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The Origin and Nature of Emotions by George W. Crile

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that have been exposed to injurious contacts with environment.

Of special significance is the pain which is due to cold,
which increases muscular tone and produces shivering. The general
increase in muscular tone produces an interesting postural phenomenon:
the limbs are flexed and the body bent forward, a position which probably
is due to the fact that the flexors are stronger than the extensors.
As muscular action is always accompanied by heat production,
the purpose of the muscular contraction and the shivering
is quite certainly caused by cold to assist in the maintenance
of the normal body temperature.

We have now discussed many of the causes of pain and in each instance
we have found an associated muscular action which apparently
serves some adaptive purpose (Figs. 24 and 25). If we assume
that pain exists for the purpose of stimulating muscular reactions,
we may well inquire what part of the nervous are is the site of
the sensation of pain--the nerve-endings, the trunk, or the brain?
Does pain result from physical contact with the nerve-endings, with
the physical act of transmitting an impression along the nerve trunk,
or with the process within the brain-cells by which energy is released
to cause a motor act?

It seems most probable that the site of the pain is in the brain-cells.
If this be so, then what is the physical process by which the
phenomena of pain are produced? The one hypothesis that can be
tested experimentally is that pain is a phenomenon resulting from
the rapid discharge of energy in the brain-cells. If this be true,
then if every pain receptor of the body were equally stimulated
in such a manner that

{illust. caption = FIG. 25.--FEAR AND AGONY. "Amid this dread
exuberance of woe ran naked spirits wing'd with horrid fear."--
Dante's "Inferno," Canto XXIV, lines 89, 90. all the stimuli
reached the brain-cells simultaneously, the cells would find
themselves in equilibrium and no motor act would be performed.
But if all the pain receptors of the body but one were equally stimulated,
and this one stimu-lated harder than the rest, then the latter
would gain possession of the final common path, the sensation
of pain would be felt, and a muscular contraction would result.
It is well known that when a greater pain is thrown into
competition with a lesser one, the lesser is completely submerged.
In this manner the school-boy initiates the novice into the mystery
of the painless plucking of hair. The simultaneous, but severe
application of the boot to the blindfolded victim takes complete
and exclusive possession of the final common path and the hair
is painlessly plucked through the triumph of the boot stimulus over
the hair stimulus in the struggle for the possession of the final
common path. Another argument in favor of this hypothesis that
pain is an accompaniment of the release of energy in the brain-
cells is found in the fact that painless stimuli received through
the special senses may completely submerge the painful stimuli
of physical injury; for although the stimuli to motor action,
which are received through the senses of sight, hearing, and smell,
cause even more powerful motor action than those caused by
physical contact stimuli, yet they are not accompanied by pain.
Examples of this triumph of stimulation of the special senses over
contact stimulation are frequently seen in persons obsessed by anger
or fear, and to a less degree in those obsessed by sexual emotion.
In the fury of battle the soldier may not perceive his wound until
the emotional excitation is wearing away, when the sensation
of warm blood on the skin may first attract his attention.
Religious fanatics are said to feel no pain when they subject themselves
to self-injury. Now, since both psychic and mechanical stimuli cause motor
action by the excitation ofprecisely the same mechanism in the brain,
and since the more rapid release of energy from psychic stimuli
submerges the physical stimuli and prevents pain, it would seem
that pain must be a phenomenon which is associated with the process
of releasing energy by the brain-cells. Were physical injury inflicted
in a quiescent state equal to that inflicted in the emotional state,
great pain and intense muscular action would be experienced.
Now the emotions are as purely motor excitants as is pain.
The dynamic result is the same the principal difference being the greater
suddenness and the absolute specificity of the pain stimuli as compared
with the more complex and less peremptory stimuli of the emotions.
A further evidence that pain is a product of the release of brain-cell
energy is the probability that if one could pierce the skin at
many points on a limb in such a manner that antagonistic points
only were equally and simultaneously stimulated, then an equilibrium
in the governing brain- cells would be established and neither
pain nor motion would follow. An absolute test of this assumption
cannot be made but it is supported by the obtainable evidence.
We will now turn to a new viewpoint, a practical as well as a
fascinating one, which can best be illustrated by two case histories:
A man, seventy-eight years old, whose chief complaint was obstinate
constipation, was admitted to the medical ward of the Lakeside Hospital
several years ago. The abdomen was but slightly distended;
there was no fever, no increased leukocytosis, no muscular rigidity,
and but slight general tenderness. He claimed to have lost in weight
and strength during the several months previous to his admission.
A tentative diagnosis of malignant tumor of the large intestine was made,
but free movements weresecured rather easily, and we abandoned
the idea of an exploratory operation. The patient gradually failed
and died without a definite diagnosis having been made by either
the medical or the surgical service. At autopsy there was found
a wide-spread peritonitis arising from a perforated appendix.
A child, several years old, was taken ill with some indefinite disease.
A number of the ablest medical and surgical consultants of a leading
medical center thoroughly and repeatedly investigated the case.
Although they could make no definite diagnosis they all
agreed that the trouble surely could not be appendicitis
because there was neither muscular rigidity nor tenderness.
The autopsy showed a gangrenous appendix and general peritonitis.
How can these apparently anomalous cases be explained?
These two cases are illustrations of the same principle that underlies
the freedom from pain which results from the use of narcotics
and anesthetics, the same principle that explains the fact that
cholecystitis may occur in the aged without any other local symptoms
than the presence of a mass and perhaps very slight tenderness;
and that accounts in general for the lack of well-expressed disease
phenomena in senility and in infancy. The reason why the aged,
the very young, and the subjects of general paresis show but few
symptoms of disease is that in senility the brain is deteriorated,
while in infancy the brain is so undeveloped that the mechanism
of association is inactive, hence pain and tenderness,
which are among the oldest of the associations, are wanting.
Senility and infancy are by nature normally narcotized.
The senile are passing through the twilight into the night;
while infants are traversing through the dawn into the day.
Hence it is that the diagnosis of injury and disease in the extremes
oflife is beset by especial difficulties, since the entire body
is as silent as are the brain, the pericardium, the mediastinum,
and other symptomless areas. For the same reason, when a patient
who is seriously ill with a painful disease turns upon the physician
a glowing eye and an eager face, and remarks how comfortable he feels,
then the end is near. This is a brilliant and fateful clinical mirage.
When one reflects on the vast amount of evidence as to the origin
and the purpose of pain, he is forced to conclude that pain is
a phenomenon of motor stimulation, and that its principal role is
the protection of the individual against the gross and the microscopic
enemies in his environment. The benefits of pain are especially
manifested in the urgent muscular actions by means of which the body
moves away from physical injury; obstructions of the hollow
viscera are overcome; rest is compelled in the acute infections--
the infected points are held rigidly quiet, the muscles of the abdomen
are fixed, and harmful peristalsis is arrested in peritonitis;
while there is absolutely no pain in the diseases or injuries
which affect those regions of the body in which in the course
of evolution no pain receptors were placed, or in those diseases
in which muscular inhibition or contraction is of no help.
In a biologic sense pain is closely associated with the emotional stimuli,
for both pain and the emotions incite motor activity for the good
of the individual. The frequent occurrence of post-operative and
post- traumatic pain is accounted for by the fact that the operation
or the injury has lowered the threshold of the brain- cells to trauma;
the brain and not the local sensitive field is the site of the pain.
I have found that, by blockingthe field of operation with
local anesthesia, post-operative pain is diminished; that is,
since the local anesthesia prevents the strong stimuli of the
trauma from reaching the brain, its threshold is not lowered.
There is a close resemblance between the phenomena of pain habit,
of education, of physical training, of love and of hate. In education,
in pain habit, in all emotional relations, a low brain- cell threshold
is established which facilitates the reception of specific stimuli;
all these processes are motor acts, or are symbolic of motor acts,
and we may be trained to perceive misfortune and pain as readily as we
are trained to perceive mathematical formulae or moral precepts.
In each and every case, readiness of perception depends, as it seems to me,
upon a modified state of the brain-cells, their threshold especially,
the final degree of perception possible in any individual being perhaps
based on the type of potential molecules of which the brain is built.
We must believe also that every impression is permanent, as only thus
could an individual animal or a man be fitted by his own experience
for life's battles. LAUGHTER AND CRYING What is laughter?
What is its probable origin, its distribution, and its purpose?
Laughter is an involuntary rhythmic contraction of certain
respiratory muscles, usually accompanied by certain vocal sounds.
It is a motor act of the respiratory apparatus primarily, although if
intense it may involve not only the extraordinary muscles of respiration,
but most of the muscles of the body. There are many degrees
of laughter, from the mere brightening of the eyes, a fleeting smile,
tittering andgiggling, to hysteric and convulsive laughter.
Under certain circumstances, laughter may be so intense and
so long continued that it leads to considerable exhaustion.
The formation of tears is sometimes associated with laughter.
When integrated with laughter, the nervous system can perform
no other function. Crying is closely associated with laughter,
and in children especially laughter and crying are readily interchanged.
We postulate that laughter and weeping serve a useful purpose.
According to Darwin, only man and monkeys laugh (Fig. 26);
other animals exhibit certain types of facial expression accompanying
various emotions, but laughter in the sense in which that word
is commonly used is probably an attribute of the primates only,
although it is probable that many animals find substitutes for laughter.
The proneness of man to laughter is modified by age, sex, training,
mental state, health, and by many other factors. Healthy, happy children
are especially prone to laughter, while disease, strong emotions,
fatigue, and age diminish laughter. Women laugh more than do men.
The healthy, happy maturing young woman perhaps laughs most, especially
when she is slightly embarrassed. What causes laughter? Good news,
high spirits, tickling, hearing and seeing others laugh; droll stories;
flashes of wit; passages of humor; averted injury; threatened breach
of the conventions; and numerous other causes might be added.
It is obvious that laughter may be produced by diverse influences,
many of which are so unlike each other that it would at first sight
seem improbable that a single general principle underlies all.
Before presenting a hypothesis which harmonizes most of the facts,
and which mayoffer an explanation of the origin and purpose of laughter,
let us return for a moment to some previous considerations--
that man is essentially a motor being; that all his responses to
the physical forces of his environment are motor; {illust. caption
= FIG. 26.--LAUGHING CHIMPANZEE. "Mike," the clever chimpanzee
in the London Zoo, evidently enjoys a joke as well as any one else.
(Photo by Underwood and Underwood, N. Y.)}

that thoughts and words even are symbolic of motor acts;
that in the emotions of fear, of anger, and of sexual love
the whole body is integrated for acts which are not performed.
These integrations stimulate the brain-cells, the ductless glands,
and other parts, and the energizing secretions, among which are epinephrin,
thyroid and hypophyseal secretions, are thrown into the blood-stream,
while that most available fuel, glycogen, is also mobilized in the blood.
This body-wide preparation for action may be designated kinetic reaction.
The fact that emotion is more injurious to the body than is
muscular action is well known, the difference being probably caused
by the fact that when there is action the above-mentioned products
of stimulation are consumed, while in stimulation without action
they are not consumed and must be eliminated as waste products.
Now these activating substances and the fuel glycogen may be consumed
by any muscular action as well as by the particular muscular action
for which the integration and consequent stimulation were made;
that is, if one were provoked to such anger that he felt impelled
to attack the object of his anger, one of three things might happen:
First, he might perform no physical act but give expression to
the emotion of anger; second, he might engage in a physical struggle
and completely satisfy his anger; third, he might immediately engage
in violent gymnastic exercises and thus consume all the motor-producing
elements mobilized by the anger and thus clarify his body.

