THE

Medico-Chirurgical Review,

No. XXV.

APRIL 1 To JULY 1, 1830.

I.

ON TEMPERAMENT.

PHYSIOLOGIE DES TEMPERAMENS OU CONSTITUTIONS; NOUVELLE DOCTRINE APPLICABLE A LA MÉDECINE-PRATIQUE, &c. Par F. Thomas, (de troisième) D.M.P. : à Paris.

[PRIZE-REVIEW.]

IF great diversity of sentiment indicate great difficulty in the subject investigated, there are few points of a more abstruse and perplexing character than the theory of those physical varieties which obtain in different individuals of the human species. That a mechanism essentially the same wherever met with-in whatever quarter of the globe and among whatever people -could furnish such endless modifications of internal function and of external feature, was not to have been expected. Every face wears a physiognomy characteristically its own; every mind presents qualities peculiar to itself. No similarity of circumstance can secure similarity of character. Individuals, born of the same parents and in the same house, suckled on the same breast and nursed on the same knee, educated by the same masters and subjected to the same authority, introduced to the world at the same period and moving in the same society-are different, frequently as different as the clumsy Japanese and the elegant Circassian are in body, or the ferocious Tartar and the harmless Hottentot in mind. Though all are generically alike, all are specifically dissimilar; though all are cast into the same mould, all come out with distinguishing personalities. Beauty adorns one, deformity marks another; judgment, or imagination forms the prominent quality of a third. Indolence and activity, talent and stupidity, passions the most headstrong and affections the most engaging, may thus be found growing out of the same soil, associating under the same roof, and peculiarizing individuals born and nurtured under the influence of the same circumstances.

How this is, and why this should be, are questions which have been more, frequently asked than answered. If great differences appear between people separated from each other by great distances, the dissimilarity may not be inexplicable. If the Laplander, who is cradled in the storm, be unlike the Negro of Guinea, who is nursed in the sun-beam, it may not be deemed marvellous. Local peculiarities can accomplish, and have effected much; and, although the cave of Trophonius lays claim to more miracles than our No. XXV. FASCIC. I.

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faith can ascribe to it, the demonstration were not difficult which proved that variety of climate, of custom and of education has wrought mental and physical transformations, which some have rashly referred to original varieties of species. It is, however, vain and preposterous to stretch the agency of these modifying causes beyond a certain limit. To a certain limit their agency is undeniable; but those physiologists, who maintain that mere difference of external condition can explain every difference of corporeal and metaphysical character, betray sad embarrassment in many of their arguments. When these constitutional peculiarities are understood in a general sense, they are denominated TEMPERAMENTS; when intended for individual application, they are styled IDIOSYNCRACIES. Temperament is the genus, idiosyncracy the species; but since each individual is marked by some distinguishing quality, through which he is made to differ from every other, there must be as many temperaments as men, the history of constitutional peculiarities would be the history of every member of the human race, and, therefore, minuteness on a subject of such extent were as vain as it would be useless. Leading points of dissimilarity alone can be considered, as they only can furnish general results, and the tender pencilling of shadowy individualities must be left for the study of the Novelist, whose aim is less instruction than amusement.

The ancients ascribed much more importance than we do to the knowledge of temperaments; and in their treatment of disease generally followed them as their guide to the choice of remedies. Corresponding to their four elements,-fire, air, earth, and water, and to the four qualities ascribed to these, heat, cold, dryness, and moisture, four varieties of constitution were discovered and described. The blood was viewed by many of them as the first vital principle, if not the life, to which every constitutional peculiarity was referred; and as it departed en masse or in its separate elements from what was supposed to be a state of health, the system was inferred to suffer in proportion. If its red particles abounded, the constitutional habit was sanguine; if the phlegm were in excess, the person was phlegmatic; and as the yellow, or the black bile preponderated, the choleric or melancholic puos prevailed. These four paties of Hippocrates Galen multiplied to nine; but this augmentation seems to have been little better than a useless refinement, for, except the last or temperamentum ad pondus, those which were added can scarcely be regarded in any other light, than as new appellations, or mere explanations of the first. Cullen has with his usual ingenuity examined how far the constitution of the blood may modify that of the system, and after a minute consideration of the subject concludes that "with respect to its aggregation, or with respect to the state and proportion of the several parts which compose it as an aggregate, it seems not only to be uncertain how far these circumstances give a difference of temperament, but, on the contrary, it seems probable that they never do so in any considerable degree."

