NATIONAL LIBRARY OF MEDICINE NLM OQl??}^ 1 # ^' 'v *m LEO KANNER 4510 WENTwIORTH BALTIMORE* MD. 21207 I \ y U.S. NATIONAL LIBRARY OF MEDICINE NLM001773441 7 t \ A TREATISE EMOTIONAL DISORDERS OF THE SYMPATHETIC SYSTEM OF NERVES. BY WILLIAM MURRAY, M.D., M.R.C.P. Lond., PHYSICIAN TO THE DISPENBAEV, AND TO THE HOSPITAL FOB SICK CHILDREN, AND LECTURER ON PHYSIOLOGY IN THE COLLEGE OP MEDICINE, NEWOA8TLE-ON-TYNE. , / & NEW YORK: A. SIMPSON & CO., 60 DUANE STREET 1867. «• i. 1 i: - ■■;-r. *^ H-m2> wi— ■■ U hi re. " /-, ■". ^LU AGATHYNIAN PRESS. CONTENTS. Section I. THE PHYSIOLOGICAL INTRODUCTION, AND THE EFFECTS OP EMOTION ON THE BODY. INTRODUCTION.................... CHAPTER I. THE VARIETIES OF EMOTION .............. Visceral Sensations. CHAPTER II. THE EFFECTS OF EMOTION ON THE CEREBRO-SPINAL SYSTEM .. CHAPTER III. THE EFFECTS OF EMOTION ON THE SYMPATHETIC SYSTEM .. The Heart. The Arteries. Involuntary Muscles. Secreting Glands. The Stomach. Dyspepsia. The Liver. The Urinary Organs. The Generative and Sexual Organs. Hysteria. CHAPTER IV. PREDISPOSING CAUSES OF EMOTIONAL DISORDERS ...... iv CONTENTS. $&cti(xn It. EMOTIONAL DISEASES AND THEIR TREATMENT. CHAPTER I. PAGE OUTLINE OF ARGUMENT....................43 CHAPTER II. DISEASES OF THE DIGESTIVE ORGANS ..............47 Cases. The Stomach. Visceral Sensations and Gasteria. The Liver and Hypochondriasis. CHAPTER III. ON THE MODUS OPERANDI OF DYSPEPSIA ............57 Explanatory Theory. Imaginary Diseases. CHAPTER IV. THE ORGANS OF GENERATION ................62 Nymphomania. Masturbation. Hysteria. CHAPTER V. THE CHANGE OF LIFE ....................06 Symptoms connected with the Sympathetic System. Flushes, &c. Emotion- al Symptoms. Uterine Affections. Miscarriages. Disordered Action of the Colon from Ganglionic Sympathy with the Uterus. CHAPTER VI. THE MALE ORGANS......................74 CHAPTER VII. TREATMENT ........................77 To prevent Emotion from injuring the Body. To relieve Injuries produced by severe Emotion. Remarks on the general Management of Cases. Stimu- c- lants: Camphor, Naphtha. Aromatics. Antispasmodics. The Fceted Gums. Valerian. Sulphur. Tonics: Iron, Nux Vomica, Quinine, the Salts of Silver, Zinc. Local Applications. The Action of Cold-water Compresses. Summary. PREFACE. A conviction that much of the mental suffering around us is due to disordered conditions of those parts of the body which are closely related to the ganglio- nic system of nerves, has emboldened me to write a Treatise containing many familiar observations on a subject which has been freely discussed and fully acknowledged by both the public and the Medical Profession. The truth is, that we are all familiar with the disor- ders which accompany disturbed conditions of the mind, but the mechanism by which this disturbance is brought about is too slightly apprehended, and too often only disguised by a name which explains noth- ing of the nature of the disease. Seeing that it is this class of disorders which sup- plies the charlatan with fit patients to work upon, and that their gloomy fears and alarm give him ample scope for the most exaggerated statements, and for the use of treatment which too often only protracts. suffering, it is hoped that a full exposition of their vi PREFACE. ailments will protect these sufferers from imposition, and direct them to a rational source of relief. The subject is vast and deep—too much so for the scope of a small work, or the experience of one per- son. I expect, however, that a correct line of investi- gation has been followed, and that by abler observers than myself, a fuller exposition of it will in due time be given by us. Let me, therefore, offer a few remarks explanatory of the object of my Essay, so as to guard the reader against the idea that a complete review of the relation* between the body and the emotions has been attempted. Wliat I have sought to establish is,—the relation tvhidi exists between the emotions and the viscera through the sympathetic system of nerves. In doing this, only so much of the physiological relation of these (the emotions and the viscera) has been touched upon as is necessary to a comprehension of the morbid states induced by a disordered condi- tion of the one or the other. And I have only to a very slight extent considered emotion in its effects upon the cerebro-spinal system, having throughout selected those phenomena which tended most to estab- lish the theory that the emotions affect the viscera, and the viscera the emotions through the sympathetic system. To mark distinctly the line which separates the phenomena which are cerebro-spinal from those which are sympathetic is impossible. As, however, some broad distinctions can now be drawn between the functions of these two divisions of the nervous system, PREFACE. vii the time has arrived when we ought to avail ourselves of this knowledge in studying emotional disorders, so as to determine those conditions of the mind and body which attach themselves to the one or the other system of nerves. The conditions of the mind, therefore, which belong to the state of the sympathetic system, are set forth in Section II; and as an introduction to the subject, Sec- tion I contains an account of the influence of emotion on the body through the sympathetic system. In speaking of the emotions, I have made no attempt at an elaborate classification such as may be found in the masterly works of Bain; for I could not, after a careful effort, allot to any one of the emotions a series of effects sufficiently special and distinct to enable me to identify it by its action on the body. I have, therefore, indicated the character of the emotions under two heads, the one including generally those which are pleasurable and beneficial in their effects, the other including those which are disagreeable and injurious; and I have not, on this account distin- guished with much nicety between appetites, desires, conations, emotions, passions, etc., each of these being held to be a variety of that flow of nervous force which is continually streaming through the visceral regions of the body. I have throughout used terms expressive of the emotions in the meaning we attach to them in every day life, and I have done this that I might appeal to my reader's common-sense and experience, at the risk of being criticised by the educated psychologist. Vlll PREFACE. I must, however, cease to make excuses for the im- perfections of my work, and leave others to pronounce upon its utility and the validity of the views advanced in it; feeling sure that I have written upon a subject of great importance in its bearing upon the happiness and well-being of my fellow-creature. To Dr. Crichton Browne, of the Wakefield Asylum, I owe much for the kind assistance he has afforded me in investigating this subject. EMOTIONAL DISEASES. SECTION I. THE EFFECTS OF EMOTION ON THE BODY. INTRODUCTION. For convenience of delineation, and as a basis for investigation, it may be well to divide this subject into two Sections. Section i will include the consideration of the emotions, appetites, and passions, with the effects produced by these upon the economy. Section ii will include the consideration of those diseases which are accompanied by derangement of that equilibrium of emotion, which goes far to make up the happy, sound, and healthy mind. In science, and especially in the science of Medicine we are obliged, in making advances, to reason from the known to the unknown, to discover the facts which are hidden from us by letting the light of acquired knowledge shine upon them. In those two sister sciences, Physiology and Pathology, this process is most useful; they mutually help each other; for that which occurs in health often helps us to understand that which is occurring in. disease, and the obscurities of physiological action are themselves not unfrequently cleared away by the revelations of Pathology. It is right, therefore, in interpreting the symptoms of an obscure disease, to throw on them all 1 2 EMOTIONAL DISEASES. the light of our knowledge of the physiological action of the parts or organs involved. As a rule, we account for the disordered action of an organ by the alteration in its structure, which may be discovered after death; hitherto, in but few cases, have we inferred the existence of diseased structure from the presence of disordered functions only, i. e., in cases where the most careful and minute dissections have failed to discover alterations of struc- ture. As all action, however, does immediately de- pend on structure, disturbed function may be taken as direct evidence of disordered structural arrange- ment: consequently we shall presume in this article to infer the existence of disease, (i. e., structural change), when we observe the functions of an organ to be so far disturbed as to give rise to symptoms. In this way we shall often be led to conclude that the sympathetic nervous system is at fault, when we observe its functions to be disturbed, notwithstanding the absence of observed structural change in its chief ganglionic centres. I might say that in some other diseases of the nervous system the same process of reasoning is pursued. In many cases of insanity, for instance, evidence of structural change is wanting; yet who doubts the implication of the brain in the disease? In epilepsy, whose cerebro-spinal origin no one doubts, are there not many cases where visible alteration of structure does not exist? Let us hope that researches with the aid of the microscope and chemical re-agents will, at no distant day, reveal structural changes in the sympathetic ganglia to INTRODUCTION. 3 account for the symptoms which we now ascribe to their disordered action. We do not here include those cases of disordered action of the sran^lia which are solely dependent on an eccentric irritant exciting these centres to increased action, and thus inducing sympathetic action in distant parts: in such cases the excitement in a ganglion must as yet be looked upon as dynamical. As the theme of our remarks is to centre in " Emotion," it may be well to form some clear idea of what is felt in the body when under its influence, and to determine as clearly as possible the particular part or region to which the sensation accompanying emotion is referred. It is of course difficult, if not impossible, to define the exact nature of emotion; but this is un- necessary, as every one is perfectly familiar in his own consciousness with what is meant by the word, both in its general sense, and in the special application of it to the different varieties of emotion. It is more impor- tant to us to know the effects of the emotions on the body, and to ascertain the relation which they bear to other sensations or conditions of the nervous system. By appealing to our own self-consciousness, by com- paring our own experience with that of others, and by referring to the investigations of psychological inquirers (Laycock), we learn that in addition to com- mon peripheral sensations, and in addition to the various sensations of the special senses, there is excited in us by the stronger emotions a sensation which is referred to the visceral regions of the body. In con- sequence of its connection with the visceral regions, 4 EMOTIONAL DISEASES. (the chest, the abdomen, the pelvis) this sensation is closely allied to our appetites and animal propensities ; and, on the other hand, it bears a close relation to emotional excitement, forming, as it were, the sub- stratum of the emotional impulses, so that when any strong special emotion is felt, these visceral regions are the parts to which it, as a sensation, is referred. So universally is this true, that in all ages terms con- necting the emotions with the viscera have been in common use; the heart, the bowels, the reins, have each in turn been the organs in which strong emotion was supposed to exist; indeed their identity has been so fully accepted in the minds of men, that the two, the emotions and the organs, have not unfrequently been spoken of under one term. "The bowels of the Apostle yearned after those he loved." "The heart was said to feel the pungency of joy or grief," &c. We would refer especially to the connection between the appetites and the emotions, because we shall have reason to believe that, though distinct in many respects, they are both, to a certain extent, de- pendent upon the state of the visceral nerves, and are felt chiefly in the ganglionic centres of the sympa- thetic system. In the appetites we are conscious of a sensation which instinctively warns us of a want felt by the system at large, the sensation expressive of the want being referred to a particular region in which the organ which specially ministers to the needs of the system in this respect, is seated. Of this nature is the sensation of hunger, and appetite or desire for food, INTRODUCTION. 5 which has its seat in the region of the stomach. Thirst or hunger for fluids is another appetite ex- pressing itself in sensations referable chiefly to the faucical and pharyngeal mucous membrane. The natural craving after certain stimuli, the love of light and exercise, the love of variety and of so- ciety, and even the irresistible impulse to obtain pure respirable air, the gasping for breath, are all the result of changes conveyed to, or going on in nervous centres, and expressing themselves in various internal visceral sensations which we call emotions or appetites, as the case may be. The various appetites or lusts connected Avith sexual organs are also expressed by sensations emphatically connected with the viscera, and having much of their origin in them. When the body is in* perfect health, and when the mind is not pre-occupied or absorbed, these various appetites arise, expressive of systemic wants, and their appearance is necessary to the well being of the subject of them. But even when these special appe- tites are in abeyance, there still remains a certain con- sciousness of "ease," "comfort," "good spirits," "enjoy- ment of life," etc. It is this we take to be the emotional susceptibility of certain parts of the nervous system, out of which the special emotions may arise, or, as we have said, it is the substratum on which they are built. Having tried to explain what we mean by the terms, we shall take the liberty of referring to this sensation as " emotional sensation," " emotional susceptibility," or " visceral sensation," and in doing so we specially 6 EMOTIONAL DISEASES. guard the reader against understanding us to refer to pain, nausea, and other sensations felt in the visceral regions. As we shall show hereafter, this " visceral sensa- tion'''' may, by having the attention directed away from it, be almost unfelt or entirely forgotten; but it at once reveals itself if the attention be directed to it. While thus in health our emotional susceptibility exists as a pleasurable consciousness, there can be no doubt that in certain states of the system it becomes changed into a continuous sensation of distress, sink- ing, and depression, suggesting and encouraging low spirits. We affirm that, apart from any special cause of grief, the nervous centres of the visceral regions— the ganglionic centres—are often, when disordered, the seat of a sensation, an emotional sensation, the very opposite of that pleasurable sensation above de- scribed ; and this condition affects the spirits for good or evil, so as to determine the "mood of mt\nd" a condition which is admitted by all observers to be constantly present, and wdiich, as we have said, varies to any degree of good, bad, high or low spirits, accord- ing to the bodily as well as the mental condition of the patient. This nervous condition varies at every turn of life, and possesses all shades of variety and intensity in different individuals. So latent in some as scarcely to be perceptible, it becomes most intensely developed in those of a sanguine or nervous tempera- ment. People, indeed, with highly strung nerves are never thoroughly at rest, because they are so highly susceptible of emotional excitement. CHAPTER I. VARIETIES OF EMOTION. Ha vino glanced at the relation which the appetites and the emotions generally bear to the internal visceral sensation above described, we can now pass by an easy gradation to the consideration of the special emotions. The influence of emotion on the body varies accord- ing to its kind and intensity: it may therefore be well to classify the emotions according as they produce healthful or baneful effects; remembering at the same time, that as the same emotion, which in one degree is beneficial, may do harm when in excess, this classi- fication is but superficial, and somewhat artificial. The leading emotions which ordinarily seem to pro- duce a healthy excitement in men, are hope, joy, mirth, gratified affection or ambition, the feelings attendant on success of any kind, what is called peace or content- ment of mind, etc., etc. Those, on the other hand, which seem to be depressing and injurious, are the feelings accompanying disappointment, despair, some kinds of anger, general distress of mind, including grief or sorrow at losses of various kinds, fear, tim- idity, terror, apprehensions, the feeling of inability to cope with difficulties, and the wounded self-conscious- 8 EMOTIONAL DISEASES. ness of sensitive persons who consider themselves slighted by their friends. Let it be noted that all these emotions injure as effectually when the cause of them is imaginary or only suspected, as when it is real and certainly present. In some people, if not in all, emotion in some form or other connects itself with every thought, word, and action; giving at one time zest to existence, at another depressing even the simplest of our powers. In a well-balanced condition of the mind, under the ordinary conditions of life, this constant play of the ' emotions can be controlled by the will; and in addition to this, the mental balance may be maintained by the existence of the two kinds of emotion to which we are subject; the sustaining power of the hopes, joys, and successes of life, compensates for the depressing in- fluence of its disappointments and sorrows, and even when the latter are greatly in excess many people are so constituted that they can bear that excess un- harmed. But on the other hand there are those in whom volition is weak and whose bodies are ill-fitted to resist the powerful effects of strong emotion; it is in these persons that we witness the teri'ible effects of those disappointments, sorrows, and wounded feelings above alluded to. We often find that there is a certain relation of dis- parity between the manifestation of the emotions and the will; where the former is strong, the latter is weak, and vice versa ; thus it is that, while the man of iron will can control and hide emotional disturbance, the person who is not strong in volitional power, is at the VARIETIES OF EMOTION. 