In these premises we find our explanation of the origin and purpose
of laughter and crying, for since they consist almost wholly
of muscular exertion, they serve precisely such clarifying purposes
as would be served by the gymnastic exercises of an angry man.
As it seems to me, the muscular action of laughter clears the system
of the energizing substances which have been mobilized in various
parts of the body for the performance of other actions (Figs. 27
to 29). If this be true, the first question that presents itself is,
Why is the respiratory system utilized for such a clarifying purpose?
Why do we not laugh with our feet and hands as well?
Were laughter expressed with the hands, the monkey might fall
from the tree and, if by the feet, man might fall to the ground.
He would at least be ataxic. In fact, laughter has the great
advantage of utilizing a group of powerful muscles which can be
readily spared without seriously interfering with the maintenance
of posture. Laughter, however, is only one form of muscular action
which may consume the fuel thrown into the blood by excitation.
That these products of excitation are often consumed by other motor
acts than laughter is frequently seen in public meetings when
the stamping of feet and the clapping of hands in applause gives
relief to the excitation (Fig. 30). Why the noise of laughter?
In order that the products of excitation may be quickly and
completely consumed, the powerful group of expiratory muscles must
have some resistance against which they can exert themselves strongly
and at the same time provide for adequate respiratory exchange.
The intermittent closure of the epiglottis serves this purpose admirably,
just as the horizontal bars afford the resistance against which muscles
may be exercised. The facial muscles are not in use for other purposes,
hence their contractions will consume a little of the fuel.
An audience excited by the words of an impassioned speaker undergoes
a body-wide stimulation for action, all of which may be eliminated
by laughter or by applause (Fig. 31).

Let us test this hypothesis by some practical examples.
The first is an incident that accidentally occurred in our laboratory
during experiments on fear which were performed as follows:
A keen, snappy fox terrier was completely muzzled by winding a broad strip
of adhesive plaster around his jaw so as to include all but the nostrils.
When this aggressive little terrier and the rabbit found themselves
in close quarters each animal became completely governed by instinct;
the rabbit crouched in fear, while the terrier, with all the ancestral
assurance of seizing his prey, rushed, upon the rabbit, his muzzle
always glancing off and his attack ending in awkward failure.

This experiment was repeated many times and each time provoked
the serious-minded scientific visitors who witnessed it
to laughter. Why? Because the spectacle of a savage little terrier
rushing upon an innocent rabbit as if to mangle it integrated
the body of the onlooker with a strong desire to exert muscular
action to prevent the cruelty. This integration caused a conversion
of the potential energy in the brain-cells into kinetic energy,
and there resulted a discharge into the blood-stream of activating
internal secretions for the purpose of producing muscular action.
Instantly and unexpectedly the danger passed and the preparation
for muscular action intended for use in the protection of the rabbit
was not needed. This fuel was consumed by the neutral muscular
action of laughter, which thus afforded relief.

A common example of the same nature is that encountered on the street
when a pedestrian slips on a banana peel and, just as he is
about to tumble, recovers his equilibrium. The onlookers secure
relief from the integration to run to his rescue by laughing.
On the other hand, should the same pedestrian fall and fracture
his skull the motor integration of the onlookers would be consumed
by rendering physical assistance--hence there would be no laughter.
In children almost any unexpected phenomenon, such as a sudden "booing"
from behind a door, is attended by laughter, and in like manner
the kinetic reaction produced by the innumerable threats of danger
which are suddenly averted, a breach of the conventions, a sudden
relief from acute nervous tension; a surprise--indeed, any excitant
to which there is no predetermined method of giving a physical response--
may be neutralized by the excitation of the mechanism of laughter.

In the same way the laughter excited by jokes may be explained.
An analysis of a joke shows that it is composed of two parts--
the first, in which is presented a subject that acts as a stimulus
to action, and the second, in which the story turns suddenly
so that the stimulus to action is unexpectedly withdrawn.
The subject matter of the joke affects each hearer according
to the type of stimuli that commonly excites that individual.
Hence it is that a joke may convulse one person while it bores another,
and so there are jokes of the classes, bankers' jokes, politicians' jokes,
the jokes of professional men, of the plebeian, of the artist, etc.
If the joke fails, the integration products of the excitation may
be used in physical resentment (Fig. 32).

Another type of laughter is that associated with the ticklish points
of certain parts of the body, the soles of the feet and certain
parts of the trunk and of the abdomen. The excitation of the
ticklish receptors, like pain, compels self-defensive motor acts.
This response is of phylogenetic origin, and may be awakened only
by stimuli which are too light to be painful. In this connection
it is of interest to note that a superficial, insect-like contact
with the skin rarely provokes laughter, and that the tickling
of the nasal, oral, and pulmonary tracts does not produce laughter.
The ticklish points that cause laughter are rather deeply placed,
and a certain type of physical contact is required to constitute
an adequate stimulus. That is, the contact must arouse a phylogenetic
association with a physical struggle or with physical exertion.
In the foot, the adequate stimuli for laughter are such contacts
as resemble or suggest piercing by stones or rough objects.. The
intention of the one who tickles must be known; if his intention
be playful, laughter results, whereas if injury be intended,
then an effort toward escape or defense is excited, but no laughter.
If deep tickling of the ribs is known to be malicious, it will excite
physical resentment and not laughter. Self-tickling rarely causes
laughter for the reason that auto-tickling can cause only a known
degree of stimulation, so that there results no excessive integration
which requires relief by the neutral muscular activity of laughter.
In fact, one never sees purposeful acts and laughter associated.
According to its severity, an isolated stimulus causes either
an action or laughter. The ticklish points in our bodies were
probably developed as a means of defense against serious attacks
and of escape from injurious contacts.

Anger, fear, and grief are also strong excitants and, therefore,
are stimuli to motor activity. It is obvious that whatever the excitant
the physico-chemical action of the brain and the ductless glands
cannot be reversed--the effect of the stimulus cannot be recalled,
therefore either a purposeful muscular act or a neutralizing act
must be performed or else the liberated energy must smoulder
in the various parts of the body.

It is on this hypothesis that the origin and the purpose of laughter
and crying may be understood. Even a superficial analysis of the
phenomena of both laughter and crying show them to be without any
external motor purpose; the respiratory mechanism is intermittently
stimulated and inhibited; and the shoulder and arm muscles, indeed,
many muscles of the trunk and the extremities are, as far as any
external design is concerned, purposelessly contracted and released
until the kinetic energy mobilized by excitation is utilized.
During this time the facial expression gives the index to
the mental state.

Crying, like laughter, is always preceded by a stimulation
to some motor action which may or may not be performed
(Figs. 33 and 34). If a mother is anxiously watching the course
of a serious illness of her child and if, in caring for it, she is
stimulated to the utmost to perform motor acts, she will continue
in a state of motor tenseness until the child recovers or dies.
If relief is sudden, as in the crisis of pneumonia, and the mother
is not exhausted, she will easily laugh if tired, she may cry.
If death occurs, the stimulus to motor acts is suddenly
withdrawn and she then cries aloud, and performs many motor
acts as a result of the intense stimulation to motor activity
which is no longer needed in the physical care of her child.
With this clue we can find the explanation of many phenomena. We can
understand why laughter and crying are so frequently interchangeable;
why they often blend and why either gives a sense of relief;
we can understand why either laughter or crying can come only
when the issue that causes the integration is determined; we can
understand the extraordinary tendency to laughter that discloses
the unspoken sentiments of love; we can understand the tears
of the woman when she receives a proposal of marriage from the man
she loves; we can understand why any averted circumstance,
such as a threatened breach of the conventions, which would have led
to embarrassment or humiliation, leads to a tendency to laughter;
and why the recital of heroic deeds by association leads to tears,
On the other hand, under the domination of acute diseases,
of acute fear, or of great exhaustion, there is usually neither
laughter nor crying because the nervous system is under the control
of a dominating influence as a result of which the body is so
exhausted that the excess of energy which alone can produce laughing
or crying is lacking.

A remarkable study of the modification of laughter and crying by disease
is found in that most interesting of diseases--exophthalmic goiter.
In this disease there is a low threshold to all stimuli.
That the very motor mechanism of which we have been speaking
is involved, is shown by an enormous increase in its activity.
There is also an increase in the size of certain at least of the
activating glands--the thyroid and the adrenals are enlarged and overactive
and the glycogen-producing function of the liver is stimulated.
The most striking phenomenon of this disease, however, is the remarkable
lowering of the brain thresholds to stimuli. In other words,
in Graves' disease the nervous system and the activating glands--
the entire motor mechanism--are in an exalted state of activity.

If this be true, then these patients should exhibit behavior
precisely contrary to that of those suffering from acute infection,
that is, they should be constantly clearing their systems of
these superabundant energizing materials by crying or laughing,
and this is precisely what happens--the flood-gates of tears are open
much of the time in Graves' disease--a disease of the emotions.

We have already interpreted pain as a phenomenon of motor activity.
When pain does not lead to muscular activity it therefore frequently
leads to crying or to moaning, just as tickling, which is equally
an incentive to motor activity, results in laughter if it does
not find full expression in action.

From the foregoing we infer that pain, the intense motor response
to tickling, and emotional excitation are all primitive biologic
reactions for the good of the individual, and that all have
their origin in the operation of the great laws of evolution.
If to this inference we add the physiologic dictum that the nervous
system always acts as a whole, and that it can respond to but one
stimulus at a time, we can easily understand that while diverse
causes may integrate the nervous system for a specific action,
if the cause be suddenly removed, then the result of the
integration of the nervous system may be, not a specific action,
but an undesigned muscular action, such as crying or laughter.
Hence it is that laughter and crying may be evoked by diverse
exciting causes. The intensity of the laughter or of the crying
depends upon the intensity of the stimulus and the dynamic state
of the individual.

The linking together of these apparently widely separated phenomena
by the simple law of the discharge of energy by association perhaps
explains the association of an abnormal tendency to tears with an
abnormally low threshold for pain (Fig. 36). In the neurasthenic,
tears and pain are produced with abnormal facility. Hence it is that,
if a patient about to undergo a surgical operation is in a state of fear
and dread before the operation, the threshold to all stimuli is lowered,
and this lowered threshold will continue throughout the operation,
even under inhalation anesthesia, because the stimulus produced by
cutting sensitive tissue is transmitted to the brain just as readily
as if the patient were not anesthetized. In like manner, the brain
may be sensitized by the administration of large doses of thyroid
extract prior to operation, the threshold to injury in such a case
continuing to be low to traumatic stimuli even under anesthesia.
Under the sensitizing influences of thyroid extract or of Graves'
disease the effect of an injury, of an operation, or of emotional
excitation is heightened. The extent to which the threshold to pain
or to any other excitant is affected by Graves' disease is illustrated
by the almost fatal reaction which I once saw result from the mere
pricking with a hypodermic needle of a patient with this disease.
As the result of a visit from a friend, the pulse-rate of a victim of this
disease may increase twenty beats and his temperature rise markedly.
I have seen the mere suggestion of an operation produce collapse.
As the brain is thus remarkably sensitized in Graves' disease, we find
that in these patients laughter, crying, emotional disturbances,
and surgical shock are produced with remarkable facility.

