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Idiosyncrasy [ἰδιοσυγκρᾶσία (ἴδιος = personal, and σύγκρᾶσις = a mixing together) = a peculiar temperament or habit of body] has been frequently defined, but it would probably be unprofitable and certainly wearisome to recite and criticize them all. According to the Oxford Dictionary the word has three senses (1) a physical constitution peculiar to an individual, now only in medical use, (2) the mental constitution peculiar to a person or class of persons; a view or feeling, a liking or aversion, and (3) a mode of expression peculiar to an author. Thus Sir Edmund Gosse^[1] recently spoke of “the complete idiosyncrasy of Samuel Johnson’s prose” revealed in Lobo, his first publication in prose, as showing “the determined cultivation of discipline in the arrangement and construction of sentences, the love of antithesis, the indulgence to the ear in rhythm, and, above all, the contrast cunningly introduced between solemnity and familiarity.” But with this rather special use of the word, which would seem to be practically synonymous with style, it is hardly necessary to deal further.

Idiosyncrasies of course vary in their degree; there is a gradual transition from the average susceptibility in two directions, to the two extremes of insusceptibility and of hypersusceptibility, the latter supplying the most dramatic examples of idiosyncrasy; between these two poles there are many minor forms of idiosyncrasy.

The word idiosyncrasy (ἰδιοσυγκρᾱσία) occurs in Liddell and Scott’s dictionary with a reference to the Tetrabiblos (called the “Bible of Astrology”) of Claudius Ptolemaeus (100-178 A.D.) an Egyptian mathematician, astronomer, and geographer; ἰδιοσυγκρισία was used by Sectus Empiricus (A.D. 225?), and ἰδιοσύγκρισις by Dioscorides (A.D. 100?). D’Arcy Power^[2] translates as “idiosyncrasies” the Latin propria employed by Pliny in the following passage. “The Art of Medicine hardly admits any precepts of general application, and even cattle doctors since they cannot learn the idiosyncrasies of dumb animals insist on observation rather than on theories in cases of disease.” In English the word appears in the seventeenth century: Francis Hering or Herring (obiit 1628) wrote a small work of 37 pages in 1604 against wearing amulets containing arsenic as preservatives against the plague, and in it (page 29) occurs the following dictum: “The sympathys or antipathys of poisons together with the forces and secret insults of contagious seminaries, are unknown to the Physician. The idiosyncrasye, or particular Natures (as Galen called them) are unknowen, and (for ought we can see) incomprehensible unto humane imbecillitie.” Sir Thomas Browne^[3] wrote “Whether quails from any idiosyncrasy or peculiarity of constitution, do innocently feed upon hellebore, or rather sometimes but medically use the same;” he described himself as “of a constitution so general that it consorts and sympathiseth with all things. I have no antipathy, or rather idiosyncrasie, in dyet, humour, air, anything” (Religio Medici, Part 2, Section 1). In 1690 J. P. Albrecht of Nuremberg wrote “De singulari quorumdam hominum idiosyncrasia.” The learned George Berkeley, Bishop of Cloyne, in Siris, Philosophical Reflections concerning the Virtues of Tar Water (1744), published in his sixtieth year, refers to “Something in the idiosyncrasy of the patient that puzzles the physician.” These quotations show that the word had the same significance as it now has; but even a hundred years ago its use seems to have been somewhat restricted, if we may judge from a review of six books on dietetics in the Edinburgh Review (1828, XLVII, 37) in which reference is made to “the special and apparently capricious varieties of digestive power, which the learned call idiosyncrasy:” the reviewer goes on “We see daily, among men of the same race and the same habits that one is poisoned by eggs, and another by honey, almonds, or cheese; another finds an antidote to dyspepsy in plum-pudding or mince-pie, and at the same time suffers from bread as from a poison.”

Definition. Idiosyncrasy may be defined as an abnormal reaction in an otherwise normal person, which may be either on the one hand greatly exaggerated or on the other hand greatly diminished; more briefly it may be described as an unusual physiological personal equation.