9 mercy of his emotions, and even his animal appetites frequently betray him. It is interesting to observe how the emotions and desires vary with the age of the individual: in the child we observe none of those strong (sexual) desires which characterize the arrival of puberty or adult life, but there is an abundance of those childish tempers and impulses which are diminished or checked in after life. At puberty the bodily development is accom- panied by the appearance of new emotional states; and as at this period the will is often weak, there is a pre- disposition to the appearance of diseases due to uncon- trolled emotional excitement (hysteria). In this pre-disposition accompanying the evolution of bodily functions, and in the periodic development of strong emotion or passion in connection with the excitement of the sexual organs in men and animals, we have a strong argument for the influence exercised by the viscera on the emotional system. In adult life the will assumes a stronger position, and as life progresses, each succeeding decade of its history sees man (and woman) passing through various phases and degrees of emotional susceptibility. In man the emotions are peculiar and distinct from those of woman, and in speaking of the pathological conditions induced by emotions, it will be seen that the abdominal viscera in his case, and the pelvic viscera in her case, are chiefly affected by emotion. CHAPTER II. THE EFFECTS OF EMOTION ON THE CEREBRO-SPINAL SYSTEM. Having reviewed the various phases of emotional excitement, which are common to all, in periods of health and disease, the next inquiry which presents itself is concerning the bodily effects produced by these emotions. One general proposition is certain: " That they do influence the body for good or evil most materially" Among the disorders in which individual peculiari- ties are observable, those connected with emotion are most conspicuous ; so much results from temperament. and temperament is so various, that the sephenomena, the effects of depressing emotions, scarcely ever occur twice exactly alike ; there are, however, certain leading features of their action common to all persons, which en- able us to draw the outlines of a picture, by a likeness to which they may be recognized.* In seeking to determine the different ways in which * The most philosophical plan of dealing with the succeeding part of our subject would be to classify the emotions, and then to trace the effects or action of each of the leading emotions throughout the body ; but, as before explained, our power to distinguish the effects or action of one kind of emo- tion from that of allied emotions, is too small to admit of the attempt. Although we cannot allot to each emotion a certain definite action by which it may be distinguished from other emotions, I flnnly believe that such a distinction THE CEREBROSPINAL SYSTEM. 11 emotional excitement may affect the body, we propose to discuss separately its effects upon the two great divisions of the nervous system, the cerebrospinal and the sympathetic. We take as our evidence, that these systems of nerves are affected. 1 st. Our anatomical knowledge of the nervous supply to the part or organ affected. 2nd. The kind of effects produced on these parts—ascribing those which are connected with gene- ral nutrition, chemical change, temperature, vascularity and secretion, chiefly to the sympathetic .system, or else to that part of the cerebro-spinal system, which is beyond the control of the will ; and ascribing those connected with the functions of animal life, such as muscular movements, speech, attitudes, and histronic expression, to the cerebro-spinal system, and especially to that part of it under the control of the will. Emotional Affections produced, through the Cerebro- spinal System.—We propose to discuss thisywr/ of the subject briefly, for the effects of emotion, acting through the cerebro-spinal system exclusively, are so evident and familiar as to require but little comment, and they seldom constitute a disease or even a functional disorder, except when they occur in extraordinary de- grees of intensity. In other words, the injurious exists, had we the means of detecting it. Until we have made this advance we can but divide the emotions into classes, and give each class the part played by it in the economy. For the present our division is very simple, our object in Section I being chiefly to determine the relation which emo- tion bears to the sympathetic system, and thus to prepare the way for a better understanding of Section II. To facilitate our inquiry into this subject, the action of emotion upon each of the organs will be considered separately ; and wherever peculiar or special effects follow the action of any one of the varieties of emotion, the emotion and its results will be indicated. 12 EMOTIONAL DISEASES. effects of emotion are generally produced through the sympathetic system of nerves, or at any rate through that part of the cerebro-spinal system which is beyond the influence or control of the will. Although we thus state that no great pathological results are likely to follow, yet a study of the effects of emotion as evinced by various movements when we are under the influence of " feeling," would prove most interesting as a purely physiological inquiry. For instance, the expression of the features in histrionic movements, the attitudes assumed under the influence of passion, and the instinctive movements which im- pulsively accompany our emotions, are well worthy of more careful consideration than they have yet received (See paper by the Author on Instinctive Movements, read at the British Association Meeting, 1863.) When shall we understand how it is that in one case we have a complete paralysis, and in another, deeds of surprising strength and agility under the in- fluence of fear, joy, or other strong emotion ; and how shall we account for the different ways in which these affect the same individual at different times and under different circumstances ? As regards the morbid effects of emotion, we know that there are several distinct diseases dependent on irregular action of cerebro-spinal nerves which can be induced by emotion. Dr. Jackson has reported some very interesting cases (in the Mtdkcd Times and Gazette), showing how easily emotion acting on an exhausted nervous system will produce chorea ; and in my own experience I have met with a fatal case of THE CEREBRO-SPINAL SYSTEM. 13 chorea which was probably determined by a severe blow to the affections. In another instance a lady suffered severely from chorea after an engagement to be married was broken oft, nor could she be cured till the engagement was renewed. It is curious that these diseases, which can be pro- duced by emotion, seem sometimes to have been cured by fright and other emotional shocks to the nervous system. Epilepsy is another convulsive affection of the cerebro-spinal system, which is sometimes undoubt- edly set up by the prevalence of depressing emotions, and when the disease is not set up by emotion, it is often aggravated by anything which excites or de- presses the spirits. Of the former fact I have a pain- ful proof, for at present I am treating a former fellow- student whose fits commenced during a severe reverse of fortune. We may instance paralysis agitans as being un- doubtedly aggravated by emotional causes in some cases, and we are all familiar with the trembling hand of the nervous man, whose emotions seem to act by withdrawing that nervous tone of the muscles which normally prevents contraction, and thus steadies the muscles. Emotion sometimes determines an attack of apoplexy. I have closely observed a patient who had a stroke during a fit of severe mental depression, at the loss of his wife; he is now slowly recovering the use of a palsied arm, but when depressed, or in any way made nervous, the palsied member begins to shake with considerable violence. 14 EMOTIONAL DISEASES. In addition to the muscular affections produced by emotion, there are others of a more serious character set up by it. Insanity is well known to result from this cause, and even where decided insanity is not reached, the reason- ing faculties may be diseased, volitional power shaken, and more or less imbecility of mind produced. In some cases emotion thus reproduces itself in a curious way. The reasoning powers being shaken, the calm calculation of sound judgment ruffled, and at the same time the power of the will being diminished, the great restraints upon emotion are gone; foolish fears are no longer dismissed by sober sense, the risings of morbid feelings are no longer controlled by the will, nor crushed by it, and thus the way is open for the rush- ing in of vain imaginations, groundless fears, or absurd suspicions, and the poor patient becomes a prey to these unhealthy occupants of the mind. The man is not insane, as we shall hereafter explain, but he is the victim of emotional disease, which, while not causing him to be haunted by positive delusions, leads him irresistibly to view the dark side of everything, to entertain the most distressing fears where none ought to exist, till life is made gloomy, morbid, miserable. The pathological changes which accompany these symptoms have not yet been made out, but there can be little doubt of their existence. Defective nutrition of the nervous centres, irregular distribution of the blood, inducing paresis through the capillaries of the brain, and fatty degeneration of the nervous tissues, are all probable conditions. THE CEREBRO-SPINAL SYSTEM. 15 May not, for instance, a paresis of the hemispheric ganglia be produced by the contraction of the cerebral vessels; and may not the contraction of these vessels be effected by a strong emotional impulse acting through the sympathetic (vasomotor) fibres supplied to their blood vessels? May we not have changes in the brain somewhat similar to those which occur in the cheek under the influence of emotion ? The pallor of the cheek produced suddenly by a strong emotion would thus be an illustration of what occurs in the brain when emotion determines an epileptic fit; the flushed cheek would illustrate (active condition of cerebral vascularity) what occurs when the brain is stimulated or excited by emotion; and the sunken countenance, with its pallid cheek and unhealthy com- plexion, such as occurs when the spirits are depressed and grief is the prevalent emotion, would form the counterpart of the jaded, weak, and imperfect action of the brain, which is so apparent in times of severe grief. CHAPTEPv III. THE EFFECTS OF EMOTION ON THE SYMPATHETIC SYSTEM. In considering the effects of emotion due to the action of sympathetic nerves, we must remember that these effects are incapable of being produced or re- pressed by the will; in fact, that they are conditions beyond voluntary control. Now, as there are most important cerebro-spinal nerves supplied to parts beyond the control of the will (pneumogastric), we shall best overcome the difficul- ties which beset our path of inquiry by comprising all such parts under our present head. At the same time, we shall as far as possible be most careful to distin- guish the action of the one system of nerves from the other, while considering the effects of emotion upon those organs which are supplied from both systems. These parts of the body which are not under the con- trol of the will are peculiarly subject to the influence of emotion, both because of their connection with the sympathetic system and because they cannot be influ- enced (even through their cerebro-spinal nerves) by any voluntary effort. Thus it is that the most baneful but least evident effects of emotion are to be found in these parts supplied by the sympathetic system— THE HEART. 17 viz.: in the viscera, in the blood-vessels, and in the involuntary muscular organs, lead in?; to disturbance in the processes of nutrition, circulation, secretion, and chemical change. The will is powerless, while emotion can, unhindered, do its worst in deranging or even destroying the important functions of these parts. We shall, in making the following observations, go carefully through the chief of the viscera (including their blood-vessels, muscular apparatus, and their functions), and of these, the organs of circulation will be considered first. 1st. The Organs of Circulation. The heart is an organ highly susceptible of emotional excitement, and even the strongest volition and the coolest tempera- ment will not give immunity from this susceptibility. Thus, easily excited in those of nervous temperament, the organ is ever being disturbed by emotion. Note, for instance, the palpitation or paralysis of fear, the sharp rapid strokes of suspense, and the intermittent action of a weak or unhealthy organ when it is under the influence of emotional excitement. Further, we have more than once noticed that long continued anxiety will lead to a weak and slow action of the heart, causing the pulse of the wrist to fall below its normal standard both in frequency and force, and at the same time rendering the organ liable to become excited and turbulent on the slightest accession of new emotional feelings. Accompanying this condition of the heart's action, we may have all the consequences of a sluggish circulation, as the following case will show: "A gentleman, disappointed in business, was 2 18 EMOTIONAL DISEASES. subjected to continual annoyance from superiors, who contrived to keep him in a subordinate position; at length he became a prey to low spirits, and mourned secretly over his trials, and at the same time he lost his health from bronchitis, dyspepsia, pains in the back, and swimming in the head; but the first and most marked symptom consisted of an exceedingly weak and slow pulse, with a tendency to intermit and to vary on the slightest occasion; when the patient was sitting its average was sixty, but on rising to his feet it immediately rose to a hundred, and continued so as long as he was in the erect posture. As soon, however, as his trials passed away the organ became restored to its normal condition." In more serious cases of sudden and painful shock to the feelings, the heart has been known to cease act- ing, or it has been excited to an action so turbulent as to injure its valves or their tendinous cords. (See case by Dr. Embleton, Northumberland and Durham Medical Society, Dec, 1862.)