While the humoral pathology reigned this theory of the ancients reigned along with it; and Stahl has with much address traced the connexion between the powers of mind and body in health and disease and the constitutional states of the animal fluids. When the system was phlegmatic the fluids were thin and unstimulating; when melancholic they were thick and inactive; when sanguine they were hot; when choleric they were acrid.

To assert that there is no truth in all this would be to say more than we are warranted, but it were not difficult to prove that it is not all true. If difference of constitutional temperament depend upon constitutional differences in the blood, it is natural to suppose that when a certain condition of this fluid obtains we should find a corresponding state of temperament; that when the blood appears thin and poor, the habit should be phlegmatic; when thick and rich, melancholic. The inverse of these propositions should also be true; when the habit is phlegmatic, the blood should be thin and poor; when melancholic, it should be richer and increased in consistency. But neither is the first proposition, nor its inverse correct; nor is it true that the average temperature of phlegmatic habits is lower than that of such as are choleric.

Dissatisfied with the humoral doctrine of Hippocrates and Galen, and the humoro-mechanical theory of Stabl, Haller attempted a new arrangement, grounded on irritability of the solids. When they united great firmness to great irritability, the habit was bilious; when they were firm, but less irritable, sanguine; when lax, but more irritable, melancholic; and when below par both in tonicity and irritability, the phlegmatic tempera ment prevailed. Niederhuber adopted a still simpler system, and ascribed every variety of constitution, not to corporeal difference, but to simple modifications of the vital power. Cabanis profited by all the doctrines which preceded him, and combined into one system, the humoral, mechanical, and vital theories. This physiologist makes six temperaments. The first four are those of Hippocrates, which he ascribes to the tone of the solids,-to the quantity and quality of the fluids,-to their proportion,-to the size and power of the lungs, heart, liver, and genital organs, and to the sympathetic communications existing between them. The last two temperaments are the muscular and nervous, which result from the reciprocal predominancy of these systems, the one above the other. The views of Richerand are very similar to those of Cabanis, and his number of temperaments is the same. Hallé distinguishes them into partial and general. The general are eight. The first four, which are those of Hippocrates, he traces to the proportions maintained between the lymphatic and sanguineous systems. When they were balanced the result was the sanguine temperament; when the lymphatic system was in excess, the constitution was pituitous; and where the sanguineous exceeded, the person was melancholic. The fifth and sixth, or plethorico-sanguine, and plethorico-lymphatic habits, are founded upon the predominancy of those two systems from which these habits derive their name; and the seventh and eighth are the same as the fifth and sixth of Cabanis. The partial temperaments are divided into two classes, and arise out of visceral plethora, whether sanguine or lymphatic, and the energy of individual organs. Kruger, Metzler, Rosanstein, Schroeder, Lawaz, Schmidt, and many others have written upon this subject, and, as may be expected, have variously modified the doctrines and divisions of those who went before them; but it is unnecessary to pursue this history further, to prove that little of importance has been added to the views of the ancients. The four car dinal points of Hippocrates have been advocated throughout, although sometimes under new designations, and his followers have rather been loading the points of the compass, which were already known, with a new nomenclature, than actually adding to their number. Yet one cannot easily dis

cover wherein lies the strength of many of the arguments by which some of his temperaments have been defended. The nomenclature, at least, is certainly indefensible, for the melancholic have no more atrabilis, nor the sanguine more blood, than their neighbours; and a system so limited as the lymphatic, can scarcely be deemed important enough to constitute the temperament known under that name.

