there must be secreted in excessive amount some substance that activates the motor mechanism; then too the nervous system in Graves' Disease is hypersusceptible to stimuli and to thyroid extract. It might follow that even a normal amount of thyroid secretion

would lead to excessive stimulation of the hypersusceptible motor mechanism.

This condition of excessive motor activity and hyperexcitability may endure for years. What is the source of this pathologic excitation?

The following facts may give a clue, viz., in suitable cases of Graves' Disease if the thyroid secretion is sufficiently diminished by a removal of a part of the gland or by interruption of the nerve and the blood supply, the phenomena of the disease are immediately diminished, and in favorable cases the patient is restored to approximately the normal condition. The heart slows, the respiration falls, the restlessness diminishes, digestive disturbances disappear,

tremors decrease, there is a rapid increase in the body weight, and the patient gradually resumes his normal state. On the other hand, if to a normal individual extract of the thyroid gland is administered in excessive dosage over a period of time, there will develop nervousness, palpitation of the heart, sweating, loss of weight, slight protrusion of the eyes, indigestion; in short there will be produced, artificially, most of the phenomena of Graves' Disease and of the strong emotions. On discontinuing the administration of the thyroid extract these phenomena may disappear. On the other hand, when there is too little or no thyroid gland the individual becomes dull and stupid and emotionless, though he may be irritable; but if a sufficient amount of thyroid extract is given such a patient he may be brought up to the normal again.

Hence, we see that the phenomena of the emotions may be, within certain limits, increased, or may be diminished, or abolished by increasing, diminishing, or totally excluding the secretion of the thyroid gland.

Graves' Disease may be increased by giving thyroid extract, and by fear. It may be diminished by removing a part of the gland, or by tying the blood and nerve supply, or by complete rest. Finally in Graves' Disease there is at some stage an increase in the size and in the number of the secreting cells. These facts relating to the normal and the pathological supply of thyroid secretion point to this gland as one of the sources of the energizing substance or substances for the execution of the motor phenomena of animals as well as the expression of their emotions.

Anger is, of course, of similar origin and is an integration and stimulation of the motor mechanism and its accessories. Animals having no natural weapons for attack experience no emotion or anger, and the animals that have weapons for attack express anger principally by energizing the muscles used in attack. Although the efficiency of the hands of man has largely supplanted the use of the teeth, he still shows his teeth in anger and so gives support to the remote ancestral origin of this emotion and the great persistence of phylogenetic association. On this conception we can understand why it is that a patient consumed by worry-which to me signifies

the state of alternation between hope and fear-interrupted stimulation, suffers so many bodily impairments and even diseases. It explains the slow dying away of animals in captivity. It explains the grave digestive and metabolic disturbance under any nerve strain— especially under the strain of fear, and the great benefits of confidence and hope; it explains the nervousness, loss of weight, indigestion-in short the comprehensive physical changes that are

FIG. 6. This is a typical picture of exophthalmic goiter, and illustrates well its resemblance to the expression of the emotion of fear. From American Practice of Surgery.

wrought by fear and sexual love and hate, On this hypothesis we can understand the physical influence of one individual over the body and personality of another; and of the infinite factors in environment that play a rôle in the functions of many of our organs all through phylogeny and association. It is because we were evolved as motor beings on the uncompromising law of survival of the fittest, hence it is that we are not in possession of any organs or faculties which have not served our progenitors in their survival in the relentless struggle of organic forms with each other. We are now as we were then essentially motor beings and our only way of responding to the dangers in our environment is by a motor response. Such a motor response implies the integration of our entire being for action and the activity of certain glands such as the adrenals, the thyroid, the liver, etc., resulting in the throwing into the blood stream substances which help to form energy, but which if no muscular action ensues are harmful elements in the blood.

While this motor preparation is going on the entire digestive tract is inhibited. It is then clear that an emotion is more harmful than action.

If the agency that inspires sufficiently the faith-whether the agency be mystical, human, or divine-whatever dispels worry will at once stop the body-wide stimulations and inhibitions which cause. lesions as truly physical as a fracture. The striking benefits of good luck, success and happiness; of the change of scenes; of hunting or fishing; of optimistic and helpful friends, are at once explained by this hypothesis. One can also understand the difference between the broken body and spirits of an animal in captivity and its buoyant return to normal condition when freed; but time will not permit following this tempting lead which has been introduced for another purpose, which I may say, is one of the principal objects sought in this paper, viz., a proposed remedy.

Worries either are or are not groundless. Of those that have a basis many are exaggerated. It has occurred to me to utilize as an antidote an appeal to the same great law that originally excites the instinctive involuntary reaction known as fear, viz., the law of self-preservation.

I have found that if an intelligent patient suffering from fear is made to see so plainly as to amount to a firm conviction that his brain, his various organs, indeed his whole being could be physically damaged by fear, this same instinct of self-preservation will to the extent of his conviction, banish fear. It is hurling threatened active militant danger, whose imperious influences are both certain and known, against an uncertain, perhaps a fancied one, or in other words fear itself is an injury which when recognized is instinctively avoided. In precisely a similar manner anger may be softened or banished by an appeal to the stronger self-preserving instinct of the fear of physical damage,-such as the physical injury of brain cells. This playing of one primitive instinct against another is comparable to the effect upon two men quarrelling when a more powerful enemy of both comes threateningly on the scene.

The acute fears of surgical operations may be banished by the use of certain drugs that depress the associational power of the brain and minimize the evidence that usually inspires fear. If in

addition the entire field of operation is blocked by local anesthesia so that the associational centres are not awakened, the patient passes through the operation unscathed.

The phylogenetic origin of fear is injury, hence injury and fear cause the same phenomena-psychic shock is the same in quality and in its phenomena as traumatic shock. The perception of danger by the special senses as the sound of the opening gun of a battle, the sight of a venomous snake, cause the same effects upon the entire body and are phylogenetically the same as operations under anesthesia or a physical combat in that they all drive the motor mechanism. The use of local anesthetics in the operative field prevents the injury currents from reaching the brain and there integrating the entire body for a self-defensive struggle, though a part of the brain is asleep and the muscles paralyzed, is the same as the interception of the terrifying sound of the gun, or the sight of the dangerous reptile, because it prevents the stimulation of the motor mechanism. From both the negative and positive side we find abundant evidence which forces us to believe that the emotions are primitive instinctive reactions representing ancestral acts which utilize the complicated motor mechanism which has arisen through the forces of evolution in establishing beings best suited for their adaptation to their environment and for procreation.

The mechanism by which the motor acts are performed, and the mechanism by which the emotions are expressed are one and the These acts in their infinite complexity are performed by association, i. e., phylogenetic association. When our progenitors came in contact with excitation in their enviromnent, action ensued then and there. There was much action-little restraint or emotion. Civilized man is really in auto-captivity. He is subjected to innumerable stimulations, but custom and convention frequently prevent physical action. When these stimulations are sufficiently strong but no action ensues, the reaction constitutes an emotion. A phylogenetic fight is anger; a phylogenetic flight is fear; a phylogenetic copulation is sexual love, and so one finds in this conception an underlying principle which may be the key to an understanding of the emotions and of certain diseases.

LAKESIDE HOSPITAL,

CLEVELAND, O.