I hope that even this admittedly crude and imperfect consideration
of this subject will suggest the possibility of establishing
a practical viewpoint as to the origin and purpose of pain,
of tickling, and of such expressions of emotion as laughter and crying,
and that it may help us to understand their significance in health
and in disease.


[*] Address before The American Philosophical Society, April 18, 1913.

The brain in all animals (including man) is but the clearing-house
for reactions to environment, for animals are essentially motor
or neuromotor mechanisms, composed of many parts, it is true,
but integrated by the nervous system. Throughout the phylogenetic history
of the race the stimuli of environment have driven this mechanism,
whose seat of power--the battery--is the brain.

Since all normal life depends upon the response of the brain
to the daily stimuli, we should expect in health, as well
as in disease, to find modifications of the functions and the
physical state of the component parts of this central battery--
the brain-cells. Although we must believe, then, that every
reaction to stimuli, however slight, produces a corresponding
change in the brain-cells, yet there are certain normal, that is,
non-diseased, conditions which produce especially striking changes.
The cell changes due to the emotions, for example, are so similar,
and in extreme conditions approach so closely to the changes produced
by disease, that it is impossible to say where the normal ceases
and the abnormal begins.

In view of the similarity of brain-cell changes it is not strange
that in the clinic as well as in daily life, we are confronted
constantly by outward manifestations which are so nearly
identical that the true underlying cause of the condition in
any individual case is too often overlooked or misunderstood.
In our laboratory experiments and in our clinical observations
we have found that exhaustion produced by intense emotion,
prolonged physical exertion, insomnia, intense fear, certain toxemias,
hemorrhage, and the condition commonly denominated surgical shock,
produce similar outward manifestations and identical brain-cell changes.

It is, therefore, the purpose of this paper to present the definite
results of laboratory researches which show certain relations
between alterations in brain functions and physical changes
in the brain-cells.

Fear.--Our experiments have shown that the brain-cell changes due
to fear may be divided into two stages: First, that of hyperchromatism--
stimulation; second, that of hypochromatism--exhaustion (Figs. 5 and
13). Hyperchromatism was shown only in the presence of the activating
stimuli or within a very short time after they had been received.
This state gradually changed until the period of maximum exhaustion
was reached--about six hours later. Then a process of reconstruction
began and continued until the normal state was again reached.

Fatigue.--Fatigue from overexertion produced in the brain-cells
like changes to those produced by fear, these changes being
proportional to the amount of exertion (Fig. 4). In the extreme
stage of exhaustion from this cause we found that the total
quantity of Nissl substance was enormously reduced.
When the exertion was too greatly prolonged, it took weeks or
months for the cells to be restored to their normal condition.
We have proved, therefore, that in exhaustion resulting from emotion
or from physical work a certain number of the brain-cells are
permanently lost. This is the probable explanation of the fact
that an athlete or a race-horse trained to the point of highest
efficiency can reach his maximum record but once in his life.
Under certain conditions, however, it is possible that, though some
chromatin is forever lost, the remainder may be so remarkably developed
that for a time at least it will compensate for that which is gone.

Hemorrhage.--The loss of blood from any cause, if sufficient to reduce
the blood-pressure, will occasion a change in the brain-cells, provided
that the period of hypotension lasts for more than five minutes.
This time limit is a safeguard against permanent injury
from the temporary hypotension which causes one to faint.
If the hemorrhage be long continued and the blood-pressure be low,
there will be a permanent loss of some of the brain-cells. This
explains why an individual who has suffered from a prolonged
hemorrhage will never again be restored to his original powers.

Drugs.--According to their effect upon the brain-cells, drugs
may be divided into three classes: First, those that stimulate
the brain-cells to increased activity, as strychnin (Fig. 37);
second, those that chemically destroy the brain-cells, as alcohol
and iodoform (Figs. 38 and 39); third, those that suspend the functions
of the cells without damaging them, as nitrous oxid, ether, morphin.
Our experiments have shown that the brain-cell changes induced
by drugs of the first class are precisely the same as the cycle
of changes produced by the emotions and by physical activity.
We have found that strychnin, according to the dosage, causes convulsions
ending in exhaustion and death; excitation followed by lassitude;
stimulation without notable after-results; or

{illust. caption = A, Section of Cerebellum of Normal Dog. C, Section of
Cerebellum of Dog after Repeated Doses of Strychnin. FIG. 37.--
drawings.)increased mental tone; while the brain-cells accurately
display these physiologic alterations in proportional hyperchromatism
in the active stages, and proportional chromatolysis in the stages
of reaction. The biologic and therapeutic application of this fact
is as obvious as it is important.

In our experiments, alcohol in large and repeated dosage caused
marked morphologic changes in the brain-cells which went as far
even as the destruction of some of the cells (Fig. 39). Ether,
on the other hand, even after five hours of administration,
produced no observable destructive changes in the brain-cells.

The effect of iodoform was peculiarly interesting, as it was the only
drug that produced a rise of temperature. Its observed effect upon
the brain-cells was that of wide-spread destruction.

Infections.--In every observation regarding the effect of pyogenic
infections on dogs and on man we found that they caused definite
and demonstrable lesions in certain cells of the nervous system,
the most marked changes being in the cortex and the cerebellum
(Fig. 40). For example, in fatal infections resulting from
bowel obstruction, in peritonitis, and in osteomyelitis, the real
lesion is in the brain-cells. We may, therefore, reasonably conclude
that the lassitude, the diminished mental power, the excitability,
irritability, restlessness, delirium, and unconsciousness which may
be associated with acute infections, are due to physical changes
in the brain-cells.

Graves' Disease.--In Graves' disease the brain-cells show marked
changes which are apparently the same as those produced by overwork,
by the emotions, and by strychnin. In the postmortem examination
of one advanced case it was found that a large number of brain-cells
were disintegrated beyond the power of recuperation, even had
the patient lived. This is undoubtedly the reason why a severe case
of exophthalmic goiter sustains a permanent loss of brain power.

Insomnia.--The brains of rabbits which had been kept awake for one
hundred hours showed precisely the same changes as those shown
in physical fatigue, strychnin poisoning, and exhaustion from
emotional stimulation. Eight hours of continuous sleep restored
all the cells except those that had been completely exhausted.
This will explain the permanent ill effect of long-continued insomnia;
that is, long-continued insomnia permanently destroys a part
of the brain-cells just as do too great physical exertion,
certain drugs, emotional strain, exophthalmic goiter, and hemorrhage.
We found, however, that if, instead of natural sleep, the rabbits
were placed for the same number of hours under nitrous oxid anesthesia,
not only did the brain-cells recover from the physical deterioration,
but that 90 per cent. of them became hyperchromatic.
This gives us a possible clue to the actual chemical effect of sleep.
For since nitrous oxid owes its anesthetic effect to its influence
upon oxidation, we may infer that sleep also retards the oxidation
of the cell contents. If this be true, then it is probable
that inhalation anesthetics exert their peculiar influence upon
that portion of the brain through which sleep itself is produced.
If nitrous oxid anesthesia and sleep are chemically identical, then we
have a further clue to one of the primary mechanisms of life itself;
and as a practical corollary one might be able to produce artificial
sleep which would closely resemble normal sleep, but which would
have this advantage, that by using an anesthetic which interferes with
oxidation the brain-cells might be reconstructed after physical fatigue,
after emotional strain, or after the depression of disease.

In the case of the rabbit in which nitrous oxid was substituted
for sleep, the appearance of the brain-cells resembled that in
but one other group experimentally examined--the brain-cells
of hibernating woodchucks.

Insanity.--Our researches have shown that in the course of a fatal
disease and in fatal exhaustion, however produced, death does not
ensue until there is marked disorganization of the brain tissue.
In the progress of disease or exhaustion one may see in different
patients every outward manifestation of mental deterioration,
manifestations which, in a person who does not show any other sign of
physical disease, mark him as insane. Take, for example, the progressive
mental state of a brilliant scholar suffering from typhoid fever.
On the first day of the gradual onset of the disease he would
notice that his mental power was below its maximum efficiency;
on the second he would notice a further deterioration, and so
the mental effect of his disease would progress until he would
find it impossible to express a thought or to make a deduction.
No one can be philanthropic with jaundice; no one suffering
from Graves' disease can be generous; no mental process is possible
in the course of the acute infectious diseases. Just prior to death
from any cause every one is in a mental state which, if it could
be continued, would cause that individual to be judged insane.
If the delirium that occurs in the course of certain diseases
should be continued, the patient would be judged insane.
In severe cases of Graves' disease the patient is insane.
Individuals under overwhelming emotion may be temporarily insane.
Every clinician has seen great numbers of cases in which insanity
is a phase of a disease, of an injury, or of an emotion.
The stage of excitation in anesthesia is insanity.
The only difference between what is conventionally called insanity
and the fleeting insanity of the sick and the injured is that of time.
We may conclude, therefore, what must be the brain-picture of the person
who is permanently insane. This _a priori_ reasoning is all that
is possible, since the study of the brain in the insane has thus far
been confined to the brains of those who have died of some disease.
And it is impossible to say which changes have been produced by the
fatal disease, and which by the condition which produced the insanity.
The only logical way by which to investigate the physical basis
of insanity would be to make use of the very rare opportunities
of studying the brains of insane persons who have died in accidents.

Our experiments have proved conclusively that whether we call a person
fatigued or diseased, the brain-cells undergo physical deterioration,
accompanied by loss of mental power (Figs. 40 to 43). Even to the minutest
detail we can show a direct relationship between the physical state
of the brain-cells and the mental power of the individual, that is,
the physical power of a person goes _pari passu_ with his mental power.
Indeed, it is impossible to conceive how any mental action,
however subtle, can occur without a corresponding change in the
brain-cells. It is possible now to measure only the evidences of
the effects on the brain-cells of gross and violent mental activity.
At some future time it will doubtless be possible so to refine
the technic of brain-cell examinations that more subtle changes
may be measured. Nevertheless, with the means at our disposal
we have shown already that in all the conditions which we
have studied the cells of the cortex show the greatest changes,
and that loss of the higher mental functions invariably accompanies
the cell deterioration.


[*] Address delivered before Sigma Xi, Case School
of Science, Cleveland, Ohio, May 27, 1913, and published
in _Science_, August 29, 1913.

Traditional religion, traditional medicine, and traditional psychology
have insisted upon the existence in man of a triune nature.
Three "ologies" have been developed for the study of each nature
as a separate entity--body, soul, and spirit--physiology, psychology,
theology; physician, psychologist, priest. To the great minds
of each class, from the days of Aristotle and Hippocrates on,
there have come glimmerings of the truth that the phenomena
studied under these divisions were interrelated. Always, however,
the conflict between votaries of these sciences has been sharp,
and the boundary lines between them have been constantly changing.
Since the great discoveries of Darwin, the zoologist, biologist,
and physiologist have joined hands, but still the soul-body-spirit
chaos has remained. The physician has endeavored to fight the gross
maladies which have been the result of disordered conduct;
the psychologist has reasoned and experimented to find the laws
governing conduct; and the priest has endeavored by appeals to an
unknown god to reform conduct.