* Terror may paralyze the heart and so may joy when it suddenly seizes upon a person already overpowered by despair. The Roman matrons, after the battle of Cannae, on seeing their sons, whom they thought to have been killed, dropped down dead on the spot. Fear, the chronic form of fright, occasions a tremulous palpitation, not the full, bounding beat of energy or courage. Mage produces prse-cordial oppression, and * The mechanism of the accident in Dr. Embleton's case is well described by him as dependent upon the interference with respiration, produced by severe sobbing. THE ARTERIES. 19 has been known to bring on an attack of angina pectoris. The apprehension of heart disease is very often pro- ductive of cardiac irregularity. As a rule, hope will excite and sustain the organ, despair or anxiety will depress it, and contentment or peace of mind will give it healthful normal action. 2nd. The Arterial System.—The state of arterial circulation is often markedly altered by mental per- turbation or excitement; of this nature in many cases are the various throbbings or pulsations to which nervous people are subject. Such arterial throbbings may become continuous, and remain after the mental excitement has passed away, and when nothing remains but the visceral sensations indicative of emotional susceptibility. In these nervous ones the abdominal aorta often becomes excited, and alarms the patient by its violent heavings. To such an extent is this true that " Abdominal Pulsation'''' has now become a recognized malady. Cases of this kind occur in nervous men of unoccupied mind, in hysterical young women, in older women at the change of life, and in all cases where the excited state of the emotions renders the sympathetic system susceptible of excitement, and thereby induces high nervous tension of the arterial system. This is the more noticeable in the case of the aorta, as its coats, while almost devoid of direct nervous supply from the cerebro-spinal system, are very plentifully supplied and freely surrounded by the sympathetic system, in the midst of which the vessel lies. Still more evident are the effects of emotion when 20 EMOTIONAL DISEASES. they are evinced by the circulation in the smaller arteries; on this subject we shall dwell somewhat at length, because it is especially over these vessels that the emotions exercise a decided sway, and because the control of arterial circulation is one of the few func- tions which direct experiment has decisively shown to be possessed by the sympathetic system of nerves. By our knowledge of this function, however, we are able to perceive that it exercises an influence not only widely diffused, but having for its object the control of the circulation througout the whole body. Through this control it promotes or prevents the nutrition of the various tissues and influences the functional ac- tivity of those organs to whose blood-vessels its branches are chiefly supplied. In the cheek, fortu- nately, we have a region influenced by emotion, and and at the same time the region where Bernard de- monstrated the influence of the sympathetic nerves. Let us, therefore, compare the effects of emotion upon the circulation in the cheek with the effects produced by division and stimulation (galvanic) of the sympa- thetic trunk: On dividing that nerve in the neck, hypersemia of the corresponding side of the neck and face present themselves while on galvanizing the divided nerve a contraction of blood-vessels producing pallor results. Accompanying the hypersemia and pallor correspond- ing changes in the temperature of the part ensue ; with the former it rises, and with the latter it falls. Effects similar to these cannot be produced by division or galvanism of the cerebro-spinal nerves supplied to Bernard's experiments. 21 these parts, and we know of no psychical power except emotion which is able to affect these vessels in a like manner. While volition is especially deficient in this power, the effects of emotion are too obvious to need much illustration. The flushed cheek and the deadly pallor of the angry adult, and the blushing cheek of the modest youth or maid are examples familiar enough to us all.* In addition to this proof of the influence of emo- tion acting through the sympathetic system in produc- ing effects entirely beyond the control of the will, we have also, in what has been said, a beautiful illustra- tion of the variety of effects produced by different kinds or degrees of emotion. In the case of the blushing youth we have a hyperemia, while in the terror-stricken man Ave may have a similar degree of pallor; nay more • the blush and pallor may in the same subject " come and go'1 at intervals, showing how soon the effects of emotion may change from one extreme to another. We have got clear proof, then, that in the cheek Ave can produce by emotion alike those effects that result from galvanic stimulation and those that follow the division of the sympathetic nerve. * We must not be supposed to exclude the cerebro-spinal system from all connection with these effects of emotion, for as yet our knowledge of the anatomy of the sympathetic system" leads us to look upon it as being in inti- mate connection with the cerebro-spinal system, and as deriving many nerve fibres therefrom—a vast offshoot, indeed, from it for the supply of the vis- cera. Emotional disturbance, however, in being distributed throughout the body, often takes the course of this offshoot, and manifests itself by effects which cannot be produced by the will, nor can they be attributed to the action of the cerebro-spinal nerves. 22 EMOTIONAL DISEASES. The same connection between emotion and the vas- cularity of organs is observable in erectile organs, which become enlarged and vascular when certain passions are aroused, viz., the penis in man, and the comb, &c, in animals. Ecstatic Bleeding.—Professors Garres, Leon, Bore, Cerise, have related an instance of religious fervor leading even to extravasation of blood, or transuda- tion of it from the skin. Marie de Marl, the ecstatic of the Tyrol, was thus affected. The bloody sweat of our Lord seems to me to have its explanation in the intensity of his emotional suffering, which would lead to such an alteration of the innervation of the blood-vessels as to produce a hyperemia intense enough (in a body already weakened by suffering) to burst them. It now remains for us to see how far this connection between emotion and the action of the sympathetic nerve can be traced in the other parts of the body. Involuntary Muscular Fibres.—In close connection with this part of our subject is the effect of emotion upon the involuntary muscular system of unstriped fibres, for doubtless many of the phenomena presented by blood-vessels under the influence of emotion are due primarily to the action of these fibres. Every- where in the body we find evidence of this. In the skin, for instance, in addition to its vascularity or anaemia, we have horripilation or erection of the hair, and cutis anserina, as results of emotional distur- bance, each of which phenomena has been shown to depend on the action of non-striped muscle. (Kol- INVOLUNTARY MUSCLES. 23 ticker and Lister.) These visible effects of emotion acting on the non-striped muscular fibres, naturally afford a clue to the mechanism of the effects of emo- tion on internal organs, especially as these fibres exist so largely in the component parts of most of the viscera, viz., in the walls of all hollow canals, in the alimentary canal, in the mucous membranes, in the ducts of glands, in blood-vessels, and in absorb- ents, all of which, more or less, contain the involuntary fibre. It will be seen, therefore, that while volition espec- ially connects itself with the cerebro-spinal nerves and striped muscle, emotion has a peculiar affinity for the sympathetic system and non-striped muscular tissue. 3d. The way is now cleared for the investigation of the influence of emotion upon those organs whose functions depend largely upon the activity of the capillary circulation in them, which contain non- striped muscular fibres, and are supplied by nerves of the sympathetic system. The Secreting Glands belong to this class or cate- gory, notwithstanding their supply of nerves from the cerebro-spinal system; for these latter never convey volitional impulses to glands, so that emotion effecting their functions must do so directly through these non-volitional cerebro-spinal nerves, or indi- rectly through the sympathetic nerves—in fact through the vaso-motor nerves. And inasmuch as the established functions of the sympathetic fibres are so strongly resembled by the effects of emotion, we are bound to admit that it is chiefly through this system 24 EMOTIONAL DISEASES. of nerves, that the bad or good influences of emotion are produced on these glands.* It will be best to inquire into this subject as it affects the glands, whose actions we can see or posi- tively determine, namely, the external glands, and then to apply our observations to those which are not visi- ble, the internal glandular organs, endeavoring to dis- cover if, under the influence of emotion, the behavior of these two classes is the same. Let us begin by observing that the salivary glands are often influenced by mental causes; the thought of food, or the sight or smell of it will often induce an immediate copious flow of saliva, causing the mouth to water, as the phrase expresses it. And we find that depression of spirits or great mental anxiety, terror, nervousnes, intense apprehension, all check and even vitiate the oral secretions, f The clammy mouth of a young speaker, whose tongue is impeded in its action by nervousness, illustrates the state of things referred to. The glands of tit" skin may have their sweating function materially increased by emotion, and in some * It does not seem necessary to our argument to pronounce as to which class of Brown-Sequard's nerve-fibers is concerned in producing the effects which we assign to emotion, whether in the case of the blood-vessels or the secreting glands. It is enough for our purpose, in this prefatory part of our Essay, to say that all these nerve-fibers must be included in the class of nerves we have indicated, as the non-volitional vehicles of emotional distur- bance in these organs. 11 have heard of rage producing a poisonous effect upon the saliva. How far is it true that the poison of some snakes is only secreted during parox- ysms of severe emotion, as fear, anger ? and how far does emotional excite- ment tend to poison the oral secretions of rabid animals ? THE MAMMARY GLAiND. 25 cases, as when the perspiration is cold, no external or physical cause can be operating in bringing this about. The mammary gland, is undoubtedly influenced by emotion and this affords an instance of the power of emotion to vitiate a granular secretion. The child at the breast is well or ill according to the quality of its mother's milk ; its health, therefore, has become a test of such quality, and experience is too vast to permit us to doubt for a moment that infants do suffer when the mind of the mother is anxious, or when her spirits are depressed. There is a story of a carpenters wife who saw a murderous assault made upon her husband, and was intensely horrified; she suckled her infant immediately afterwards, and though the child was at the time in perfect health, it died of convulsions in a few minutes. The lachrvmal glands, the last of these external glands, are more susceptible of emotional excitement than any other glands, and the effects produced are most patent to us all. Leaving now those secreting organs, of whose action we have visible evidence, let us seek in other hidden organs for evidence of similar effects produced in them by emotion. The stomach will be found to be most intimately connected with morbid emotions ; we propose, there- fore, to dwell upon this organ first, and inquire if the effects produced in its secreting apparatus are not analogous to those of the salivary, mammary, or lachry- mal glands. The action of the stomach is largely 26 EMOTIONAL DISEASES. influenced by its vascularity, and its vessels are freely supplied by sympathetic nerves from the large centres in immediate proximity to which it lies, while its muscular coat is composed of fibres over which the will has no control. Emotion, on the other hand, can produce vomiting from nausea at the sight or thought of a disgusting object, its one visible action, so that from anatomical data and from this action or function which we can see, there is evidence in favor of the organ being one which will be influenced by emotion. Tak- ing the expression of hunger (appetite) as a sensation really produced by systemic wants, but felt in nervous centres presiding over gastric functions, how suggestive is the influence which emotion notoriously exercises in destroying or in interfering with this healthful sensation. Further, how are we to account for de- rangement of the process of digestion in cases where it is arrested or checked by strong emotion, or how to interpret the evident aid to digestion derived from a cheerful frame of mind, except by attributing the former to an arrest (or perversion) of secretion, and the latter to an increased and encouraged flow of gastric fluid ?* We have seen reason then to believe' that the secreting power of the stomach is influenced by the emotions, and, as is the case in other o?*ga?is,we infer that this is brought about by alterations in its vascularity which we have seen to be regulated by sympathetic nerve fibres. * It is curious as illustrating the effect of temperament in modifying the effects of emotion, that certain choleric persons cannot digest their meals prop- erly without a dose of anger as an accompaniment; who, if they are not quarrelsome, are sure to be dyspeptic. THE STOMACH. 27 It is important to remember here that in close prox- imity to the stomach we have the great centres of the sympathetic system, and that when strong emotion of any kind is felt, the abdomen and that part of it called the pit of the stomach is the part to which the sen- sation is generally referred.* All that distress of mind accompanied by emotion experienced by those who have to contend with the harassing difficulties and trials of life, is rendered baneful chiefly by this visceral sensation referred to the gastric region; for its accompanying conditions lead to morbid states of the digestive organs. The appetite fails in such cases, the sensation of hunger being ex- changed for a sensation of emotion ; and while the sensation of hunger fails, the want of food felt by the system is made known by prsecordial faintness and sinking ; the patient complains that food '' has to be forced down,'' and if a full meal be taken it is certain to be followed by uneasy fulness or weight at the epigastrium, and other symptoms indicating the in- ability of the stomach to digest its contents; palpitation or fluttering then occurs, and flatulence is very common. Accompanying these symptoms there is always an ac- cession of emotional distress. In other cases an empty state of the viscus is the more distressing, and relief is afforded by the introduction of food; for by it the patient is stimulated and the * Dr. Browne, of the Newcastle Lunatic Asylum, tells me that he has seen a case of emotional insanity, in which there was a sensation of a bright flash of light in the epigastrium, and he has treated three others who complained of darkness in the same region. 28 EMOTIONAL DISEASES. spirits raised for a time. With these symptoms there is more or less irregularity of the bowels ; and in some whose temperament is excitable, nervous or sanguine, when the emotions are of an exciting nature, diarrhoea or even dysenteric symptoms with tenesmus may supervene. Many patients have declared that every vexation of mind through which they passed was certain to be followed by diarrhoea. In others again, whose temperament is sluggish and melancholic, and where the emotion is depressing, the bowels become sluggish and confined.