Preventable Diseases

by Woods Hutchinson

A graphic illustration of the importance of muscular action in emotional states is the art of the actor. Not only would it be impossible for an actor to make an audience believe in the genuineness of his supposed emotion if he stood glassy-eyed and wooden-limbed declaiming his lines in a monotone, without gestures or play of expression of any sort, but it would also be impossible for him to feel even the counterfeit sensation which he is supposed to represent. So definite and so well recognized is this connection, that many actors take some little time, as they express it, to "warm up" to their part, and can be visibly seen working themselves up to the pitch of emotion desired for expression by twitching muscles, contractions of the countenance, and catchings of the breath. This last performance, by the way, is not by any means confined to the stage, but may be seen in operation in clashes and disagreements in real life. An individual who knows his case to be weak, or himself to be lacking in determination, can be seen working himself up to the necessary pitch of passion or of obstinacy. There is even a lovely old fairy-tale of our schoolboy days, which is still to be found in ancient works on natural history, to the effect that the King of Beasts himself was provided with a small, horny hook or spur at the end of his tail, with which he lashed himself into a fury before springing upon his enemy!

What, then, will be the physical effect of a shock or fright or furious outburst of anger upon the vital secretions? Obviously, that any processes which require a full or unusually large share of blood-supply for their carrying out will be instantly stopped by the diversion of this from their secreting cells, in the wall of the stomach, in the liver, or in the capillaries of the brain, to the great muscular masses of the body, or by some strange, atavistic reflex into the so-called "abdominal pool," the portal circulation. The familiar results are just what might have been expected. The brain is so suddenly emptied of blood that connected thought becomes impossible, and in extreme cases we stand as one paralyzed, until the terror that we would flee from crashes down upon us, or we lose consciousness and swoon away. If the process of digestion happens to be going on, it is instantly stopped, leaving the food to ferment and putrefy and poison the body-tissues which it would otherwise have nourished. The cells of the liver may be so completely deprived of blood as to stop forming bile out of broken-down blood pigment, and the latter will gorge every vessel of the body and escape into the tissues, producing jaundice.

Every one knows how the hearing of bad news or the cropping up of disagreeable subjects in conversation at dinner-time will tend to promote indigestion instead of digestion. The mechanism is precisely similar. The disagreeable news, if it concern a financial or executive difficulty, will cause a rush of blood to the brain for the purpose of deciding what is to be done. But this diminishes the proper supply of blood to the stomach and to the digestive glands, just as really as the paralysis of violent fright or an explosion of furious anger. If the unpleasant subject is yet a little more irritating and personal, it will lead to a corresponding set of muscular actions, as evidenced in heightened color, loud tones, more or less violent gesticulation, with marked interruption of both mastication and the secretion of saliva and all other digestive juices. In short, fully two-thirds of the influences of emotional mental states upon the body are produced by their calling away from the normal vital processes the blood which is needed for their muscular and circulatory accompaniments. No matter how bad the news or how serious the danger, if they fail to worry us or to frighten us,—in other words, to set up this complicated train of muscular and blood-supply changes,—then they have little or no effect upon our digestions or the metabolism of our liver and kidneys.

The classic "preying upon the damask cheek" of grief, and the carking effect of the Black Care that rides behind the horseman, have a perfectly similar physical mechanism. While the primary disturbance of the banking balances of the body is less, this is continued over weeks and months, and in addition introduces another factor hardly less potent, by interfering with all the healthful, normal, regular habits of the body,—appetite, meal-times, sleep, recreation. These wastings and pinings and fadings away are produced by mental influence, in the sense that they cannot be cured by medicines or relieved at once by the best of hygienic advice; but it is idle to deny that they have also a broad and substantial physical basis, in the extent to which states of emotional agony, despair, or worry interfere with appetite, sleep, and proper exercise and recreation in the open air. Just as soon as they cease to interfere with this normal regularity of bodily functions, the sufferer begins to recover his health.

