Origin and Nature of Emotions Part 14

In fact, in Graves' disease we find displayed to an extraordinary degree an exaggeration of the whole action of the kinetic mechanism.

We have stated that in acute Graves' disease there is a tendency to the production of spontaneous fever, and that there is a magnified diurnal variation in temperature which is due to an increased output of energy in even the normal reaction producing consciousness. In Graves'

disease there is, therefore, a state of intensified consciousness, which is a.s.sociated with low brain thresholds to all stimuli--both to stimuli that cause muscular action and to stimuli that cause fever. The intensity of the kinetic discharge is seen in the constant fine tremor.

It is evident that the thresholds of the brain have been sensitized.

In this hypersensitization we find the following strong evidence as to the ident.i.ty of the various mechanisms for the production of fever.

In the state of superlative sensitization which is seen in Graves'

disease we find that the stimuli that produce muscular movement, the stimuli that produce emotional phenomena, and the stimuli that produce fever are as nearly as can be ascertained equally effective.

Clinical evidence regarding this point is abundant, for in patients with Graves' disease we find that the three types of conversion of energy resulting from emotional stimulation, from infection stimulation, and from nociceptor stimulation (pain), are, as nearly as can be judged, equally exaggerated.

In the acute cases of Graves' disease the explosive conversion of latent energy into heat and motion is unexcelled by any other known normal or pathologic phenomenon. Excessive thyroid secretion, as in thyrotoxicosis from functioning adenomata, and excessive thyroid feeding, cause all the phenomena of Graves' disease except the exophthalmos and the emotional facies (Figs. 15 and 23).

The ligation of arteries, the division of its nerve supply, or the excision of part of the gland, may reverse the foregoing picture and restore the normal condition. The patient notes the effect on the second day and often within a week is relatively quiescent.

On the contrary, if there is thyroid deficiency there results the opposite state, a reptilian sluggishness.

At will, then, through diminished, normal, or excessive administration of thyroid secretion, we may produce an adynamic, a normal, or an excessively dynamic state. By the thyroid influence, the brain thresholds are lowered and life becomes exquisite; without its influence the brain becomes a globe of relatively inert substance. Excessive doses of iodin alone cause most of the symptoms of Graves' disease. As we have stated, the active const.i.tuent of the thyroid is iodin in a special protein combination which is stored in the colloidal s.p.a.ces.

Hence one would not expect to find changes in the cells of the thyroid gland as a result of increased activity unless it be prolonged.

We have thus far considered the normal roles played by the brain, the adrenals the liver, the muscles, and the thyroid in transforming latent into kinetic energy in the form of heat and motion as an adaptive response to environmental stimuli.

The argument may be strengthened, however, by the discussion of the effect of the impairment of any of these links in the kinetic chain upon the conversion of latent into kinetic energy.

Effect Upon the Output of Energy of Impaired or Lost Function of Each of the Several Links in the Kinetic Chain

(1) _The Brain_.--In cerebral softening we may find all the organs of the body comparatively healthy excepting the brain.

As the brain is physically impaired it cannot normally stimulate other organs to the conversion of latent energy into heat or into motion, but, on the contrary, in these cases we find feeble muscular and intellectual power. I believe also that in patients with cerebral softening, infections such as pneumonia show a lower temperature range than in patients whose brains are normal.

(2) _The Adrenals_.--In such destructive lesions of the adrenals as Addison's disease one of the cardinal symptoms is a subnormal temperature and impaired muscular power. Animals upon whom double adrenalectomy has been performed show a striking fall in temperature, muscular weakness,--after adrenalectomy the animal may not be able to stand even,--and progressive chromatolysis.

(3) _The Liver_.--When the function of the liver is impaired by tumors, cirrhosis, or degeneration of the liver itself, then the entire energy of the body is correspondingly diminished.

This diminution of energy is evidenced by muscular and mental weakness, by diminished response and by gradual loss of efficiency which finally reaches the state of asthenia.

(4) _The Muscles_.--It has been observed clinically that if the muscles are impaired by long disuse, or by a disease such as myasthenia gravis, then the range of production of both heat and motion is below normal.