* In one case the liver seemed to become large and congested and the stools pale, after a few weeks of anxiety and excitement; in others a copious discharge of vitiated bile is not an uncommon accompaniment of distress. It should be added that many persons are subject to an attack of piles when passing through mental suffering and anxiety. The Liver.—There is no organ more intimately bound up with emotional disturbance than the liver. This relation has been observed for many centuries, and was of old more thoroughly believed in than it is now. As will be seen hereafter, this organ is not only influenced by emotion, but it has the most won- derful influence over the mind when its functions are disturbed. That an organ so closely connected with emotion and mental vigor should also be well sup- plied by nerves, is to be expected, and while we know that the liver in some of its functions is presided over by the pneumogastric nerve, we know, too, that its * In melancholic insanity there is generally a constipated state of the bowels. EMOTIONAL DISEASES AND DYSHEPSIA. 29 large supply of nerves from the solar plexus must also have an important influence over its functions. Rea" soning from the known and visible to the unknown and hidden, Ave are, I think, free to infer that the se- cretions of the liver and the state of the portal circu- lation are largely influenced by the emotions, the effect of Avhich influence is to produce the many "bilious" symptoms complained of by the gloomy and depressed. Many patients ha\Te a " bilious attack" eATery time their mind is disturbed ; and, worse than this, jaundice is sometimes produced by a sudden or severe emotion. EMOTIONAL DISTRESS AND DYSPEPSIA. While Ave are laboring under the influence of fear, anxiety, or any emotions of this class, the digestive organs may have their functions materially deranged. This Ave have already seen to be the case with the chief digestive organs considered separately, but there remains for our consideration the general condition in- to Avhich a patient may be brought, when these viscera haA^e been affected by deleterious emotion. Such a man puts on a dejected aspect, his movements become languid, his eye is dim, his natural force is abated- and the attention, liable to wander, easily concentrates itself upon the cause of distress, be it real or imaginary; unnerved, he fears the approach of difficulty; he shrinks from strange society, and is apt to allow the sensations in his disordered organs to occupy his at- tention till his " emotional distress" is greatly in- creased thereby. These and many other symptoms 30 EMOTIONAL DISEASES. appear as the result of a reaction which rapidly super- venes, whereby the organs begin to tell upon the fac- ulties of the mind. In addition, the tongue becomes coated, and is often tremulous. The appetite is lost, digestion very seriously interfered Avith, sleep becomes disturbed, and often fails to be " tired Nature's sweet restorer," by leaving the sufferer to find himself ex- hausted befere he leaves his bed to enter on his daily duties. With all this the functions of the sympa- thetic system become seriously disturbed. Exhaus- tion of the semilunar ganglia and solar plexus, or an irritated condition of these parts, may become de- veloped, with the usual symptoms indicative of these conditions, which are to be fully described in Sec- tion II. The disordered conditions of the sympathetic system not only induce a disordered action in the various viscera, by which the nutrition of the system is inter- fered with, but there is also more or less interference with the action of more remote parts. The impaired functions of the cerebro-spinal system, and the failure of the general nutrition of the body, are both instances of this. The mind becomes less able to bear up against anxiety, the patient becomes jaded, unable to work at his usual business, and the memory and other men- tal faculties in time become diseased. Attention to objects of interest and duty become difficult, the mind grows confused, and the whole system becomes weak and depressed—a ready victim to any evil which may arise, because of having lost its resisting power and reserve strength. [See Paper by Dr. Myrtle on Jaded A CASE IN POINT. 31 Brains, Transactions Northumberland and Durham Medical Society, 1864.] Such is a slight sketch of the manner in which the mind and body may become affected by emotion act- ing through the sympathetic system upon the diges- tive tract. We will close our remarks on the subject by quoting the case of Mr. W.----as an instance of the above-noted sequence of events, and as showing that apart from mental activity emotion will lead to such a state of things. In this case the mental faculties being moderately exercised, he suddenly loses his son, and becomes severely depressed in spirits. In due time the digestive organs suffer; he complains greatly of sinking at the epigastrium, and soreness felt internally. From this he goes on to lose energy, and imagines a host of other evils to be before him. He then becomes a prey to every little trial which may arise, is unable to face the ordinary difficulties of life, and eventually gets into a continual whirl of emotional excitement and suscepti- bility. At every turn his emotions are upsetting his digestiA^e organs, and in their turn the digestive organs, when in the least disturbed, keep up his distress of mind. Thus life is made wretched and miserable long after the first cause of grief has been almost forgotten. 4th. The Urinary Organs.—Our remarks on this secretion necessarily involve the consideration of those changes which, occurring in the system at large when it is under the influence of emotion, lead to abnormal couditions of the urine. The renal organ itself is closely related to the sympathetic system, and is easily 32 EMOTIONAL DISEASES. influenced by emotion. Bernard has shown that division of the sympathetic nerve may lead to saccha- rine urine, diabetes insipidus, or simple increase of the aqueous parts of the urine, and under the influence of emotion we Avitness somewhat similar results, such as the excessive Aoav which occurs in hysteria or the rapid secretion Avhich goes on during periods of anxiety, as, for instance, in young people and others who for the first time are about to subject themseh^es to the ordeal of acting or speaking before a public assembly. Dr. Crichton Browne Avrites to me—" In Dr. Begbie's wards in the Edinburgh Infirmary, some two years ago, I recollect seeing a lad who was in the house as con- valescent after some trifling complaint, and who, owing to the overcrowding of the hospital at the time, was sent to sleep in a bed with a patient Avho was labor- ing under diabetes mellitus. He was very averse to this arrangement, and only yielded to it after much persuasion, expressing his conviction that he Avould catch the disease. The first morning after sleeping Avith the diabetic patient he began to pass enormous quantities of urine. Day after day the amount in- creased, until he presented a singularly well marked case of diabetes insipidus. No deception was possible —the extraordinary quantities of urine were actually passed, and were only reduced to a normal standard by changing his bed. Here was diabetes insipidus caused by apprehension. " The chemical changes in the urine indicative of more profound changes in the system in connection with nutrition and the metamorphosis of tissue are of great THE URINARY ORGANS. 33 pathological value, but, unfortunately, are hard to be understood. It would be interesting to know whether any change in the acidity of the urine occurs during a paroxysm of emotional excitement. Beneke found, after an elaborate inquiry, that when the tone of his nerves was good the amount of his urine and urea in- creased, and that A\dien he was languid and depressed the quantity diminished.—(Parkes.) The obseiwations of Begbie and others establish a close relation between the state of the emotions and the presence of oxalic acid in the urine; and whatever doubt there may be as to the origin and indication of that acid in the urine, the fact remains that it is very commonly present when patients are suffering from depressing emotion; and, doubtless, sometimes results from such depression of spirits. Uric acid, too, and urates, are very often present in urinary deposits during times of mental distress.* We have, however, no observations to show that there is any real increase in the excretion of these substances, as their presence may be due to deficiency of urinary water, or to ex- cessive acidity of the urine. We somewhat doubt the production of the phosphatic diathesis by any mental anxiety which does not manifestly derange the cerebro- spinal centres, and we think that excess of phosphates * It is important to observe that the bladder seems to lose its containing powers during periods of emotional excitement; it is also important to dis- tinguish the frequent micturition which then occurs from the real increase of urine which also takes place. The condition of the bladder may arise from increased irritability of its muscular coat, from increased sensitiveness of its mucous membrane, from relaxation of its sphincter, or from a combination of these conditions. 3 34 EMOTIONAL DISEASES. is more the result of excessive intellectual activity than of emotional excitement, for often an iridescent pellicle and phosphatic deposits appear, AArhen none but the most amusing and interesting studies have engaged the mind; whereas, on the other hand, obser- vation of excess of phosphates during mere mental distress is wanting. Putting together the little we knoAv of the effects of emotion on the urine, we are led to infer— 1st. That the changes are due to alterations in the circulatory and secretory apparatus of the kidneys. 2d. That the chemical changes are those which are commonly associated Avith derangement of the digestive organs inducing uric and oxalic acid diathe- sis, and not those associated Avith changes in the cere- bro-spinal nervous system inducing the phosphatic diathesis. 5th. The Generative Organs.—The influence of emotion on the organs of generation is most decided, and produces its effects through both the cerebro- spinal and sympathetic systems of nerves. The ordi- nary functions of the sexual organs are to a great ex- tent under the influence of the emotions ; although the will may control, encourage, or check the emo- tions or desires, these latter still form the chief psychal excitants of the sexual organs; for, apart from desire the will is powerless to bring them into proper action. While the muscular movements induced by sexual ex- citement are chiefly of cerebro-spinal origin, the intense vascularity (arterial and capillary excitement of the parts) is doubtless due to changes induced THE SEXUAL ORGANS. 35 through the sympathetic system. In the female, the generative organs are more extensively susceptible of emotional influence than in the male ; for, in addition to the ordinary sexual functions of the organs, which are, equally Avith the male organs, brought into action by sexual desire, the periodical- functions are often markedly influenced by sudden or depressing emo- tions. At one time a diminished, at another an in- creased catamenial Aoav is induced, while at a third complete arrest of the function folloAvs exposure to sudden or seA*ere mental shock. For the present, howeATer, Ave leave this point, to direct our attention to the male organs in their relation to emotional influ- ence. Where there is deficiency of sexual passion, the functions of the organs become impaired and their structure atrophies. This condition is seen in the recluse, in celibate, or in him who has never allowed his affections to go out towards another. It is seen in him, too, who has exhausted the nervous powers of his mind by long-continued mental strain. It occurs also in many cases AAmere men are exhausted by the cares of business. In others the functions of the organ are weakened by alienation of the affections, as seen Avhen the conjugal ties are only of nominal or legal tenure and man and Avife live together without affecting sexual intercourse from this cause alone. In the man who is " used up" and exhausted we find more or less of his ennui to result from want of emotional force in his system. The functions of the sexual organs seem to require 36 EMOTIONAL DISEASES. the abeyance for the time of all other passions or emotions, except those Avhich induce their excitement; i. e., they require the concentration of all emotional force into one channel. This paralyzing influence of other emotions is seen Avhen, in addition to the sexual passion, great anxiety or general nervousness is present; the unsuccessful attempts at sexual inter- course in newly married men are an instance of this ; these attributing their Avant of success to some bodily weakness become still more nervous, and it is not until they obtain confidence (by the abeyance of the interfering emotions) that the necessary emotion can have its Avay to success. Cases occur wherein a morbid excitability of the organs is kept up by the too constant existence of erotic thoughts ; these lead either to too great indul- gence in sexual intercourse, and thus injure the system, or they lead to self-abuse, Avith its train of attendant evils. As the female is in a great measure the passive agent in sexual intercourse, the direct eAridence of the effect of emotion upon her sexual organs is small. Doubtless, however, as in men, the functions of the organs may be exalted or depressed by corresponding emotions, and in some cases the presence of an undue amount of disturbing emotions is paralyzing to her functions. By exciting the female to masturbation, the sexual instincts may, Avhen in excess, do great harm. On the organs of generation proper we have \-arious effects produced by emotion. The periodical health THE GENERATIVE ORGANS. 37 may suffer in various Avays. Amenorrhcea from de- pressing emotion or sudden shock, excessive flow from exciting anxiety, and in some cases menorrhagia with loss of clots of blood from wearing mental excite- ment, are not uncommonly observed. Pain may be added to the above symptoms, and, indeed, all the effects Avhich can be ascribed to dilatation or contrac- tion of the blood-A essels of the uterus, or to contrac- tion of those muscular fibres Avhich preside over their calibre and that of the organ Avhich they supply, do occasionally occur, as the result of emotion. Of more serious consequence, and more thoroughly proved by experience, are the effects of emotion upon the devel- opment of the foetus in utero. It is needless to discuss the numerous teratological departures from the normal standard of deATelopment Avhich are occur- ing eAery day around us, and to connect these with some well established mental shock, in order to show that even the member or organ through which the shock is conveyed to the nervous system is that which suffers in the child. Indeed, evidence is not wanting to show that the cause of the emotion can often be traced in the kind of deformity which exists in the child. The effects produced by the general tenor of the spirits upon pregnant Avomen are beyond dispute; excitement and depression both interfere with the safety of the mother and the development or nutri- tion of the foetus, and the origin of many inherited diseases connected Avith nutrition is doubtless to be found in the state of the sympathetic nervous system 38 EMOTIONAL DISEASES. induced by emotion during pregnancy. More strik- ing still, as showing the effects of emotion, are the miscarriages, abortions, and premature confinements, which follow sudden shocks, excitement, grief, de- pression, and the many other varieties of emotion which play upon the female mind. It must be re- membered that during the period of pregnancy the nervous system is very susceptible ; new instincts, passions, and emotions are being evolved in it which readily respond to even slight exciting causes. While these neAV emotions are evolved, we do not see a corresponding increase in the intellectual faculties; nor, indeed, is there any evidence of change effected in the cerebro-spinal system. Ovarian excitement ending in congestion of the ovary, ovarian pain, leucorrhcea,* ulceration of the os uteri, and perhaps other more serious diseases (such as cancer), are often in part due to emotional excess, and when these diseases exist, they are always aggravated by an accession of mental anxiety or grief. It would be impossible to complete this part of our subject without ad Averting to those cases of hysteria which manifestly depend upon a morbid state of mind combined Avith a susceptible state of body; and though this disease must be discussed in the pa- thology of the uterine organs as often originating in them, it is equally important to view that aspect of the disease which results from the play of morbid emotions on the "body. Our view of hysteria Avhen caused by mental emotion, may be stated as follows : strong passions, jealousy, anger, and sudden fears, in HYSTERIA. 