We even meet with the curious paradox of individuals who, though suffering the keenest grief or anxiety over the loss or serious illness of those nearest or dearest to them, are positively mortified and ashamed because their countenances show so little of the pallid hues and the haggard lines supposed to be inseparably associated with grief. So long as the body-surplus is abundant enough to stand the heavy overdrafts made on it by grief and mental distress, without robbing the stomach of its power to digest and the brain of its ability to sleep, the physical effects of grief, and even of remorse, will be slight.

It must be remembered that loss of appetite is not in itself a cause of trouble, but a symptom of the stomach's inability to digest food; in this instance, because it finds that it can no longer draw upon the natural resources of the body in sufficient abundance to carry out its operations. The state is exactly like a tightness of the money market, when, on account of unnatural retention or hoarding in some parts of the financial field, the accumulation of sufficient amounts of floating capital at the banks for moving the crop or paying import duties cannot be carried out as usual. The vital system is, in fact, in a state of panic, so that the stomach cannot get the temporary credit or capital which it requires.

A similar condition of temporary panic, call it mental or bodily, as you will, occurs in disease and is not confined to the so-called imaginary diseases, or even to the diseases of the nervous system, but is apt to be present in a large number of acute affections, especially those attended by pain. Sudden invasion of the system by the germs of infectious diseases, with their explosions of toxin-shells all through the redoubts of the body, often induces a disturbance of the bodily balance akin to panic. This is usually accompanied and aggravated by an emotional dread and terror of corresponding intensity. The relief of the latter, by the confident assurance of an expert and trusted physician that the chances are ten to one that the disease will run its course in a few days and the patient completely recover,—especially if coupled with the administration of some drug which relieves pain or diminishes congestion in the affected organs,—will often do much toward restoring balance and putting the patient in a condition where the natural recuperative powers of the system can begin their work. The historic popularity of opium, and of late of the coal-tar products (phenacetine and acetanilide), in the beginning of an acute illness, is largely based on the power which they possess of dulling pain, relieving disturbances of the blood-balance, and soothing bodily and mental excitement. Fever-panic or pain-panic, like a banking panic, though it has a genuine and substantial basis, can be dealt with and relieved much more readily after checking excessive degrees of distrust and excitement. An opiate will relieve this physical pain-panic, just as a strong mental impression will relieve the fright-paralysis and emotional panic which often accompany it, and thus give a clearer field and a breathing space for the more slowly acting recuperative powers of nature to assert their influence and get control of the situation.

But neither of them will cure. The utmost that they can do is to give a breathing spell, a lull in the storm, which the rallying powers of the body, if present, can take advantage of. If the latter, however, be not adequate to the situation, the disease will progress to serious or even fatal termination, just as certainly as if no such influence had been exerted, and often at an accelerated rate. In fact, our dependence upon opiates and mental influence have been both a characteristic and a cause of the Dark Ages of medicine. The more we depended upon these, the more content we were to remain in ignorance of the real causes of disease, whether bodily or mental.

The second physical effect produced by mental influence is probably the most important of all, and that is the extent to which it induces the patient to follow good advice. We as physicians would be the last to underestimate the importance of the confidence of our patients. But we know perfectly well that our retention of that confidence will depend almost entirely upon the extent to which we can justify it; that its principal value to us lies in the extent to which it will insure prompt obedience to our orders, and intelligent and loyal coöperation with us in our fight against disease. The man who would depend upon the confidence of his patients as a means of healing, would soon find himself without practice. We know by the bitterest of experience that no matter how absolute and boundless the confidence of our patients may be in our ability to heal them, no matter how much they may express themselves as cheered and encouraged by our presence, ninety-nine per cent of the chance of their recovery depends upon the gravity of the disease, the vigor of their powers of resistance, and our skill and intelligence in combating the one and assisting the other.

Valuable and helpful as courage and confidence in the sick-room are, they are but a broken reed which will pierce the hand of him who leans upon it too heavily, be he patient or physician. We can all recall, as among our saddest and most heart-breaking experiences, the cases of fatal disease, which were well-nigh hopeless from the start, and yet in which the sufferers expressed, and maintained to the last moments of conscious speech, a bright and pathetically absolute confidence in our powers of healing, based upon our success in some previous case, or upon their own irrepressible hopefulness.