The great impulse to a deeper and keener study of man's relation,
not only to man, but to the whole animal creation, which was given
by Darwin, has opened the way to the study of man on a different basis.
Psychologists, physicians, and priests are now joining hands as never
before in the great world-wide movement for the betterment of man.
The new science of sociology is combining the functions of all three,
for priest, physician, and psychologist have come to see that man
is in large measure the product of his environment.

My thesis to-night, however, will go beyond this common agreement,
for I shall maintain, not that man is in _*large measure_ the product
of his environment, but that environment has been the actual CREATOR
of man; that the old division between body, soul, and spirit
is non-existent; that man is a unified mechanism responding in every
part to the adequate stimuli given it from without by the environment
of the present and from within by the environment of the past,
the record of which is stored in part in cells throughout
the mechanism, but especially in its central battery--the brain.
I postulate further that the human body mechanism is equipped, first,
for such conflict with environment as will tend to the preservation
of the individual; and, second, for the propagation of the species,
both of these functions when most efficiently carried out tending
to the upbuilding and perfection of the race.

Through the long ages of evolution the human mechanism has been
slowly developed by the constant changes and growth of its parts
which have resulted from its continual adaptation to its environment.
In some animals the protection from too rough contact with
surroundings was secured by the development of an outside armor;
in others noxious secretions served the purposes of defense,
but such devices as these were not suitable for the higher animals
nor for the diverse and important functions of the human race.
The safety of the higher animals and of man had to be preserved
by some mechanism by means of which they could become adapted
to a much wider and more complex environment, the dominance over
which alone gives them their right to be called "superior beings."
The mechanism by the progressive development of which living
beings have been able to react more and more effectually to their
environment is the central nervous system, which is seen in one
of its simplest forms in motor plants, such as the sensitive
plant and the Venus fly-trap, and in its highest development only
in the sanest, healthiest, happiest, and most useful men.

The essential function of the nervous system was primarily to secure
some form of motor activity, first as a means of securing food,
and later as a means of escaping from enemies and to promote procreation.
Activities for the preservation of the individual and of the species
were and are the only purposes for which the body energy is expended.
The central nervous system hag accordingly been developed for the purpose
of securing such motor activities as will best adapt the individuals
of a species for their self-preservative conflict with environment.

It is easy to appreciate that the simplest expressions of nerve response--
the reflexes--are motor in character, but it is difficult to understand
how such intangible reactions as love, hate, poetic fancy, or moral
inhibition can be also the result of the adaptation to environment
of a distinctively motor mechanism. We expect, however, to prove
that so-called "psychic" states as well as the reflexes are products
of adaptation; that they occur automatically in response to adequate
stimuli in the environment; that, like the reflexes, they are
expressions of motor activity, which, although intangible and unseen,
in turn incite to activity the units of the motor mechanism of the body;
and finally, that any "psychic" condition results in a definite depletion
of the potential energy in the brain-cells which is proportionate
to the muscular exertion of which it is the representative.

That this nerve mechanism may effectively carry out its
twofold function, first, of self-adaptation to meet adequately
the increasingly complicated stimuli of environment; and second,
of adapting the motor mechanism to respond adequately to its demands,
there have been implanted in the body numerous nerve ceptors--
some for the transmission of stimuli harmful to the mechanism--
nociceptors some of a beneficial character--beneceptors; and still
others more highly specialized, which partake of the nature of both
bene- and nociceptors--the distance ceptors, or special senses.

A convincing proof that environment has been the creator
of man is seen in the absolute adaptation of the nociceptors
as manifested in their specific response to adequate stimuli,
and in their presence in only those parts of the body which throughout
the history of the race have been most exposed to harmful contacts.
We find they are most numerous in the face, the neck, the abdomen,
the hands, and the feet; while in the back they are few in number,
and within the bony cavities they are lacking.

Instances of the specific responses made by the nociceptors might be
multiplied indefinitely. Sneezing, for example, is a specific response
made by the motor mechanism to stimulation of nociceptors in the nose,
while stimulation of the larynx does not produce a sneeze, but a cough;
stimulation of the nociceptors of the stomach does not produce cough,
but vomiting; stimulation of the nociceptors of the intestine
does not produce vomiting, but increased peristaltic action.
There are no nociceptors misplaced; none wasted; none that do not
make an adequate response to adequate stimulation.

Another most significant proof that the environment of the past
has been the creator of the man of to-day is seen in the fact
that man has added to his environment certain factors to which
adaptation has not as yet been made. For example, heat is
a stimulus which has existed since the days of prehistoric man,
while the _x_-ray is a discovery of to-day; to heat, the nociceptors
produce an adequate response; to the _x_-ray there is no response.
There was no weapon in the prehistoric ages which could move at
the speed of a bullet from the modern rifle, therefore, while slow
penetration of the tissues produces great pain and muscular response,
there is no response to the swiftly moving bullet.

The response to contact stimuli then depends always on the presence
of nociceptors in the affected part of the body and to the type
of the contact. Powerful response is made to crushing injury by
environmental forces; to such injuring contacts as resemble the impacts
of fighting; to such tearing injuries as resemble those made by teeth
and claws (Fig. 9). On the other hand, the sharp division of tissue
by cutting produces no adaptive response; indeed, one might imagine
that the body could be cut to pieces by a superlatively sharp knife
applied at tremendous speed without material adaptive response.

These examples indicate how the history of the phylogenetic experiences
of the human race may be learned by a study of the position
and the action of the nociceptors, just as truly as the study
of the arrangement and variations in the strata of the earth's
crust discloses to us geologic history.

These adaptive responses to stimuli are the result of the action
of the brain-cells, which are thus continually played upon by
the stimuli of environment. The energy stored in the brain-cells
in turn activates the various organs and parts of the body.
If the environmental impacts are repeated with such frequency that
the brain-cells have no time for restoration between them, the energy
of the cells becomes exhausted and a condition of shock results.
Every action of the body may thus be analyzed into a stimulation
of ceptors, a consequent discharge of brain-cell energy,
and a final adaptive activation of the appropriate part.
Walking, running, and their modifications constitute an adaptation
of wonderful perfection, for, as Sherrington has shown,
the adaptation of locomotion consists of a series of reflexes--
ceptors in the joints, in the limb, and in the foot being stimulated
by variations in pressure.

As we have shown, the bene- and nociceptors orientate man to all
forms of physical contact--the former GUIDE HIM TO the acquisition
of food and to sexual contact; the latter DIRECT HIM FROM contacts
of a harmful nature. The distance ceptors, on the other hand,
adapt man to his distant environment by means of communication
through unseen forces--ethereal vibrations produce sight; air waves
produce sound; microscopic particles of matter produce smell.
The advantage of the distance ceptors is that they allow time
for orientation, and because of this great advantage the majority
of man's actions are responses to their adequate stimuli.
As Sherrington has stated, the greater part of the brain has been
developed by means of stimuli received through the special senses,
especially through the light ceptors, the optic nerves.

We have just stated that by means of the distance ceptors animals
and man orientate themselves to their distant environment.
As a result of the stimulation of the special senses chase and escape
are effected, fight is conducted, food is secured, and mates are found.
It is obvious, therefore, that the distance ceptors are the primary
cause of continuous and exhausting expenditures of energy.
On the other hand, stimuli applied to contact ceptors lead to short,
quick discharges of nervous energy. The child puts his hand
in the fire and there is an immediate and complete response
to the injuring contact; he sees a pot of jam on the pantry shelf
and a long train of continued activities are set in motion,
leading to the acquisition of the desired object.

The contact ceptors do not at all promote the expenditure of energy
in the chase or in fight, in the search for food or for mates.
Since the distance ceptors control these activities, one would expect to
find that they control also those organs whose function is the production
of energizing internal secretions. Over these organs--the thyroid,
the adrenals, the hypophysis--the contact ceptors have no control.
Prolonged laboratory experimentation seems to prove this postulate.
According to our observations, no amount of physical trauma inflicted upon
animals will cause hyperthyroidism or increased adrenalin in the blood,
while fear and rage do produce hyperthyroidism and increased adrenalin
(Fig. 44) (Cannon). This is a statement of far-reaching importance
and is the key to an explanation of many chronic diseases--
diseases which are associated with the intense stimulation of
the distance ceptors in human relations.

Stimuli of the contact ceptors differ from stimuli of the distance
ceptors in still another important particular. The adequacy of stimuli
of the contact ceptors depends upon their number and intensity,
while the adequacy of the stimuli of the distance ceptors depends
upon the EXPERIENCE of the species and of the individual.
That is, according to phylogeny and ontogeny this or that sound,
this or that smell, this or that sight, through association
recapitulates the experience of the species and of the individual--
awakens the phylogenetic and ontogenetic memory. In other words, sights,
sounds, and odors are symbols which awaken phylogenetic association.
If a species has become adapted to make a specific response to a
certain object, then that response will occur automatically in an
individual of that species when he hears, sees, or smells that object.
Suppose, for example, that the shadow of a hawk were to fall
simultaneously on the eyes of a bird, a rabbit, a cow, and a boy.
That shadow would at once activate the rabbit and the bird to an
endeavor to escape, each in a specific manner according to its
phylogenetic adaptation; the cow would be indifferent and neutral;
while the boy, according to his personal experience or ontogeny,
might remain neutral, might watch the flight of the hawk with interest
or might try to shoot it.

Each phylogenetic and each ontogenetic experience by an indirect
method develops its own mechanism of adaptation in the brain;
and the brain threshold is raised or lowered to stimuli by
the strength and frequency of repetition of the experience.
Thus through the innumerable symbols supplied by environment the distance
ceptors drive this or that animal according to the type of brain
pattern and the particular state of threshold which has been developed
in that animal by its phylogenetic and ontogenetic experiences.
The brain pattern depends upon his phylogeny, the state of threshold
upon his ontogeny. Each BRAIN PATTERN is created by some particular
element in the environment to which an adaptation has been made
for the good of the species. The _*state of threshold_ depends
upon the effect made upon the individual by his personal contacts
with that particular element in his environment. The presence
of that element produces in the individual an associative recall
of the adaptation of his species--that is, the brain pattern developed
by his phylogeny becomes energized to make a specific response.
The intensity of the response depends upon the state of threshold--
that is, upon the associative recall of the individual's
own experience--his ontogeny.

If the full history of the species and of the individual
could be known in every detail, then every detail of that
individual's conduct in health and disease could be predicted.
Reaction to environment is the basis of conduct, of moral standards,
of manners and conventions, of work and play, of love and hate,
of protection and murder, of governing and being governed, in fact,
of all the reactions between human beings--of the entire web of life.
To quote Sherrington once more: "Environment drives the brain,
the brain drives the various organs of the body."

By what means are these adaptations made? What is the mechanism through
which adequate responses are made to the stimuli received by the ceptors?
We postulate that in the brain there are innumerable patterns
each the mechanism for the performance of a single kind of action,
and that the brain-cells supply the energy--electric or otherwise--
by which the act is performed; that the energy stored in the brain-cells
is in some unknown manner released by the force which activates
the brain pattern; and that through an unknown property of these brain
patterns each stimulus causes such a change that the next stimulus
of the same kind passes with greater facility.

