MENTAL ASPECTS OF ORDINARY DISEASE. 567 



lio-ht ; can comprehend how mental depression may wait upon and 

 depart with abdominal disturbance. The disturbance does not extend 

 to the intellectual processes ; the emotions alone are involved. The 

 sense of well-being, or of discomfort, depending upon systemic condi- 

 tions, tells of the relation existing between the emotions and the or- 

 ganic processes ; and the nerve-tracks just described enable us to com- 

 prehend the subject more clearly. 



There is an interesting point connected with this division of the 

 cerebral hemispheres, and the functions of each division, to which we 

 may advert. It is the association existing between states of emo- 

 tional depression and abdominal disease, and the comparative absence 

 of such depression in affections of the lungs. Marshall Hall writes : 

 " The temper of the patient is singularly modified by different dis- 

 orders and diseases. The state of despondency in cases of indigestion 

 forms a remarkable contrast with that of hopefulness in phthisis pul- 

 nionalis, and other serious organic diseases." 



In diseases of the lungs, the condition of depression is rarely pres- 

 ent, and, when so present, is possibly due to some abdominal compli- 

 cation; though, of course, some of the existing depression may be 

 fairly attributed to the anxiety naturally arising from an intelligent 

 comprehension of the danger impending. In tuberculosis of the lung 

 there is commonly such an emotional attitude in the patient as has 

 earned for itself the designation of spes phthisica. Here the hopeful- 

 ness is as irrational as is the depression of some other affections. The 

 consumptive patient just dropping into the grave will indulge in plans 

 stretching far into the future, ignoring his real condition, and the im- 

 possibility of any such survival as he is calculating upon. It is a cu- 

 rious yet a familiar state. Hope seems to rise above the intelligence, 

 just as in certain abdominal diseases there is a depression which defies 

 its corrections. The intellect is not equal to finding the true bearings 

 or of correcting the exalted emotional centres. In curious relation to 

 these conditions stand well-known differences of the pulse. In chest- 

 diseases the pulse is usually full, sometimes bounding ; in abdominal 

 disease it is small and often thready. The pulse of pneumonia and the 

 pulse of peritonitis are distinctly dissimilar and contrast with each 

 other. It is well known that there is much more tendency to collapse 

 in abdominal than in thoracic disease ; taking the conditions of the 

 pulse together with the emotional attitudes of these affections, the 

 synthesis is unavoidable that some effect is produced by the tubercular 

 disease in the lungs upon the emotional centres as opposite to the 

 effect of abdominal disease as are the varied effects upon the pulse ; 

 and further that the result is probably produced through the circula- 

 tion. The explanation which is shadowed out, for it really does not 

 amount to more, is that abdominal disease causes a depletion of the 

 emotional centres of which depression is the outward indication 

 while phthisis leads to a plethoric state associated with exalted emo- 



