MENTAL OVER-WORK AMONG PUBLIC MEN. 31 



pairment of the restraining and regulating influence of these cen- 

 tres that we must refer the origination of such serious organic dis- 

 eases — not nervous in their manifestations, and yet evidently aris- 

 ing from primary nervous disturbance — as phthisis, diabetes, Bright's 

 disease, pneumonia, erysipelas, etc. I have already spoken of the 

 probable method of origin of paretic dementia and posterior spinal 

 sclerosis. The occurrence of heart failure, cardiac palpitation, and 

 digestive disorders through the involvement of the pneumogastric 

 centres is readily explicable. 



Even the cervico-occipital distress, which comes on as the result 

 of over-work and overstrain, is probably to be attributed to exhaus- 

 tion of the nerve-centres of the bulbar region. In some cases of 

 organic disease with demonstral^le involvement of these centres this 

 symptom is present. ■ It was prominent in the case of a man fifty 

 years old, who was suddenly stricken in health as the result of 

 overstrain in business, and died of acute bulbar paralysis. The 

 succession of symptoms was facial paralysis, diplopia, difficulty in 

 swallowing, muffled voice, laryngeal cough, ojDpressed breathing, 

 nausea, vomiting, and fever with delirium. It was prominent also in 

 the case of Vice-President Wilson, Avho had had a hemiplegic at- 

 tack in 1874. When he last consulted Dr. Hammond,^ in Novem- 

 ber, 1875, his marked symptoms were vertigo, thickness of speech, 

 facial twitching, irregular respiration and heart action, slight diffi- 

 culty of swallowing, extreme restlessness, sleeplessness, and intense 

 pain in the back of the head and nape of the neck. His death 

 was attributed by Hammond to plugging of one or more of the 

 minute vessels of the nucleus of the pneumogastric. 



The higher cerebral centres certainly exercise a certain amount of 

 what might be termed unconscious control over the organic centres. 

 Mental overstrain from excessive intellectual work weakens the 

 inhibitory mechanism of the brain. The organic functions — respi- 

 ration, cardiac and vaso-motor control, etc. — must be maintained 



^ Boston Medical and Surgical Journal, December 16, 1875. 