This is in agreement with the experimental findings that anesthetics, curare, or any break in the muscle-brain connection causes diminished muscular and heat production.

(5) _The Thyroid_.--In myxedema one of the cardinal symptoms is a persistently subnormal temperature and, though p.r.o.ne to infection, subjects of myxedema show but feeble febrile response and readily succ.u.mb. This clinical observation is strikingly confirmed by laboratory observations; normal rabbits subjected to fear showed a rise in temperature of from one to three degrees, while two rabbits whose thyroids had been previously removed and who had then been subjected to fright showed much less febrile response.

Myxedema subjects show a loss of physical and mental energy which is proportional to the lack of thyroid. Deficiency in any of the organs of the kinetic chain causes alike loss of heat, loss of muscular and emotional action, of mental power, and of the power of combating infections--the negative evidence thus strongly supports the positive. By acc.u.mulating all the evidence we believe we are justified in a.s.sociating the brain, the adrenals, the thyroid, the muscles, and the liver as vital links in the kinetic chain.

Other organs play a role undoubtedly, though a minor one.

Studies in Hydrogen Ion Concentration in Activation of the Kinetic System

Having established the ident.i.ty of some, at least, of the organs which const.i.tute the kinetic chain, we endeavored to secure still further evidence regarding the energy-transforming function of these organs by making studies of the H-ion concentration of the blood, as one would expect, _prima facie_, that the normal reaction would be altered by kinetic activation.[*]

[*] The H-ion observations were made in my laboratory by Dr. M. L. Menten.

H-ion concentration tests were made after the application of the adequate stimuli by which the function of the kinetic organs had been determined, and we studied also the effect upon the acidity of the blood of strychnin convulsions after destruction of the medulla; of deep narcotization with morphin before anesthesia; of deep narcotization with morphin after the H-ion concentration had already been increased by fear, by anger, by exertion, by injury under anesthesia, or by anesthesia alone.

The complete data of these experiments will be later reported in a monograph; here it is sufficient to state that anger, fear, injury, muscular exertion, inhalation anesthesia, strychnin, alcohol, in fact, all the stimuli which we had already found to produce histologic changes in the brain, the adrenals, and the liver-excepting bacterial toxins--caused increased H-ion concentration.

Of striking significance is the fact that morphin alone caused no change in the H-ion concentration, while if administered before the application of a stimulus which by itself produced increased H-ion concentration, the action of that stimulus was neutralized or postponed. If, however, morphin was administered after increased acidity had been produced by any stimulus, or by inhalation anesthesia, then the time required for the restoration of the normal alkalinity was much prolonged, and in some instances the power of acid neutralization was permanently lost.

After excision of the liver, the normal H-ion concentration was maintained for periods varying from one to several hours, after which the concentration (acidity) began to increase as the vitality of the animal began to decline, the concentration (acidity) increasing rapidly until death. After excision of the adrenals the blood remained normal for from four to six hours, when the H-ion concentration increased rather suddenly, the increase being synchronous with the incidence of the phenomena which immediately preceded death.

In none of these cases was it determined whether the increased H-ion concentration was due to other causes of death or whether death was due to the increased acidity.

It is also significant that after the application of each of the adequate stimuli which increased the H-ion concentration of the blood in other parts of the body the blood from the adrenal vein showed a slight diminution in acidity, as, in most instances, did the blood from the hepatic vein also.

In fact, the H-ion concentration of the blood in the adrenal vein was less than in the blood of any other part of the circulation.

Kinetic Diseases

If our conclusions are sound, then in the kinetic system we find an explanation of many diseases, and having found the explanation, we may find new methods of combating them.

When the kinetic system is driven at an overwhelming rate of speed,-- as by severe physical injury, by intense emotional excitation, by perforation of the intestines, by the pointing of an abscess into new territory, by the sudden onset of an infectious disease, by an overdose of strychnin, by a Marathon race, by a grilling fight, by foreign proteins, by anaphylaxis,--the result of these acute overwhelming activations of the kinetic system is clinically designated shock, and according to the cause is called traumatic shock, toxic shock, anaphylactic shock, drug shock, etc.

The essential pathology of shock is identical whatever the cause.