Each separate motor action presumably has its own mechanism--
brain pattern--which is activated by but one ceptor and by
that ceptor only when physical force of a certain intensity
and rate of motion is applied. This is true both of the visible
contacts affecting the nociceptors and of the invisible contacts
by those intangible forces which affect the distance ceptors.
For example, each variation in speed of the light-producing
waves of ether causes a specific reaction in the brain.
For one speed of ether waves the reaction is the perception
of the color blue; for another, yellow; for another, violet.
Changes in the speed of air waves meet with specific response
in the brain patterns tuned to receive impressions through the
aural nerves, and so we distinguish differences in sound pitch.
If we can realize the infinite delicacy of the mechanisms adapted
to these infinitesimal variations in the speed and intensity of
invisible and intangible stimuli, it will not be difficult to conceive
the variations of brain patterns which render possible the specific
responses to the coarser contacts of visible environment.

Each brain pattern is adapted for but one type of motion,
and so the specific stimuli of the innumerable ceptors play
each upon its own brain pattern only. In addition, each brain
pattern can react to stimuli applied only within certain limits.
Too bright a light blinds; too loud a sound deafens. No mechanism
is adapted for waves of light above or below a certain rate of speed,
although this range varies in different individuals and in different
species according to the training of the individual and the need
of the species.

We have already referred to the fact that there is no receptive
mechanism adapted to the stimuli from the _x_-ray, from the
high-speed bullet, from electricity. So, too, there are innumerable
forces in nature which can excite in man no adaptive response,
since there exist in man no brain patterns tuned to their waves,
as in the case of certain ethereal and radioactive forces.

On this mechanistic basis the emotions may be explained as activations
of the entire motor mechanism for fighting, for escaping, for copulating.
The sight of an enemy stimulates in the brain those patterns formed
by the previous experiences of the individual with that enemy, and also
the experiences of the race whenever an enemy had to be met and overcome.
Each of these many brain patterns in turn activates that part of
the body through which lies the path of its own adaptive response--
those parts including the special energizing or activating organs.
Laboratory experiments show that in an animal driven strongly
by emotion the following changes may be seen: (1) A mobilization
of the energy-giving compound in the brain-cells, evidenced by a
primary increase of the Nissl substance and a later disappearance
of this substance and the deterioration of the cells (Figs. 5 and 13);
(2) increased output of adrenalin (Cannon), of thyroid secretion,
of glycogen, and an increase of the power of oxidation in the muscles;
(3) accelerated circulation and respiration with increased
body temperature; (4) altered metabolism. All these are adaptations
to increase the motor efficiency of the mechanism. In addition,
we find an inhibition of the functions of every organ and tissue that
consumes energy, but does not contribute directly to motor efficiency.
The mouth becomes dry; the gastric and pancreatic secretions are
lessened or are completely inhibited; peristaltic action stops.
The obvious purpose of all these activations and inhibitions is
to mass every atom of energy upon the muscles that are conducting
the defense or attack.

So strong is the influence of phylogenetic experience that though
an enemy to-day may not be met by actual physical attack,
yet the decks are cleared for action, as it were, and the weapons
made ready, the body as a result being shaken and exhausted.
The type of emotion is plainly declared by the activation
of the muscles which would be used if the appropriate physical
action were consummated. In anger the teeth are set, the fists
are clenched, the posture is rigid; in fear the muscles collapse,
the joints tremble, and the running mechanism is activated
for flight; in sexual excitement the mimicry is as obvious.
The emotions, then, are the preparations for phylogenetic activities.
If the activities are consummated, the fuel--glycogen--and the activating
secretions from the thyroid, the adrenals, the hypophysis are consumed.
In the activation without action, these products must be eliminated
as waste products and so a heavy strain is put upon the organs
of elimination. It is obvious that the body under emotion might be
clarified by active muscular exercise, but the subject of the emotion
is so strongly integrated thereby that it is difficult for him
to engage in diverting, clarifying exertion. The person in anger
does not want to be saved from the ill effects of his own emotion;
he wants only to fight; the person in fear wants only to escape;
the person under sexual excitement wants only possession.

All the lesser emotions--worry, jealousy, envy, grief, disappointment,
expectation--all these influence the body in this manner, the consequences
depending upon the intensity of the emotion and its protraction.
Chronic emotional stimulation, therefore, may fatigue or exhaust
the brain and may cause cardiovascular disease, indigestion, Graves'
disease, diabetes, and insanity even.

The effect of the emotions upon the body mechanism may be compared
to that produced upon the mechanism of an automobile if its engines
are kept running at full speed while the machine is stationary.
The whole machine will be shaken and weakened, the batteries and weakest
parts being the first to become impaired and destroyed, the length
of usefulness of the automobile being correspondingly limited.

We have shown that the effects upon the body mechanism of the action
of the various ceptors is in relation to the response made by the brain
to the stimuli received. What is this power of response on the part
of the brain but CONSCIOUSNESS? If this is so, then consciousness
itself is a reaction to environment, and its intensity must vary
with the state of the brain and with the environmental stimuli.
If the brain-cells are in the state of highest efficiency, if their
energy has not been drawn upon, then consciousness is at its height;
if the brain is fatigued, that is, if the energy stored in the cells
has been exhausted to any degree, then the intensity of consciousness
is diminished. So degrees of consciousness vary from the height
maintained by cells in full vigor through the stages of fatigue
to sleep, to the deeper unconsciousness secured by the administration
of inhalation anesthetics, to that complete unconsciousness
of the environment which is secured by blocking the advent to
the brain of all impressions from both distance and contact ceptors,
by the use of both local and inhalation anesthetics--the state
of anoci-association (Fig. 14).

Animals and man may be so exhausted as to be only semi-conscious.
While a brain perfectly refreshed by a long sleep cannot immediately
sleep again, the exhausted brain and the refreshed brain when subjected
to equal stimuli will rise to unequal heights of consciousness.
The nature of the physical basis of consciousness has been
sought in experiments on rabbits which were kept awake from
one hundred to one hundred and nine hours. At the end of this
time they were in a state of extreme exhaustion and seemed
semi-conscious. If the wakefulness had been further prolonged,
this state of semi-consciousness would have steadily changed
until it culminated in the permanent unconsciousness of death.
An examination of the brain-cells of these animals showed physical
changes identical with those produced by exhaustion from other causes,
such as prolonged physical exertion or emotional strain (Figs. 45
and 46). After one hundred hours of wakefulness the rabbits were
allowed a long period of sleep. All the brain-cells were restored
except those that had been in a state of complete exhaustion.
A single seance of sleep served to restore some of the cells,
but those which had undergone extreme changes required prolonged rest.
These experiments give us a definite physical basis for explaining
the cost to the body mechanism of maintaining the conscious state.
We have stated that the brain-cell changes produced by prolonged
consciousness are identical with those produced by physical exertion
and by emotional strain. Rest, then, and especially sleep,
is needed to restore the physical state of the brain-cells which
have been impaired, and as the brain-cells constitute the central
battery of the body mechanism, their restoration is essential
for the maintenance of normal vitality.

In ordinary parlance, by consciousness we mean the activity
of that part of the brain in which associative memory resides,
but while associative memory is suspended the activities of the brain
as a whole are by no means suspended; the respiratory and circulatory
centers are active, as are those centers which maintain muscular tone.
This is shown by the muscular response to external stimuli made
by the normal person in sleep; by the occasional activation of motor
patterns which may break through into consciousness causing dreams;
and finally by the responses of the motor mechanism made to the injuring
stimuli of an operation on a patient under inhalation anesthesia only.

Direct proof of the mechanistic action of many of life's phenomena
is lacking, but the proof is definite and final of the part
that the brain-cells play in maintaining consciousness;
of the fact that the degree of consciousness and mental
efficiency depends upon the physical state of the brain-cells;
and finally that efficiency may be restored by sleep,
provided that exhaustion of the cells has not progressed too far.
In this greatest phenomenon of life, then, the mechanistic theory
is in harmony with the facts.

Perhaps no more convincing proof of our thesis that the body is
a mechanism developed and adapted to its purposes by environment
can be secured than by a study of that most constant manifestation
of consciousness--pain.

Like the other phenomena of life, pain was undoubtedly evolved
for a particular purpose--surely for the good of the individual.
Like fear and worry, it frequently is injurious. What then may
be its purpose?

We postulate that pain is a result of contact ceptor stimulation
for the purpose of securing protective muscular activity.
This postulate applies to all kinds of pain, whatever their cause--
whether physical injury, pyogenic infection, the obstruction
of hollow viscera, childbirth, etc.

All forms of pain are associated with muscular action, and as in every
other stimulation of the ceptors, each kind of pain is specific
to the causative stimuli. The child puts his hand in the fire;
physical injury pain results, and the appropriate muscular
response is elicited. If pressure is prolonged on some parts
of the body, anemia of the parts may result, with a corresponding
discomfort or pain, requiring muscular action for relief.
When the rays of the sun strike directly upon the retina, light pain
causes an immediate protective action, so too in the evacuation
of the intestine and the urinary bladder as normal acts, and in
overcoming obstruction of these tracts, discomfort or pain compel
the required muscular actions. This view of pain as a stimulation
to motor action explains why only certain types of infection are
associated with pain; namely, those types in which the infection
may be spread by muscular action or those in which the fixation
of parts by continued muscular rigidity is an advantage.
As a further remarkable proof of the marvelous adaptation
of the body mechanism to meet varying environmental conditions,
we find that just as nociceptors have been implanted in only those
parts of the body which have been subject to nocuous contacts,
so a type of infection which causes muscular action in one part
of the body may cause none when it attacks another.

This postulate gives us the key to the pain-muscular phenomena
of peritonitis, pleurisy, cystitis, cholecystitis, etc., as well as to
the pain-muscular phenomena in obstructions of the hollow viscera.
If pain is a part of a muscular response and occurs only
as a result of contact ceptor stimulation by physical injury,
infection, anemia, or obstruction, we may well inquire which part
of the nerve mechanism is the site of the phenomenon of pain.
Is it the nerve-ending, the nerve-trunk, or the brain? That is,
is pain associated with the physical contact with the nerve-ending,
or with the physical act of transmission along the nerve-trunk,
or with the change of brain-cell substance by means of which
the motor-producing energy is released?

We postulate that the pain is associated with the discharge of energy
from the brain-cells. If this be true, then if every nociceptor in
the body were equally stimulated in such a manner that all the stimuli
should reach the brain-cells simultaneously, then the cells would
find themselves in equilibrium and no motor act would be performed.
But if all the pain nerve ceptors but one were equally stimulated,
and this one more strongly stimulated than the rest, then this
one would gain possession of the final common path--would cause
a muscular action and the sensation of pain.

It is well known that when a greater pain or stimulus is thrown
into competition with a lesser one, the lesser is submerged.
Of this fact the school-boy makes use when he initiates
the novice into the mystery of the painless pulling of hair.
The simultaneous but severe application of the boot to the blindfolded
victim takes complete but exclusive possession of the final common
path and the hair is painlessly plucked as a result of the triumph
of the boot stimulus over the pull on the hair in the struggle
for the final common path.