39 their effects or action on the body, often expend themselAres upon the internal organs, and this espe- cially when their outward manifestation through the cerebro-spinal system is suppressed or restrained. The organs which chiefly sustain the effect of these emotions and suffer thereby, are in man the diges- tive, in woman the generate. While primarily interfering Avith the neiwous system at large, these emotions are especially directed to that part of it which presides OA^er the uterus and its appendages. When this organ becomes disordered, it keeps up the disturbed conditions of the emotional centres represent- ed in the ganglia of the hypogastric plexus, till at last the emotions become too strong for the weakened power of the will, and a paroxysm of hysteria is the result. This is the history of the development of hysteria when the emotions are not encouraged by the will, but in cases where the Avill is in league with the emotions, of course the attack Avill be more easily induced, and will take on a someAvhat different form. CHAPTER IV. THE PREDISPOSING CAUSES OF EMOTIONAL EXCITEMENT. Before proceeding to the second part of our subject, it seems necessary, now that we have concluded our observations on the bodily effects of emotion, to make a feAV observations on the chief causes of emotional excitement; i.e., on those circumstances and conditions which predispose to an excess of morbid emotion. One of the most common predisposing causes is want of occupation. The mind left without an object to feed upon, turns inAvard upon itself, thereby be- comes intensely sensitive to little evils, and tends to dwell upon them. This is seen to be the case very often in those who, having been accustomed to an active life, seek retirement, thinking it will bring with it peace and rest to their overworked minds. For instance, men of business, after a life of toil and care, often retire into private life, thinking thereby to obtain rest and comfort of mind and body, but they are not unfrequently sadly disappointed, for they be- come a prey to depression of spirits ; they get out of their element, and nothing will rectify their mental state but actiAre employment in interesting pursuits, thus showing that a healthy exercise of mind and body is by far the best cure for the imaginary evils of an unoccupied mind. Solitude is another frequent predisposing cause of CAUSES OF EMOTIONAL EXCITEMENT. 41 one or other of the depressing emotions. " It is not good that man should be alone." Students who live alone, bachelors, AvidoAVS and AvidoAvers who have to mourn alone, and old maids, are among the many victims of gloomy solitude Avhich often so affects the mind as to implicate the bodily organs in disease. We all acknowledge hoAv differently we eat and digest our food when a genial glow of pleasant emotions re- sulting from good company takes the place of those sad forebodings so apt to fill a mind, which, for want of another object, turns inward and feeds upon itself till all its A^igor and life are devoured. A want of prospect in life is another predisposing cause of depression of spirits, and a blighted prospect still more so ; these sap the foundations of sanguine hope and ardent expectation Avhich are so healthful, especially to the young mind and body. Persons situated as those above described, especially if they haAe Avhat is termed a sensitive mind, are liable to become possessed by a morbid self-consciousness; they find thoughts of self at every turn ; in reading a book they soon cease to follow the story of its pages and become lost in self; if they travel or devote their time to the most interesting pursuits, it is the same; and thus the mind becomes, to all that concerns its OAvner, exquisitely sensitive, and a hurtful emotion arises from causes of the slightest and most imaginary nature. Generally such persons are beset by one or more imaginary evils ; they see these in everything and everywhere, all things are seen to bear a relation to them, to increase them or make them more certain> 42 EMOTIONAL DISEASES. till the sufferer's poor body is scarcely able to carry his burdened soul; burthened not so much by any real sorrow as by some imaginary eAoL conjured up by the aid of diseased emotions. Monomania often re suits ; not a monomania however in the sense of a rea delusion; for emotional disorder seems to distinguish itself practically from real insanity by one marked feature, Ariz.; it can exist apart from delusions as to any fact or affliction really present, although it induces suffering from dreaded evils equally as pungent as if the evil had really occurred. These sufferers do not, for instance, like the rich or Avell-befriended lunatic, bewail the loss of friends and fortune ; but they pass their time dreading lest such losses should occur to them. When there is but a morbid apprehension that some dreaded evil may come, or that some dreaded disease is already lurking in the system ready to engulf the sufferer in its terrible consequences, every trifling cir- cumstance is interpreted as in some way leading to this dreaded evil, and therefore alarm is taken at every incident that may arise. Much of all this suffer- ing results from Avant of occupation in other things; for the attention directed to and concentrated on one object, and that object connected with self, so intensi- fies the importance of it as to make it unbearable. The directing of too much attention to any one part of the body has a very injurious influence by producing or intensifying sensations in it, in some cases even causing an illness, in others greatly increasing one.— (Sir H. Holland^ SECTION II. EMOTIONAL DISEASES AND THEIR TREATMENT. CHAPTER I. OUTLINE OF ARGUMENT. The A^arious lesions of function and structure which induce a diseased condition of the emotions will next occupy our attention. In opening out this department of our subject, we would look upon it as most important in a practical point of a4cav, and as deriving its importance chiefly from the fact that the pathological conditions present are generally amenable to treatment, so that in many cases relief of mental distress is attainable by medi- cine ; in other Avords, Ave shall find that morbid con- ditions of the internal viscera do so affect the state of the nerA^ous system as thereby to lead to serious mental results, and that these serious mental affections are not removable by treatment, except it be directed to the condition of the said internal viscera. Further, we shall see that the counterpart of what was true 44 EMOTIONAL DISEASES. Avith regard to the influence of the emotions on the viscera, is true with regard to the influence of the viscera on the emotions, viz., that the digestive and generative organs, with their system of nerves, are those generally at fault, and that the power of an organ to induce emotional disorder runs pari passu with its supply of nerves from the sympathetic system. Indeed, Ave hope by adducing many facts and illustra- tions, and by draAving fair and legitimate conclusions from these, to show that in so far as the mind is in- fluenced by the body, the state of the sympathetic nervous system chiefly determines the state of the emotions ; and that the emotional part of man's mental constitution is to the above extent influenced by, if not dependent upon, the state of the sympathetic system. Our opinion is, that the intellectual faculties them- selves derive zest and their motive* poAver from the action of the sympathetic nerves supplied to the blood- vessels of the brain, and that these faculties may therefore be strengthened or Aveakened by the state of the sympathetic system, from which they thus derive potentiality. And, if we can shoAv that certain emo- tions which excite the functions of the sympathetic nerves are stimulating to the intellectual faculties, and that a healthy state of the sympathetic system is con- ducive, if not necessary, to the existence of such emo- tions, we shall have reason for the conclusion that the sympathetic nerves supplied to the brain form the * The power which is derived from "motive." OUTLINE OF ARGUMENT. 45 medium through which the intellectual faculties are so influenced by the emotions ; and, conversely, a de- pressing emotion, or a want of emotional force for any purpose, Avill be poAverless to stimulate the brain, and will, by a reverse action of the sympathetic system, even depress its poAvers. Thus is it that courage, zeal, determination, hope, and Aarious kinds of ex- citement, will carry the mind through wonderful intellectual feats, Avhile despair, anxiety, suspense, and other A'arieties of nervous depression, have a par- alyzing effect. Thus, also, it happens that Avhen the organs are deranged, the sympathetic system fails to con\rey the impulses of healthful stimulating emotions. The mind loses its tone, motive becomes unavailing, endurance weak, fortitude lost, and all that supply of animal courage so necessary to mental vigor becomes deficient; while its place is taken by groundless fears, a nervous apprehension of imaginary evils, morbid self-consciousness, and a host of enervating injurious thoughts A\rhich render a man helpless and rob him of that AA'hich enables him to battle with the trials of life, causing him to sink in despair, and succumb to the most trifling difficulties. In this way then we may see how needful the corpus sanum is to the mens sana. The conclusion at which Ave arrived in the former Section, was that the body may suffer from the effects of a depressing emotion ; and that at Avhich we hope to arrive in this latter Section is, that the emotional mind may suffer, 1st. From an exhausted condition of the nervous system, and especially of the sympathetic 46 EMOTIONAL DISEASES. division of it; or, 2dly. From a disordered condition of the sympathetic system, inducing a flow of morbid emotions, which have an injurious effect on the other mental faculties. These points then form the subject of the present division of this article, viz.: "The various mental effects produced by a diseased or exhausted condition of the visceral system of nerves, and the lesions of the viscera which lead to these morbid conditions of the nerves." CHAPTER II. DISEASES OF THE DIGESTIVE ORGANS. As we said before, the digestive Avith the generative system forms the most interesting field for the study of emotional disorder. On referring to our remarks on the influence of the emotions upon these organs, it will be seen how powerful this may become in pro- ducing disease. We shall hoav proceed to quote examples in order to shoAv, conAersely, how the emotional mind may become affected by disorder of the digestiA'e organs. And having shoAvn, 1st. That amotions affect these organs to a very marked degree.; 2d. That emotion is felt chiefly in situations Avhere sym- pathetic ganglia abound; 3d. That the effects produced by emotion on the viscera are attributable to the action of the sympathetic nerves ; 4th. That disturbance in organs supplied by sympathetic nerATes is accom- panied by emotional disturbance ; AAre shall have gone far to establish the theory of emotional diseases on which this article is built. " A lady of strong mind, equable temperament, and high moral character, is subject to sudden attacks of indigestion after eating a heavy meal; during the attack she becomes highly nervous, and a host of fears and apprehensions suggest themselves to her mind. 48 EMOTIONAL DISEASES. For some years she thought these attacks were of purely mental origin, and was grieved accordingly ; but in time she observed that she was in her usual happy frame of mind when free from dyspepsia, and that she became perfectly relieA7ed (in her mind) as soon as each attack had passed away. Having gained this experience, she can reason on her fears and de- pression even when suffering from them, and can attribute them to their right source; in fact, she understands the nature of her depression of spirits, and her mind is at ease on the subject." "Again, Mr. H. has from time to time been the victim of the most tormenting fears and depression with a tendency to cry, and a most distressing sensation of fluttering and sinking at the epigastrium; the tongue trembles and the hand shakes, while his countenance expresses a most dejected and pitiable state of mind : all this occurs without any known mental cause (he is wretched about nothing), but it is fully accounted for by the disturbed state of his stomach, and obstinate constipation of his bowels. That this is the case is confirmed by the fact that relief can neArer be obtained till the bowels have been opened, and the secretions put in order; Avhen this is done, the man is cheerful and happy." T. P., an old man of strong and clear intellect, Avith whom the things of this life run smoothly, says, "That many years ago he received an injury to his foot, which confined him to the house for some Aveeks, during which time he was seized with a morbid idea that his soul Avas lost, although previous to this time EXAMPLES. 49 he had enjoyed the comforts of religion This, and a host of other fears beset his mind and tormented him for some time; he, however, fully recovered, till fifteen years after, when he partook largely of ox's heart, which disagreed with him, and from that time he has been a prey to morbid depressing emotions. Some- times he has intervals of ease and comfort, but is again seized by his morbid fears when the digestive organs become deranged." His digestive organs are now weak and easily deranged, but otherwise he is still a healthy man. These cases illustrate, beyond all doubt, that a state of nervous trepidation and mental depression from groundless fears may be induced by disorder of the digestive organs. We have here persons of even temperament, sound mind, and good character, ren- dered for the time a prey to tormenting fears without foundation, crying with a sense of distress, and enter- taining thoughts which at the very time Avere knoAvn to be absurd, and to be caused by indigestion. The state of the digestive organs in each of these cases seems to have depended on weak and sluggish action. We have notes of other cases showing that flatulence causes the same state of things. For instance, one man, "greatly disturbed by flatulence in the stomach, and distressed low feeling," says "he is at once relieved by a little aromatic medicine which brings the wind off his stomach;" and a woman often complaining of a sudden feeling of low spirits, obtains instant relief by the escape of a large quantity of flatus. In Avomen, whose uterine functions are perfectly healthy, symp- 4 50 EMOTIONAL DISEASES. toms of emotional disorders often occur in connection with a loaded state of the colon, and a disordered stomach. They may "fret about nothing," complain of imaginary evils, take false alarm at every turn, and undergo a torture from evil forebodings, which resist all the moral means that can be used to remove them, and they find no relief till the digestive organs are relieved. E. M., a lady whom I know well, has for some time suffered from the above symptoms, more or less, and is in constant dread of a cancer in the throat. She is unable to throw aside her fears, and looks into her throat many times daily, to be re-assured that " there really is no cancer." In spite of this, however, and in spite of all persuasion from her medical attendant and husband, she persists that her throat is diseased. Caustic has been applied, and many other remedies used, but all to no purpose. " The sensation of cancer still remains." On seeing this case for the first time, I examined the throat carefully, and found it to be quite healthy; but on examining into the state of the digestive organs I found them loaded, the tongue foul, and the bowels constipated. By adjusting the diet, exhibiting aloetic purgatives, with nux vomica, and an acid stomachic mixture, I completely relieved her in about ten days. All her fears disappeared, her mind became easy, and her throat disease Avas forgotten. As a proof that this was the result of treatment, I may say that some months afterwards she returned to me in the same state as before, and Avas easily relieved by medicines of the same kind. VISCERAL SENSATIONS. 