Bodies Make a Difference

If a man's arms are short from shoulder to elbow, he is more than ordinarily susceptible to stomach ulcers. If he has kept a few baby teeth, he should watch his white blood-cell count. If a child has wide-set eyes, a low nose bridge, folds of skin obscuring the inner eye-corners and wide spaces between his front teeth, he should be especially careful about exposure to infantile paralysis.

Packed with such relationships between man and his bodily ailments is Human Constitution in Clinical Medicine (Hoeber; $3.50), by Dr. George Draper, Anthropologist C. Wesley Dupertuis and Dr. John Lyon Caughey Jr. of Manhattan's Presbyterian Hospital.* Material for the book was gathered from the hospital's unique Constitution Clinic, founded in 1916. To find its facts the clinic uses Sheldon's system of calculating body build (TIME, July 15, 1940), rates each patient for androgyny (male and female characteristics), photographs patients nude (of 2,500, only four have refused), performs needed laboratory tests and interviews each patient for about five hours.

The book's aim is to show medical students that a routine medical history, laboratory diagnosis and treatment are not enough. The authors point out that seemingly unrelated facts often have direct bearing on disease. For instance, retention of baby teeth has no apparent connection with faulty blood formation, until it is realized that teeth are formed at the period of embryonic life when the burden of blood-formation shifts from liver to bones.

Reading the Body. The doctors tell in detail how, given two patients with severe pain over the stomach, they may be able to tell which has a gastric ulcer and which has gall-bladder trouble. The patient with the ulcer is likely to be alert, dark-haired (but with an almost hairless chest), slim, long-jawed (but with delicate facial bones). He is likely to have oblong teeth, long hands, a sharp angle where ribs join the breastbone, "somewhat narrow lips, often down-curving at their angles." The patient with gall-bladder trouble is likely to be phlegmatic, blond (but pretty hairy), heavy-set with rather feminine flesh distribution, square-jawed with square teeth. He is likely to have a wide rib-breastbone angle, full lips. If the ulcerish type has short square hands, the doctors still suspect ulcer but look for it in the duodenum. If the head and neck are large and the legs slim, duodenal ulcer is almost certainly the answer.

Other constitutions and diseases:

> Diabetics fall into two rough groups, the thin, muscular ones and the fat ones. The doctors found that 88% of the thin ones had an acute form of the disease and were hard to regulate on insulin. Of the fat ones, 88% had a mild form of diabetes, were easily adjusted on insulin.

> Children with infantile paralysis are usually fine and big, but not so fully developed as healthy ones. The broad, flat nose bridge, which the doctors noticed as indicating a disposition toward the disease, is a carry-over from fetal life--a mature nose has a high bridge. Another feature frequently found in paralysis cases: long eyelashes.

> With susceptibility to rheumatic fever is usually found a long, slim build, a childlike expression, lack of bodily symmetry. A guess at such a patient's age is likely to be far off.

> About 60% of women with cancer of the uterus or breast have a hard, raised bony protuberance where the hard palate joins the soft palate.

> About 97% of ulcer cases worry about losing the approval of their mothers or some mother substitute (such as wife, older brothers, etc.).

> Men with prostatic disease are shorter and stockier than the average.

> Gout is almost exclusively a man's disease, cancer of the gall bladder almost exclusively a woman's. People who get diseases that are more frequent in the opposite sex are likely to have many of that sex's physical and mental characteristics. The doctors mean no insult by this--they say it is the gynic (female) factors in a man that make him a good physician.

Dr. Draper and his associates urge that there should be no dividing line between "clinical medicine" and "scientific [laboratory] medicine," a division which developed when the discovery of laboratory tests stimulated a disparaging attitude toward old-fashioned observation. Besides helping diagnosis, a thorough knowledge of the patient's constitution often shows why a treatment does or does not work (e.g., a nervous person may die of waterlogged lungs during a blood transfusion because his veins will not carry the extra blood to the heart).

*Dr. Draper is Actress Ruth Draper's brother, Dancer Paul Draper's uncle.

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