If, however, instead of an intense overwhelming activation, the kinetic system is continuously or intermittently overstimulated through a considerable period of time, as long as each of the links in the kinetic chain takes the strain equally the result will be excessive energy conversion, excessive work done; but usually, under stress, some one link in the chain is unable to take the strain and then the evenly balanced work of the several organs of the kinetic system is disturbed. If the brain cannot endure the strain, then neurasthenia, nerve exhaustion, or even insanity follows.

If the thyroid cannot endure the strain, it undergoes hyperplasia, which in turn may result in a colloid goiter or in exophthalmic goiter.

If the adrenals cannot endure the strain, cardiovascular disease may develop. If the liver cannot take the strain, then death from acute acidosis may follow, or if the neutralizing effect of the liver is only partially lost, then the acidity may cause Bright's disease.

Overactivation of the kinetic system may cause glycosuria and diabetes.

Identical physical and functional changes in the organs of the kinetic system may result from intense continued stimulation from any of the following causes: Excessive physical labor, athletic exercise, worry or anxiety, intestinal autointoxication, chronic infections, such as oral sepsis, tonsillitis, and adenoids; chronic appendicitis, chronic cholecyst.i.tis, colitis, and skin infections; the excessive intake of protein food (foreign protein reaction); emotional strain, pregnancy, stress of business or professional life-- all of which are known to be activators of the kinetic system.

From the foregoing statements we are able to understand the muscular weakness following fever; we can understand why the senile have neither muscular power nor strong febrile reaction; why long-continued infections produce pathologic changes in the organs const.i.tuting the kinetic chain; why the same pathologic changes result from various forms of activation of the kinetic system.

In this hypothesis we find a reason why cardiovascular disease may be caused by chronic infection, by auto-intoxication, by overwork, or by emotional excitation. We now see that the reason why we find so much difficulty in differentiating the numerous acute infections from each other is because they play upon the same kinetic chain.

Our postulate harmonizes the pathologic democracy of the kinetic organs, for it explains not only why, in many diseases, the pathologic changes in these organs are identical, but why the same changes are seen as the result of emotional strain and overwork.

We can thus understand how either emotional strain or acute or chronic infection may cause either exophthalmic goiter or cardiovascular disease; how chronic intestinal stasis with the resultant absorption of toxins may cause cardiovascular disease, neurasthenia, or goiter.

Here is found an explanation of the phenomena of shock, whether the shock be the result of toxins, of infection, of foreign proteins, of anaphylaxis, of psychic stimuli, or of a surgical operation with its combination of both psychic and traumatic elements.

This conception of the kinetic system has stood a crucial test by making possible the shockless operation. It has offered a plausible explanation of the cause and the treatment of Graves' disease. Will the kinetic theory stand also the clinical test of controlling that protean disease bred in the midst of the stress of our present-day life?

Present-day life, in which one must ever have one hand on the sword and the other on the throttle, is a constant stimulus of the kinetic system.

The force of these kinetic stimuli may be lessened at the cerebral link by intelligent control--a protective control is empirically attained by many of the most successful men. The force of the kinetic stimuli may be broken at the thyroid link by dividing the nerve supply, reducing the blood supply, or by partial excision; or if the adrenals feel the strain, the stimulating force may be broken by dividing their nerve supply, reducing the blood supply, or by partial excision.

No theory is worth more than its yield in practice, but already we have the shockless operation, the surgical treatment of Graves'

disease, and the control of shock and of the acute infections by overwhelming morphinization (Figs. 62, 72, and 73).

Conclusions

To become adapted to their environment animals are transformers of energy.

This adaptation to environment is made by means of a system of organs evolved for the purpose of converting potential energy into heat and motion. The princ.i.p.al organs and tissues of this system are the brain, the adrenals, the thyroid, the muscles, and the liver.

Each is a vital link, each plays its particular role, and one cannot compensate for the other. A change in any link of the kinetic chain modifies proportionately the entire kinetic system which is no stronger than its weakest link.

In this conception we find a possible explanation of many diseases one which may point the way to new and more effective therapeutic measures than those now at our command.

ALKALESCENCE, ACIDITY, ANESTHESIA--A THEORY OF ANESTHESIA[*]