Persons who have survived a sudden, complete exposure to superheated steam,
or whose bodies have been enwrapped in flame, testify that they
have felt no pain. As this absence of pain may be due to the fact
that the emotion of fear gained the final common path, to the exclusion
of all other stimuli, we are trying by experimentation to discover
the effects of simultaneous painful stimulation of all parts of the body.
The data already in hand, and the experiments now in progress,
in which anesthetized animals are subjected to powerful stimuli
applied to certain parts of the body only, or simultaneously to
all parts of the body, lead us to believe that in the former case
the brain-cells become stimulated or hyperchromatic, while in the latter
case no brain-cell changes occur. We believe that our experiments
will prove that an equal and simultaneous stimulation of all parts
of the body leaves the brain-cells in a state of equilibrium.
Our theory of pain will then be well sustained, not only by common
observation, but by experimental proof, and so the mechanistic view
will be found in complete harmony with another important reaction.

We have stated that when a number of contact stimuli act simultaneously,
the strongest stimulus will gain possession of the final common path--
the path of action. When, however, stimuli of the distance ceptors
compete with stimuli of the contact ceptors, the contact-ceptor
stimuli often secure the common path, not because they are stronger
or more important, but because they are immediate and urgent.
In many instances, however, the distance-ceptor stimuli are strong,
have the advantage of a lowered threshold, and therefore compete
successfully with the immediate and present stimuli of the
contact ceptors. In such cases we have the interesting phenomenon
of physical injury without resultant pain or muscular response.
The distance-ceptor stimuli which may thus triumph over even powerful
contact-ceptor stimuli are those causing strong emotions--as great
anger in fighting; great fear in a battle; intense sexual excitement.
Dr. Livingstone has testified to his complete unconsciousness
to pain during his struggle with a lion; although he was torn
by teeth and claws, his fear overcame all other impressions.
By frequently repeated stimulation the Dervish secures a low
threshold to the emotions caused by the thought of God or the devil,
and his emotional excitement is increased by the presence of others
under the same stimulation; emotion, therefore, secures the final
common path and he is unconscious of pain when he lashes, cuts,
and bruises his body. The phenomena of hysteria may be explained
on this basis, as may the unconsciousness of passing events
in a person in the midst of a great and overwhelming grief.
By constant practice the student may secure the final common path for
such impressions as are derived from the stimuli offered by the subject
of his study, and so he will be oblivious of his surroundings.
Concentration is but another name for a final common path secured
by the repetition and summation of certain stimuli.

If our premises are sustained, then we can recognize in man no will,
no ego, no possibility for spontaneous action, for every action must
be a response to the stimuli of contact or distance ceptors, or to their
recall through associative memory. Memory is awakened by symbols which
represent any of the objects or forces associated with the act recalled.
Spoken and written words, pictures, sounds, may stimulate the brain
patterns formed by previous stimulation of the distance ceptors;
while touch, pain, temperature, pressure, may recall previous
contact-ceptor stimuli. Memory depends in part upon the adequacy
of the symbol, and in part upon the state of the threshold.
If one has ever been attacked by a snake, the threshold to any
symbol which could recall that attack would be low; the later
recall of anything associated with the bite or its results would
produce in memory a recapitulation of the whole scene, while even
harmless snakes would thereafter be greeted with a shudder.
On the other hand, in a child the threshold is low to the desire
for the possession of any new and strange object; in a child,
therefore, to whom a snake is merely an unusual and fascinating object,
there is aroused only curiosity and the desire for the possession
of a new plaything.

If we are to attribute to man the possession of a governing
attribute not possessed by other parts of the animal creation,
where are we to draw the boundary line, and say "here the ego--
the will--the reason--emerges"? What attribute, after all, has man
which in its ultimate analysis is not possessed by the lowest
animals or by the vegetable creation, even? From the ameba,
on through all the stages of animal existence, every action is
but a response to an adequate stimulus; and as a result of adequate
stimuli each step has been taken toward the higher and more
intricate mechanisms which play the higher and more intricate parts
in the great scheme of nature.

The Venus fly-trap responds to as delicate a stimulus as do
any of the contact ceptors of animals, and the motor activity
resulting from the stimulus is as complex. To an insect-like touch
the plant responds; to a rough contact there is no response; that is,
the motor mechanism of the plant has become attuned to only such
stimuli as simulate the contact of those insects which form its diet.
It catches flies, eats and digests them, and ejects the refuse
(Fig. 47). The ameba does no less. The frog does no more,
excepting that in its place in creation a few more reactions are
required for its sustenance and for the propagation of its species.
Man does no more, excepting that in man's manifold relations
there are innumerable stimuli, for meeting which adequately,
innumerable mechanisms have been evolved. The motor mechanism
of the fly-trap is perfectly adapted to its purpose.
The motor mechanism of man is adapted to its manifold uses,
and as new environmental influences surround him, we must believe
that new adaptations of the mechanism will be evolved to meet
the new conditions.

Is not this conception of man's activities infinitely more wonderful,
and infinitely more comprehensible than is the conception that his
activities may be accounted for by the existence of an unknown,
unimaginable, and intangible force called "mind" or "soul"?

We have already shown how the nerve mechanism is so well adapted
to the innumerable stimuli of environment that it can accurately
transmit and distinguish between the infinite variations of speed
in the ether waves producing light, and the air waves producing sound.
Each rate of vibration energizes only the mechanism which has
been attuned to it. With marvelous accuracy the light and sound
waves gain access to the nerve tissue and are finally interpreted
in terms of motor responses, each by the brain pattern attuned
to that particular speed and intensity. So stimuli and resultant
actions multiplied by the total number of the motor patterns
in the brain of man give us the sum total of his life's activities--
they constitute his life.

As in evolutionary history the permanence of an adaptation of the body
mechanism depends upon its value in the preservation of the life
of the individual and upon its power to increase the value of
the individual to the race, so the importance and truth of these
postulates and theories may well be judged on the same basis.

The fundamental instincts of all living matter are self-preservation
and the propagation of the species. The instinct for self-preservation
causes a plant to turn away from cold and damaging winds toward
the life-giving sun; the inert mussel to withdraw within its shell;
the insect to take flight; the animal to fight or to flee; and man
to procure food that he may oppose starvation, to shelter himself
and to provide clothes that he may avoid the dangers of excessive
cold and heat, to combat death from disease by seeking medical aid,
to avoid destruction by man or brute by fight or by flight.
The instinct to propagate the species leads brute man by crude methods,
and cultured man by methods more refined, to put out of his way sex
rivals so that his own life may be continued through offspring.
The life of the species is further assured by the protective
action exercised over the young by the adults of the species.
As soon as the youngest offspring is able successfully to carry on his
own struggle with environment there is no longer need for the parent,
and the parent enters therefore the stage of disintegration.
The average length of life in any species is the sum of the years
of immaturity, plus the years of female fertility, plus the adolescent
years of the offspring.

The stimuli resulting from these two dominant instincts are now
so overpowering as compared with all other environmental stimuli
that the mere possession of adequate knowledge of the damaging effects
of certain actions as compared with the saving effects of others will
(other things being equal) lead the individual to choose the right,--
the self- and species-preservative course of action, instead of the wrong,--
the self- and species-destructive course of action.

The dissemination of the knowledge of the far-reaching
deleterious effects of protracted emotional strain, of overwork,
and of worry will automatically raise man's threshold to
the damaging activating stimuli causing the strong emotions,
and will cause him to avoid dangerous strains of every kind.
The individual thus protected will therefore rise to a plane
of poise and efficiency far above that of his uncontrolled fellows,
and by so much will his efficiency, health, and happiness be augmented.

A full acceptance of this theory cannot fail to produce in those
in whose charge rests the welfare of the young, an overwhelming
desire to surround children with those environmental stimuli only
which will tend to their highest ultimate welfare.

Such is the stimulating force of tradition that many who
have been educated under the tenets of traditional beliefs
will oppose these hypotheses--even violently, it may be.
So they have opposed them; so they opposed Darwin; so they
have opposed all new and apparently revolutionary doctrines.
Yet these persons themselves are by their very actions proving
the efficiency of the vital principles which we have enunciated.
What is the whole social welfare movement but a recognition
on the part of municipalities, educational boards, and religious
organizations of the fact that the future welfare of the race
depends upon the administration to the young of forceful
uplifting environmental stimuli?

There are now, as there were in Darwin's day, many who feel that man
is degraded from his high estate by the conception that he is not
a reasoning, willing being, the result of a special creation.
But one may wonder indeed what conception of the origin of man can
be more wonderful or more inspiring than the belief that he has
been slowly evolved through the ages, and that all creatures
have had a part in his development; that each form of life has
contributed and is contributing still to his present welfare
and to his future advancement.


Psychology,--the science of the human soul and its relations,--
under the mechanistic theory of life, must receive a new definition.
It becomes a science of man's activities as determined by the
environmental stimuli of his phylogeny and of his ontogeny.

On this basis we postulate that throughout the history of the race nothing
has been lost, but that every experience of the race and of the individual
has been retained for the guidance of the individual and of the race;
that for the accomplishment of this end there has been evolved through
the ages a nerve mechanism of such infinite delicacy and precision
that in some unknown manner it can register permanently within
itself every impression received in the phylogenetic and ontogenetic
experience of the individual; that each of these nerve mechanisms
or brain patterns has its own connection with the external world,
and that each is attuned to receive impressions of but one kind,
as in the apparatus of wireless telegraphy each instrument can
receive and interpret waves of a certain rate of intensity only;
that thought, will, ego, personality, perception, imagination,
reason, emotion, choice, memory, are to be interpreted in terms
of these brain patterns; that these so-called phenomena of human
life depend upon the stimuli which can secure the final common path,
this in turn having been determined by the frequency and the strength
of the environmental stimuli of the past and of the present.

Finally, as for life's origin and life's ultimate end,
we are content to say that they are unknown, perhaps unknowable.
We know only that living matter, like lifeless matter, has its own
place in the cosmic processes; that the gigantic forces which operated
to produce a world upon which life could exist, as a logical sequence,
when the time was ripe, evolved life; and finally that these cosmic
forces are still active, though none can tell what worlds and what
races may be the result of their coming activities.


[*] Oration in Surgery. Delivered at the 147th Annual Meeting of the
Medical Society of New Jersey, at Spring Lake, N. J., June 11, 1913.

In this address the paragraphs which were taken from the preceding
paper, "A Mechanistic View of Psychology," have been omitted,
those portions only being republished in which the premises have
been applied in a discussion of certain medical problems rather
than of psychological problems.

The human body is an elaborate mechanism equipped first for such
conflict with environment as will tend to the preservation
of the individual, and second for the propagation of the species,
both of these functions, when most efficiently carried out,
tending to the upbuilding and perfection of the race.
From the date of Harvey's discovery of the circulation of the blood,
to the present day, the human body has been constantly compared
to a machine, but the time for analogy and comparison is past.
I postulate that the body is itself a mechanism responding in every
part to the adequate stimuli given it from without by the environment
of the present and from within by the environment of the past,
the memory of which is stored in the central battery of the mechanism--
the brain.
* * * * * * * * * *
* * * * * * * * * *

If the full history of the species and of the individual
could be known in every detail, then every detail of that
individual's conduct in health and disease could be predicted.
Reaction to environment is the basis of conduct, of moral standards,
of manners and conventions, of work and play, of love and hate,
of protection and murder, of governing and being governed, in fact,
of all the reactions between human beings--of the entire web of life.
As Sherrington has stated, "Environment drives the brain, the brain
drives the various organs of the body," and here we believe we find
the key to a mechanistic interpretation of all body processes.