51 This fear of "diseased throat" is by no means un- common ; I have notes of several cases in which it has occurred. It seems to me to depend upon a hypera33- thetic condition of the nerves supplied to the pharyn- geal mucous membrane, a condition Avhich frequently accompanies emotional excitement. Having by these examples shown the existence of disturbed emotions resulting from disorder of the digestive organs, we noAV proceed to speak of these organs severally, and especially of the stomach and liver. Stomach.—We haA^e already quoted instances of flatulent distension of the stomach leading to an ab- normal depression of spirits or nervousness, and have shoAvn that simple aromatics have acted like a charm in removing this flatulence, and with it the emotional disturbance. We have also expressed the opinion that during some kinds of emotional distress gaseous secre- tions take place from the mucous membrane of the stomach. We Avould now refer especially to another very constant and distressing symptom occurring in that form of dyspepsia which produces the greatest emotional distress, viz., the sensation referred to the same region as emotion, felt most acutely when the emotions are excited, and by its presence apparently predisposing the subject of it to the inroad of feelings most morbid and depressing—a sensation which seems sometimes to suggest groundless fears to the mind, and tends to concentrate the attention upon the organ near Avhich it is seated, till alarm is taken at disorders which, if unheeded, would be of very trivial conse- 52 EMOTIONAL DISEASES. quence. Then the organ becomes in its turn still more disordered, and by the mutual influence between body and mind the sensation and its accompanying emotional distress render the sufferer most miserable, dejected and helpless. The sensation to which I refer is described by some as " a sinking at the pit of the stomach," by others as " a want or a weight felt there," by others as a feeling "as if they would die," as a fluttering or a soreness, or, indeed any shade of perversion of that internal visceral sensation of health or good spirits which, as the normal sub- stratum of the emotions, is described in the first divi- sion of this paper. All this Ave unhesitatingly affirm to be the result of an exhausted, parsesthetic, or irri- tated condition of the sympathetic nerves supplied to the stomach ; and Ave believe that the different terms under AA'hich it is described are a clue to the particular disturbance present. The sense of want and a defi- ciency of resisting power, is indicative of an exhausted condition of the sympathetic centres; Avhile a sense of soreness, uneasiness, distress, or of nervous excitement, indicates various degrees of irritation or excitability of those centres. These states of the gastric nervous system connect themselves with similar states of the organ itself, Avhich states of disorder, we shall find, ar- range themselves under two A^arieties, the one a state of irritation, the other a state of exhaustion. The 1st. Gastric irritation, includes cases of gastric catarrh and congestion ; cases where the stomach is irritated by the presence of bile, or by the products of fermentation, such as Butyric and Lactic acid, or, GASTERIA. 53 more commonly still, by the presence of undigested food. This state of gastric irritation is met with in the dyspeptic man of irregular habits, or in him Avho is imprudent in his indulgence in food and drink. Any form of diet, occupation, habit of life, or distress of mind which engenders dyspepsia, predisposes to it, and induces (in addition to the general symptoms of such a state of the stomach), symptoms of a decided emo- tional character. In these cases the temper of the dyspeptic often becomes soured, self-control becomes diminished, and the mind becomes apt to take a sharp inconsiderate view of things. During such a state of the stomach patients will pass through seasons of the greatest irritability, alarm and fear, Avithout being able to assign any adequate 'cause for these. Hours will pass AAdien to their oAvn consciousness and to that of their friends these persons are unlike themselves— "not in their usual way." And if the dyspepsia be long continued, temper, disposition and general bearing may become completely altered, till he avIio has been remarkable for an even temper and calm, considerate judgment, becomes much more remarkable for his morbid irritability and inconsiderate acerbity. The 2d. Weakness of the organ, leading to defi- ciencies of its digestive powers. The Aveakness may result from loss of nervous power, from deficient quantity or quality of gastric juice, or from a want of muscular tone. This state of the stomach often connects itself with the weakness of hard worked suckling Avomen; often generates in them a tendency to nervous trepida 54 EMOTIONAL DISEASES. tion and fear, and is accompanied by a sense of want, or Aveight, or sinking, with a fluttering in the cardiac region. Young Avomen suffering from anaemia, who are not hysterical, are often sufferers from this, which we may term Gasteria. It may complicate the nervous symptoms present at the change of life, and is gen- erally connected with a mobile state of the system. Liver.—A disordered condition of the liver, entailing, as it does, disorder of all parts from Avhich the portal blood is derived, has been for ages acknoAvledged as the chief cause of mental depression. Volumes might be written and have been written upon the Ararious phases of this " Hypochondriasis." The emotional de- pression of jaundice, being accompanied by loss of energy of the other mental faculties, proves. that the existence of bile in the *blood is one fruitful cause of these symptoms; it is therefore important to remember that the cerebro-spinal nerve-centres may be poisoned or injured by this secretion. The kind of emotion which is produced by hepatic derangement is not of a highly sensitive nervous type, but rather of a dull, heavy, morose nature, causing the patient Avith a " jaundiced eye" to take a gloomy view of everything and everybody, to become suspi- cious, apathetic, cantankerous and sad. In such cases all the cares of life press heavily, for the patient cannot rouse himself to meet them, and almost any extent of despair or morbid mental condition, short of insanity, may be reached. Lassitude and an ac- cession of low feelings are very common after a hearty meal, about the time when duodenal digestion ought HYPOCHONDRIASIS. 55 to begin. The spirits, low in the morning until tea or some stimulant is taken, are usually better in the eA^ening. Such patients often awake with a horrible sense of weight and depression of spirits, feeling no better for their sleep either in body or mind, and a melancholy "nausea of life" damps every feeling of energy for the day. These symptoms, and such as these, are very often due almost entirely to derange- ment of the liA'er, and are Avell known to disappear Avhen appropriate medicines and other treatment have rectified the functions of that organ. We have notes of cases not unlike the following, dependent on deranged and sluggish action of the liver. Captain A. has often come to me in great fear about himself, imagining that he is the victim of many terrible complaints; he" sometimes feels quite well, but as soon as his boAvels become disordered and his liver inactive, his spirits become depressed, and he is very anxious about affairs of trivial importance. He says that he (Avith several other seamen whose ships trade Avith Spain) can assure me that as soon as he passes Cape St. Vincent (which seems to separate the temperate climate of the north from the hot climate which prevails in Spain), he is certain to have the above attack, accompanied by symptoms of con- gested liver; and while in Spain he is never out of the Spanish doctors' hands. So nervous does he become. that if he coughs he cannot be easy in his mind till he has examined the sputum, and satisfied himself that he is not in a consumption. He has often declared to me that he would give all he possessed if 56 EMOTIONAL DISEASES. he were certain at these times that he was free from disease. Gout, both in its acute paroxysms and in its latent form, is very injurious to the nervous system, and developes many curious conditions of the mind. During the paroxysm, these conditions are generally of an exciting, irritating nature, leading to sharpness of temper and disposition. Latent gout leads to de- pression of spirits, and very serious impairmemt of nervous power. CHAPTER III. GENERAL REMARKS ON THE MODUS OPERANDI OF DYS- PEPSIA PRODUCING EMOTIONAL DISTURBANCE. If Ave \vere asked the special utility aimed at in writing upon the subject of this article, and if we could furnish no other reason, we should deem the attempt to relieve that A'ast fund of mental suffering which depends upon disordered conditions of the di- gestiA-e organs to be sufficient, so great is the distress often felt by the victims of these disorders. These conditions of the digestiAre organs often play a serious part in " shattering the nerves" of men Avho were once remarkable for their strength of Avill and power of mind. True, these have generally been a prey to hard Avork entailing mental anxiety, but this very anxiety reacts upon the mind by the injury it inflicts upon the digestive organs ; for it is through the influence of these that the mind and its emotions become diseased. In such cases Ave find that all self-reliance and self-possession are gone, and their place is taken by vacillation, timidity, and in- ability to make up the mind on the most triv- ial questions. We haAre known one gentleman to pass a day of torture in making up his mind 58 EMOTIONAL DISEASES. to post a letter, another unable to bring himself to seal a letter, and Ave have heard of a third who spent a Avhole day in writing a satisfactory epistle. This state of things is most trying to the patient's friends, and its removal generally resists their efforts ; nevertheless, it is within the range of improvement by medical, regiminal, and hygienic treatment. I might quote many cases to show how the digestive organs, when they are disturbed, disturb and unhinge the mind too. " A woman attending the Newcastle Dis- pensary is in continual dread of death, and many other evils, and she can never get them off her mind till her constipated boAvels and flatulent stomach have been relieved by a feAV doses of Dispensary Mist: Purgans with Asafoetida." " A student of medicine, who Avas most miserable and dejected in Paris, found himself ' all right' on returning to England, and on reA'iewing his case, attributed it entirely to the influ- ence of the constant dyspepsia entailed upon him by French diet and hot weather." " John Sutherland is under a constant impression that he Avill die, and this is kept up by a sense of dis- tress at the epigastrium; he is treated by means di- rected to the digestive organs, and he gets well of the distress and the fears too." It often happens that where any great evil has once threatened a nervous patient, he is certain to fear its recurrence when the stomach is disturbed. The mind sometimes becomes diseased by having its attention constantly occupied with the stomach and its disorders, or what is more trying still, by dwelling upon other imaginary dis- IMAGINARY DISEASES. 59 eases. The patient fancies he is ill. If the heart palpitates he imagines it is diseased; if the abdomi- nal aorta should be felt to pulsate, he Avill imagine there is disease there; if a deposit of urates be seen in his utensil it is construed into a disease of the kidneys, and so on, till AA'ith Aveakened nerves, a mind full of terrors, and a body supposed to be at fault, the poor dyspeptic becomes a creature to be deeply pitied. All this neiwousness and misery exist Avithout any real mental cause, and they exist so constantly in con- nection with disorder of the digestive organs, that it is impossible to avoid the conclusion that they bear to each other the relation of cause and effect; and yet. on the other hand, there are many very decided diseases of the digestiA'e organs, in Avhich there is no disturbance of the emotions, and there are persons avIio do not suffer from depression of spirits Avhen the digestive organs are disordered. Very much, as we have before stated, depends upon temperament, and temperament is doubtless connected Avith the particu- lar mould or constitution of the nervous system. It is therefore of great importance to note first, the kind of disorder AA'hich does, and the kind of disorder which does not, produce depression of spirits; also the particular type of nervous temperament most subject to these attacks. We Avill here venture to explain our views as to the nature of these cases of intense mental suffering from disturbed condition of the visceral nerves. It Avould seem that the digestive tract may be se- riously irritated as regards its sympathetic nerves, 60 EMOTIONAL DISEASES. when no great amount of irritation in the ordinary sense of the word, exists. Such a paraesthetic or hypersesthetic state of these nerves seem to excite morbid emotion rather than pain or other sensations indicative of ordinary irritation in the part, and this is done chiefly by destroying the quality of that vis- ceral sense, which is, as we have said, the substratum of the emotional states. In irritation of these sym- pathetic nerves then, we see that one of their special functions is at fault; and that function alone may suffer, just as in some affections of an organ of special sense, such as the eye, we find alteration in the special function of its nerve to be the first and only indica- tion of disease. We may conArey to the reader's mind the best idea of this by referring to an hypothesis which has some- times served us good purpose in studying these dis- eases ; it refers especially to the manner in which emotions, rather than ordinary sensations, are excited by the sympathetic nerve. We Avill assume that the Will excites a force which manifests itself in muscular movements, and this force generated in the cerebro-spinal system, travels along the cerebrospinal nerves, and manifests itself in mus- cular movements of aA^oluntary nature; again, irritation of the cerebro-spinal nerves is conveyed to the brain, where it is received as a sensation. We aver that emotional impulses, on the other hand, travel along the sympathetic system of nerves as Avell as the cerebro- spinal, and so doing manifest themselves in various changes in the functions of the abdominal viscera. EXPLANATORY THEORY. 61 Conversely, an irritated or disordered condition of these viscera, producing irritation of their nerves (the sympathetic nerves), does not lead to a sensation of ordinary pain, but to an alteration of the •'emotional sense" inducing an emotional state different from that of health. It is this latter condition to which we refer. The intestinal nerves become irritated, or the nerves of the liver may be affected by a disordered condition of its functions, the nerves of the stomach likeAvise may partake in the same state of things, and the whole of that part of the sympathetic system may thus get into a parsesthetic, a hvperaasthetic, or hypothetic condi- tion, as the case may be, which powerfully predisposes the patient to the inroad of feelings of depression or apprehension, robs him of self-confidence, tone and courage, makes everything a burden and a difficulty before Avhich he sinks, destroys the best of tempers, changes the most amiable into the suspicious and unforbearing, blunts the ablest intellectual faculties, takes the zest out of the most favorite pursuits, and renders the poor sufferer a prey to the most distress- ing emotional excitement or depression. I have known the character to be thus most materially changed not so much as to principle but as to manner and feeling, and those who were once the most loving, most pleasant, and acceptable of men to become cantankerous,* depressed, and burdensome to their dearest friends and relations. * I use the word "cantankerous" simply because it conveys the idea of a state of mind to which no other word appliee. CHAPTER IV. EMOTIONAL DISTURBANCES DUE TO DISEASES OF THE ORGANS OF GENERATION. Before proceeding to the consideration of the special diseases of these organs, we would note their close relation to the emotions and appetites of both male and female. Indeed, their purely sexual func- tions we have seen to be dependent on the appetites, and their accompanying emotions, for their full mani- festation. In the case of the female, the pathological condition of her sexual organs, which affect the emo- tions, are more numerous and more important than in the male. This is due, no doubt, to the nature of her many functions which powerfully excite the instinctive feelings of the mother and the wife. If proof of the relation of the emotions of the bodily condition of the subject of them were needed, it would be found most satisfactorily in the development of passion and affection during the periodical excitement of these organs in men and animals; in the former puberty, and in the latter the period of heat are dis- tinctly the occasion of sexual passions and emotions. HYSTERIA. 