It is thus distinguished from the abnormal effects seen in disease, for example on the one hand the more severe response to certain drugs (e.g. calomel and potassium iodide) in kidney disease when they cannot be properly eliminated, and on the other hand the tolerance to large doses in other diseases, such as of iodides in tertiary syphilis, opium in pain, and the reputed failure of digitalis to influence the heart in fever. Although idiosyncrasies have thus been distinguished from the modified and chiefly the exaggerated effects of drugs in disease, they may produce well marked and even severe symptoms. Abnormalities, such as colour blindness, and diseases such as haemophilia, it must be admitted, might not be thought to be excluded by the terms of this definition; but nevertheless they do not come within the generally recognised four quarters of the word’s meaning.

Idiosyncrasies, being functional aberrations, are in a different category from the effects of definite organic defects, such as short-sight, the day blindness of albinos due to lack of pigment, the night blindness of retinitis pigmentosa. But no doubt they depend on some modification of the physico-chemical structure of protoplasm, analogous to the arrangements of the electrons in the atom. More than forty years ago Jonathan Hutchinson argued that developmental defects, such as coloboma of the iris, hare-lip, clefts in the eyelid, and absence of the levator palpebrae muscle, are congenital idiosyncrasies of structure; but this view though logically defensible is tantamount to using the word idiosyncrasy to describe a gross anatomical lesion instead of confining it to an abnormal physiological reaction, the structural basis of which may indeed be assumed, but is beyond our powers to recognise. Idiosyncrasy is a semi-popular rather than a scientific term in physiology, pathology, or psychology, and it may therefore be well to mention some other conditions which may have relation to it.

Allergy (ἄλλος‚ = other, and ἐργία^[4] = action) was introduced by von Pirquet in 1911 to describe all forms of altered reactivity of the organism, whether according to the time, early, accelerated, delayed, according to quantity, exaggerated, diminished or abolished, or according to quality, colour. It therefore includes both hypersensitiveness and immunity, but it is now so commonly regarded as synonymous with hypersensitiveness and anaphylaxis, which is not the original meaning attached to it, that a fresh name anergy is sometimes used to express extreme insensitiveness. As von Pirquet^[5] employed it, allergy is the equivalent of idiosyncrasy, but now that allergy has come to be regarded as another name for anaphylaxis a distinction has been drawn between allergy and idiosyncrasy.

Anaphylaxis (ἀνα = a negative prefix and φύλαξις = protection), meaning the converse of immunity, was constructed by Charles Richet and Portier^[6] in 1902 to describe the hypersensitiveness produced by one injection of a poisonous protein to a subsequent non-toxic dose. It was soon proved, as indeed Magendie (1839) and Flexner^[7] (1894) had previously noticed, that the responsible cause of the changed reactivity was the protein and not the poison, so the original significance of the word was lost. Anaphylaxis is therefore an acquired hypersensitiveness to a foreign protein, and depends upon an antigen-antibody reaction; it explains some, but not all, cases of idiosyncrasy.

To recapitulate, all cases of anaphylaxis come under the original meaning of allergy, namely altered reaction, but some only of the allergic manifestations are anaphylactic.