On this basis we may see that the activities of life depend upon
the ability of the parts of the body mechanism to respond adequately
to adequate stimulation. This postulate applies not only to stimuli
from visible forces, but to those received by the invasion of
the micro-bodies which cause pyogenic or non-pyogenic infections.
In the case of dangerous assaults by visible or invisible enemies,
the brain, through the nerves and all parts of the motor mechanism,
meets the attack by attempts at adaptation. Recovery, invalidism,
and death depend upon the degree of success with which the attacking
or invading enemies are met. Questions regarding disease become,
therefore, questions in adaptation, and it is possible that,
when studied in the light of this conception, the key to many hitherto
unsolved physical problems may be found.

Perhaps no more convincing proof of our thesis may be secured
than by a study of that ever-present phenomenon--pain. In whatever
part of the body and by whatever apparent cause pain is produced,
we find that it is invariably a stimulation to motor activity--
whose ultimate object is protection. Thus by the muscular action
resulting from pain we are protected against heat and cold;
against too powerful light; against local anemia caused by prolonged
pressure upon any portion of the body. So, too, pain of greater
or less intensity compels the required emptying of the pregnant
uterus and the evacuation of the intestine and the urinary bladder.

It should be noted that in every instance the muscular activity
resulting from pain is specific in its type, its distribution,
and its intensity, this specificity being true not only of pain
which is the result of external stimulation, but also of the pain
associated with certain types of infection.

Pain, however, is not the only symptom of the invasion of
the body by pyogenic or parasitic organisms. Fever, invariably,
and chills, often, accompany the course of the infections.
Can these phenomena also be explained as adaptations of the motor
mechanism for the good of the individual?

As the phenomena of chills and fever are most strikingly exhibited
in malaria, let us study the course of events in that disease.
It is known that the malarial parasite develops in the red
blood-corpuscles, and that the chills and fever appear when
the cycle of parasitic development is complete and the adults
are ready to escape from the corpuscles of the blood plasma.
Bass, of New Orleans, has proved that the favorable temperature
for the growth of the malarial organism is 98'0, and that at 102'0
the adult organisms will be killed, though the latter temperature
is not fatal to the spores. The adult life of the malarial
parasite begins after its escape into the blood plasma, and it is
there that the organism is most susceptible to high temperature.
We must infer, therefore, that the fever is an adaptation on the part
of the host for despatching the enemy.

What, then, may be the protective part played by the chill?
A chill is made up of intermittent contractions of all the external
muscles of the body. This activity results in an increase
of the body heat and in an anemia of the superficial parts
of the body, so that less heat can be lost by radiation.
By this means, therefore, the external portions of the body contribute
measurably to the production of the beneficent and saving fever.

It must be remembered that this power of adaptation is not peculiar
to man alone, but that it is a quality shared by all living creatures.
While the human body has been adapting itself for self-protection
by producing a febrile reaction whereby to kill the invading organisms,
the invaders on their side have been adapting themselves for a life
struggle within the body of the host. In these mortal conflicts
between invaders and host, therefore, the issue is often in doubt,
and sometimes one and sometimes the other will emerge victorious.

We must believe that a similar adaptive response exists in all
parasitic infections--the cycles varying according to the stages in
the development of the invaders. If the bacteria develop continuously,
the fever is constant instead of intermittent, since the adequate
stimulus is constantly present.

Bacteriology has taught us that both heat and cold are fatal
to pathogenic infections; for this reason either of the apparently
contradictory methods of treatment may help, _i. e_., either hot
or cold applications. It should be borne in mind, however, that we have
to deal not only with the adult organisms, but with the spores also.
The application of cold may keep the spores from developing,
while heat may promote their development, and the course of the disease
may vary, therefore, according to our choice of treatment.

From this viewpoint, we can understand the intermittent temperature
in a patient who is convalescing from an extreme infection,
as peritonitis, pylephlebitis, multiple abscess of the liver, etc.
In these conditions there may occur days of normal temperature,
followed by an abrupt rise which will last for several days--
this in turn succeeded by another remittance. This cycle may be
repeated several times, and on our hypothesis we may believe it
is caused by the successive development to maturity of spores
of varying ages.

If these premises are sound, the wisdom of reducing the temperature
in case of infection may well be questioned.

On this mechanistic basis the emotions also may be explained
as activations of the entire motor mechanism for fighting,
for escaping, for copulating.
* * * * * * * * * *
* * * * * * * * * *

The emotions, then, are the preparation for phylogenetic activities
(Fig. 48). If the activities were consummated, the fuel--glycogen--
and the activating secretions from the thyroid, the adrenals,
the hypophysis, would be consumed. In the activation without
action these products must be eliminated as waste products
and so a heavy strain is put upon the organs of elimination.
It is obvious that the body under emotion might be clarified
by active muscular exercise, but the subject of the emotion is so
strongly integrated thereby that it is difficult for him to engage
in diverting, clarifying exertion.
* * * * * * * * * *
* * * * * * * * * *

So, as we have indicated already, certain deleterious effects are
produced when the body mechanism is activated without resultant action.
For example, the output of adrenalin is increased, and, as a consequence,
arteriosclerosis and cardiovascular disease may occur in persons
who have been subjected to prolonged emotional strain, since it
has been proved that the prolonged administration of adrenalin
will cause these conditions. We have stated that the emotions cause
increased output of glycogen. Glycogen is a step toward diabetes,
and therefore this disease, too, is prone to appear in persons
under emotional strain. It is most common in those races which
are especially emotional in character, so we are not surprised
to find it especially prevalent among Jews. So common is this
particular result of prolonged emotion that some one has said,
"When the stocks go down in New York, diabetes goes up."
Nephritis, also, may result from emotional stress, because of the strain
put upon the kidneys by the unconsumed activating substances.
The increased heart action and the presence of these activating
secretions may cause myocarditis and heart degeneration.
Claudication also may result from the impaired circulation.

The emotions may cause an inhibition of the digestive secretions
and of intestinal peristalsis. This means that the digestive processes
are arrested, that putrefaction and autointoxication will result,
and that still further strain will thus be put upon the organs
of elimination. Who has not observed in himself and in others when under
the influence of fear, anger, jealousy, or grief that the digestive
processes and general well-being are rapidly and materially altered;
while as tranquillity, peace, and happiness return the physical
state improves accordingly?

Dentists testify that as a result of continued strong emotion the character
of the saliva changes, pyorrhea develops, and the teeth decay rapidly.
Every one knows that strong emotion may cause the hair to fall
out and to become prematurely gray.

As to the most important organ of all--the brain--every one is
conscious of its impaired efficiency under emotional strain,
and laboratory researches show that the deficiency is accounted
for by actual cell deterioration; so the individual who day by day
is under heavy emotional strain finds himself losing strength slowly--
especially do his friends note it. By summation of stimuli
his threshold becomes lowered until stimuli, which under normal
conditions would be of no effect, produce undue responses.
"The grasshopper becomes a burden," and prolonged rest and change
of environmental conditions are necessary for restoration.

If in a long emotional strain the brain is beaten down;
if the number of "low-efficiency" cells increases, the driving
power of the brain is correspondingly lessened and therefore
the various organs of the body may escape through the very
inefficiency of the brain to produce in them forced activity.
On the other hand, if the brain remains vigorous, the kidneys
may take the strain and break down; if the kidneys do not break,
the blood-vessels may harden; if the blood-vessels are not affected,
the thyroid may become hyperplastic and produce Graves' disease;
if the thyroid escapes, diabetes may develop; while if the iron
constitution of the mechanism can successfully bear the strain
in all its parts, then the individual will break his competitors,
and their mechanisms will suffer in the struggle.

This whole train of deleterious results of body activation without
action may be best observed and studied in that most emotional
of diseases--exophthalmic goiter. In this disease the constantly
stimulated distance ceptors dispossess the contact ceptors from
the common path, and drive the motor mechanism to its own destruction,
and the patient has the appearance of a person in great terror,
or of a runner approaching the end of a Marathon race (Figs. 16
and 48 to 54).

Exophthalmic goiter may result from long emotional or mental stress
in those cases in which the thyroid takes the brunt of the strain upon
the mechanism. As adrenalin increases blood-pressure, so thyroid
secretion increases brain activity, and increased brain activity
in turn causes an increased activation of the motor mechanism
as a whole.

We know that a deficiency or lack of thyroid secretion will inhibit
sexual emotion and conception, will produce stupidity and inertia;
will diminish vitality. On the other hand, excessive thyroid secretion
drives the entire mechanism at top speed; the emotions are intensified;
the skin becomes soft and moist, the eyes are brilliant and staring;
the limbs tremble; the heart pounds loudly and its pulsations often
are visible; the respiration is rapid; the stimulation of the fear
mechanism causes the eyes to protrude (Fig. 16); the temperature
mounts at every slight provoca-tion and may reach the incredible
height of 110'0 even. In time, the entire organism is destroyed--
literally consumed--by the concentration of dynamic energy.
It is interesting to note that in these patients emotion gains complete
possession of the final common path; they are wild and delirious--
but they never have pain.

All the diseases caused by excessive motor activity may be called
kinetic diseases. Against the conditions in life which produce
them man reacts in various ways. He intro-

{illust. caption = FIG. 51.--CROSS-COUNTRY RACE. Winner of six-mile
cross-country race showing typical expression of exhaustion.
(Copyright by Underwood and Underwood, N. Y.) duces restful variety
into his life by hunting and fishing; by playing golf and tennis;
by horseback riding; by cultivating hobbies which effectually.
turn the current of his thoughts{illust. caption = FIG. 52.--{A B
and C} from the consuming stress and strain of his business
or professional life. These diversions are all rational
attempts to relieve tension by self-preservative reactions.
For the same reason man attempts to relieve the strain of
contention with his fellow-man by unions, trusts, corporations.
In spite of all efforts, however, many constitutions are
still broken daily in the fierce conflicts of competition.
We know how often the overdriven individual endeavors to minimize
the activities of his motor mechanism by the use of agents which diminish
brain activity, such as alcohol, tobacco, and various narcotics.
Occasionally also, some person, who can find no respite from his own
relentless energies, seeks relief in oblivion by suicide.

Most fortunately, two fundamental instincts--self-preservation and
the propagation of the species--act powerfully to prevent
this last fatal result, and instead the harassed individual
seeks from others the aid which is lacking within himself.
He may turn to the priest who seeks and often secures the final
common path for faith in an over-ruling Providence, a faith which in
many incontrovertible instances has proved sufficient in very truth
to move mountains of lesser stimuli; or he turns to a physician,
who too often treats the final outcome of the hyperactivity only.
The physician who accepts the theory of the kinetic diseases,
however, will not only repair as far as he may the lesions caused
by the disordered and forced activities, but will, by compelling and
forceful suggestion, secure the final common path for right conduct,
that is, for a self- and species-preservative course of action
as opposed to wrong conduct-a self- and species-destructive
course of action.

By forcefully imparting to his patient the knowledge of the far-reaching
effects of protracted emotional strain, of overwork, and of worry,
the physician will automatically raise his threshold to the damaging
activating stimuli which have produced the evil results.
Even though some parts of his organism may have been permanently disabled,
a patient thus protected may yet rise to a plane of poise and
efficiency far above that of his uncontrolled fellows.