63 To commence our remarks let us direct attention to those conditions of the female organs Avhich dis- tinctly induce sexual desire, and then Ave shall pursue our inquiry concerning the emotions similary induced. Nymphomania, for instance, is a disease involving morbid excitability of the loAver attributes of human affection, by AA'hich the mind is led to be filled with desires naturally in abeyance, and it is due to an excited state of the external organs of generation. The presence of ovarian irritation, as we shall see, may lead to similar results. In the female the prac- tice of masturbation is not uncommon, and in some cases the tendency to the habit becomes so strong as to constitute a disease Avhich is dependent on a morbid irritation of the clitoris and adjacent parts, and which is curable by removing that organ or subduing its irritability. The primary or immediate effect of this practice being to excite, or rather to gratify erotic thoughts, we might naturally expect an excitement of kindred • emotions as the consequence, but the emotions which ultimately result from the practice are of a very different nature, such as fear, timidity, nervousness, and apathetic depression of spirits, and other feelings which can be" accounted for by the disordered and exhausted condition of the hypogastric ganglia pre- siding over these regions. The distressing effect of this disease on the spirits is so closely allied to Avhat occurs in the male who masturbates that Ave shall defer its further consideration till Ave consider the male organs of generation. 64 EMOTIONAL DISEASES. Passing from these conditions to that more general condition of the nervous system called " Hysteria," we need not stay to remark upon its dependence on disorder of the uterine organs ; for we have before shown these organs to be influenced by emotion, and we have also seen them to be the occasion of the most disturbed emotional conditions, leading to hysteria. We expressed our belief that hysteria generally depends upon the mutual reaction which exists betAveen the mind and body through the sympathetic nervous system. By this, the too active play of emo- tion, Avhether exciting or depressing, produces a dis- turbed condition of the sexual organs, which affects their nerves so powerfully that the sympathetic centres from Avhich the nerves are derived may become disordered. The vehicles of emotional force, thus rendered unfit to carry healthy impulses, are on the other hand excited to produce an unhealthy condition of the " emotional sense," and thus to modify the char- * acter of the emotions to no small extent. In this way the unoccupied minds of young women are doubtless subjected to an unnatural excitement by unhealthy emotions when their sexual functions become dis- turbed, and the result is that state of mind and body which Ave call " hysteria." It would be impossible to specify any one disorder of the sexual organs which acts in this way, or from Avhich hysteria is thus derived. All affections of parts supplied by sympa- thetic nerves lead to it, but especially affections of the pelvic viscera, such as congestion or sluggish action of the uterine system, and difficult, scanty, or profuse menstruation. HYSTERIA. 65 In the hysteria of anaemic subjects, the poverty of blood doubtless adds its quota to make up the attack, through the loss of tone in the nervous system engen- dered by the imperfect supply of nutritive matter. The other emotions (not of an erotic nature) which are excited by disorder of the sexual organs will now be considered. 5 CHAPTER V. THE CHANGE OF LIFE. While the state of mind developed during the first change of life in youth is sometimes most distress- ing, it is not to be compared in this respect to that attendant on the second " change" peculiar to ad- vancing years. Inasmuch as the former has been fully described in many Avorks, Avhile the latter has not been so fully noticed as it ought, we propose to dAvell on it more at length. We will therefore dismiss the new emotions and their early outbursts in the breast of the young maid, and turn our attention to the curious mental states which accompany the departure of the child- bearing function. In doing this, Ave propose in the first place to allude to the various bodily symptoms which occur at " the change," shoAving that they for the most part are due to a disordered condition of the visceral system of nerves ; and then to examine the mental phenomena which accompany these conditions. 1st. Mushes.—Women who have been of cool tem- perament, and Avhose nervous tone has enabled them to control expression of feelings with the greatest ease are at the change of life surprised to find that in spite SYMPTOMS AT CHANGE OF LIFE. 67 of every effort, and at seasons most inopportune, a sensation of heat, arising generally in the epigastrium, will diffuse itself over the whole surface of the body. This is accompanied by flushing or redness of the cutaneous surface, and is most apparent in the face, neck, and hands. When " the change " is accom- panied by any untoward circumstances or conditions, these hypersemiaB become most distressing, and are greatly aggravated by the peculiar nervous condition of the subject of them. It may be argued that this is merely the diffusion of blood Avhich ought to have been lost in another direction. This Ave admit, but for such a diffusion Ave know that a certain condition of vessels is necessary, and this condition Ave know to be dependent on the control of the sympathetic ner- vous system, so that after all the latter must be in a peculiar state or the symptoms Avould not occur. We need not say that Bernard's experiments suffi- ciently proAre that a " Avant of tone," leading to a partial paralysis of the sympathetic centres, is the condition to Avhich Ave allude. It leads to occasional loss of control over the capillaries or small arteries, on the occurrence of Avhich a wave of Arascularity passes over the surface and exists till the nervous centres have once more regained their tone. 2d. Perspirations of the face and hands are most common and distressing to females at the change of life, and are doubtless due to similar states of the arterial nerves, which are derived from ganglionic centres. 3d. Sensations in the epigastric region are often 68 EMOTIONAL DISEASES. most common and trying to the patient, especially as they so commonly connect themseU'es with emotions of various kinds. The chief of these sensations are a fluttering, accompanied by a sense of choking or dysphagia, and a feeling of faintness Avhile the heart's action is good and regular; on which account the sensation is rarely the precursor of an attack of syn- cope. While the absence of pain in the region of these sensations is against their being of cerebro-spinal origin, our present knowledge justifies us, because of their nature, relations, and seat, in ascribing them to an exhausted or irritated condition of the semilunar ganglia and solar plexus of nerves. 4th. The organs of digestion suffer from sympathy, and aggravate these symptoms, the bowels become sluggish, the liver torpid, the stomach easily disor* dered; the heart's action is sometimes feeble, and the circulation so languid as to give the impression that stagnation of blood occurs in parts; at other times the heart palpitates, and this worries the patient by a fear that the disease is there. 5th. Other sensations of various kinds occur, e.g.r creepings, heat, cold, feelings as if a hand were being applied to the back, tingiings in the fingers and face, pulses in various parts, fidgets, shiverings, &c, all be- tokening a curious condition of the nervous system, for Avhich as yet Ave have no name. Noav, accompanying all these bodily phenomena, there are various mental states which cause them to assume an importance (in the mind of the patient) so great as to make *' the change'' one of the most trying EMOTIONS AT CHANGE OF LIFE. 69 of the ordeals through Avhich woman has to pass. An epoch in her history when mind and body are disturbed together, and when the former, thus un- hinged by the latter, is, as it were, almost overwhelmed by its burdensome condition.* It will therefore be important to see what mental phenomena accompany these various symptoms which are dependent on disorder of the sympathetic system of nerves. For instance, during the accession of heat and flushes there is often developed an inward ner- vousness which is intensely painful to bear. In such cases, AArhen in the company of others, the poor woman becomes flushed in the face and nervous, grows slightly confused, fancies everybody is looking at her and closely observing her, attributes this to their curiosity or impudence, and imagines they think her flushes are due to some secret indulgence in spirit-drinking. She then shuns society and seeks solitude, there to brood over all sorts of imaginary evils, and to yield to the conviction that she is the victim of some terrible malady. When the heart palpitates she often imagines it is diseased, or, if the head be light, that there is mischief in the brain. The back and loins are often the seat of pain, and its endurance is a source * We shall not dwell upon the various forms of insanity developed at this period; they belong to another department; for, we repeat, emotional disease will always be found to differ from insanity in one or two respects. 1st. How- ever great the apprehension of unreal evils, or however strong the temptation to believe in evils which do not exist, there is no delusion as to facts which are patent to ordinary observation. 2d. It is rather the misinterpretation of facts, and taking false alarm at little things which constitute the disease. This distinction is most important in a medico-legal point of view. 70 EMOTIONAL DISEASES. of many anxious fears and alarms. Persons with the above symptoms not unfrequently conceive a great dislike to those with whom they were once on terms of greatest friendship; they become jealous and sus- picious of those very near and dear to them ; they harp sometimes on one string of evils; at other times every- thing is Avrong Avith them. They may at one time suffer from distressing excitement, Avhile at another the most gloomy depression sets in,. The temper once amiable, becomes most fretful and trying to those with whom the patient lives. We have knoAvn a lady of \Tery high character Avho within the last two years has become a perfect tyrant to her. sister, and who spends some hours every morning in A'apid thoughts and useless complaints; this state of things is always worse AA'hen the bowels are confined, when the stomach is disturbed, or when the uterine system is out of order. The change Avhich sometimes occurs in the marvellous poAvers of endurance possessed by women is most marked. Giving Avay to fears about nothing, fretting continually, greatly annoyed by trivial com- plaints, they seek for sympathy from those Avho cannot enter into their feelings or understand their case, and failing to obtain this, they become still more cast doAvn. Too often their medical attendants ridicule their complaints, ascribe it all to fancy, and refuse to treat them; and though it is quite right to ridicule the imaginary diseases complained of, and to labor to coiwince the patient that no serious disease exists,, yet the practice of ignoring the existence of the dis- UTERINE AFFECTIONS. 71 ordered condition of the nervous system, and of refusing to treat it, is to be condemned. I Avould not dAvell on things apparently so trivial as these, had I not seen some of the worst misery this world witnesses induced thereby. The conviction that this is the result of mere bodily infirmity ought therefore to nerve the physician to its investigation, treatment, and cure. The folloAving are the conditions of the uterine organs Avhich cause much mental mischief, and at the same time induce the train of symptoms before indicated:—-Leucorrhcea, ulceration of the os uteri, prolapsus uteri, and other displacements of the organ leading to congestion. Other conditions allied to these frequently occur. For instance, it not unfre- quently happens that after her confinement a female finds herself suffering from pains in the right or left ovarian region, Avith aching in the back and loins. At the same time there is a burning heat felt in the neck of the uterus, a thick yelloAv discharge makes its appearance, and on examination a congested and ulcerated condition of the os and cervix uteri is revealed. The patient then feels her spirits begin to droop, everything becomes a burden; fears and appre- hensions occupy her, and she, looking at the dark side of all her symptoms, and imagining herself to be seriously ill, becomes very apprehensive as to her own safety and that of her child. Sometimes hysterical symptoms manifest themselves, and frequent outbursts of tears are the result. Life becomes Aveary and a burden, and she is found to be in a most pitiable con- 72 EMOTIONAL DISEASES. dition. With all this there is that sense of " faintness or want" in the region of the solar plexus, which indicates its weakness and disorder. Such a letter as this not unfrequently reaches the medical attendant: —"Sir, come immediately to me. I have become miserable, and I am afraid I shall never be better. What will become of my poor children ? Is there nothing to cure me? I am very ill and distressed." A cloud thus hovers over the mind, and nervous per- turbation succeeds, with a sense of alarm at nothing. We have seen that mere leucorrhceal discharge may induce this state of things in a minor degree, and prolapsus uteri is on this account one of the most distressing maladies. Often with tearful eye and sobbing breast has the victim of depressing emotion confessed to me that she suffered from a "bearing down or fall" of the womb, and to her surprise has been assured that her depression of spirits resulted entirely from her uterine affection. And many of these cases have seen most striking relief afforded to the mind by treatment directed to the uterus, e. g., the use of a comfortable pessary has on some occasions entirely relieved both mind and body. I specially allude to this because all these uterine affections are seriously aggravated by the congestion produced by displacement of this organ. Miscarriages frequently determine a course of suf- fering in the life of a female which affects both mind and body in a most mysterious way. The nervous system becomes completely unhinged in some cases, and actual insanity results: in less severe cases, MISCARRIAGES. 