “strike, but hear me,” made to Eurybiades, when he had raised his staff to give him a blow.
But might not a man of any other temperament have evinced the same love of truth and justice?
Another bilious example is found in Pope Sextus V., whom accident made a priest, talent a popular preacher, and consummate art a cardinal. Determined to obtain the highest rank in the church, which he foresaw could only be effected by art, he went systematically to work; by privations of every sort, he acquired the reputation of being the most humble, meek, and yielding of men. For the same purpose, he used a crutch, feigning weakness of limbs, and also wrapped himself up closely in his cloak, under pretence of diseased lungs. Out of forty-two cardinals, fourteen of them were intriguing for the tiara. The cardinal Montalto, having on his side four out of the six parties that were to decide the contest, was elected, in consequence of his infirmities and good nature, for they presumed he would be an easy tool in their hands. When the conclave was over, and he was informed of his good fortune, exclaiming –“Gods, I am pope of Rome,” he pulled off the cloak in which he was muffled, threw away his crutch, and bending back his head, spat up to the very ceiling of the high chamber of the vatican, to show the soundness and strength of his lungs. But why he was selected as an instance of the bilious temperament, it is impossible to conceive, for ambition belongs as well to the sanguineous as to the bilious, and we should rather imagine him to be of the former class. The sanguineous temperament could hold out longer against such great abuses of the constitution. Montalto thought it necessary to submit, or rather to inflict upon himself years of constraint, and privations of even the most painful nature, to effect his purpose. If bile had preponderated over the other secretions, he would soon have become atrabilarious, for he moved about slowly and avoided all excitement, that he might impress others with a belief of his infirmities.
The doctrine of temperaments, therefore, as it is now explained to us, is not of much importance in a curative point of view. It may amuse the speculator on character, but to the physician it is entirely useless. There are idiosyncracies and anomalies in almost every human being, and although he may belong to a class, yet that class itself has never yet been clearly defined. A certain individual may possess the
extravagancies of a particular temperament in an excessive degree, so as to amount to disease; his medical adviser certainly would not extend the same treatment to others of kis temperament, though external appearances would appear to justify him. The most disastrous consequences have resulted from this habit of generalizing on temperaments, for there are scarcely two men, having all the external indicia of the same constitution, who can bear the same treatment, although apparently laboring under the same disease.
Suppose a man to possess what is called the melancholic temperament, he is afflicted with disease, and it terminates in a disposition to suicide, perhaps the fever was one of a low type. On post mortem examination, this morbid state of the system was found to arise from pressure on the brain. Another patient, of the same temperament, is similarly affected with fever, and undergoes the same treatment ; he commits suicide, and, on examination, there is no lesion of the brain, but evidence of great gastric derangement, Now, the physician, trusting to the outward similarity of temperament and fever, prescribes for both alike, and one of the patients is badly treated, perhaps loses his life in conse
quence of it.
The truth is, that a diseased viscus, or a general visceral derangement will operate banefully and decisively upon every temperament; but this is disease, either local or constitutional. If it be local, the system will recover its tone as soon as the cause of irritation is removed. If it be constitutional, the manifestations of disease will be perpetually recurring. But constitutional irregularities, amounting to conspicuous differences, are not common, and the very fact of their rareness, renders each case more the subject of analysis and speculation.
The moment a man labors under an increased circulation, and his skin assumes too florid an appearance, he comes under the sanguineous temperament. If some preternatural excitement exist in the liver or biliary ducts, he is of the bilious class, and so on of the rest; we must, therefore, abandon the present doctrine, as it now stands, and take quite a new view of it. In doing this we must make a new classification, and of a more specific nature. Even the term temperaments must be discarded, perceiving, as we now do, that the doctrine based upon it holds out no security to the anxious physician or the curious investigator, both of whom are so frequently misled by it.
Putting out of view the merits of phrenology, as a science on which we can at all times rely, the study of it discloses new and important facts, which throw additional discredit on the doctrine of temperaments. The recent attention which has been paid to the nerves, has likewise thrown new light on our views, and makes us desirous of seeing the subject of temperaments assume a new form. This is not the place, however, to discuss it fully and in detail, but our suggestions may serve as the base for a more comprehensive exposition.
Let us take a classification like the following; and, in adopting the term diathesis instead of temperament, we more fully explain our meaning. Diathesis is a constitutional disposition, either to health or disease; an unhealthy diathesis is either congenital, or caused by long residence in ungenial climates. It may arise, likewise, in early youth, from intemperance in eating and drinking, or from unhealthy occupations. When this constitutional disposition is hereditary, the remedy is scarcely within our power, but, in every other case there may be great alleviation, and often an entire cure, by simple alteratives.
The most prominent of these diatheses are the following: 1. the healthy diathesis ; 2. the vitiated ; 3. the nervous ; 4. the bilious, or sanguineous; 5. the rheumatic; 6. the scrofulous, or phlegmatic.
1. Healthy diathesis. When the organization is perfect, and no local disease exists, the mental faculties are in free exercise, and mind and body, acting in concert, move harmoniously. The complexion, eyes, hair, and skin, may be light or dark, fine or coarse, and the body robust or delicate, and yet health will be equally diffused throughout the system. We have constantly recurring examples of persons who have all the external marks of melancholic temperament, as it is called, who never had an hour's indisposition, and scarcely a moment's ennui in their life.
But a healthy diathesis need not include great muscular strength. A man may be unable to lift a great weight, and yet enjoy perfect health. Of two men, equal in every respect, one may walk ten miles without fatigue, and the other break down under a walk of four miles. One of them may talk on an exciting topic for several hours together, while the