In introducing the author, whose work is now before us, it is not quite certain whether we shall be adding much to our stock of knowledge on the subject of Temperaments. His system, although advanced as new, only requires explanation to divest it of every claim to originality. It is adorned, no doubt, with a few novelties, and the charms of phrenological mysticism have been tastefully thrown over it; but its basis was long since laid, and part of its superstructure has been erected for ages. But, like all doctrines which are formed upon popular sentiments, and which, by interweaving their interests with those of leading national feelings, embark their claims to public favour upon the same bottom, the doctrine of Thomas has gained, and is now gaining on society, and if the signs of the times can be any guide, it would not exceedingly amaze us, were it eventually installed into the canons of our own College. His theory sets out with the position, that the relative size of an organ indicates the relative energy of its functions; or, in other words, that the volume and functions of a part are relatively proportional. Living bodies, he argues, are composed of matter disposed in organs, the nature and number of whose functions are generally regulated by the peculiaries of their structure. Each organ exerts a specific action which is peculiar to itself, and a reciprocal action which respects the system as a whole. All the organs of which the whole is composed, having thus a mutual dependence on each other accompanied with a distinct existence, one cannot exert more than its intended allotment of activity, without imparting a peculiarity of action to the whole. The most important organs are those which are contained in the three great cavities. Such as lie without are subservient; instruments by which these internal organs are assisted in discharging their own functions. In the first cavity lies the brain, which is the exclusive organ of intelligence and passion; in the second are placed the lungs and heart, which are the organs of sanguification and circulation; and within the abdomen are found the principal secreting organs, and such as are destined for the formation of chyle. Now, proceeds Dr. Thomas, it is found that in all animals the functions of these organs bear a constant relation to their size. When the brain is large, in proportion to the rest of the body, cerebral function predominates; when the viscera of the thorax exceed, the respiratory and circulating functions prevail; and when those of the abdomen, abdominal functions preponderate. In Reptiles, and other cold-blooded animals, the lungs are clumsy and unfit for active function. In the Frog, Lizard, and Salamander, they are mere sacs, internally divided into a few cells, and the heart is equally simple in construction; whereas in Birds, and Mammalia, in which both these organs are complicated, these functions are energetically performed. Among Zoophytes the abdomen constitutes nearly the entire animal; in Insects the mechanism is more complicated; among reptiles the thoracic, or cerebral system is more developed, and the size of the abdomen is proportionally diminished. In birds, the abdominal functions are less neces

sary still.

In the Herbivore the abdominal secretions and excretions are very copious, because their internal organs are very large; while the Carnivora are as remarkable for the deficiency of both.

"Men, whose abdomen is either prominent or collapsed, approach very nearly the two extremes of herbivorous, and carnivorous animals. The first class, abdominaux, eat little at a time, but eat frequently; they digest almost continually, sleep much, and pass a sweet and tranquil life; but on the contrary, men, whose abdominal apparatus is small, compared with that of the head or chest, eat greedily, have imperfect digestion, form little chyle, and are dry and thin. It is not easy to conceive how physiologists can maintain, and even to the present hour, that a prominent abdomen, and great corpulency, are evidences of general weakness, for, say they, cellular tissue, and lymphatic fluids inundate all the organs, confine and impede their functions. But, besides that this explanation is altogether mechanical, it is not applicable to any organ, nor supported by any fact. It is easy to see, that the debility arises from the cerebral and thoracic systems, not from that of the abdomen, which is peculiarly active and predominant, which elaborates much chyle, and whose secretions are very copious. For how can one imagine, if we reflect for a moment, that large organs, which are in constant action, and whose products are considerable, have little energy. The abdominal viscera are subject to the general laws of organism; the more they are exercised, at the expense of others, the more they augment in relative size, and, by consequence, in relative energy; so that we can conclude, as we have done with respect to the thorax and head, that the relative size of the abdominal viscera indicates the relative energy of their functions." 103.

This, then, is the essence of Thomas's theory of temperament, and it may be submitted to the reader, whether it wears the attractions of a novelty. It is nothing more than the doctrine of proportion, which has been maintained from Hippocrates to Cabanis, and upon which, in fact, almost every division of this subject has hitherto rested. If any of the four constituents of the blood varied in quantity, this variation was made the origin of a new temperament. This opinion of Hippocrates, which was already as much a fancy as a fact, was stretched still further by his followers, and in place of limiting this variation to the elements of the blood it was extended to the general materials of the whole system; hence, we had the muscular temperament, if the muscular system prevailed, the bilious when the bile was in excess. But all this was proportion and nothing else, and when we are now told that we are getting a new system, and that the "author's astonishment was extreme" in finding so many accredited errors among writers on this department of physiology, we can neither say much for his modesty, nor participate in his surprise. It seems to us a distinction without much difference, whether we ground our doctrine of temperaments upon the predominancy of certain tissues and fluids, or of certain organs into the composition of which these tissues and fluids enter. The fundamental principle of both doctrines is proportion, and the arguments, which may be advanced in defence of the one, will equally apply to the maintenance of the other. If predominance of bile made the constitution bilious, or of blood sanguine, was not the disproportion, or preponderancy of either fluid the cause of such constitutional differences? And if the muscular, or nervous tissue prevailed, was not the excess of these tissues over the other textures of the system the reason why the constitutional habit was in the one case denominated muscular, and in the other nervous? If this be