73 hysteria with depression of spirits, loATe of solitude, and timidity when in society, mark the disordered condition of the mind. The system of nerves pecu- liarly iiwolved in these cases is the sympathetic, for although the cerebro-spinal system suffers, it is entire- ly because of its connection Avith the sympathetic system; and treatment to be of any avail must be directed to this latter system. We may remark that the disordered action of the colon which so frequently connects itself with these cases, is probably due to the ganglionic sympathy betAveen it and the uterus, for no tAvo parts are more fully supplied by sympa- thetic nerves, and both readily respond to the exercise of emotion. Diarrhcea with dysenteric symptoms, but more frequently constipation, are the conditions usually engendered Avhen the colon becomes involved in the diseased action. The suffering from these dis- ordered conditions of the colon tends to unnerve and alarm the patient. They alarm by the pain and burning heat in the colon, also by the discharge of mucus, pus, and blood; they unnerve by keeping up t disease of the hypogastric centres of the sympathetic system. CHAPTER VI. MALE ORGANS. Passing now to the diseases in the male organs of generation we shall consider that aspect of masturba- tion which consists of the mental distress resulting from the bodily excess. Let us here note the gradation Avhich exists between the ordinary sense of touch and mental emotion. The sense of touch is not far removed in its nature from the sense of taste, Avhich is one of the special senses liable at any time to be excited, and to lead to over- indulgence in the pleasure it affords. But more closely connected Avith emotion, giving rise to, it and easily excited by it, there is the sexual appetite or sense, which is still more poAverful in making its votary the Auctim of its excessive indulgence. When the sexual sense is indulged by unnatural means without its proper emotional stimulus, the nervous centres Avhich have to do with the functions of the generative organs (the secreting functions) become weak and excited. At the same time, from a A'ariety of causes, the cerebro-spinal system becomes exhausted; intellect, reason, and power of will diminish, the man becomes ruled by depressing, morbid emotion, and is the victim of an un- MALE ORGANS. 75 naturally excited* appetite which impels him forward in spite of reason, conscience, advice, threats, and Avarn- ings. Such an one then presents himself to the physi- cian a deplorable Avreck in mind, and body. Both are Aveak, both exhausted, the one under the influence of emotions most morbid, the other the victim of an ex- cited feeling or impulse which is driving the subject of it secretly to destruction. We need not here re, hearse the fears, anxieties, and distress by which the charlatan is enabled to practice on his weakness; nor is it necessary to dAvell upon the various functions Avhich become disordered ; the palpitating heart, the trembling hand, the shy and skulking expression of eye and countenance, the coated, trembling tongue, the constipated boAvels and impaired digestion from feeble secreting poAver, all go to make up the sum total of this Avretched state of things. Another condition engendering much mental dis- tress is that which follows the occurrence of venereal disease. In these cases, as Ave shall see, the mind is already predisposed to the fears and depression of which the nervous system \v ill soon be the ready ve- hicle. Gleet is often the source of vast mental distress to young men; by it the attention is kept on the dis- ease, and thus, I believe, it is often prolonged, Avhile the mental system becomes nervous, apprehensive, and even suicidal; the mind seems ready to be influenced and absorbed by the fear of disease. * The relation between the appetite here spoken of, and emotion, is ex- plained in the remarks on female masturbation. 76 EMOTIONAL DISEASES. Stricture, in some cases, establishes a ATariety of mental disturbances. Worse than either of these, Syphilis is not unfre- quently the source of much mental suffering. Arous- ing the emotional system by the alarm it creates, to- gether Avith the deleterious effects of the disease, and perhaps with mercury to aid, it establishes that curious condition, Syphilophobia, which preys upon the spirits, energies, and life of many. This unfits them for im- portant duties AArhich, if accepted and fulfilled, would have made them men of power and influence. Thus their prospects are often blighted ; they fail for want of nerAre, confidence, and courage ; and these they have not, because they are taken up Avith selfish ailments, and have their life eaten out of them by anxiety and depression about a phantom idea, an unreal evil. Some of the most distressing instances of depressed spirits result from exhaustion of the nervous system due to A^enereal excess in early life, As years advance, such men become the victims of a curious debility of their nervous system, shoAving itself in a loss of inter- est in their faA^orite pursuits, an inability to contend with difficulties, apprehensions of poverty, &c. In these cases, oxalic acid or phosphates often abound in the urine. CHAPTER VII. TREATMENT. The treatment of these affections naturally divides itself into tAvo parts, one of which is connected with the earlier portion of this Essay, and involves the consideration of the means for preventing and curing the ill effects of severe or injurious emotions ; the other belongs to the latter division of our subject, and has to do with the treatment of those diseases de- scribed as inducing emotional distress. In making this division, let us not fail to recognize that, whatever tends to remove diseases producing emotion, will, in most instances, be one of our best safeguards against the injurious effects of emotion Avhen it necessarily exists. How are Ave to preA'ent severe and injurious emo- tions from damaging the bodily functions, and hoAv are we to remove such injury Avhen it has been inflicted ? To the former part of this question we find an ansAver on referring to the many causes which have been enu- merated as encouraging the inroad of morbid feelings, and depression of spirits. These causes, if possible, are to, be avoided. 78 EMOTIONAL DISEASES. We cannot here enter upon individual cases, and show how each must be met by advice directed ac- cording to the cause and subject of the suffering ; our province is, as we have indicated, to deal with those general conditions which intensify emotional distress, and to show how they may be aA^oided so as to pre- vent mental suffering from becoming the cause of bodily disease. For instance, solitude often tends to increase a sorrow by alloAving the mind to dwell too much upon it; and the habit of doing this, so soon acquired, is with difficulty thrown aside. Want of occupation sometimes operates in the same manner; therefore both of these conditions must, if possible, be removed. The solitary man or woman will find the opening of the heart to a confidential friend to be its best re- lief for pent-up sorroAV, and the pleasures of agreeable society will greatly relieve its sting; the unoccupied man Avill best drive away his fears and distress by getting his mind thoroughly occupied in some engros- sing pursuit. Let him try " the expulsive power of a new affection." Persons who have been disappointed in marriage are often ruined in health and spirits for a time. Where a chance of a new tie exists, let it be formed, or where the old longed-for affection can be renewed, let it be so. I have known a poor girl made most seri- ously ill from dejection of spirits (accompanied by chorea), all resulting from the breaking off of a much cherished engagement; in this instance, an immediate cure followed its renewal. Cases must be dealt with TREATMENT. 79 according to temperament; but, in all, let it be re- membered that the old idea of persons being able to shake these things off by an effort of their own, is a false one. It is not in them to do this. They must be assisted by the sympathy of friends, the consolations of religion, a cheering prospect, and some wise, con- siderate scheme or plan by which a change of air, of scene, or, better still, of society and mode of life, may be secured. The great thing is to remoA'e or diminish the emotion before it injures the body, or sets up a disease Avhich will perpetuate the evil. I belieA'e many go on suffering because of this, long after the original cause of grief Avould have ceased to trouble them, had they taken means to prevent its injurious effects on the nervous system. There are some persons on Avhom emotion tells with special poAver, and these ought to be spared bad or sudden neAvs of any kind. Convalescents from severe illness are often A^ery nervous ; even a tap at their door may shake them, so that anything of a more serious nature, to speak figuratiArely, shatters them. Pregnant or suckling AAromen are to be protected in the sameAvay, and in such cases the mind should be prepared for startling news or shocks. Further, it is of great importance to regulate the functions of the body by medicine, Avhen times of mental trial test its strength. The functions of the stomach, liver, and bowels claim special attention. The bowels must be cleared out, the liver kept in action, and any irritability of the stomach at once corrected. If the digestive organs be weak, they must be strength- 80 EMOTIONAL DISEASES. ened by appropriate tonics, such as shall be indicated hereafter. When the mind has been overworked by anxiety, and the body shattered as a consequence, medicine alone Avill not effect a cure; such will need the invigorating power of a bracing sea air, or an alterative and tonic course of mineral waters at some watering-place like Harrowgate or Aix-la-Chapelle ; and to these, Ave repeat, must be added the genial in- fluence of agreeable society and amusing pursuits. In such cases, partial change will do but little good; there must be a complete removal from all the cares and anxieties of life—a change of scene and society into which the invalid must not carry his anxiety with him, but leaving all behind, enter, as it were, on a new phase of life. As will be shown hereafter, the use of cold water in various ways will prove very beneficial. Cold shower-baths, or sponge-baths, in some cases sea bathing, and in others cold water sheets and com- presses to the epigastrium (and eAren the application of ice to that part) prove most beneficial. Such measures, hoAvever, will avail but little, AAdiile the diet is improper or irregular. At these times, if the patient be plethoric, a light, non-stimulating diet will be necessary ; and in cases Avith constipation it should also be of a someAvhat laxative nature, consisting of preparations of oatmeal, gruel or porridge, as opposed to the heavier and more constipating farinaceous foods. In all cases of exhaustion or Aveakness, a well ad- justed nutritious diet is absolutely necessary;it must, however, be free from all indigestible substances such as cheese, pastry, dough puddings, ham with its dried TREATMENT. 81 and hardened fibre, &c, cfec. Stimulants will be need- ed in some cases, and must be carefully avoided in others. When the boAvels are loose and the system weak, brandy, especially after meals, or as an aid to sleep, is most useful. Tea, coffee, and even tobacco, may be used Avith benefit as occasional restoratives, the tAvo former Avhen the system is depressed, the latter when excitement prevails. In speaking of the medic- inal treatment of emotional diseases, we shall discuss the virtues of the various medicines to be used; let us here allude to the most salient points of medical treatment during a period of emotional distress. Sal volatile, and other spirits of ammonia, with chloric ether are useful as diffusible stimuli in cases of great depression; they afford temporal y relief, a most im- portant point, the advantage being that we limit the duration of this depression, and thus prevent it from injuring the body. Camphor, as spt. camphor, or camphor julep, is also useful in such cases; and musk or hyoscyamus, afford the nervous system useful aid at such times. The disturbed state of the digestive organs is best treated by mild alteratives: in cases of Aveakness with irrita- tion of the stomach, it might be well to combine the spirits of ammonia, or potash with bismuth and hydro- cyanic acid or the tinctures of rhubarb and cardamoms with hyoscyamus and some vegetable bitter. The mineral acids are at once aids to digestion and tonics easily borne by the system. It will be most important at such seasons to detect the weak points of the particular system we have to 6 82 EMOTIONAL DISEASES. deal with, and to direct our treatment accordingly. Thus the liver, the heart, and the uterus Avill chiefly demand our attention after the claims of the stomach have been attended to. The liver Avill need special attention, and, according to its condition, should be gently or poAverfully acted on by blue pill or podo- phyllin, folloAved by the nitro-muriatic acid and dandelion. The heart's action must be regulated by digitalis, chloric ether, ammonia, hyoscyamus, or green hellebore. Sulphur, hip-baths, &c, Avill have their effects on the uterus fully explained hereafter. The few indications we haA^e here laid down will be enough for tiding a patient of ordinary type safely through a season of great mental distress, anxiety, or grief;.there are many other details of treatment which remain to be mentioned; but our space Avill not permit us to enter on their consideration. The treatment of emotional disorders of course in- volves the treatment and remo\Tal of those diseases by Avhich they are specially induced; it Avould, how- ever, be altogether beyond the province of this article to go into detail on the various means to be used for removing diseases, such as dyspepsia of A'arious kinds, leucorrhcea, or hysteria, all of which should be treated by the usual means; Ave shall, therefore, deem it sufficient for our purpose to speak of the action of the various drugs which influence the (sympathetic) nervous system, and through it, the emotions. Stimulants.—Sal volatile and other spirits of am- monia are often most useful; they not only rouse the nerves of the stomach, but, being diffusible stimuli, TREATMENT. 83 excite the whole system, and thus often become the means of dispelling a fit of depression or nervous tre- pidation. By adding chloric ether these advantages are increased, and the combination often affords most striking relief. The lady Avhose case is related at page 72, is an instance of this; her groundless fears were at once dispelled by drachm doses of ammonia and chloric ether. The inhalation of eau de Cologne sometimes affords relief by its strong stimulant action. Alcohol proA'erbially "gladdens man's heart." but its action on the spirits is so complicated by other effects, that I refrain from prescribing it, except in urgent cases and in moderate doses, to relieve local conditions of the stomach, or to procure sleep. Camphor has a soothing action upon the system generally, and especially upon the nerves of organic life. It may be taken internally to effect this, or it ma}' be used ex- ternally, either to the epigastrium or the generative organs. In exhaustion of the solar plexus, with faint- ness at the epigastrium, the use of a camphorated poultice, a camphor bag worn next the skin, or a camphorated plaster are useful adjuncts to treatment. Camphor is well known to soothe pain in the gene- rative organs, and this is prima facie evidence that other conditions depending on nervous irritation there will also be relieved. Baths containing camphor I have found to have a useful influence over the nerves of the hypogastric plexus, and to relieve many of those nervous symptoms depending on irritation of the womb. While soothing, it also exhilarates when well borne by the stomach, and often removes the 84 EMOTIONAL DISEASES. horrible sense of Avant or faintness accompanied by fear, which is referred to the epigastrium. The effect of a moderate dose of alcohol (whisky) at bed-time is most grateful to an anxious over-Avorked patient; he often experiences a comfortable or happy sensation, in place of the depressing emotion which in spite of himself, has previously possessed him; passes a night of quiet sleep, and instead of awaking in a depressed state, with a dry tongue coated with viscid mucus, he aAvakes with a moist clean tongue, and is refreshed and strengthened for the duties of the day. All this can be produced by alcohol without the slightest deleterious result. You get the stim- ulant Avithout any succeeding narcotic effect. AromeUics are also of use in these diseases; an aromatic tincture like that of cardamoms (I have shoAvn) will, by relieving flatulent distension of the stomach, remove the excited and distressing feelings of a neiwous patient; the distressing feeling being doubtless due to the pressure of the distended stomach on the ganglionic system of nerves. Cardamoms, laA^ender, nutmeg, cloves, cinnamom,