MENTAL ASPECTS OF ORDINARY DISEASE. 565 



dilation in chronic renal inadequacy. There is usually decided hyper- 

 trophy of the left ventricle, and a high arterial tension, originating in 

 a contracted condition of the terminal arteries. As a consequence of 

 this tension, the blood-pressure on the brain is well sustained ; and a 

 free supply of arterial blood, rendered perhaps more than ordinarily 

 stimulating by the presence of nitrogen in excess, evokes a heightened 

 activity of the cerebral cells. Simple hypertrophy of the heart is 

 mostly found in the subjects of chronic renal changes. That there is 

 a certain explosiveness in the gouty, together with much mental ac- 

 tivity, is simply a clinical fact. The excess of nitrogen in the blood 

 stands in a suggestive relationship to the explosive irritability, while 

 the high blood-pressure is evidently causally related to the heightened 

 mental activity. The two factors requisite for rapid evolution and 

 discharge of force by the cerebral cells are found together under the 

 above-named combination. If the changes in the circulation are im- 

 perfect, and the blood-pressure is but low, or even normal, the gouty 

 person is not mentally inactive, but is despondent. 



Bichat observed that the length of the neck exercises an influence 

 over the mental activity of the individual. Persons with short necks 

 have a better sustained power of work than those who have long 

 necks, or, in other words, other things being equal, the brain, which 

 is superimposed on a short neck, has an advantage over the brain fed 

 by a long carotid artery. Van der Kolk is in agreement with Bichat 

 upon this point. An extensive series of observations inclines me to 

 agree with them. 



Van der Kolk also quotes from Haller the observation that rickety 

 children have generally large heads, and possess quick perceptive fac- 

 ulties ; and that the blood-vessels of their heads are distinguished for 

 their large calibre. Certainly such children are commonly very pre- 

 cocious. There is a point, however, in relation to this matter which 

 must not be overlooked. Rickety children are usually of scrofulous 

 tendency, and in the scrofulous there is usually an excess of lithates 

 in the blood, which will not be without the ordinary effect exercised 

 by nitrogen on the brain. The great Dutchman also states, " It is a 

 known fact that hunchbacked individuals, in whom the blood flows 

 more quickly and strongly toward the brain, are remarkable for vivaci- 

 ty of spirit." It will not do, in this consideration, to leave out of the 

 question the possibility of a mental factor ; that the physical deform- 

 ity turns the mind of the individual toward mental cultivation as a 

 compensation for bodily defects. Granting this, we must also remem- 

 ber that mere will and perseverance exercise a limited influence, and 

 only permit a brain to make the most of itself. What exists there 

 potentially, it may draw out into actual manifestation ; but with this 

 the power of the will ceases. An effort of the will may and does 

 dilate the blood-vessels of the brain, and permits larger circulation 

 through it ; but the general blood-pressure in the systematic vessels 



