[4] Maurice Craig, Lancet June 25, 1898.
[5] Leonard Hill, "Cerebral Circulation" p. 74.
Four charts from a very large number are given which illustrate the above points.
It must be understood that these experiments while accurate so far as they go, and carefully conducted under my supervision by a competent assistant, were not made in a well appointed laboratory, but were clinical observations made in the crowded ward of a hospital for the insane. The central disturbance here was the result of shock from sudden and excessive fear acting on a highly sensitive subject as will appear later. It has been shown by Cannon[6] that such major emotions as fear, rage, or pain acting upon the adrenal glands through the autonomic nervous system are accompanied by an increased discharge of adrenalin into the blood, and by a passing of stored glycogen from the liver for circulation through the body as dextrose, the object of which is the increasing and liberation of muscular energy for the animal's successful flight or fight. This discharge takes place very quickly, and we are told that fright exhausts the adrenal glands, a somewhat puzzling statement at first sight, but borne out by the experience of our case where a fall of pressure occurred under the paralyzing effect of extreme fear and distress continued not merely for minutes but for hours at a time. By and bye as her distress lessened and her expression of it became more and more automatic, there was a return to the normal adrenal discharge and consequent normal rise in pressure. It is possible, of course, that there may be another explanation in the inhibition of metabolism caused by fear. Most of us have experienced the arrest of salivation and digestion under the influence of fear or rage. This inhibition would affect the products upon which the adrenal secretion depends, but the more likely cause is where this fear, in this case really a recurring representation of the original shock, acts through the autonomic nervous system on the adrenal glands. The emotional disturbance here then was primarily of central origin, and was certainly not originated by circulatory or visceral changes which were secondary to it, and the facts do not support the James, Lange theory of the emotions as it is generally understood. In this connection we may refer very briefly to the laboratory experiments of Sherrington[7] and Bechterew.[8] The former by spinal and vagal transection in a dog removed "completely the sensation of the viscera, of all the skin and muscle behind the shoulder. The procedure at the same time cuts from connection with the organs of consciousness the whole of the circulatory apparatus of the body. Yet the dog exhibited rage, fear, disgust, etc., under appropriate stimuli as a normal dog might do." The conclusion reached after admitting possible objections to them is that, "the vasomotor theory of the production of emotion becomes, I think untenable, also that visceral presentations are necessary to emotion." Bechterew, discussing this question as to whether the vascular changes are anterior to the other processes, which determine the alterations of the neuropsychic tone according to the James, Lange theory, states that the experiments in his laboratory by Dr. Serenewsky, appear to lead to an opposite conclusion having shown that under the effects of fear the alteration of the neuropsychic tone is produced before the appearance of the cardiovascular phenomena. There are no doubt objections to accepting laboratory experiments upon inferior animals as conclusive where the psychic part of the process in question is after all the dominant one, nor must we forget that biochemical changes may be as important as the integrity of nerves. We have however referred to these experiments because of their bearing on the conclusions to be drawn from the above described clinical facts which so far as the initiation of the emotional process is concerned confirm them; though we feel that the bodily concomitants of the emotion are essential to its full development, and that we owe much to James's presentation of his theory even admitting its "slap dash"[9] character to use his own phrase. It was to be expected that the artificially raised blood pressure would have had some effect in improving the patient's mental condition, and in the case of adrenalin, at any rate, some such effect should have occurred if we are to accept the recently published conclusions of Crilel[10] to the effect that "adrenalin causes increased brain action," "that brain and adrenalin action go hand in hand, that is, that the adrenal secretion activates the brain, and that the brain activates the adrenals." More in harmony with the clinical experiences here is the fact according to Biedl[11] "that the adrenalin affects the intracranial and the pulmonary vessels only slightly if at all." We presume that what is true of adrenalin in this respect will be true of all drugs which increase blood pressure. And while the rise of the arterial pressure generally will accelerate the flow of blood through the brain, yet we know that the cerebral circulation is in "all physiological conditions, but slightly variable."[12] Besides, while that increased flow must necessarily lead to increased cerebral activity, that activity may be pathological as well as physiological, as in our patient, who was quite uninfluenced mentally by the rise of blood pressure which followed the administration of those drugs. The nature and genesis of the emotional disturbance in this case may be understood from the following history and observations.
[6] The interrelations of emotion as suggested by W. B. Cannon. Recent physiological researches, The American Journal of Psychology, April, 1914.
[7] The Integration of the Nervous System—Sherrington.
[8] Bechterew "La psychologic objective," p. 312.
[9] Psychological Review, Vol. I, where Prof. James admits the defective presentation of his theory and uses the above words to express it. He gives all due importance to the associated memories, and ideas to which are related the incoming currents as well as all pleasure and pain tone connected with them, etc.
[10] S. W. Crile, "The Origin and Nature of the Emotions," 1915.
[11] Biedl innere secretion—Quoted by Cannon, 2 ed. 1913.