In extreme cases it does not seem unreasonable to believe that the
uncontrolled patient might be rescued by the same principle which has
proved effective in saving patients from the emotional and traumatic strain
of surgical operations--the principle of anoci-association. That is,
by disconnecting one or more of the activating organs from the brain,
the motor mechanism might be saved from its self-destruction.

Under this hypothesis, that man in disease, as in health,
is the product of his phylogeny as well as of ontogeny, the sphere
of the physician's activities takes on new aspects of far-reaching
and inspiring significance. Prognosis will become definite in proportion
to the physician's knowledge not only of the ontogenetic history of
the individual patient, but also of the phylogenetic history of the race.
As that knowledge increases, as he appreciates more and more keenly
the significance of environment in its effect upon individual development,
in so far will the physician be in a position to contribute mightily
to the welfare of the race.


[*] Address delivered before the New York State Medical Society, April 28,
1914, to which has been added a further note regarding studies
of hydrogen ion concentration in the blood.

In this paper I formulate a theory which I hope will harmonize a large
number of clinical and experimental data, supply an interpretation
of certain diseases, and show by what means many diverse causes
produce the same end effects.

Even should the theory prove ultimately to be true, it will in the mean
time doubtless be subjected to many alterations. The specialized
laboratory worker will, at first, fail to see the broader clinical view,
and the trained clinician may hesitate to accept the laboratory findings.
Our viewpoint has been gained from a consideration of both lines
of evidence on rather a large scale.

The responsibility for the kinetic theory is assumed by myself,
while the responsibility for the experimental data is shared fully
by my associates, Dr. J. B. Austin, Dr. F. W. Hitchings, Dr. H. G. Sloan,
and Dr. M. L. Menten.[t]

[t] From H. K. Cushing Laboratory of Experimental Medicine,
Western Reserve University, Cleveland.


The self-preservation of man and kindred animals is effected
through mechanisms which transform latent energy into kinetic energy
to accomplish adaptive ends. Man appropriates from environment
the energy he requires in the form of crude food which is refined
by the digestive system; oxygen is taken to the blood and carbon
dioxid is taken from the blood by the respiratory system;
to and from the myriads of working cells of the body, food and oxygen
and waste are carried by the circulatory system; the body is cleared
of waste by the urinary system; procreation is accomplished through
the genital system; but none of these systems was evolved primarily
for the purpose of transforming potential energy into kinetic energy
for specific ends. Each system transforms such amounts of potential
into kinetic energy as are required to perform its specific work;
but no one of them transforms latent into kinetic energy for the purposes
of escaping, fighting, pursuing, nor for combating infection.
The stomach, the kidneys, the lungs, the heart strike no physical
blow-their role is to do certain work to the end that the blow may
be struck by another system evolved for that purpose. I propose
to offer evidence that there is in the body a system evolved primarily
for the transformation of latent energy into motion and into heat.
This system I propose to designate "The Kinetic System."

The kinetic system does not directly circulate the blood,
nor does it exchange oxygen and carbon dioxid; nor does it perform
the functions of digestion, urinary elimination, and procreation;
but though the kinetic system does not directly perform these functions,
it does play indirectly an important role in each, just as the kinetic
system itself is aided indirectly by the other systems.

The principal organs which comprise the kinetic system are
the brain, the thyroid, the adrenals, the liver, and the muscles.
The brain is the great central battery which drives the body;
the thyroid governs the conditions favoring tissue oxidation;
the adrenals govern immediate oxidation processes; the liver fabricates
and stores glycogen; and the muscles are the great converters
of latent energy into heat and motion.

Adrenalin alone, thyroid extract alone, brain activity alone,
and muscular activity alone are capable of causing the body temperature
to rise above the normal. The functional activity of no other gland
of the body alone, and the secretion of no other gland alone, can cause
a comparable rise in body temperature--that is, neither increased
functional activity nor any active principle derived from the kidney,
the liver, the stomach, the pancreas, the hypophysis, the parathyroids,
the spleen, the intestines, the thymus, the lymphatic glands,
or the bones can, _per se_, cause a rise in the general body
temperature comparable to the rise that may be caused by the activity
of the brain or the muscles, or by the injection of adrenalin
or thyroid extract. Then, too, when the brain, the thyroid,
the adrenals, the liver, or the muscles are eliminated, the power
of the body to convert latent into kinetic energy is impaired or lost.
I shall offer evidence tending to show that an excess of either
internal or external environmental stimuli may modify one or more
organs of the kinetic system, and that this modification may cause
certain diseases. For example, alterations in the efficiency
of the cerebral link may yield neurasthenia, mania, dementia;
of the thyroid link, Graves' disease, myxedema; of the adrenal link,
Addison's disease, cardiovascular disease.

This introduction may serve to give the line of our argument.
We shall now consider briefly certain salient facts which relate to
the conversion of latent into kinetic energy as an adaptive reaction.
The experimental data are so many that they will later be published
in a monograph.

The amount of latent energy which may be converted into kinetic
energy for adaptive ends varies in different species, in individuals
of the same species, in the same individual in different seasons;
in the life cycle of growth, reproduction and decay;
in the waking and sleeping hours; in disease and in activity.
We shall here consider briefly the reasons for some of those variations
and the mechanisms which make them possible.

Biologic Consideration of the Adaptive Variation in Amounts
of Energy Stored in Various Animals

Energy is appropriated from the physical forces of nature
that constitute the environment. This energy is stored in
the body in quantities in excess of the needs of the moment.
In some animals this excess storage is greater than in other animals.
Those animals whose self-preservation is dependent on purely
mechanical or chemical means of defense--such animals as crustaceans,
porcupines, skunks or cobras--have a relatively small amount
of convertible (adaptive) energy stored in their bodies.
On the contrary, the more an animal is dependent on its muscular
activity for self-preservation, the more surplus available
(adaptive) energy there is stored in its body. It may be true that all
animals have approximately an equal amount per kilo of chemical energy--
but certainly they have not an equal amount stored in a form
which is available for immediate conversion for adaptive ends.
Adaptive Variation in the Rate of Energy Discharge

What chance for survival would a skunk have without odor; a cobra
without venom; a turtle without carapace; or a porcupine shorn
of its barbs, in an environment of powerful and hostile carnivora?
And yet in such an hostile environment many unprotected animals
survive by their muscular power of flight alone. It is evident that
the provision for the storage of "adaptive" energy is not the only
evolved characteristic which relates to the energy of the body.
The more the self-preservation of the animal depends on motor activity,
the greater is the range of variation in the rate of discharge of energy.
The rate of energy discharge is especially high in animals evolved
along the line of hunter and hunted, such as the carnivora and
the herbivora of the great plains.

Influences That Cause Variation in the Rate of Output of Energy
in the Individual

Not only is there a variation in the rate of output of energy among
various species of animals, but one finds also variations in the rate
of output of energy among individuals of the same species.
If our thesis that men and animals are mechanisms responding to
environmental stimuli be correct, and further, if the speed of energy
output be due to changes in the activating organs as a result of
adaptive stimulation, then we should expect to find physical changes
in the activating glands during the cycles of increased activation.
What are the facts? We know that most animals have breeding
seasons evolved as adaptations to the food supply and weather.
Hence there is in most animals a mating season in advance of
the season of maximum food supply so that the young may appear at
the period when food is most abundant. In the springtime most birds
and mammals mate, and in the springtime at least one of the great
activating glands is enlarged--the thyroid in man and in animals shows
seasonal enlargement. The effect of the increased activity is seen
in the song, the courting, the fighting, in the quickened pulse,
and in a slightly raised temperature. Even more activation
than that connected with the season is seen in the physical state
of mating, when the thyroid is known to enlarge materially,
though this increased activity, as we shall show later, is probably
no greater than the increased activity of other activating glands.
In the mating season the kinetic activity is speeded up; in short,
there exists a state--a fleeting state--of mild Graves' disease.
In the early stages of Graves' disease, before the destructive phenomena
are felt, the kinetic speed is high, and life is on a sensuous edge.
Not only is there a seasonal rhythm to the rate of flow of energy,
but there is a diurnal variation--the ebb is at night,
and the full tide in the daytime. This observation is verified
by the experiments which show that certain organs in the kinetic
chain are histologically exhausted, the depleted cells being
for the most part restored by sleep.

We have seen that there are variations in speed in different species,
and that in the same species speed varies with the season of the year
and with the time of day. In addition there are variations also in
the rate of discharge of energy in the various cycles of the life
of the individual. The young are evolved at high speed for growth,
so that as soon as possible they may attain to their own power
of self-defense; they must adapt themselves to innumerable bacteria,
to food, and to all the elements in their external environment.
Against their gross enemies the young are measurably protected
by their parents; but the parents--except to a limited extent in
the case of man--are unable to assist in the protection of the young
against infectious disease.

The cycle of greatest kinetic energy for physiologic ends is the period
of reproduction. In the female especially there is a cycle of increased
activity just prior to her development into the procreative state.
During this time secondary sexual characters are developed--
the pelvis expands, the ovaries and the uterus grow rapidly,
the mammary glands develop. Again in this period of increasing
speed in the expenditure of energy we find the thyroid,
the adrenals, and the hypophysis also in rapid growth.
Without the normal development of the ovary, the thyroid,
and the hypophysis, neither the male nor the female can develop
the secondary sexual characters, nor do they develop sexual desire
nor show seasonal cycles of activity, nor can they procreate.
The secondary sexual characters--sexual desire, fertility--may be
developed at will, for example, by feeding thyroid products from
alien species to the individual deprived of the thyroid.

At the close of the child-bearing period there is a permanent
diminution of the speed of energy discharge, for energy is no
longer needed as it was for the self-preservation of the offspring
before adolescence, and for the propagation of the species
during the procreative period. Unless other factors intervene,
this reduction in speed is progressive until senescent death.
The diminished size of the thyroid of the aged bears testimony
to the part the activating organs bear in the general decline.

We have now referred to variations in the rate of discharge of
energy in different species; in individuals of the same species;
in cycles in the same individual--such as the seasons of food supply,
the periods of wakefulness and of sleep, the procreative period,
and we have spoken of those variations caused artificially
by thyroid feeding, thus far having confined our discussion
to the conversion for adaptive purposes of latent into kinetic
energy in muscular and in procreative action. We shall now consider
the conversion of latent into kinetic energy in the production of
heat,[*] and endeavor to answer the questions which arise at once:
Is there one mechanism for the conversion of latent energy into heat
and another mechanism for its conversion into muscular action?
What is the adaptive advantage of fever in infection?

[*] We use the terms "heat" and "muscular action" in the popular sense,
though physicists use them to designate one and the same kind of energy.

The Purpose and the Mechanism of Heat Production in Infections

Vaughan has shown that the presence in the body of any alien protein
causes an increased production of heat, and that there is no difference
between the production of fever by foreign proteins and by infections.
Before the day of the hypodermic needle and of experimental medicine,
the foreign proteins found in the body outside the alimentary tract
were brought in by invading microorganisms. Such organisms interfered
with and destroyed the host. The body, therefore, was forced
to evolve a means of protection against these hostile organisms.
The increased metabolism and fever in infection might operate
as a protection in two ways--the increased fever, by interfering
with bacterial growth, and the increased metabolism, by breaking up
the bacteria. Bacteriologists have taught us that bacteria grow best
at the normal temperature of the body, hence fever must interfere
with bacterial growth. With each rise of one degree centigrade

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