Diathesis (διάθεσις = disposition) is an old word much in vogue until the advent of bacteriology drove it out of favour as being by comparison with visible micro-organisms a vague old-world phantasy. The French, however, remained attached longer than other nations to the conception of diatheses, especially to the arthritic diathesis. But championship of the diathesis was not wholly absent elsewhere, for in 1908 Dyce Duckworth^[8] proclaimed his belief in four diatheses, which recall the ancient temperaments: he pleaded for the recognition of the arthritic, the scrofulous or lymphatic, the nervous, and the bilious diatheses; since that date increased knowledge of heredity and biochemical research have justified a modified and more scientific conception of diatheses, and the anthropometric investigation of the constitutional factors in the etiology of disease has brought the importance of diatheses to the fore. Diatheses, such as the exudative lymphatic, the spasmophilic, the neuro-arthritic, and the hypersthenic gastric which tends to cause peptic ulcer (Hurst^[9]) are now in evidence. Diathesis was defined as any bodily condition of prolonged peculiarity of health giving proclivity to definite forms of disease, or more briefly as “a persisting morbid proclivity” by Jonathan Hutchinson^[10] who regarded idiosyncrasy as “indeed to a large extent nothing but diathesis brought to a point” and as “individuality run mad.” There are, however, distinct differences between diatheses and idiosyncrasies; diatheses definitely tend to the development of disease, for example the scrofulous diathesis of our forebears favours the onset of tuberculosis; idiosyncrasies are abnormal reactions but do not necessarily dispose to disease. Diatheses are essentially hereditary and much more specifically so than idiosyncrasies, for in a diathesis there is a tendency to one morbid change, such as tuberculosis or peptic ulcer of the stomach or duodenum, whereas in idiosyncrasies the hereditary factor is usually a more widespread supersensitiveness or insensitiveness, the first of which tends later to crystallize out in some particular direction, it may be eczema, asthma, or sometimes to some particular food.

Constitution or the bodily make-up of the individual has been defined by Knud Faber^[11] as “the nature of the body, including under this all inherent properties, such as the anatomical structure of the body, its morphological composition, as well as the functioning properties of the separate organs and cells.” Constitution therefore includes hereditary variations from the average both in structure and function, and of the latter “the inborn errors of metabolism” or “chemical malformations” so happily named by Sir Archibald Garrod, are examples; they may be advantageous, harmless, though of scientific interest, or pathological, and therefore concern everyone, normal or otherwise. Although definitions are proverbially dangerous, clear thinking depends on an accurate use of terms, and it is therefore well to have a distinct notion of the relation of constitution to diathesis. Diathesis has been defined as a “persisting morbid proclivity” and so is a morbid constitution. Draper^[12], who defined constitution as “the aggregate of hereditary characters influenced more or less by environment, which determines the individual’s reaction, successful or unsuccessful to the stress of environment,” has isolated a number of morbid forms of constitution which are practically the same as what others call diatheses. The constitutional variations of function may be the basis of idiosyncrasies.

Temperament, now employed mainly in a psychological sense, was formerly much in medical use and was originally founded on a physiological basis, the four temperaments being established on the lines of the ancient humoral conceptions, namely the choleric or bilious, the phlegmatic, the melancholic, and the sanguine. Hutchinson in 1884 defined temperament as “the sum of the physical peculiarities of an individual, exclusive of all definite tendencies to disease,” thus separating temperament from diathesis and making it of less importance from a medical point of view, and so but distantly related to, at any rate medical, idiosyncrasies. Alexander Stewart, who in 1887 produced a large book on “Our Temperaments” with many quotations, recognized four pure temperaments: the sanguine, bilious, lymphatic, and nervous, and regarded temperament as the association of certain mental with certain physical peculiarities. Psychologists on the other hand have regarded temperament as a type of mental character with tendencies to certain forms of emotion, Wundt defining them according to the strength of the emotions and the rate at which they alter; thus in the choleric temperament the emotions are strong and change quickly, in the melancholic strong and slow, in the phlegmatic weak and slow, and in the sanguine weak and quick.

Idiosyncrasy is usually applied to exaggerated susceptibility, but logically, like allergy, it connotes also the opposite condition of abnormal insensibility, in which the individual is remarkable for his “phlegm” or thick-skinned nature, for his ostrich-like digestion, tolerance to drugs, and resistance to infections, and biting flies and insects. This hyposensitive group of idiosyncrasies is less easy to illustrate, because, for one reason, it is difficult to eliminate acquired immunity or tolerance, such as has been ascribed to the arsenic eaters of Styria.

Idiosyncrasies have been divided into (i) psychological or mental, and (ii) those more familiar and of greater medical interest concerned with the body and called, possibly for sake of contrast, physical; but “physical” is perhaps not a suitable adjective, for it might be interpreted as meaning structural and the outcome of gross change, such as a malformation visible to the naked eye; the descriptive title “physiological” would therefore be better than “physical.”